By Dr. Jeff Daniels EBS Medical Columnist

The Medical Clinic of Big Sky’s 22nd ski season has begun at Big Sky Resort. It’s surreal to change what we’ve been doing for the past seven months, shifting efforts to the resort, while still plugging away at our office in Big Sky Town Center. We’ve expanded operations to a seven-day workweek, and anticipate more injuries this winter than during summer and fall.

Every year opening day is a little different. This season’s early snows gave us hope for excellent Thanksgiving conditions, but the descriptions I heard from injured patients made the conditions sound thin and rocky, and conducive to injuries.

In the first two days of the season, we saw three dislocated shoulders – I think that’s a record. All three were immediately diagnosed and reduced within a minute or two, but it’s not a great way to begin a winter of skiing or snowboarding.

I still remember the first dislocated shoulder of our first ski season on Dec. 12, 1994. We were relaxing in the waiting room when a man walked in holding his right arm at an odd angle. It took a few moments to figure out what was wrong, several more minutes to consult an emergency textbook, and then about two or three hours to finally get the shoulder back into place.

I needed the help of the ski patrol, as well as Dr. Fran Balice who gave advice and pulled on the arm. Balice had helped ski patrol with medical problems in the years before I came to Big Sky, and together we finally fixed the dislocation. I can still hear the loud pop it made went it went back in the socket.

This year, after a busy Thanksgiving Day, there were progressively fewer people on the mountain, until $20 Friday. That morning I recorded a radio ad warning about hitting rocks, and several people came in later in the day with cuts on their legs from run-ins with rocks. My advice in the radio ad was that we should all wear kneepads – like the telemark skiers do – if we’re using our “rock” skis.

One unlucky lady fell very hard on her right shoulder and not only dislocated it, but also broke off a piece of bone called the “greater tuberosity.” It’s an uncommon but possible complication when the shoulder dislocates. At first, the broken fragments of bone look very far apart, but when the dislocation is reduced, the pieces come back together.

This complication not only makes for an even more painful injury than a simple dislocated shoulder, but also delays the healing process by several months since normal, healthy bone takes that long to fuse back together.

In an uncomplicated dislocation, the soft tissues holding the shoulder joint in place need time to tighten back up. Immobilization for a week is necessary and then physical therapy usually gets the shoulder back to normal, so that it won’t dislocate again at the slightest provocation. Those who don’t heal well, or are traumatized too soon after a first dislocation, can end up with a shoulder that won’t stay in place, eventually resulting in surgery.

Stay safe out there during the holiday season!

Dr. Jeff Daniels has been practicing medicine in Big Sky since 1994, when he and his family moved here from New York City. A unique program he implements has attracted more than 700 medical students and young doctors to train with the Medical Clinic of Big Sky.