What to do if a child has a dislocation of the elbow joint? Causes and symptoms of dislocation of the elbow joint - treatment Principles of treatment of congenital subluxation in children under the age of one year

The main reason why a child can dislocate the elbow joint is a closed hand injury, which usually occurs when falling on an outstretched limb. Also, a dislocation can be obtained with a strong tension of the ligaments of the arm. In addition, the elbow joint can be dislocated upon impact, that is, during an open injury to the upper limb. Often, dislocations of the elbow joint occur when lifting weights, with significant physical exertion. Parents themselves often provoke the occurrence of dislocation when they pull the child hard by the arm. Especially often such a dislocation occurs in children under the age of three. Also, children often get injured during physical education or on the horizontal bar. Often dislocations occur when getting into a traffic accident, both among pedestrians and passengers.

Dislocations of the elbow joint can be of different types. Most often in children, posterior dislocation occurs, which occurs due to insufficient strength of children's bones ....

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The systems and organs of the child are in a state of development and growth, and therefore they cannot be called formed. At this stage, the body is most vulnerable, and even the slightest injury can lead to serious consequences. Elbow dislocation is considered the most common type of traumatic joint injury in children, so it is important to know how to recognize such an injury.

What is a dislocation and why does it occur

A dislocation is a discrepancy between the movable surfaces of the articular element

A dislocation is a discrepancy between the movable surfaces of the articular element, which occurs as a result of mechanical action.

The degree of such damage can be different:

When the parts do not completely separate, subluxation is diagnosed; dislocation occurs when the parts do not touch each other at all.

In children, a high level of injuries of this type occurs due to the structural features of the musculoskeletal skeleton - ...

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Dislocation of the elbow joint in a child: causes, symptoms and treatment

Many parents have faced a serious problem - a dislocation of the elbow joint in a child. Dislocation in young children is very difficult to recognize, since in babies the joints themselves are very mobile, fragile, not strong. Parents themselves cannot determine a dislocation in a child. Therefore, if the baby complains of pain in the elbow area, you should contact a traumatologist, surgeon or pediatrician.

Dislocation as a disease

A dislocation is a joint lesion in which the anatomically correct relationships of the articular surfaces are violated. With a dislocation of the elbow joint, the articular surfaces of the elbows separate.

In medicine, there are 2 categories of dislocations:

Subluxation, when the surfaces of the joints diverge partially, that is, not completely. A dislocation in which the surfaces of the joints diverge completely and do not touch each other. Complicated dislocation, in which there is a rupture of the ligaments.

The reasons...

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How to treat subluxation of the elbow joint in a child?

Subluxation of the elbow joint in a child is not uncommon. This is due to the peculiarity of the structure of this part of the body, which consists of three joints:

The shoulder joint, which is responsible for the ability to bend and unbend the radius bones. The shoulder joint, which is responsible for the work of the bones of the forearm. The elbow joint, thanks to it, the radius rotates, and the forearm makes turns.

There are two types of dislocations:

Incomplete dislocation or subluxation, when there is partial contact between the joints. Complete dislocation, when the dispersed joints cease to contact each other.

This article is more about the issue of subluxation, its causes, symptoms, consequences and methods of treatment.

Subluxation of the head of the radius

Most often, subluxation of the head of the radius occurs in childhood, mainly in the preschool period. Such a twist...

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Subluxation of the elbow joint in a child

Treatment of a dislocated elbow

Elbow subluxation is quite common. Today it is one of the most common injuries. The dislocation can be either posterior or anterior. Often this problem occurs in children. Therefore, parents should carefully monitor their child.

Elbow injury options

Symptoms and causes of a dislocated elbow

Elbow dislocation occurs as a result of a specific injury. This may be a fracture of one of the limbs or other bones. This phenomenon can occur due to rupture of blood vessels and nerve endings that are located in a certain area. Impaired hand sensitivity is also a common cause of dislocation.

Main symptoms:

Complete lack of movement of the joint; the appearance of edema; the limb becomes insensitive, it is possible and ...

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It is not for nothing that a typical injury in children of the first three or four years of life was called "nanny's elbow". After all, the main (albeit unwitting) "culprits" of this injury are "nannies", that is, adults who, insuring the baby from falling, sharply pull him by the handle. The result: subluxation in the elbow joint, which can become habitual and cause a lot of suffering and trouble until the child reaches a certain age.

Little tracker

In early childhood, the child makes the greatest number of discoveries. Knowing the world, the baby does not sit still for a minute. He has no time: the world is so big, and his steps are still so tiny! Need to hurry! And the baby is in a hurry, despite the fact that under the legs there is bare ice or uncomfortable steps, small pebbles or a stick forgotten by someone, provoking the baby to a dangerous fall.

Of course, nature took care of the safety of the baby and arranged the children's musculoskeletal system, taking into account its restless mobility: a child of the first years of life ...

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Take care of your child's joints! © flickr.com

Having barely learned to walk, the baby trustingly put his hand into the strong hand of an adult and, touchingly struggling with ice and his own legs, bravely stomps on the globe behind the tit teasing him. Or a cat. And suddenly he stumbles and...

"Don't pull, I'm fragile!"

And the adult accompanying the baby, trying to protect the baby from falling, sharply pulls his hand up. The baby regains balance. It seems that everything is in order, the danger of falling has passed and the walk can be continued. But the baby, sobbing, suddenly loses interest in what is happening. If within two or three minutes you fail to restore his joyful mood - do not waste your efforts in vain, try to return home as soon as possible.

Wrong walk...

Half an hour after the incident, is the baby still crying and complaining of pain in the pen, diligently protecting it from touching, and even using the second hand, if necessary, to change position? His hand is turned palm...

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Dislocation of the elbow joint and its treatment

Elbow dislocation is an injury to the elbow that results in overextension of the elbow. The articular surface of the forearm is displaced relative to the humerus.

The formation of this phenomenon is directly related to the pressure of one's own body weight on the hand, for example, when falling.

The elbow joint is united by three articular joints, the humerus, ulna and radius.

The bones are connected by special connective ligaments that ensure the mobility of the arm, and external interference leads to their complex dislocation.

Dislocations of the elbow joint are divided into anterior, posterior and lateral in the direction of the bend. The most common occurrence was posterior dislocation, rarely lateral, and anterior isolated dislocation is considered the rarest injury to the elbow joint.

The bend of the joint is directly related to the sharp pressure of its own weight when falling on an outstretched arm back or forward. Anterior dislocation occurs when you fall on a bent...

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To date, such pathology as dislocation and subluxation in childhood is consecrated very superficially and without a systematic approach. It should be noted that subluxations are very rarely formed in children under the age of five, however, due to an increase in physical activity, the number of these injuries increases significantly in the age category of 8-12 years. In principle, today there is a situation where dislocations and subluxations are formed in children much less frequently than in adults. The distribution of this pathology has the following picture - 1/10 of the total number of subluxations is formed in children and 9/10 in adults. This ratio is due to the peculiarities of the children's skeleton and the functioning of the musculoskeletal system.

Definition of subluxation in a child

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View Full Version: Frequent joint subluxations, 2 year old child

Hello!
My daughter is 2 years and 2 months old. Over the past 2 months, I have already been to traumatology 3 times with subluxation of the elbow joint on different hands. Surprisingly, no one pulled her hands and twisted the handles. One of these times, she generally just climbed over her grandmother lying on the couch. In traumatology, we are told every time that up to 5 years this is normal, this often happens. But for some reason, in my environment, this happens only with my child. Can you please tell me what can be done to fix this problem?
I am worrying a lot. I have a hard time enduring each reduction of the joint in my child, I cry with her. Help me please. Will we really be regular clients of traumatology until the age of five??

orthopedists are invited to the topic
...

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The elbow joint in an adult is rarely injured, and young children, especially at the age of 2-3 years, are quite common with subluxation of the elbow joint.

This injury is sometimes called "nanny's elbow", because its culprits are often adults who incorrectly insure the baby from falling, pulling him by the handle, or act incorrectly when dressing the baby.

How does subluxation of the elbow occur?

Children, as soon as they start walking, strive to explore the world and move a lot. Toddlers are often restless, they love to run, but the coordination of movements is still imperfect, so falls are not uncommon. Nature has taken care to protect the child from many injuries. Children have a rather large volume of soft tissues, an elastic ligamentous apparatus. All this protects their bones and joints. However, some sudden movements still lead to injury.

When elbow subluxation is possible:

At the time of the fall of the child, when the adult abruptly ...

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common data

The human elbow joint is quite complex. In its formation, three bones are taken: the radius, ulna and humerus. Due to this structure, high strength and the ability to move the forearm in different directions are simultaneously ensured. Dislocation of both bones of the forearm (ulna and radius) or only the radius can occur.

Causes of dislocations of the elbow joint

Depending on the type of injury and the direction of displacement of the bones, the following types of dislocations of the elbow joint are distinguished:
Posterior dislocations - displacement of the bones of the forearm backwards. Occur during a fall on an outstretched arm or excessive hyperextension in the elbow joint.
Anterior dislocations - displacement of the bones of the forearm forward. Occur when falling on the elbow, when the arm is in a bent state.
Lateral dislocations. The bones of the forearm are displaced to the side. This type of dislocation in the elbow joint is rare, with a fall on an outstretched and laid aside arm.
...

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The elbow joint is a connected work of three joints:

brachial, responsible for flexion and extension of the radius; humeroulnar, responsible for flexion and extension of the forearm; ulnar, responsible for the rotation of the radius and rotation of the forearm.

Traumatic dislocation in the shoulder joint

Causes of dislocation of the elbow joint

In connection with this classification, dislocations are open (a blow to a bent elbow) and closed (a fall on an extended arm).

There is another classification of causes for dislocation. It:

Falls from a height, car and other types of accidents, injuries occurring at high speed.

In the photo you can see how badly the joint is damaged.

X-ray with dislocation of the elbow joint

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Elbow dislocation is a very common injury of the upper limb, second only to shoulder dislocation in frequency. The elbow joint is a complex anatomical structure. In fact, it consists of three separate joints, which is why the movements in the elbow are so diverse. Violation of the congruence of the articular surfaces in at least one of the three joints that make up the joint is called a dislocation of the elbow joint.

The reasons

The cause of dislocation of the elbow joint is trauma. The most common causes of this pathology are the following types of traumatic injuries:

Indirect injury, when force acts on distant parts of the body, but is transmitted to the elbow joint (for example, a fall on a straight arm); direct blow to the elbow joint; accidental stretching of the forearm, such an injury is possible only in a child under 3 years old ("nanny's elbow") , occurs when the baby falls, and the parents try to keep him on his feet, while grabbing his forearm; falling from ...

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If the dislocation in the elbow joint was repeated more than 3 times without adequate trauma, we can talk about habitual dislocation of the forearm. This pathology is very rare: only 1.9% of dislocations in the elbow joint become habitual.

Constitutional features (weakness of the ligamentous apparatus, anomalies in the development of the semilunar notch of the ulna) and post-traumatic changes in the elbow joint predispose to habitual dislocation of the forearm.

Of great importance in stabilizing the elbow joint is the sufficient depth of the semilunar notch of the ulna. Normally, it averages an arc of 178.9° (160-190°). When the arc is less than 160°, the depth of the notch decreases and sufficient adhesion of the shoulder block and the notch of the ulna is not provided. In children, the coronoid process is still cartilaginous, small in size, as a result of which flattening of the notch is also observed. In addition, in early childhood, a fracture of the cartilaginous coronoid process, invisible on radiographs, often does not...

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Dislocation of the elbow joint is characterized by displacement of the articular surfaces relative to each other, they lose the total area of ​​contact. This injury often occurs in children of different ages, as they are very active and mobile.

Symptoms of a dislocation of this joint are very characteristic. They immediately indicate the presence of an injury, the nature of which will be clarified by diagnostic measures.

In the article, you will learn everything about dislocation and subluxation of the elbow joint in children, as well as the treatment of injury.

Common causes of dislocation in children

In children, the ligamentous apparatus is not yet strong enough to cope with excessive stress on the joints. Many factors can provoke their overstretching, which leads to dislocation.

Causes of dislocation of the elbow joint in a child:

Symptoms and types of dislocation and subluxation

In traumatology, it is customary to separate dislocation and subluxation of the elbow joint. With dislocation, there is no contact between the articular surfaces, but incomplete dislocation (or subluxation) is characterized by incomplete displacement of the parts of the joint (they have a common contact area).

According to the presence of complications:

• Complicated;
• Uncomplicated.

Types of dislocation depending on the direction of the traumatic force:

• Anterior, found in pediatrics infrequently;
• Posterior, most often diagnosed in children, due to anatomical and physiological characteristics;
• Lateral (medial and lateral), as rare as anterior dislocation.

The symptoms of this injury are quite pronounced, so that it can be detected immediately after the onset:

• Pain. This is the very first and most pronounced sign of dislocation. Pain sensations are intense, they increase with movement and palpation (palpation) of the injured limb;
• The child is crying, his behavior is restless;
• The position of the limb is unusual. The child is trying to protect her from external influences. He holds her with his good hand;
• Hand movements are sharply limited;
• The presence of a hematoma in the elbow joint. However, this feature is not always present;
• Swelling in the area of ​​damage, the skin becomes hot to the touch;
• General hyperthermia (increased body temperature). It occurs reflexively and is associated with prolonged anxiety of the child. However, it should be remembered that the body temperature in this case should not exceed low-grade values ​​(no more than 37.7 - 38 ° C);
• In severe cases, there may be a lack of sensation and pulsation in the injured limb.

Injury diagnosis

It is quite difficult to determine the type of injury on your own. If a child, after a fall or an awkward movement, complains of pain in the elbow, then you should immediately contact the trauma center. Otherwise, the baby will face severe complications and adverse consequences of injury.

When a patient is contacted, the doctor should conduct a survey and physical examination. It is necessary to find out the cause of the injury and characteristic complaints. After that, visual (edema, hyperemia, hematoma) and palpation (definition of the head of the joint, local hyperthermia and pain) signs are determined.

To clarify the nature of the injury and the presence of complications, an X-ray examination is performed. Not a radiograph (image) determines the exact localization of the articular parts, and also excludes a fracture.

In the presence of complications, a neurological examination and ultrasound examination of large blood vessels are performed.

First aid for dislocation

Before sending a child to a trauma center, his condition should be alleviated. For this must be able to provide first aid:

Treatment of a dislocated elbow in a child

Treatment is carried out in a hospital. First, the doctor must set the joint. The method of reduction will depend on the type of dislocation.

Conservative treatment is indicated in the absence of complications. Only a doctor can correct a dislocation! You cannot carry out this manipulation on your own (this can lead to serious complications), the exception is an emergency (if you are far from the city and cannot get to the hospital in the near future). This procedure is performed only after adequate anesthesia.

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After reduction, the arm is fixed with a bandage. Immobilization of the limb is carried out for 1 week. At that time you need to take medications prescribed by your doctor:

• Painkillers;
• Vitamin complex;
• non-steroidal anti-inflammatory drugs;
• Antibiotics (if necessary).

If there are complications (rupture of ligaments, damage to blood vessels and nerves), then surgical treatment is necessary. The operation is performed under general anesthesia. The surgeon sews together ligaments, large vessels and nerve endings. The duration and severity of the operation depends on the type of complications and the condition of the patient's body.

After the operation, a plaster bandage is applied to fix the limb. This period lasts up to 30 days, after which the doctor decides on further treatment and rehabilitation of the patient.

In the postoperative period, it is necessary to use antibacterial drugs to avoid the development of an inflammatory process in the body. It also shows the intake of vitamins and good nutrition. According to the indications, symptomatic therapy is carried out.

If the child has a habitual subluxation, then the doctor can teach parents to set it on their own. However, all traumatologists recommend seeking qualified help in the event of any injury.

Rehabilitation after an injury

Children recover faster from injury than adults. But after treatment, they also need to undergo a rehabilitation course.

Rehabilitation is aimed at the complete restoration of the functionality of the limb. Rehabilitation includes several activities:

Complications and consequences

Near the elbow joint are large vessels and nerves. In case of incorrect or self-reduction, as well as at the time of injury, they can be damaged:

• Bleeding from large blood vessels;
• If the nerves are damaged, there is a loss of sensation in the limb, as well as complete and partial paralysis (the hand or individual fingers may stop moving).

Improper treatment and untimely seeking medical help (an old injury) lead to certain consequences:

• If the parents showed the child to a specialist late, 3 days after the injury, then he is operated on (cartilage tissue plasty). The recovery period in this case is significantly increased;
• Contracture is difficulty in moving a limb. She may not fully bend and unbend;
• With a severe injury, rehabilitation is quite long and requires a lot of effort;
• A habitual dislocation is formed when an injury occurs with displacement and damage to the ligamentous apparatus.

Now you know everything about dislocation and subluxation of the elbow joint in a child. You can read about dislocation of the elbow in adults.

In children, the ligamentous apparatus is elastic and flexible, therefore it is stretched more than in adults, because of this, a dislocation of the elbow joint occurs.

The mechanism of development of subluxations in children

The main mechanism for the formation of subluxations in children is excessive stretching of the ligaments and tendons that strengthen the joint, which leads to a fuzzy fixation of the articulation and a violation of its anatomical structure due to an uncontrolled and unlimited range of motion that is not available in the normal state.

That is, the child has a poorly fixed joint, due to which he can make a movement that is impossible in the norm, as a result of which the bones will disperse and a subluxation will form. Too much non-physiological movement in a poorly strengthened joint can be accompanied by tearing of ligaments or tendons from their attachment to the bones.

By adolescence, the musculoskeletal system is formed, and acquires the features and properties of an adult. Therefore, starting from adolescence, the mechanism of development of subluxations and dislocations has features and properties characteristic of an adult organism.

The elasticity of muscles and ligaments in children leads to a more frequent development of subluxations compared to adults, since a greater force is required to completely dislocate the joint. Such formation of subluxations, which are easily reduced and in most cases do not lead to negative consequences, can be considered as an increased compensatory reserve of the musculoskeletal system in children.

Causes of dislocation

Dislocation of the elbow joint in a child most often occurs at school age. Before the age of five, this is a rare occurrence, but still occurring.

The fall of a child. When falling, the weight of the body is transferred to the hands. The force of this gravity on the area of ​​the elbow zone is such that the articular surfaces are displaced. With a strong fall with support on the hands, the child can receive more serious injuries, such as a fracture. In a fall, posterior dislocation is most common.

Children injure joints and get subluxations most often with a variety of falls. The second place in the frequency of causes of subluxations in children is occupied by the carelessness of parents, who intensively pull the child's arm, stretching the ligaments and leading to joint injury.

Older and teenage children can dislocate joints when lifting weights or performing sports exercises without a trainer, and with unjustified overload of the bones of the skeleton.

Traumatic dislocation - the result of exposure to the joint (fall, blow):

1. Indirect injury - the impact on the elbow joint occurs indirectly. That is, the application of force is not directed at the elbow joint itself;
2. Straight grass - a blow directly to the elbow joint;
3. A sharp jerk by the hand is the most common cause of dislocation of the elbow joint in young children.

1. Indirect injury, when the place of application of force is distant from the injured joint.
2. Direct injury, characterized by a blow to the joint area.
3. Accidental pulling (dislocation in this case is possible only in young children under three years old).

In connection with this classification, dislocations are open (a blow to a bent elbow) and closed (a fall on an extended arm).

There is another classification of causes for dislocation. It:

1. falling from height,
2. automobile and other types of accidents,
3. injuries occurring at high speed.

In the photo you can see how badly the joint is damaged.

The main reason is a sharp stretching of the arm as a result of an extended position, when the stretching occurs by the hand or the lower end of the forearm along the longitudinal axis of the limb up or to the side. This condition can occur in the following cases:

1. When a baby falls, when an adult manages to grab his hand, or until that moment he did not let go of the child’s hand.
2. When the child rotates around the axis, holding hands, at the time of the game.
3. When putting on or taking off a narrow sleeve.

In some cases, parents claim that a certain crunch in the hand occurs during these actions.

In children, the ligamentous apparatus is not yet strong enough to cope with excessive stress on the joints. Many factors can provoke their overstretching, which leads to dislocation.

A dislocation of the elbow joint causes a critical stretching of one or more ligaments of the elbow joint. In contrast to the usual stretching of the tendons of the elbow, there is a displacement of the articular surfaces relative to each other.

There are several reasons for dislocation of the elbow, the main one is weak and elastic ligaments.

If in an adult the impact on the ligaments in the elbow joint causes counteraction of the ligamentous apparatus, which does not allow the bones to lose their compliance with the articular surfaces, then in a child, even a slight impact on the arm leads to overstretching of the ligaments and dislocation.

The characteristic effects that can lead to dislocation in the elbow joint are not much different from the causes. A dislocation may result from a fall on the arms. A child-specific cause of dislocation is an attempt by an adult to keep the child on his feet by grabbing his arm. The usual picture: mother leads the child by the hand, in the other hand - a bag. The child slips, and the mother with a sharp movement tries to keep him on his feet. The result - a dislocation of the elbow joint. "Innocent" games in the carousel with your own child can lead to dislocation. Even more common is a dislocation received when trying to put tight clothes on a child, or quickly take off his coat.

The joint can dislocate after an indirect blow: the site of physical impact is located away from the injured (falling on the palm of an outstretched arm dislocates the elbow joint).

Direct dislocation of the joint is formed from a bruise directly into the joint, such a displacement occurs much less frequently than indirect.

A common dislocation of the elbow joint in children is a displacement of the bones from a jerk, which happens mainly due to a sharp extension of the arm. The child makes a sharp turn of the hand, and the joint is displaced.

Displacement always occurs with a rupture of the capsule, deformation of tendons, muscle structures, blood channels, perivasal plexuses of nerve fibers and can be complicated by bone destruction.

Dislocation is open and closed:

• open - displacement of articulation sites with deformation of the skin and the formation of a wound;
• closed - the skin is not damaged.

Also, dislocations of the elbow joint appear during a period of minor sprains and bags of the joint. This is a "habitual dislocation", it is a complicated condition of unhealed or improperly healed bone displacement: the joints are not firmly established in the joint cavity, and the displacement begins with any sharp or uncomfortable movement of the hand.

According to the direction of movement, the dislocation is classified:

• lateral - the epiphyses are folded to the side. This displacement is formed after a fall on the outstretched palm set aside;
• anterior - the head of the articular area moves back, occurs as a result of physical pressure on the arm bent at the elbow;
• posterior - the most common type, characterized by the movement of the articular head forward. Occurs when falling on a straightened arm.

The most common cause of a dislocated elbow is trauma. Usually this:

• indirect injury, when the impact is transmitted through the elbow joint;
• direct blow to the elbow area;
• accidental stretching of the forearm, in children under 3 years old, when the mother tries to keep from falling;
• falling from height;
• car crashes.

According to statistics, the main reason for contacting a traumatologist with a dislocated elbow is a fall on an outstretched arm. The second place is occupied by injuries that occurred due to a car accident and other traumatic injuries.

Obvious signs of a dislocation are:

• Severe pain localized in the joint. Accompanied by swelling, inability to perform normal household movements, to lift weights.
• Lack of tactile sensations. In some cases, the victim cannot feel the pulse, he ceases to feel the hand.
• If the blood vessels or nerve fibers that pass in the immediate vicinity of the joint are damaged, hemorrhage is observed. The arm does not unbend, swelling is observed.

Full rehabilitation of the elbow joint after dislocation is possible only if medical assistance is provided in a timely manner. Therefore, if signs indicating an injury are found, it is necessary to immediately contact the duty surgeon - traumatologist.

The elbow joint is a connected work of three joints:

• brachioradialis, responsible for flexion and extension of the radius;
• humeroulnar, responsible for flexion and extension of the forearm;
• ulnar, responsible for the rotation of the radius and rotation of the forearm.

Elbow subluxation occurs as a result of direct and indirect trauma. Injuries are caused by active movements, overloading the joint with a large weight, an awkward sharp turn of the arm, and a fall.

Pulling subluxation of the head of the radius and ulna, more often occurs in children with vigorous stretching of the arm in an extended state. According to statistics, subluxation is more common in girls than in boys. In most cases, the left hand is injured. Subluxation of the joint is not visually visible

Subluxation symptoms:

• pain is the first sign of subluxation. The sensation of pain is intense, it increases with movement and palpation of the injured limb;
• hand movements are sharply limited;
• the appearance of a hematoma in the area of ​​​​the elbow joint - this sign is not always present. Swelling in the area of ​​injury, the injured area of ​​the skin is hot to the touch;
• rupture of the joint capsule;
• with a contact examination, the head of the radius is well defined;
• weak pulsation of the artery;
• damage to nerve endings reduces the sensitivity of some parts of the hand, the appearance of a crawling sensation;
• body temperature in children is slightly increased from stress and is due to the child's anxiety, but should not exceed 38 ° C.

Classification

Depending on the complexity of the damage, two types of elbow dislocation are distinguished:

• incomplete or subluxation (the presence of partial contact between the bone surface);
• complete (absolute dissociation of the joint surface).

Depending on the direction of displacement:

• front view;
• rear view;
• side view.

In medicine, dislocations of a pathological, habitual and open type are distinguished. The first type happens due to ailments of the muscles and joints.

The habitual appearance is formed due to the weakening of the apparatus of the ligaments, in which, under the influence of the slightest load, the surface of the joint is displaced. It is rare.

When open, a dislocation of the head of the ulna occurs, violating the integrity of the soft tissue and coming out.

In traumatology, it is customary to separate dislocation and subluxation of the elbow joint. With dislocation, there is no contact between the articular surfaces, but incomplete dislocation (or subluxation) is characterized by incomplete displacement of the parts of the joint (they have a common contact area).

According to the presence of complications:

• Complicated;
• Uncomplicated.

Types of dislocation depending on the direction of the traumatic force:

• Anterior, found in pediatrics infrequently;
• Posterior, most often diagnosed in children, due to anatomical and physiological characteristics;
• Lateral (medial and lateral), as rare as anterior dislocation.

Traumatologists conventionally divide dislocations according to several key features. The main feature: the degree of displacement of the articular surfaces relative to each other.

A dislocation is a complete loss of conformity of the articular surfaces. If the correspondence is not completely lost, and the articular surfaces partially touch when the ligaments are stretched, then this is not a dislocation, but a subluxation.

Dislocations are also divided into congenital and acquired. The most common group of elbow dislocations are acquired dislocations, and traumatic ones predominate among them, that is, resulting from injuries. They are fresh and old, as well as familiar and spontaneous.

The presence of complications is the second key sign of classification.

A dislocation can be accompanied by injury to the nerves and blood vessels, a violation of the integrity of the skin (then it becomes open). If this does not happen, then the dislocation is closed.

According to the geometry of the displacement of the bones, dislocations are divided into anterior, posterior and lateral. Only lateral dislocation fully corresponds to its name, when the heads of the bones come out of the articular surfaces “to the side” - towards the body or from the body along the shoulder axis. With an anterior dislocation, the head of the ulna leaves the joint backward, and with a posterior ulnar dislocation, it comes forward.

Most often in children there is a posterior dislocation of the elbow, less often - anterior and lateral.

The displacement of the bones of the ulnar joint can be expressed to varying degrees and be accompanied by complications. In this regard, such an injury is classified into 3 categories:

1. Subluxation. Violation of the anatomical relationship of the surfaces of the bones of the joint occurred only partially.
2. Dislocation. The bones were completely displaced, stopped touching and interacting with each other.
3. Complex dislocation. The displacement of the articular surfaces resulted in a rupture of the ligaments and damage to other structures (capsule, cartilage, etc.).

Depending on the direction in which the displacement occurred, posterior and anterior dislocations are distinguished.

Features of the course of subluxations in children - the rate of development of irreversible changes

However, one should take into account the high rate of metabolic reactions in children, which leads to the rapid development of degenerative processes in the joint area with subluxation. Such degenerative changes consist in the development of an inflammatory reaction and the replacement of normal ligamentous, muscle and tendon tissue with connective tissue, which reduces the volume of the joint capsule, making it impossible to reduce the subluxation and completely normalize the functional activity of the joint.

In children, such a decrease in normal anatomical relationships is formed very quickly, within a few days. Therefore, subluxations should be diagnosed in time and reduced as quickly as possible so as not to bring the situation to the point of requiring surgical intervention in order to restore normal anatomical relationships of the damaged joint.

Hip subluxation in a child

If the child complained of pain and discomfort in the hand, parents should carefully examine the baby's hand. If they find the above symptoms, or even at least one of them, then the child should be shown to specialists as soon as possible. Under no circumstances should you correct a dislocation on your own! This should only be done by a professional.

At home, parents should ensure the immobility of the injured arm of the child and apply ice to the sore spot. Older children can be given pain medication.

Before repairing a dislocation, the doctor must determine the type of damage. The method of repositioning the damaged joint will depend on this, and it will also be clear whether the child needs anesthesia or not. Once the joint is in place, the doctor will order an X-ray to make sure that the elbow surfaces of the joint are in tight contact with each other.

If the dislocation is serious, complicated by damage to the ligaments, the child is operated under local anesthesia, during which the ligaments are sutured, the elbow plates are put in place. After such an operation, a splint is applied to the baby.

This is followed by a period of rehabilitation. The patient is prescribed physiotherapy, massage, physiotherapy exercises.

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When a child complains of severe pain and discomfort in the hand, parents should immediately examine the limb. If there are symptoms of a dislocation of the elbow joint in children, you should immediately seek help from a doctor.

Home treatment is not allowed. An adult should immobilize the injured hand of the child, and place a bag with cold filling on the injured area.

Older children are allowed to take an anesthetic drug.

Before reducing the dislocation, the doctor determines the type of damage. After putting the joint in its place, an x-ray is taken, with the help of which the contact of the ulnar surfaces of the joint with each other is checked. In case of complex damage, surgery is performed with further splinting. The final stage is the rehabilitation period.

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Subluxation and dislocation of the joint is the same pathology in all age categories. So, subluxation is a violation of the normal articulation of the articular surfaces, in which their partial contact is preserved.

A subluxation is also called an incomplete dislocation. The term dislocation in this case reflects the clinical picture of complete dislocation.

A dislocation is a violation of the normal anatomical structure of the bone joint, in which there is a divergence of the articular surfaces with no points of contact between them, which leads to a significant disruption in the functioning of the joint.

The relatively low frequency of subluxations in children is explained by the fact that the joints, bones, ligaments and muscles at this age are still soft and easily extensible, and the range of motion is much greater, which leads to a high resistance of the joint to damage.

The bones of the articular capsule in children are soft, so they are easily deformed without the head popping out of the cavity, that is, the formation of subluxation or dislocation does not occur. .

Diagnosis of any subluxation is based on the reconstruction of the incident, that is, it is necessary to clarify the presence of an injury, a fall, an uncomfortable movement, etc.

After clarifying the possible cause of the injury, it is necessary to conduct a visual examination, in which pay attention to the following signs of subluxations:

• pain syndrome of the injured joint;
• violation of the range of motion in the joint;
• unnatural position of a body part;
• forced position of a body part;
• asymmetry of the right and left halves of the body or limbs;
• protrusion of the head of the bone.

The above symptoms are non-specific, that is, characteristic of many pathological conditions. Therefore, the presence of these signs makes it possible to suspect subluxation or dislocation, which requires clarification of the diagnosis and correct treatment.

The general principles of subluxation treatment are reduced to the normalization of the anatomical position of the structures of the joint, and the complete restoration of range of motion. Complete relaxation of the muscular apparatus surrounding the joint often allows for self-reduction of the subluxation.

Such relaxation can be achieved with subluxations of the limbs as follows: hang the injured limb freely down so that the muscles get tired. In a child of average physical abilities, usually complete muscle fatigue develops after 15 minutes, after which the reduction of the subluxation can occur on its own, or with little effort.

Let us consider in more detail the most common subluxations of childhood - the cervical vertebrae, elbow, hip joints and some others.

The elbow joint is at high risk of injury in childhood. In this joint, complex and combined injuries are often observed, since children, when falling, rely on the arm bent at the elbow.

Moreover, dislocations and subluxations account for about 40% of all types of elbow joint injuries in children. Very often, children have a subluxation of both bones of the forearm, which is formed when the child falls on the arm bent at the elbow.

Varieties of dislocations and subluxations of the elbow joint in children

Dislocations and subluxations of the elbow joint are divided into several types, depending on the direction of the force and the relative position of the bones after the injury:

• posterior dislocations (posterolateral and posteromedial);
• anterior dislocations;
• lateral dislocations (lateral and medial);
• anterolateral dislocations;
• divergent dislocations (anteroposterior, lateral and mixed).

These types of subluxations occur with varying frequency, with the most rare being anterior and anterolateral, and frequent being posterior. This predominance of posterior subluxations is due to the peculiarities of the anatomical structure of the joint.

The mechanism of formation of subluxation of the elbow joint in a child

In children under three years of age, the most common injury is pronation subluxation of the radius of the elbow joint. This subluxation is formed by pulling with vigorous pulling or lifting the child by the outstretched arm while walking or at home.

Often, adults do not want to act by persuasion, and in a hurry they simply pull the child by the handle, which rests, and further enhances the mechanical traumatic effect. This subluxation is formed at an early age, since the tissues of the child's joint are very soft, and the ligaments cannot reliably strengthen the bone in the required position.

After reaching the age of five, the ligaments, muscles and tendons of the child acquire sufficient strength and are able to prevent the formation of subluxation, which leads to a decrease in the incidence of this pathology. After a five-year milestone in children, complete dislocation of the elbow joint is more often formed.

Symptoms of subluxation of the elbow joint in a child

Symptoms of subluxation of the elbow joint in children are few, and quite sufficient for a correct diagnosis without an additional x-ray. First of all, the child is worried about a strong pain sensation, which increases when trying to bend the arm at the elbow, feel the head of the radius and rotate the forearm to the “palm up” position.

A small child, as a rule, does not indicate the exact location of the pain, but prefers to withdraw the entire upper limb when trying to examine and feel it. The child's hand in a relaxed state is in a forced position, which looks like a slight bent at the elbow and the palm is turned inward.

The area of ​​the elbow joint has a slight swelling and, in some cases, redness.

Adults should monitor the child and, if signs of subluxation of the elbow joint are detected, seek qualified medical help in order to restore the normal anatomical structure.

The reduction of dislocation must be carried out as soon as possible, since the tissues of the child are subject to rapid degenerative changes, which are the degeneration of cartilage and ligaments into connective tissue elements.

In children, such a degeneration occurs within a few days, disrupting the normal ratio of the sizes of the bone elements of the joint, and creating conditions for the impossibility of a complete restoration of the structure and functions of the elbow joint.

Principles of treatment of subluxation of the elbow joint

The reduction of the subluxation is usually carried out without anesthesia, since this procedure does not cause strong discomfort. The reduction is carried out by slow and persistent pulling of the forearm while pushing the head of the radius into its place.

The convergence of the bones of the joint must be carried out against the background of muscle relaxation so that their resistance does not create additional stress and difficulties during reduction. Complete muscle relaxation is achieved either with the help of 10-15 minutes of tension with the formation of fatigue, or with the use of special preparations.

Complete restoration of the normal structure of the articulation is determined by a click and restoration of the range of motion in the joint, with the complete disappearance of the pain syndrome.

After the subluxation reduction procedure, the child's arm is bent at the elbow at an acute angle, placing a soft tampon between the forearm and shoulder, and fixed in this position with a bandage for 2-4 days. If there is a habitual subluxation, then the fixation of the handle is carried out by applying plaster for a period of 2-3 weeks.

After reduction of the subluxation, thermal baths have a good restoring effect. .

Outcome of subluxation of the elbow joint

The outcome of subluxation of the elbow joint directly depends on the speed of its reduction. This means that full recovery and restoration of functions is possible only within 2-3 days after the injury.

After this short period of 3-4 days, the subluxation is almost impossible to correct, and a complete cure with restoration of functions is possible only after tissue plastic surgery.

Such a short interval to the “point of no return” fully illustrates the importance of timely access to a doctor to reduce the subluxation of the elbow joint as soon as possible. .

The hip joint of a child is quite resistant to the formation of subluxations, since the head of the femur is located deep in the acetabulum, and is well strengthened by ligaments, tendons and muscles. Subluxation in the hip joint is characterized by stretching of the ligaments and some divergence of the articulated surfaces.

Classification of subluxations of the hip joint in a child

Complete dislocation of the hip joint has four varieties:

• iliac;
• sciatic;
• obturator;
• pubic.

The most common is iliac dislocation and subluxation, and the least common is pubic.

Reasons for the formation of acquired and congenital subluxation of the hip in a child

Children have two main variants of subluxation of the hip joint - acquired and congenital. Acquired hip subluxation is caused by injury, most often as a result of a fall on a bent leg in a position where the toes of the feet are turned inward (as in clubfoot).

And congenital subluxation of the hip is caused by a violation of the normal structure during fetal development. Acquired subluxation of the hip is a rather rare phenomenon, unlike congenital.

Therefore, various varieties and degrees of severity of congenital subluxation of the hip joint are of great clinical importance.

The cause of the formation of acquired hip subluxation is trauma. The cause of congenital subluxation can be due to one of two fundamental processes occurring during fetal development: 1. Violation of the development of normal tissues of the hip joint.2. Laying defective tissues of the hip joint.

Both of these processes - the laying of initially defective tissues, or the incorrect development of initially normal tissues - lead to the development of abnormal anatomical structures of the hip joint, which is manifested by congenital subluxation.

Sometimes the lack of space and too tight pressing of the legs of the fetus to the stomach in the last months of pregnancy also leads to a violation of the normal ratio of the articular surfaces, forming a congenital subluxation in the child.

This phenomenon is observed in primiparous women, especially of short stature, with breech presentation of the fetus (booty down). .

Hip subluxation symptoms

Hip subluxation has clear clinical symptoms and objective signs. Often, traumatic subluxation is accompanied by pain syndrome, forced position of the limb, which is slightly bent at the knee and twisted inward so that the foot looks like a clubfoot.

The limbs have different lengths (the difference is 1-2 cm), and the gluteal fold is also located at different levels. Confirmation and final determination of the ratio of bones and the position of the elements of the joint is carried out using x-ray examination.

X-rays are taken in different positions to get more objective information. .

Functional tests in the diagnosis of hip subluxation

Diagnosis of hip subluxation is also carried out on the basis of functional tests - abduction, symptom of slippage and identification of the shape of the buttocks. The abduction test is as follows: the child is laid on his back, the legs are bent at the knees and hips at an angle of 90o, and they are spread apart.

The leg, which has a subluxation of the hip joint, makes a movement of a smaller amplitude, that is, it is retracted much worse. The shape of the buttocks is revealed with the maximum flexion of the legs in the hip and knee joints, which are pressed against the stomach.

In this position, the presence of subluxation of both hip joints forms a saddle-shaped buttocks. The symptom of slippage is determined when the movements of the child's legs are made with the control of the exit fingers from the hip joint.

Possible complications of hip subluxation

It is necessary to correct the subluxation of the hip as soon as possible, since degeneration of the joint tissues quickly develops in children. The degeneration of the joint consists in the fact that the volume of the capsule decreases, the head of the bone increases, the nutrition of tissues is disrupted and, thus, conditions are created for the impossibility of reduction and complete normalization of functions.

megan92 2 weeks ago

Tell me, who is struggling with pain in the joints? My knees hurt terribly ((I drink painkillers, but I understand that I am struggling with the consequence, and not with the cause ... Nifiga does not help!

Daria 2 weeks ago

I struggled with my sore joints for several years until I read this article by some Chinese doctor. And for a long time I forgot about the "incurable" joints. Such are the things

megan92 13 days ago

Daria 12 days ago

megan92, so I wrote in my first comment) Well, I'll duplicate it, it's not difficult for me, catch - link to professor's article.

Sonya 10 days ago

Isn't this a divorce? Why the Internet sell ah?

Yulek26 10 days ago

Sonya, what country do you live in? .. They sell on the Internet, because shops and pharmacies set their margins brutal. In addition, payment is only after receipt, that is, they first looked, checked and only then paid. Yes, and now everything is sold on the Internet - from clothes to TVs, furniture and cars.

Editorial response 10 days ago

Sonya, hello. This drug for the treatment of joints is really not sold through the pharmacy network in order to avoid inflated prices. Currently, you can only order Official site. Be healthy!

Sonya 10 days ago

Sorry, I didn't notice at first the information about the cash on delivery. Then, it's OK! Everything is in order - exactly, if payment upon receipt. Thank you so much!!))

Margo 8 days ago

Has anyone tried traditional methods of treating joints? Grandmother does not trust pills, the poor woman has been suffering from pain for many years ...

Andrew a week ago

What kind of folk remedies I have not tried, nothing helped, it only got worse ...

Ekaterina a week ago

I tried to drink a decoction of bay leaves, to no avail, only ruined my stomach !! I no longer believe in these folk methods - complete nonsense !!

Maria 5 days ago

Recently I watched a program on the first channel, there is also about this Federal program for the fight against diseases of the joints spoke. It is also headed by some well-known Chinese professor. They say they have found a way to permanently cure the joints and back, and the state fully finances the treatment for each patient