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Immobilisation - Shoulder immobiliser

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Indications

Shoulder dislocation (post reduction)

Acromioclavicular injuries (grade 1-3)

Fracture of humeral head, greater tuberosity or clavicle

Contraindications (absolute in bold)

Open fractures

Neurovascular compromise

Complex fractures

Alternatives

Broad arm sling

Open reduction internal fixation

Informed consent

Verbal consent

Less complex non-emergency procedure with low risk of complications

Potential complications

Dermatitis

Abrasions and pressure sores (with risk of infection)

Joint stiffness

Procedural hygiene

Standard precautions

PPE: non-sterile gloves

Area

Anywhere

Staff

Procedural clinician

Equipment and sizing

Shoulder immobiliser of correct size (XS, S, M, L, XL)

Sling should end at the metacarpophalangeal joints, cover the entire forearm with elbow snug into sling

Positioning

Shoulder slightly abducted and internally rotated (palm facing abdomen)

Sequence

Undo the waist and shoulder straps

Slide under the patient’s forearm and thumb

Attach strap over the shoulder and waist

Adjust the padding to lie over the patient necks and tighten strap

Secure and adjust the waist strap around the trunk

Open Velcro strap on side of wrist

Post-procedure care

Should be worn all times unless instructed otherwise

Encourage elbow, wrist and hand exercises to prevent stiffness

Tips

Avoid skin contact with Velcro edges with can cause abrasion’s

Peer review

This guideline has been reviewed and approved by the following expert groups:

Emergency Care Institute

Please direct feedback for this procedure to ACI-ECIs@health.nsw.gov.au.

References

NSW Agency for Clinical Innovation. Orthopaedic/musculoskeletal. Sydney: ACI; 2020. Available from https://www.aci.health.nsw.gov.au/networks/eci/clinical/clinical-resources/clinical-tools/orthopaedic-and-musculoskeletal

Roberts JR, Custalow CB, Thomsen TW. Roberts and Hedges’ clinical procedures in emergency medicine and acute care. 7th ed. Philadelphia, PA: Elsevier; 2019.

Dunn RJ, Borland M, O’Brien D (eds.). The emergency medicine manual. Online ed. Tennyson, SA: Venom Publishing; 2019.

Eiff MP, Hatch R. Fracture management for primary care. 3rd ed. Philadelphia PA: Saunders; 2011.

Stracciolini A. Basic techniques for splinting of musculoskeletal injuries In: UpToDate. Waltham (MA): UpToDate. 2019 April 18. Available from: https://www.uptodate.com/contents/basic-techniques-for-splinting-of-musculoskeletal-injuries

Liverpool hospital emergency department: Plaster booklet (2019)

© Agency for Clinical Innovation 2021