In traumatological practice, dislocation of the shoulder joint is not uncommon. The condition is manifested by pain, deformity of the shoulder, a feeling of numbness. There are several types of dislocation, which are classified according to the nature of the displacement of the articular heads. To avoid consequences, the victim should be given first aid in a timely manner and delivered to a medical facility. Only a doctor will be able to correctly diagnose, prescribe treatment and make recommendations for rehabilitation.
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Causes: How does injury occur?
Dislocation occurs due to the influence of adverse factors when the head of the humerus breaks the joint capsule and shifts. Injury is often accompanied by fractures. The most common dislocation of the shoulder joint occurs in children and the elderly, in whom the ligamentous apparatus is weakened. The main causes of injury are as follows:
- falling on an outstretched, outstretched arm,
- professional activities associated with lifting weights or a heavy load on the hands,
- extreme and strength sports,
- direct blow to the shoulder
- lack of calcium and collagen in the body,
- diseases that entail a weakening of the ligaments and bones.
The child has a dislocation may be accompanied by a fracture and occurs under the following circumstances:
- careless handling of the baby while playing with him,
- reckless attempts to wear outerwear,
- sharp movements in the form of a jerk,
- improper behavior of adults during the occupation of dynamic gymnastics.
What are the types of sprains?
The displacement of the articular heads of the shoulder may be as follows:
Pathology may develop during the development of the fetus.
- Traumatic, resulting from injury.
- Habitual dislocation of the shoulder or chronic, in which the displacement occurs due to the weakening of the ligaments.
- Congenital, when the pathology happens in the period of intrauterine development.
By the duration of injury, the following types are distinguished:
- Fresh, occurred not later than 72 hours.
- Stale - the period ranges from 3 days to 3 weeks.
- An old one is calculated for a period of more than 1 month.
The complexity of the injury is divided as follows:
- Uncomplicated when the dislocation is not accompanied by trauma to the surrounding tissue.
- Complicated, in which there is a fracture of bone joints, rupture of ligaments and tendons, pinching of blood vessels or nerves.
The classification by damage localization is as follows:
- Anterior, which is divided into axillary, subclavian, intra-and subclavicular.
- The posterior dislocation of the shoulder is sub-axial (passing under the axis of the scapula) and subacromial. Damage feature - the hand rises up and cannot be lowered.
- Lower, ie, articular.
Symptoms: how to recognize damage?
The main manifestation of dislocation - pronounced asymmetry of the shoulder.
Signs of dislocation of the shoulder joint are as follows:
- strong pain,
- crunch, heard at the time of injury,
- restriction of mobility or reduction of the amplitude of movements,
- acromion and head of the humerus protrude
- the arm is bent at the elbow and a little forward,
- subcutaneous hemorrhage, if blood vessels are damaged,
- numbness or paresis of the limb when the radial nerve is injured.
Complications and consequences
Combined injuries are dangerous - depressed fractures or breaks in the lesions, which are accompanied by a violation of the integrity of the bone, rupture of connective tissue, tearing of the humeral head. Bone fragments can cut through the skin and form a wound. Old injuries provoke repeated dislocation. In general, the symptoms of dislocation of the shoulder joint lead to the following consequences and complications:
- chronic pain
- instability of the shoulder joint
- partial or complete loss of functionality of the limb, due to which you can get the status of a disabled person,
- loss of sensation or hand paralysis due to pinching or tearing of a nerve,
- internal bleeding
- damage to surrounding organs by bone fragments in fractures,
- change in posture due to asymmetry of the left or right shoulder,
- infection through a wound with dangerous pathogens.
How to give first aid?
Primary dislocation of the shoulder joint requires immediate medical consultation. Self-reset mobile connection is prohibited. Home First Aid (PMP) is rendered as follows:
- Provide complete immobility of the hand.
- Apply a cold compress wrapped in cloth so that ice does not directly contact with the skin.
- Fix the shoulder with a rail, tire or plank so that the edges of the clamps protrude beyond the injury.
- Treat the wound with complicated dislocation of hydrogen peroxide, without touching the damaged tissue.
- The bandage for dislocation of the shoulder for transporting the victim should be kosynochnaya when the hand lies on the wide edge of the fixer, and the ends are tied to the back of the neck.
- Give painkillers.
- Deliver to the emergency room.
Diagnoses dislocation of the shoulder orthopedist or traumatologist. The doctor listens to complaints, makes a description in the history of the victim, establishes the cause of the injury, assesses the severity of damage to the bones and surrounding tissues. To determine the nature of the bias and get a complete clinical picture, doctors recommend the following diagnostic procedures:
You can examine the articulation with the help of ultrasound.
- magnetic resonance or computed tomography,
If the pulse on the arm is weak or cannot be felt, this is a sign of damage to the blood vessels.
Immobilization and medication
Straighten the arm and insert the joint into place can only be an expert. If the dislocation is uncomplicated and local, the doctors apply a plaster cast. Depending on the complexity of the injury, gypsum must be worn from 2 weeks to 2-3 months. The limb heals and restores about 3-4 months. Conservative treatment after the reduction of traumatic dislocation includes the use of the following drugs in the table:
If the dislocation of the shoulder is combined with other joint damage, surgery is required. The doctor stitches the torn ligaments and nerves, strengthens the bones with metallosynthesis objects. Fixed with plaster or orthosis. During the period of wearing the latch should undergo a control X-ray of the left or right injured hand. If the joint is completely destroyed as a result of the injury, endoprosthesis replacement is applied. The recovery period in this case lasts up to 6 months.
Physiotherapy and massage
Physiotherapy treatment of shoulder dislocation and restoration of mobility includes the following procedures:
- magnetic therapy
- ozocerite or paraffin thermal applications,
- exposure to ultrasound,
- laser therapy
- ultraviolet irradiation.
It is recommended to do a massage, starting a session with the forearm, gradually moving to the place of dislocation. Effective stroking, point pressure. Developing a hand is useful in hydro-massage and swimming, as well as using a studded rubber ball. Therapeutic effects of procedures on the shoulder joint are as follows:
- help restore mobility and develop a limb
- promote the production of synovial fluid
- accelerate tissue regeneration
- relieve pain and inflammation
- normalize blood circulation
- improve the flow of lymph,
- saturate tissues with oxygen.
The following set of exercises (exercise therapy) is used to strengthen and develop the arm:
- shrug - simultaneous and alternate,
- swing a hand
- lifting and lowering limbs
- making hands behind the head,
- circular rotations of the limb
- side bends with simultaneous stretching of the arm,
- push-ups in a pose with the emphasis on the wall on the palm,
- lessons with a stick
- to load the muscles of the shoulder using a weight of not more than 2 kg.
The development of the arm must begin with minimal stress, so that the tissues of the joint have time to get stronger and heal.
Treatment of folk remedies
Dislocation of the humeral head can be cured by preparing a compress from comfrey roots according to the following recipe:
- Take 30 grams of plants and pour 0.5 liters of cool water.
- Put on a small fire and then 30 minutes, not boiling.
- Remove from heat and let stand for 4 hours.
- To filter
- Dampen a cloth in the tool and attach on the shoulder.
If a shoulder is broken and sore, home treatment includes an ointment preparation. The recipe is as follows:
- Take 5 ml of oil from Hypericum.
- Grind the wheat sprouts into mush.
- Add 20 g of butter.
- Ingredients then in a water bath for 20 minutes.
- Remove from heat and allow to cool slightly.
- Remove the top layer - the drug.
- Heat until applied to the joint and add 2 drops of thuja oil.
- Apply the ointment on the sore spot.
Prevention of shoulder dislocation
In order not to dislocate the shoulder, it is recommended to avoid falls. To do this, wear comfortable shoes with low heels. Elderly people prone to dizziness, you need to use a walker or a cane. Previous injuries must be treated promptly. To strengthen the connective tissue and bones, it is recommended to adjust the diet by consuming foods with calcium and collagen. After dislocation, it is recommended not to sleep on the sore arm in order to avoid a relapse of the injury.
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Anatomy of the shoulder joint
The shoulder joint is formed by the head of the humerus and the articular cavity of the scapula. The articular surfaces are covered with hyaline cartilage. Their contact areas are 3.5: 1 or 4: 1. On the edge of the articular cavity of the scapula there is an articular lip with a fibro-cartilage structure. From it begins the articular capsule that attaches to the anatomical neck of the humerus. Capsule thickness is uneven. In the upper section, it is thickened due to interlocking articular-humeral and coraco-humeral ligaments, and in the anterior-medial section it is significantly thinned, respectively, here it is 2-3 times less durable. In the anteroposterior region, the joint capsule attaches well below the surgical neck, increasing its cavity and forming axillary torsion (Riedel's pocket). The latter allows the shoulder to be removed as much as possible, while the neurovascular bundle approaches articulating surfaces, which should be remembered during surgical interventions. The bundle includes nerves of the brachial plexus: the medial cutaneous nerve of the shoulder and forearm, the musculo-cutaneous nerve, the median, radial, ulnar, and axillary nerves. Here are the vessels: the axillary artery and vein with their branches (breast-acromial, subscapularis, upper thoracic, front and rear arteries, enveloping the humerus, with the accompanying veins).
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Shoulder dislocation classification
- pathological (chronic),
- Complicated: open, with damage to the neurovascular bundle, with tendon rupture, fractures, pathological recurring, long-standing and habitual shoulder dislocations.
Traumatic shoulder dislocations reach 60% of all dislocations. This is explained by the anatomical and physiological features of the joint (the spherical head of the humerus and the flat articular cavity of the scapula, the discrepancy of their size, the large joint cavity, the weakness of the ligamentous capsular apparatus, especially in the anterior section, the peculiar work of the muscles and a number of other factors contributing to the appearance of dislocation).
In relation to the scapula, there are distinguished anterior shoulder dislocations (subclavicular, intraclavicular, axillary), lower (subarticular) and posterior (subacromial, subarticular). The most common (75%) are anterior sprains, underarm accounts for 24%, the rest is 1%.
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Examination and Physical Examination
The shoulder joint is deformed: flattened in the anteroposterior direction, acromion stands under the skin, there is a retraction under it. All this gives the joint a distinctive appearance.
On palpation, a violation of the external orientation of the proximal shoulder is determined: the head is palpated in an unusual place for it, often inside or outwards from the articular cavity of the scapula. Active movements are impossible, and when trying to perform passive movements, a positive symptom of springy resistance is detected. Rotational movements of the shoulder are transmitted to an atypically located head. The feeling and definition of the motor function of the shoulder joint are accompanied by pain. The movements in the distal joints of the arm are preserved in full. Movement, as well as skin sensitivity, the surgeon must determine, because sprains may be accompanied by damage to the nerves, the axillary nerve most often suffers. Damage to the great arteries is not excluded, so a pulsation should be checked on the limb arteries and compared with the pulsation on the healthy side.
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Laboratory and instrumental studies
The main auxiliary research method for shoulder dislocation is radiography. Without it, it is impossible to make a final diagnosis, and an attempt to eliminate the dislocation before radiography should be attributed to medical errors. Without a radiograph, fractures of the proximal end of the humerus or scapula may not be recognized, as a result of which, during manipulation, harm the patient.
Conservative treatment of dislocated shoulder
Sprained segment is necessary to set right immediately upon diagnosis. Pain relief can be both general and local. Preference should be given to anesthesia. Local anesthesia is provided by introducing 1% procaine solution in the amount of 20-40 ml into the joint cavity after a preliminary subcutaneous injection of the morphine solution or codeine + morphine + narcotine + papaverine + thebaine are injected.
Reduction of the shoulder without anesthesia should be considered a mistake. Before eliminating the dislocation, it is necessary to get in touch with the patient: to calm him down, to determine the behavior at the stages of reduction, to achieve maximum muscle relaxation.
Conductive anesthesia of the brachial plexus is used according to the method of V.A. Meshkov (1973). Perform it as follows. The patient sits in a chair, leaning on his back, or lying on the dressing table. His head is turned in the direction of a healthy shoulder. For anesthesia, a point is defined below the lower edge of the clavicle on the border of its outer and middle third above the top of the palpable coracoid process of the scapula, where a “lemon crust” is made.Then, a needle is introduced perpendicular to the skin surface to a depth of 2.5-3.5 cm (depending on the severity of the patient's subcutaneous fat and muscle layers) and 20 ml of 2% or 40 ml of 1% procaine solution are injected.
Research V.A. Meshkov showed that the needle in this place cannot damage the subclavian vessels, and the solution injected through it washes the nerve branches involved in the innervation of the capsule and the muscles of the shoulder joint.
After reaching anesthesia, they start to lower the shoulder.
There are more than 50 ways to eliminate shoulder dislocation. All of them can be divided into three groups:
- lever ways
- physiological methods based on muscle fatigue by traction,
- methods involving pushing the humeral head into the joint cavity (jogging methods).
It should be noted that such a division is very conditional, since in many ways they combine various elements of the leverage reduction technique.
The most famous example lever principle the reduction of the shoulder is the Kocher method (1870). The patient is sitting on a chair. A towel in the form of an 8-shaped loop covers the injured shoulder joint, creating a counter draft. The doctor places his hand, the same name as the injured person’s sprained hand, on top of the elbow bend and covers it, and the second hand holds the wrist joint, bending the patient's limb at the elbow joint at a right angle. Further actions of the doctor consist of four stages, smoothly replacing each other:
- extension along the axis of the limb and bringing the shoulder to the body,
- continuing the movements of the first stage, rotate the shoulder outwards by deflecting the forearm in the same direction,
- without changing the achieved position and thrust, move the elbow joint anteriorly and medially, bringing it closer to the midline of the body,
- make an internal rotation of the shoulder over the forearm, moving the hand of this hand on a healthy shoulder girdle.
Kocher's way is one of the most traumatic, it can be used to reduce the shoulder in young people with anterior shoulder dislocations. Older people can not use it because of the threat of fracture of the porosity of the shoulder bones and other complications.
Method F.F. Andreeva (1943). The patient lies on his back on the couch. The surgeon, standing at the head, takes the injured arm of the injured person by the forearm bent at a right angle and lifts it up to the frontal plane, simultaneously producing thrust along the axis of the shoulder. The hand is rotated first inwards, then outwards and lowered down.
The most numerous should be recognized group of methods based on reduction of dislocation by traction. Traction is often combined with rotational or swinging movements. The most ancient method in this group is Hippocrates (IV century BC). The patient lies on a couch on his back. The doctor places the heel of his spreading legs (of the same name with the patient's arm sprained) in the axillary region of the patient. Grabbing the victim's hand, he performs traction along the long axis of the arm with simultaneous gradual adduction and heel pressure on the head of the shoulder outwards and upwards. When pushing the head it is repositioned.
Method E.O. Mukhina (1805). The patient is lying on his back or sitting on a chair. The damaged shoulder joint is covered behind the folded sheet, the ends of which cross over the patient's chest. Assistant uses it for protivotypyi. The surgeon smoothly, with increasing strength, produces traction over the shoulder of the patient, gradually taking him to the right angle and at the same time making rotational movements (Figure 3-10).
The method of Mota (1812). The patient lies on the table. The assistant pulls his sore arm upward, resting his foot on the injured's shoulder girdle, and the surgeon seeks to adjust the head of the shoulder with his fingers.
There are several other methods for eliminating shoulder dislocation based on traction for damaged konegnost. These are the ways of Simon (1896), Hofmeister (1901), A.A. Kudryavtsev (1937).
According to Simon's method, the patient is laid on the floor on a healthy side. The assistant stands on a stool and pulls the sprained arm up with the hand, while the surgeon with his fingers tends to straighten the head of the humerus.
Ways Hofmeister and A.A. Kudryavtsev is distinguished by the fact that in the first case traction for a limb is carried out with the help of a load suspended from the arm, and in the second case with the help of a cord thrown over the block.
The most physiological, atraumatic in this group is recognized as the method of Yu.S. Janelidze (1922). It is based on the relaxation of the young by traction, the gravity of the injured limb. The patient is placed on the dressing table on its side so that the sprained arm hangs over the edge of the table, and a high table or nightstand is placed under the head.
The patient's body is fixed with rollers, especially in the area of the shoulder blades, and left in that position for 20-30 minutes. Muscle relaxation occurs. The surgeon, capturing the bent forearm of the patient, performs traction down the arm (outwards), followed by rotation outwards and inwards. The direction of the shoulder can be determined by a characteristic click and the restoration of movements in the joint.
A small number of methods are based on direct pushing the humeral head into the articular cavity without the use of traction or with very little traction.
The way of V. D. Chaklina (1964). The patient is placed on his back. The surgeon, capturing the upper third of the forearm, bent at a right angle, somewhat removes the dislocated arm and stretches the axis of the shoulder. At the same time, the other hand, inserted into the armpit, presses on the head of the shoulder, which leads to a reduction.
The way of V. A. Meshkov (1973) is categorized as atraumatic, it is convenient for eliminating anterior and (especially) lower dislocations.
After the subclavian conduction anesthesia described earlier, the patient is placed on the table on his back. The assistant removes the sprained limb up and anteriorly at an angle of 125-130 ° and holds it in this position, without producing any action for 10-15 minutes to fatigue and relax the muscles. The surgeon with one hand creates a back-stop due to the pressure on the acromion, and the second-pushes the head of the shoulder from the armpit upwards and backwards with anterior dislocations and only upwards - with the lower ones.
The above methods of eliminating dislocation of the shoulder are not equivalent in terms of technique and popularity, but each of them can restore the anatomy of the joint. True, this does not mean that the surgeon is obliged to use all methods and their modifications in his work. It is enough to master the technique of adjusting the head in three or five ways, they will be quite enough to eliminate any types of traumatic dislocations. It is necessary to choose sparing, atraumatic reduction methods. The methods of Janelidze, Kudryavtsev, Meshkov, Chaklin, Hippocrates, Simon can be considered as deserving of widespread practice. But they will be successful only when the manipulation is carried out carefully and with complete anesthesia.
It should be noted that sometimes even with the classical performance of the technique, it is not possible to restore the articulation. These are the so-called unreducible dislocations of Meshkov's shoulder. They occur when the tissue gets between the articulated surfaces. Interponents are most often damaged tendons and muscles, the edges of a ruptured and wrapped capsule of a joint, a slipped tendon of a long head of biceps muscle, bone fragments. In addition, the muscles of the scapula, tied to the joint capsule and referred to as surgeons by a rotator cuff, can be an obstacle detached from the large tubercle of the tendon of the muscles of the shoulder blade.
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Surgical treatment of shoulder dislocation
Irreducible dislocations are considered as indications for surgical treatment of shoulder dislocation - arthrotomy of the shoulder joint, elimination of an obstacle, elimination of dislocation and restoration of the congruence of the articulated surfaces.
After the shoulder is closed or opened, the limb should be immobilized with a plaster Longuet on the Turner from the healthy shoulder girdle to the heads of the metacarpal bones of the injured limb. The term of immobility, in order to avoid the development of habitual dislocation of the shoulder, should be in young people at least 4 weeks, in older people - 3 weeks. In the elderly and people of old age they apply girdle bandages (instead of plaster) for a period of 10-14 days.
Assign analgesics, UHF on the shoulder joint, exercise therapy of the static type and active movements in the joints of the hand.
After the elimination of immobilization prescribed exercise therapy for the shoulder joint. Exercises should be passive and active types, aimed at restoring circular movements and shoulder abduction. During therapeutic gymnastics, it is necessary to control that the movements of the shoulder and the scapula are separated, and in the presence of the shoulder-shoulder syndrome (the shoulder moves with the scapula), the methodologist must fix the scapula. Rhythmic galvanization of the muscles of the shoulder and shoulder girdle, electrophoresis of procain, ozokerite, laser beam, magnetic therapy, and occupations in the swimming pool are also prescribed.
Dislocation of the shoulder - a common injury. Dislocations of the shoulder make up more than 50% of the total number of dislocations and 3% of all traumatic injuries. Such a high frequency of pathology is due to the peculiarities of the anatomical structure and a large amount of movement in the shoulder joint. The shoulder joint is formed by the flat-concave articular surface of the scapula, which includes a spherical head of the humerus by a quarter. The head is held in place due to the so-called rotator cuff - ligaments, muscles and joint capsules.
As a rule, a traumatic dislocation of the shoulder results from an indirect injury - a fall on an arm that is removed or raised. The capsule of the shoulder joint is broken, the head of the shoulder is displaced in the direction of the rupture. In some cases, the cause of anterior dislocation of the shoulder becomes a direct blow from behind, and the cause of posterior dislocation is a direct blow to the front of the shoulder joint.
Depending on the etiology in traumatology and orthopedics, primary (traumatic), arbitrary, congenital, habitual and pathological shoulder dislocations are distinguished.
- Habitual dislocation of the shoulder develops as a result of insufficient restoration of the rotational cuff of the shoulder after traumatic dislocation.
- Pathological dislocation may occur due to lesions of the tissues of the shoulder joint with tumors, osteomyelitis, tuberculosis, osteochondropathy, osteodystrophy, etc.
Dislocation of the shoulder can be combined with a fracture of the head, anatomical or surgical neck of the shoulder, separation of the small or large tubercle of the humerus, fracture of the articular cavity, acromion or coracoid process of the scapula, damage to adjacent tendons, vessels and nerves. When combined with another dislocation injury speak of a complicated dislocation of the shoulder. Depending on the direction of displacement of the humeral head, anterior, posterior and lower shoulder dislocations are distinguished. Most often (3/4 of cases) anterior dislocation of the shoulder occurs. The second place in frequency is occupied by the lower shoulder dislocation (about 20%).
Symptoms of shoulder dislocation
Traumatic dislocations of the humerus are accompanied by a sharp pain in the injury site, deformity of the shoulder joint (the joint becomes angular, hollow, concave). Movement in the joint is impossible. At attempt of passive movements the characteristic spring resistance is determined.
With anterior shoulder dislocation, the head moves forward and down. The hand is in the forced position (side retracted or bent, retracted and turned outwards). On palpation, the humeral head is not detected at the usual place, it can be palpated in the anterior sections of the armpit (with frontal dislocations) or below the coracoid process of the scapula. The anterior and lower limb dislocations are sometimes accompanied by the tearing off of the large tubercle of the humerus, fracture of the coracoid or acromion processes of the scapula.
In case of lower shoulder dislocation, the head moves to the axilla. In the armpit are vessels and nerves. If the head squeezes the neurovascular bundle, skin numbness and muscle paralysis occur in the area that the squeezed nerve innervates. The posterior dislocation of the shoulder is characterized by a displacement of the head toward the shoulder blade.
Description and statistics
Among traumatic dislocations, dislocation of the shoulder is the most common. It accounts for about 55% of all injuries. The shoulder joint performs many different movements, but it is very vulnerable to injuries, because the contact area of its articular surfaces is quite small. For example, most often the dislocation of the shoulder is indirect: a person falls on the arm extended forward or to the side, its movement exceeds the physiological norm, the capsule is torn by the head of the humerus and falls out of the articular cavity.
Much less common rear sprains. Statistics witnessed about 2% of the case. These injuries are formed due to fairly frequent situations when, for example, a fall occurred, but at the same time the arms were stretched forward. Then the gap occurs in the back section. Virtually no lower sprains. This species differs in that the head of the bone of the shoulder moves down. With such injuries, the motor function decreases markedly downwards. Accordingly, in front of the victims there is a need to keep the injured limb in such a position that the arm is raised and directed upwards.
There is a risk of re-dislocation. It may occur within six months after the first is fixed. Repetitions can happen more than once - up to ten times a year. Every time the changes will increase. This will provoke an increase in the diagnosis of repeated dislocations. Statistics show that such injuries usually occur in people under 20 years of age.
Causes of shoulder dislocation
We have already mentioned that the shoulder joint is very mobile. Man most often "bosoms" with this part of the skeleton. He is very vulnerable, and most often he is affected by a disease such as dislocation. Its frequent cause is the rendering of general power influence, the movement itself has a twisting or twisting character. To cause injury, it must be performed with a simultaneous violation of the volume of all possible joint movements.
There are other reasons and factors:
Excess movement directed to this part of the skeleton is diagnosed in 12% of cases, and this type of health disorder is called “joint hypermobility”.
Rear or front species appear for various reasons, but more often because the articular cavity appears to be strongly inclined.
If the scapular articular cavity has a small capacity, the cause changes markedly and the risk factor for dislocation increases.
A common cause is hypoplasia of the articular cavity, that is, for the most part, its lower region changes, as well as many other physiological changes occur.
Often, people are forced to repeat movements of the same type, and because of this, the ligaments and the articular capsule are repeatedly stretched. Among patients, in this case, most often are athletes (swimmers, handball players, etc.)
Particularly high risk associated with excessive amplitude of movements. In medicine, this method of movement is called "generalized hypermobility". There are a number of reasons related to the anatomical features of the structure of the joint. Then it is necessary to conduct research in advance and avoid traumatic situations.
Types of shoulder dislocation
Dislocations of the shoulder are classified into congenital and acquired. Acquired dislocations, in turn, are divided into traumatic and non-traumatic. Non-traumatic shoulder dislocations are arbitrary and pathological (chronic).Traumatic dislocations can be uncomplicated and complicated. Dislocation of the shoulder may be complicated by the violation of the integrity of the skin, tendon rupture, fracture, damage to the nerves and blood vessels. Also shoulder dislocations are old and pathologically repetitive.
Depending on the location of the surfaces of the joints of the humerus and shoulder blades, the shoulder dislocations are divided into anterior, posterior and lower. Anterior dislocation of the shoulder can be subclavicular and subclavian, the lower one can be axillary, and the posterior one can be subacromyal and infraclavicular. Anterior sprains account for the overwhelming majority of cases of shoulder dislocations (about 75%), followed by axillaries (24%). The remaining sprains account for only 1% of cases.
Classify shoulder dislocations and the time elapsed since the injury. They are old (the injury was inflicted more than three weeks ago), stale (the time of injury - from three days to three weeks) and fresh (not more than three days).
In addition, dislocation happens:
The cause of the disease is often any movement, even such as cleaning or combing. If the primary dislocation has undergone the wrong treatment, or has not been treated at all, complex pathologies of a recurrent dislocation of a traumatic nature develop.
Diagnosis of joint dislocation
Dislocation of the joint is diagnosed according to certain indicators. Many of them we have already listed among the symptoms. But anyway, the traumatologist performs a professional inspection, concluding on the basis of the complaints that he lists.
Other medical examinations are also important. The radiographic examination is distinguished by great efficiency, for which the method of direct projection or, if necessary, axial technology is used. The quality of the X-ray is enough to view the location of the bone head, to identify the features of its displacement, which also leads to damage to the integrity of the skeleton. The most important task is to identify whether it is dislocated - front or rear. It is important to identify whether there are any fractures.
Before setting the shoulder joint, the patient needs pain relief. Anesthesia can be both general and local. There are many ways to reduce shoulder dislocation. They are divided into lever, physiological and jogging (pushing the humerus into the articular cavity). But these methods are often combined with each other.
After setting and immobilizing the plaster Longuet of the diseased joint, its movement should be limited to three weeks. When longetu is removed, it is recommended to undergo a rehabilitation course, restoring joint mobility and preventing repeated dislocations. The complex of procedures includes massage, medical gymnastics, electrical stimulation of muscles, water exercises and so on.
Reposition - the basic method of treatment of dislocation of the shoulder joint. It is not produced independently. The only thing the patient can do to cure the disease is to consult a doctor as soon as possible. First sprains require special attention. They are more complex, given that it is the first dislocations that are harder to settle down.
Treatment of dislocation of the shoulder joint is presented in a wide range.
All methods can be divided into two broad categories:
The non-surgical or closed method is to treat the head of the humerus. To do this, anesthesia is done. In this case, it is customary to use novocaine solution.
Do not delay with medical intervention. If it is received out of time - you need to expect consequences such as muscle contraction, and this factor greatly complicates contraction. Then anesthesia is not enough; in addition, a number of special preparations will be required, whose task is muscle relaxation. They are called "muscle relaxants." If such a measure fails, then the patient will have to prepare for the operation. It usually is an open joint repair technology.
This is followed by treatment based on immobilization of the damaged part of the skeleton. This leads to splicing of torn ligaments and restoration of the articular lip. This process can occur due to the fact that the articular capsule that runs in front, in a peculiar way, is stretched, which allows you to press the severed articular lip to the surface of the desired bone. As a rule, at this stage plaster casts are applied. They should be used for about three weeks.
Dislocation of the shoulder is treated in different ways, not excluding:
pain medication in the form of tablets or injections, necessary for the normalization of the general condition of the victim, eliminating pain and not only
impact on the injured area with cold, because it reduces pain and swelling.
One of the simplest methods of physiotherapy is associated with the application of cold to the affected area. The intensity of the pain decreases markedly, and the inflammation is relieved. In the near future after injury, you need to put a compress with ice. This reduces the risk of dangerous defects and speeds recovery.
There is a special complex. His task is to help create the muscular framework, protecting the patient from the development of this disease in the future. If habitual dislocation of the shoulder joint of a permanent nature is diagnosed, exercise therapy does not bring positive results. Such a pathology prevents the creation of conditions for the further protection of the joint. Good results are given by the course of paraffin therapy, electrophoresis, SMT on the area of the affected joint. Not all methods of physiotherapy are relevant in this or that case. For example, patients who have stepped over the 70 - year milestone require caution. Patients of the elderly category cannot be treated with the help of physiotherapy.
Stages of rehabilitation
After the dislocation of the chaff joint, a certain rehabilitation is necessary. It consists of several parts:
includes activating the functionality of the damaged muscle area when the immobilization period comes, the course duration is about three weeks,
the functions of the shoulder joint are restored, the duration is approximately three months,
the final steps of the rehabilitation of joint functions, the duration is six months.
The bone joint must be immobilized. This requires immobilization. It is the best tool, and it is used after removing the plaster. Then comes the time of the rehabilitation process, when you need to perform special exercises. They are aimed at using circular movements to produce circular movements of the shoulder. Good results give exercises in the water.
A disease such as habitual dislocation of the shoulder, requires treatment in certain conditions of a specialized trauma hospital. This will require a measure such as surgery. Here, conservative procedures will not give a positive result. Surgery offers a whole section on the treatment of this pathology. The treatment should be consistent with the cause that led to the dislocation of the shoulder joint. Recall that due to this displacement of the head of the humerus, different characters may be worn.
After the operation, they undergo a special rehabilitation. Electrical muscle stimulation, massage and exercise therapy.
When it takes three months after the operation, small loads are allowed (for example, six months later, heavy physical labor). The fixing bandage is surely used, it is not removed within 1-4 weeks. The time depends on the type of operation performed.
Rehabilitation helps to strengthen the muscles of the shoulder girdle. They begin to grow stronger in terms of the stabilizing effect on the joint. In the early stages, physiotherapy exercises are required when instructor supervision is required. After some time, the patient gets the opportunity to study at home. This stage can last 2-4 months.
Education: Diploma in "General Medicine" received in 2009 at the Medical Academy. I.M. Sechenov. In 2012, completed a postgraduate course in the specialty "Traumatology and Orthopedics" in the City Clinical Hospital. Botkin at the Department of Traumatology, Orthopedics and Disaster Surgery.
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Causes of damage
Dislocations of the shoulder have a different factor of occurrence, but the most common is trauma or forceful action.
- Trauma - is a fall on an outstretched arm or on the shoulder and entails a fracture of the articular cavity, the head of the bone, the coracoid, and other processes of the scapula.
- Congenital anomalies in the shoulder joint - an anatomical feature of the development of the articular groove in the scapula is characterized by a small depth, inferiority of form.
- Increased joint activity or generalized hypermobility is a pathology in which uncharacteristic movements appear in the joint. Excessive mobility of the shoulder joint occurs in 10–15% of the world's inhabitants.
- Stretching of the articular capsule is provoked by the implementation of identical repetitive movements. They cause permanent stretching of the capsule, ligaments. Most often sportsmen, namely swimmers, tennis players suffer from this.
- Such diseases of the shoulder joint as - arthritis, arthrosis.
- Systemic and other pathologies - tuberculosis, osteomyelitis, osteodystrophy, osteochondropathy.
Repeated shoulder injuries cause weakening of the ligaments, and as a result, the stability of the joint itself also weakens. The habitual dislocation of the shoulder is provoked by the fact that the muscle of the rotator cuff could not fully recover after the patient dislocated the shoulder in connection with the injury.
The recurrence of shoulder dislocation can provoke the usual daily movements: cleaning the apartment, washing the floors, trying to put the thing on the upper shelf. Moreover, each subsequent dislocation of the humeral head more and more violates the stability of the joint, as a result, the intervals between relapses are reduced, and subluxations or dislocations occur more and more often.
Signs of dislocation of the shoulder joint, if the primary injury is pain, which is mostly due to the rupture of soft tissues. With repeated dislocations, the pain is much less or does not occur at all. This is due to the fact that the structures that stabilize the joint were damaged by a previous injury.
Symptoms of dislocation of the shoulder joint are very similar to signs of damage to other joints.
Symptoms of subluxation of the shoulder joint, as well as dislocation, are characterized by a sharp pain in the corresponding place. One of the signs is a shoulder deformity and a hanging arm. Any movement is impossible to carry out due to increased pain and disruption of its functioning. When passive movement felt springy resistance.
Visually noticeable asymmetry of the shoulder joints. The articulation itself becomes angular, concave or hollow. On palpation, the doctor determines the protruding head of the bone coming out of the bed.
- For anterior dislocation is characterized by moving the head down and forward.
- For the anterior-lower one — displacement to the anterior axilla or down the coracoid process of the scapula. The victim is forced to keep his hand in a comfortable position: retracted and turned out or bent.
- In the lower form of pathology, the head shifts to the axilla, the arm goes numb completely or in certain areas.
- When posterior dislocation of the head moves in the direction of the scapula.
Dislocated shoulder symptoms may have others.
- swelling of the shoulder joint
- goose bumps on the arm
- pain not only in the area of injury, but also along the pinched nerve.
With a serious dislocation of the shoulder, complications can develop. The greatest danger is represented by damage to the neurovascular bundle, open damage to the bone structure and soft tissues, closed fracture of the shoulder bone.
The habitual dislocation of the shoulder can be complicated by other pathological situations. Among them is the Bankart damage, when the joint capsule is torn and a portion of the joint lip comes off. There are no external manifestations, but severe pain, but the consequences are unpleasant.
How to determine the dislocation of the shoulder? Knowing the listed signs of damage, it will be easy to do.
What to do with dislocation of the shoulder? When assisting the main thing is not to try to set the joint on its own. The joint should be adjusted only by a specialist, a non-professional can lead to damage to the nerves or blood vessels.
- Completely eliminate any movements with a damaged hand.
- Use painkillers.
- Apply a cold compress to the affected area.
- To hang up a hand on a scarf.
- Call the medical team.
The first stage - reposition
The reduction is closed and open - non-surgical and, accordingly, with the operation.
Closed reduction of fresh shoulder dislocation is done under local anesthesia, for this, the affected area is cut off with novocaine. To relax the muscles injected intramuscularly muscle relaxant, and with severe pain - a narcotic analgesic. An old habitual dislocation of the shoulder joint is removed under general anesthesia.
The most common variants of joint reduction are the method of Janelidze, Mukhina-Mota, Hippocrates, Kocher. Which one is used depends on the type of damage.
Reduction of habitual repeatedly occurring injuries or those that could not be eliminated by the closed method is carried out with the help of a surgical intervention with fixation of the humeral head with special needles, sutures in the articular cavity.
Treatment of habitual dislocation, performed by surgery, at this stage consists of taking nonsteroidal anti-inflammatory drugs, non-narcotic analgesics.
The second stage - immobilization
Treatment after resetting the shoulder is immobilization. This is necessary to secure the joint in the desired position, heal the capsule and prevent recurrence. On a hand impose a special bandage or longgetu for a period of one month. As soon as the joint takes the correct position, the signs of injury will pass.
It is important to maintain the recommended wearing time, even if the swelling, pain and other symptoms have disappeared. Articular capsules do not heal if shoulder immobilization was terminated early. This provokes the usual dislocation, with subsequent damage to the surrounding tissues.
The third stage - rehabilitation
For the restoration of the functions of the dislocated articulation after immobilization, the rehabilitologist is taken. Physiotherapy helps to strengthen the ligaments and muscles of the shoulder - massage, electrical stimulation of muscles and exercise therapy.
Rehabilitation is also divided into three periods:
The first 3 weeks are aimed at improving muscle tone, activation of their functions after immobilization.
The complex of exercises after the dislocation of the shoulder joint begins with circular movements in the wrist joint, then flexion-extensor movements of the hand are performed followed by squeezing the fingers into a fist. By sending a mental impulse to the shoulder muscles, resting your elbow on the bandage, you can achieve a rhythmic tension of the shoulder muscles.
At this stage, you can carry out physiotherapy procedures aimed at anesthesia, removal of edema and resorption of hematomas.
The first 3 months are spent on joint development, mobility restoration.
In case of dislocation of the shoulder joint at this particular time, it is recommended to carry out a massage, which warms the limb in front of a complicated set of exercises.
The entire exercise therapy for dislocation of the shoulder joint is performed on a bandage bandage and all movements associated with the load on the shoulder are carried out in a passive mode using a healthy hand. At this time, swinging, swing and circular movements of the shoulder, vises on the arms are not allowed.Allowed only not a sharp movement of the muscles of the shoulder girdle up and down.
Six months is given to a full recovery after the dislocation.
After they have stopped treating the dislocation of the shoulder joint, they begin to gradually return the full load on the shoulder. It is recommended to perform exercises with reasonable weighting, they prescribe a special massage.
Important! In case of non-observance of medical prescriptions, neglect of the rehabilitation period, prerequisites are created for the occurrence of the usual shoulder dislocation. And due to the fact that habitual dislocation of the shoulder is not accompanied by pain, and the frequency of its occurrence pushes patients to treat dislocation of the shoulder joint at home, without resorting to specialized care. All this leads to negative consequences.
Dislocation of the shoulder joint is a fairly serious injury. Rehabilitation and therapy without accurate diagnosis can lead to the following complications:
- Joint instability.
- Peripheral nerve damage.
- The range of motion in the joint is limited.
- Relapse after the slightest injury.
- Degenerative changes of the joint.
Important! Dislocation of the shoulder joint, home treatment can be carried out only after the specialist takes all the necessary actions. After the dislocation of the shoulder, at home, you must comply with all prescriptions. Only in this case, treatment and rehabilitation will give positive results. It should be remembered that it is impossible to immediately load the damaged joint - it should be given a physical load gradually.
Do not pull with the diagnosis and treatment of the disease!
Treatment of shoulder dislocation
First aid is to immobilize the damaged joint with a Deso dressing or a ladder splint. A traumatic dislocation of the shoulder is accompanied by sharp pain, to reduce which the patient is given non-narcotic (analgin) or narcotic (pro-poor) analgesics. It should be borne in mind that the more time has passed since the injury, the harder it will be to straighten the shoulder, so the patient must be taken as soon as possible to the orthopedic traumatologist in the emergency room or the emergency department.
Upon admission to the shoulder joint, a local anesthetic is administered. Under local anesthesia, a closed removal of the dislocation of the shoulder joint is performed. The method of Janelidze, Kocher, Hippocrates, Mukhin-Kota is used. Sometimes, under local anesthesia, dislocation of the shoulder is impossible to correct. The inability to reposition may be due to the infringement of soft tissues or the relatively long prescription of dislocation. In such cases, the dislocation is reset under anesthesia. If the joint cannot be set right without an operation, an open reduction is performed, followed by fixation with a needle or polyester sutures.
After the reduction of the shoulder dislocation, a Deso dressing is applied for a period of 3-4 weeks. As soon as the head of the shoulder takes its place, the pain decreases sharply and may disappear in a few days, however, the bandage is retained to ensure adhesion of the damaged soft tissues. After healing of the capsule of the shoulder, the bandage is removed, physiotherapy procedures and therapeutic exercises for joint development are prescribed.
Prognosis and prevention
With timely reduction of dislocation and compliance with the recommendations of the doctor, the prognosis is usually favorable. When premature unauthorized removal of the bandage in the long-term period is often observed habitual dislocation of the shoulder. Primary prevention is to prevent injuries, secondary - in strict adherence to medical recommendations, ensuring the immobility of the joint for the period necessary for the complete healing of damaged structures.