A 57-year-old woman fell from a ladder as it slipped away from the wall and came to rest lying prone on the ladder with both arms extended above her head. The only significant finding was severe pain in both shoulders which was treated with Entonox and morphine.

Examination of both upper limbs revealed no bony tenderness or neurovascular deficit. Immobilisation of the cervical spine was felt necessary in view of the mechanism of injury, so the patient was log-rolled from the ladder onto a long board with the arms supported in extension. Gentle attempts were made to restore the limbs to a neutral position but this resulted in extreme pain and the arms appeared locked; from first principles, a bilateral inferior shoulder dislocation was surmised. The patient was secured to the board with …