10 Most Common Bicycling Injuries

Shoulder Injuries

Your Patient (PT) will probably be sitting on the ground leaning slightly forward with his/her injured shoulder drooping a good two inches lower than the other shoulder. PT will probably be holding his/her injured arm and probably will be in significant pain. PT may be pale and possibly sweating profusely.

The chief complaint will be the clavicle/shoulder. Attempt to put the PT in a position of comfort. Then do scene size up including checking the PT for other injuries. Do a head to toe exam. A broken clavicle hurts and it is possible the PT has other significant injuries that are being “masked” by the pain of the clavicle. Be sure and check the helmet. If the PT fell hard enough to break his/her collarbone, then the PT probably hit his/her head/helmet as well and you may have a head and spinal injury that has been masked by the pain of the broken clavicle. Any PT that fell hard enough to crack/break his/her helmet goes to the hospital to be checked out (see head and spinal injuries). Further, any PT with a suspected broken clavicle needs to get to a hospital for an x-ray and further treatment. It is the PT’s decision on how to get to the hospital. Calling 911 or finding a friend to drive them to the hospital but make sure THEY GO TO THE HOSPITAL- DO NOT LET THEM RIDE his/her bike. While the PT is waiting for the ambulance or his/her friend to pick them up, the best thing you can do is keep them calm, conduct on going assessment (SAMPLE, vitals, etc.) and immobilize the arm/shoulder of the injury. Triangular bandages are easy to carry and should be used to immobilize the arm – probably best if PT will let you have the injured arm/shoulder at about a 45 degree angle from elbow to the opposing shoulder. Have someone else or the patient if there is not one else, hold the arm to relieve pain. Do a sling and swathe and wrap as much as possible and wrap it hard. The less movement, the less pain. Obviously, you should consider the PT’s input on position, pain level, etc. when performing sling and swathe. The proper method to sling and swathe is a skill taught in First Aid courses.

Things to look out for: A broken clavicle can act like a dagger and during intense respiration, can cut into/puncture a lung. This is primarily a concern if the break of the clavicle is closer to the neck. In that case if the PT raises his/her arm the sharp edges of the broken clavicle may actually be pushed downward and punctures a lung. As a care giver, if you see a broken clavicle very close to the neck this is a serious concern. Move the PT as little as possible and immobilize if possible and CALL 911. This sort of injury requires a different type of immobilization than a mid-clavicle break or a fracture close to the shoulder. Both types of immobilization are taught in First Aid Course.

Other shoulder injuries are similar: Dislocated shoulders are very painful and the PT will probably feel relief from the pain if the shoulder is immobilized. Again, it is best to splint and then immobilize. However, it is simple 1st Aid is to sling and swathe and wrap it pretty tight. Movement is pain so immobilize. Get the PT to the hospital. A dislocated shoulder is a serious injury, as well as painful. I have seen a doctor nick an artery when attempting to reduce the dislocation and the patient was immediately wheeled into emergency surgery to fix the artery. Again, the 1st Aid – pre-hospital care is to immobilize the shoulder utilizing the sling & swathe and get the PT to a hospital

In the unusual situation where the patient has a dislocated shoulder but the arm cannot be lowered, then immobilize the shoulder with the shoulder/arm in the position found. Do not attempt to move the arm or lower the arm. This requires a rather complex combination of splint/ immobilizing requiring blankets/jackets /numerous triangular bandages, bandanas, or whatever items are available. This method of splinting/immobilizing is taught in a First Aid Course.

Other concerns: while examining the patient check his/her Circulation/Motor/Sensory (CMS). This can be accomplished by asking the PT to move fingers and also feeling PT’s fingers (pinching the fingers). If PT cannot feel the pinching or has trouble moving his/her fingers and/or they have a tingling feeling when trying to move his/her fingers or arm, there may be some nerve damage. Something is probably pushing against a nerve or a nerve has been severed. If the PT’s arm/fingers are cold (no circulation) check for a radial pulse and also make sure the PT can move his/her fingers. Testing the extremities for CMS is a standard and ongoing test that should be completed until higher medical authority takes over care of PT. Possible circulation (blood flow) issues are a potentially serious condition. If circulation is blocked or partially blocked – DO NOT HESITATE TO CONTACT 911 – IF OUT OF 911 RANGE GET THE PT to a hospital.

More on CMS, whenever a PT has an injured clavicle, shoulder, upper arm injury, it is necessary to perform CMS – BEFORE and AFTER immobilizing. If while immobilizing, the PT’s CMS has been compromised then loosen or take off all bandages. Then re-bandage again and check for CMS. We are not doctors and we are not in a hospital nor do any of us have x-ray vision. This is pre-hospital medicine. Usually the best thing we can do is immobilize the injury and get them to the hospital.

Conducting CMS, a head to toe exam , sling and swathe, splinting, SAMPLE, vitals these are skills that need to be done correctly and they are skills learned in a 1st Aid Course. Then – practice – practice – practice! The time to learn how to conduct a head to toe exam is not when you have a live PT on the ground that is having trouble breathing and the time to learn how to sling and swathe is not when you have a PT in serious pain with a broken clavicle. Take a course.