On September 28, 2024, four kayakers camping at Cosby Creek Campground in Great Smoky Mountains National Park put on Cosby Creek at the Cosby Creek Picnic Ground. The water level at this put-in was very low and less than idea. This is well above the put-in listed on Whitewater of the Southern Appalachians, Volume Two: the Mountains by Kirk Eddlemon (page 217) and necessitated multiple portages. The kayakers chose this stretch as it was close to their campground, had time before meeting other kayakers, and there was water present in this rarely running stream. Cosby Creek is also largely road-side with many locations for passing motorists to pull off to enjoy the creek and idyllic setting in warmer weather.
At about the location recommended by Eddlemon as the put-in, the water approached a better level and the character of the stream changed to actually have some eddies and pools. Unfortunately the water was still low and lacked room for a person under an upside-down kayak. So when the fourth kayaker flipped there was no room or place to roll. Thus, while moving down the river over the shallow rocks on his right side, the kayaker chose to quickly plant his paddle on the bottom of the stream to get enough leverage to pull the kayak under the torso. Unfortunately, the paddle caught on something and wrenched the kayaker completely over. The kayaker knew immediately that the right shoulder was injured and pulled the skirt to come out of the boat. Luckily, the three other kayakers were in a small pool below watching and ready to assist. The kayaker quickly realized that his right arm was not moving and the shoulder was dislocated. Presumably the paddle pulled the arm into external rotation and over-head abduction. The other three kayakers quickly got out of their boats and came to the aid of the fourth with throw ropes and physically stabilizing the injured kayaker.
While this was occurring a motorist passing by on the road presumably heard the shouting and stopped to help. By the time this Good Samaritan was noticed the injured kayaker was already out of the water walking around on the far bank. Without conversation the Good Samaritan departed, likely realizing that his assistance wasn’t needed.
The water was shallow enough for the inured kayaker to cross without concern. While two kayakers emptied water from boats, re-stuffed throw ropes and brought gear across the stream to the road-side pullout, the third kayaker hitched a ride from a passing motorist back to the Cosby Picnic Area to retrieve his vehicle.
Upon returning with a vehicle to the site of the injury, the injured kayaker lay across the hood of the truck face-down with the injured arm hanging down. In the injured arm, the kayaker held the chin strap and buckle of his helmet while one of the other kayakers slowly filled it with rocks. The injured kayaker had heard of using this technique to slowly stretch out the arm of a dislocated shoulder in order to put it back in place from experienced paddlers years ago.
While this approach certainly relieved growing pain in the shoulder, there was no indication that the arm had popped back into the socket. After emptying the helmet of rocks and starting the process over again, the other kayaker massaged, probed and put slightly increasing pressure on the head of the arm near the shoulder of the injured kayaker.
Growing tired of laying on the hood of the truck the injured kayaker sat up and decided to remove paddling gear. To the surprise of both, the injured arm moved as it apparently had returned to place in the socket. The injured kayaker expected a “pop” or noticeable effect of the arm returning to the socket which had not occurred.
The injured kayaker felt great, had good range of motion, and little pain immediately after noticing the shoulder had been reduced. So the injured kayaker volunteered to drive shuttle for the other kayakers who paddled two more streams in the park that day, camped another night and another the following day. However pain increased throughout the day and was especially high when attempting to sleep on the back.
It should be noted that medicine and ice were not utilized to mask pain in order to minimized potential additional tissue damage.
In retrospect, the injured kayaker should have sought medical attention immediately, returned home instead of camping, (according to some schools of thought) used ice initially to reduce swelling, and stabilized the arm with a sling to relieve pressure on the shoulder joint. However, upon returning home the injured kayaker sought medical attention from an orthopedist, massage therapist, chiropractor, physical therapist, an athletic trainer, a strength and conditioning coach within days. The injured kayaker also received dry needling, drank a lot of water, incorporated a sling to relieve pressure from the joint (which helped while laying on the back sleeping), utilized hydration supplements, took vegetable supplements, avoided sugar and alcohol, attended physical therapy multiple times each week, exercised diligently outside of physical therapy, and continued with weekly massage therapy sessions.
The injured kayaker attributed the above interventions, as well as pre-injury levels of fitness and reducing the dislocation within 15 minutes of injury with a solid rehabilitation and recovery.
Three months after injury the kayaker has returned to normal activities with no limitations but due to the propensity for re-injury is severely limiting paddling to flat water and conservative stretches of white water rivers. The kayaker continues to attend physical therapy and focuses training upon strengthening and stabilizing the shoulder with a series of exercises designed to promote shoulder health, strengthen and stability.
