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To: philv who wrote (19641)	11/19/2003 7:24:48 PM
From: sea_urchin	Read Replies (1) \| Respond to of 82254

Phil re : Hossein Barkhah of Iran dislocates his elbow attempting to lift 157.5 kilograms in the snatch category in group A of the men's 77 kilogram weight class at the World Weightlifting Championship Allowing for the fact that I am on the other side of the earth from the patient, it is nevertheless my opinion that the injury appears to be a dislocation of the shoulder rather than a dislocation of the elbow. Dislocation of the elbow happens in a fall on the outstretched hand and the displacement of the dislocated part (forearm) takes place backwards. The alignment of the arm, however, would still be normal, and the hand and forearm would point forwards, unlike in Hossein's injury where the whole arm, from the shoulder down, has been rotated backwards through 180 degrees so that the elbow is now pointing forwards. I also think that dislocation of the elbow is extremely unlikely during the lifting of a heavy weight but a dislocation of the shoulder is possible. Reduction of dislocations is actually quite simple but it is usually necessary to have general anaesthesia with good muscle relaxation. With a dislocated shoulder, especially with a very muscular man like a weight-lifter, it would be best to do the procedure on the floor. The operator, sitting on the floor, then pulls on the forearm while while applying a counter-force against the patient's chest with his foot in order to reduce the displacement and bring the head of the humerus (upper arm) into its position of normal articulation with the scapula (shoulder bone?). With a dislocated forearm, an assistant can apply counter-traction to the upper arm while the operator attempts first to reduce the dislocation and then to replace the articular surface of the forearm (ulna) into the position of articulation with the upper arm (humerus). At the time of injury, the arm should be placed in a sling as soon as possible to prevent further damage to nerves or blood vessels by gravitational traction and also diminish pain. Soon you'll be ready for Orthopedics 1.