Ointment for the treatment of chronic dislocation of the shoulder. Dislocation of the shoulder joint: classification, symptoms, treatment

Shoulder dislocation is the most common musculoskeletal problem. The reason is a peculiar design that provides the greatest range of motion among all the joints of our body. In this article, we will look at how to recognize shoulder dislocations, the symptoms of the disease. Prevention and treatment as important measures to prevent and get rid of the consequences of such injuries will also be described in the presented material.

What is a dislocation?

We call a dislocation the loss of contact of the articular surfaces with each other. Injuries occur most often during sports or traffic accidents. People involved in volleyball, hockey, handball and winter sports are especially susceptible to this. Shoulder injuries require proper diagnosis.

One of the most complex types of shoulder injury is a dislocation of the shoulder joint. The causes and treatment are established by the doctor upon careful examination of the victim. Further therapy is to restore the functioning of the joint and prevent complications.

Why does this problem happen?

The most common causes of dislocation of the shoulder joint are injuries during physical activity, a fall on the outer (lateral) part of the arm. The cause of the problem can be a strong blow. Sometimes an injury occurs as a result of a fall from a height, for example, while working on a construction site. Upon impact, the head of the shoulder bone is displaced. Depending on the direction in which it has moved, shoulder dislocations can be divided into:

1. Anterior shoulder dislocation. This is the most common type of displacement and is usually caused by a fall on an outstretched arm or shoulder.
2. Posterior shoulder dislocation. This kind of misalignment can be caused by a direct blow or sharp turns of the shoulder.

Problem symptoms

Shoulder dislocation can damage other structures in the shoulder area. How to identify the problem and what to do after the diagnosis of "shoulder dislocation"? Symptoms and treatment (first aid) depend on the severity of the injury.

Shoulder dislocation symptoms:

1. Sudden, very severe pain in the shoulder area.
2. Large swelling or hematoma.
3. Limitation of joint mobility.
4. Distortions of the outline of the joint, the absence of the head of the humerus is felt, which moves to the armpit.
5. The pain increases when trying to move the joint (therefore, the patient keeps the hand closer to the body).
6. Fainting and increased body temperature.

Therapeutic measures and diagnostics

A dislocation of the shoulder joint is considered a very serious injury. First aid and medical intervention are indispensable conditions for quick rehabilitation and the return of the patient to a normal lifestyle. It is necessary to anesthetize the shoulder joint, which is performed under general anesthesia, in order to prevent other injuries during the work of the doctor. Treatment is based on manual factors and radiography.

After that, a plaster is applied to the shoulder (where the scapular joints) with a bandage. Such immobilization of the limb, as a rule, lasts about 4 weeks. After removing the cast and examining the radiograph, if there is no re-dislocation of the shoulder joint, rehabilitation becomes a necessary condition for restoring the work of the diseased shoulder. It is also recommended to refrain from physical activity for another two to three months.

Sometimes surgery is a necessary part of the recovery process to treat a doctor's diagnosis of habitual dislocation of the shoulder joint, as other problems can be identified, such as:

• fracture of the bones of the shoulder;
• muscle or joint bursa injuries;
• damage to blood vessels or nerves.

As a rule, arthroscopy is performed. The surgeon makes very small incisions in the tissue through which the camera and instruments are inserted. If the patient has numerous hand injuries and habitual dislocation of the shoulder joint, the operation becomes a rather difficult task for the surgeon, after which the patient must avoid movement of the upper limb for a long time (6 weeks).

Rehabilitation

Rehabilitation is necessary for further treatment. You also need to take into account the following nuances:

1. Avoid sudden movements of the shoulder joint for a short time after removal of the cast.
2. Apply cold compresses to reduce swelling.
3. Pharmacological treatment, which consists in taking anti-inflammatory drugs. If the pain is intense, you can ask the doctor to prescribe analgesics. The drug "Nurofen Plus" must be taken every 6 hours, 15 ml.
4. Perform therapeutic procedures. They promote analgesic and anti-inflammatory effects (cryotherapy), restore damaged soft tissues (magnetotherapy, laser therapy, ultrasound), increase muscle mass and strength (electrical stimulation), improve blood circulation and tissue nutrition (whirlpool bath for the upper limb).
5. Massage of the tissues adjacent to the joint relieves tension and improves blood circulation and nutrition.
6. Mobilization of the shoulder joint.

It is best to perform therapeutic exercises in the initial stage of rehabilitation with a psychotherapist. It is necessary to choose easy manipulations without stress on the diseased joint, for example: isometric exercises and stretching tasks that stimulate the neuromuscular tissue. Gradually, exercises on emphasis are introduced, strengthening muscle strength and improving stability, elasticity of soft tissues. At the last stage of treatment, exercises are used for the entire upper limb, which increase strength, control movement and work, and improve the dynamics of the shoulder joint.

Kinesiotherapy consists in wrapping the joint with special elastic plasters. They have a sensory effect, improve the functioning of the joints. Patches applied to the scapular joints provide stability, improve healing processes and reduce the risk of injury during exercise.

Complications

Unfortunately, the diagnosis of "dislocation of the shoulder joint" is quite serious. Rehabilitation and treatment without accurate diagnosis can lead to numerous complications. These include:

• joint instability;
• damage to peripheral nerves (tingling sensation, sensitivity disorders of the entire upper limb);
• limitation of the range of motion in the joint;
• relapses even after a banal injury;
• degenerative changes in the shoulder joint.

Ways to treat shoulder injuries at home

A small relief is brought by the imposition of a cold compress on the damaged area if a dislocation of the shoulder joint has occurred. Treatment at home for severe injuries is impossible without the provision of qualified medical care. The victim must be taken to a doctor who will take the necessary measures after taking x-rays. During transportation, the arm must be fixed: it can be slightly bent at the elbow, pressed to the chest and wrapped with a bandage to the body.

To relieve pain, an analgesic or non-steroidal anti-inflammatory drug (Nurofen Plus or Ibuprofen, 15 ml every 6 hours) should be given. Recovery usually takes 3-6 weeks.

Then it is recommended to perform stretching exercises for the muscles of the arm and shoulder. After a series of such exercises, when the limb is fully functional, you can return to the sport, but only in special clothes so that in the event of a fall, it would prevent dislocation of the shoulder joint. Home treatment and rehabilitation after an injury is possible with the systematic implementation of stretching exercises so that the muscles are elastic and less prone to damage. In case of muscle tension, for example, after an intense workout, ice can be applied to the shoulder.

Shoulder dislocation

This is a severe injury associated with the inability to move the arm due to the fact that a dislocation of the shoulder joint has occurred. Home treatment (first aid): drink painkillers at the dosage indicated in the instructions, tie your hand to the body, and then urgently visit an orthopedist or traumatologist. Such damage is a very serious injury that can lead to the death of nerves and blood vessels.

Tendon strain

What to do if there was a sprain and dislocation of the shoulder joint? Treatment at home involves the use of a cold compress (it is applied for half an hour), drugs with analgesic and anti-inflammatory effects (gels, ointments). They are applied in a thin layer to the damaged area several times a day. It is also necessary to give a rest to the hand, that is, to limit movement.

Shoulder injury

As a rule, it occurs as a result of a sharp fall, which leads to damage to soft tissues. Signs of injury: gradually increasing pain, hematoma, swelling. Ice should be quickly applied to the injury site. This will limit the hematoma and swelling of the soft tissues, unless, of course, a dislocation of the joint has occurred.

And the treatment of folk remedies in this case will not be superfluous: several times a day for 20 minutes, apply cooling compresses or ice cubes wrapped in foil or wrapped in a cloth. Relief is also brought by ointments with analgesic and anti-inflammatory effects. They are applied several times a day. However, if the pain does not recede, it is necessary to consult an orthopedist, as the injury can be much more serious than you think.

Folk remedies

There are a lot of home ways to eliminate the consequences associated with the diagnosis of “dislocation of the joint”. Treatment with folk remedies is aimed at relieving pain. The use of hot milk compresses is recommended: it must be heated, bandages moistened in it and applied to the sore joint. Finely chopped onion or “dough” from a glass of flour and a spoonful of vinegar helps well. They need to be applied to the damaged area and kept for half an hour.

Shoulder dislocation is a pathology in which the contact of the articular surfaces of the shoulder bone and scapula is lost.

This condition may be accompanied by a rupture of the ligaments and articular bag in the affected area.

If symptoms of a violation appear, you should contact a specialist who will set the joint. After that, you can treat a dislocated shoulder joint at home.

Classification

Depending on the characteristics of the injury, the head of the humerus can be displaced in different directions from the glenoid cavity. According to this feature, the following types of dislocations are distinguished:

1. Front- occur in 80% of cases and are the result of a fall on a straight arm, which is laid back. With a strong displacement of the head, fractures of the scapula or separation of a large tubercle of the shoulder bone can occur.
2. Lower- make up approximately 18% of pathologies and are the result of injuries on the horizontal bar. Also, a problem may occur in a child when adults raise his hand. In this case, the head of the bone is displaced into the armpit. It can be felt on palpation.
3. Rear- make up no more than 2% and arise as a result of a direct impact. In this case, the head of the humerus is displaced in the direction of the scapula. Often this condition is accompanied by a fracture of the surgical neck of the shoulder bone.

Symptoms

Before treating a dislocation of the shoulder joint, it is necessary to analyze the clinical picture of this pathology. The main manifestations of the disease include the following:

1. Shoulder deformity associated with the removal of the head of the shoulder bone beyond the glenoid cavity.
2. Restriction of motor activity. In this case, the hand can spring, but directed movements are completely excluded.
3. acute pain in the affected area with primary dislocation and slight discomfort in case of habitual dislocation. Especially often it occurs on palpation or attempts to make a movement.
4. Loss of sensation in the limb. Sometimes there may be numbness or tingling. These symptoms are due to nerve damage.

First aid

First aid for dislocation of the shoulder joint is to reduce motor activity in the affected area, eliminate the traumatic factor and timely seek help from a doctor.

If a dislocation is suspected, the following measures should be taken:

1. Provide rest to the joint- Completely refrain from physical activity. For this, a special bandage is used for dislocation of the shoulder joint.
2. Apply ice or other cold This will help reduce inflammation and swelling of the tissues.
3. Call a doctor.

In addition, this measure can provoke damage to the muscles, blood vessels and nerves that are in this area.

General Treatments

What to do with a dislocated shoulder? Typically, treatment for this condition involves doing the following:

1. Local anesthesia- Helps relieve pain. To do this, the doctor injects Lidocaine or Novocain. This stage cannot be categorically ignored, since the reduction is accompanied by severe pain. Do not try to straighten the joint on your own or with the help of loved ones. This can cause its destruction and even fracture.
2. Hand reduction. This is a difficult and painful stage. There are several reduction methods. The doctor must choose a specific method, otherwise there is a risk of unpleasant consequences.
3. Surgical intervention. This method is used in the event that it is not possible to set the joint with the usual method. In such a situation, it is fixed with sutures and knitting needles. This intervention is performed under general anesthesia.
4. Joint immobilization. This will help eliminate the risk of relapse and ensure rapid healing. A splint is applied to the affected area. You will have to wear the device for 1-2 months - it all depends on the severity of the injury.
5. Rehabilitation. It is forbidden to ignore this stage, since it allows you to strengthen and restore the joint, as well as prevent its re-injury. For this, gymnastics, massage and other medical procedures are used.

After a full recovery, care must be taken. To do this, you should abandon the load on the injured hand and try to exclude situations in which you can be injured.

Rehabilitation

Rehabilitation after dislocation of the shoulder joint includes exercise therapy. The recovery period is divided into several stages:

• a gradual increase in the volume of motor activity of the shoulder muscles - 3-4 weeks;
• normalization of the normal working capacity of the shoulder joint - 2-3 months;
• restoration of the full range of shoulder functions - up to six months.

To immobilize the dislocation area, apply a bandage and an orthosis to the affected area. A plaster bandage is used only in the most difficult cases.

In simple situations, a reinforced bandage in the form of a scarf is sufficient. This device is made of soft and elastic material, which allows you to sleep and take a shower with it.

To prevent dislocations during sports activities, it is recommended to use a soft shoulder brace.. It provides weak fixation of the shoulder and practically does not reduce the volume of physical activity.

At the same time, the product gently massages the muscle tissue and has a warming effect. With such a bandage, you can perform a variety of exercises after a dislocation of the shoulder joint.

In difficult cases, it is necessary to wear a rigid shoulder orthosis. It securely fixes the bones and shoulder. This device is made of a metal frame and is supplemented with motion amplitude regulators.

How to develop a hand after a dislocation, the doctor will tell. Usually, simple exercises are recommended that do not cause pain, but provide an improvement in the structure of muscle tissue.

It is very important to strengthen the biceps, trapezius and deltoid muscles. This will prevent re-dislocation.

Introductory exercises are performed already at the stage of immobilization. Thanks to this, it will be possible to prepare the muscles for subsequent work and performing more complex movements. They allow you to normalize metabolism, stabilize the functions of the heart, blood vessels and respiratory system.

A person needs to make movements with the hand and fingers of the hand on which the fixing device is located all the time. It is very important to strain the muscles of the hand, shoulder and forearm.

After immobilization, gymnastics should be aimed at restoring mobility in the muscles and joints. Due to the complication of exercises, they help to eliminate tension, cope with contractures and develop endurance.

At this stage, it is useful to perform the following movements:

• bend and unbend fingers, elbow;
• raise an injured arm and support it with a healthy limb;
• take one or both hands aside;
• perform rotational movements;
• take your hand behind your back;
• make swinging movements with your hands.

It is very important to perform gymnastics not only with a sick hand, but also with a healthy one. Thanks to this, it will be possible to restore normal coordination of movements.

Folk methods

Homemade recipes are used to eliminate pain. They also help to restore the mobility of the affected joint and cope with swelling.

It is very important to use folk remedies systematically. Otherwise, you will not be able to achieve the desired results.

Some of the most effective home remedies include:

1. Take bryonia root, dry and grind. Half a small spoon pour 500 ml of water and put on the stove. Cook for a quarter of an hour, then cool and strain the broth. Add a large spoonful of the resulting product to half a glass of sunflower oil. This composition is ideal for rubbing the affected area.
2. Tansy should be used to restore shoulder mobility.. For this, it is recommended to take 3 tablespoons of the flowers of this plant. They are recommended to be mixed with boiling water and infused for 1 hour. Then the composition should be filtered and applied to wet compresses.
3. Cornflower has a good analgesic effect. To make a useful composition, you need to take 3 small spoons of flowers, mix with 500 ml of boiling water and leave for 1 hour. Strain and cool the decoction. It can be taken orally in half a glass 3 times a day. This must be done before meals.
4. An ointment is considered a good remedy, which is often used at the recovery stage. For its preparation you should take 100 g of propolis and vegetable oil. Mix the ingredients and heat on a steam bath. Turn off after dissolving propolis. Treat the affected areas with a cooled agent. It is allowed to store this composition for no more than 90 days.
5. Cope with habitual dislocation of the shoulder will help composition based on barberry root and bark. These ingredients should be crushed and mixed thoroughly. Take 1 small composition, mix with a glass of milk and bring to a boil. Use three times a day for 1 small spoon. The composition has a pronounced firming effect.
6. Alcohol tinctures have an excellent effect. They may contain a wide variety of ingredients. So, you can make a tincture of mountain arnica. To do this, it is recommended to take 20 g of plant flowers and add 200 ml of alcohol. Leave for a week to infuse, then strain. Take half a small spoon twice a day.
7. A good remedy is composition based on sugar and onions. This vegetable should be used fresh or baked. To make a medicinal composition, you need 1 onion and 10 small spoons of sugar. The ingredients must be mixed and used as lotions. The bandage is recommended to be changed every 5-6 hours.
8. Elecampane root has an excellent effect. Raw materials should be crushed, add a glass of boiling water and leave to infuse for half an hour. The resulting decoction is used for compresses and lotions.
9. Ficus leaf tincture is considered a good remedy.. To make it, you need to grind 1 leaf of the plant and pour 250 ml of vodka. Leave for a couple of weeks to infuse. This should be done in a dark and cool place. In the filtered composition, put 1 large spoonful of honey and egg yolk. The resulting composition is rubbed into the affected area before going to bed. After that, it is recommended to wrap the affected shoulder with a warm scarf. The course of therapy should be continued for 2 weeks, and then take a break. If necessary, the treatment can be repeated.

Nutrition Features

With a dislocation of the shoulder joint, a complete and balanced diet helps to speed up recovery.. It should be aimed at strengthening bone tissue, ligaments and joints.

The menu should contain a sufficient amount of proteins, fats and carbohydrates. Also be sure to consume vitamins and minerals.

Proteins are required to build new tissues. It is especially useful to eat dairy products, which ensure the restoration of cartilage that envelops the bones of the joints.

Milk protein is highly digestible. In addition, such products contain a lot of calcium, which is needed to strengthen bone tissue.

The menu should include lean meats and fish.. It is also very useful to eat buckwheat, beans and lentils. To improve the absorption of proteins will help the use of these products in boiled, baked or stewed form.

It is also useful to eat jelly and jelly. These dishes include collagen, which provides excellent strength to cartilage and bones.

In order for the body to get enough energy, you need to eat carbohydrates.. It is important to eat foods that contain complex carbohydrates. These include vegetables, fruits and grains.

The diet should also contain fats that are needed for the normal course of metabolic processes.. Preference should be given to butter and vegetable fats.

The refractory fats that are present in meat disrupt blood flow and lead to the appearance of cholesterol plaques on the walls of blood vessels.

When compiling the menu, you must follow these rules:

1. Products should improve metabolic processes.
2. Meat and fish are recommended to be eaten boiled.
3. You should not eat soups with strong meat broth, as it contains a lot of purine bases. These substances adversely affect the condition of the joints.
4. To normalize the water-salt metabolism, dishes from pumpkin, zucchini are useful. You also need to eat greens, watermelons, dried apricots and prunes.
5. Raw foods should be consumed 3 times more than those dishes that have been heat-treated.
6. To normalize bowel function, you need to eat fiber. It is present in cereals, vegetables, fruits, wholemeal bread.
7. Instead of ordinary tea, you need to drink dried fruit compote, a decoction of rose hips. Herbal teas are also very helpful.

Complications

If therapy is not started on time, there is a risk of dangerous complications..

These include the following:

• joint instability;
• damage to peripheral nerves;
• decreased motor activity of the joint;
• recurrence of dislocation even after simple injuries;
• degenerative processes in the shoulders.

Dislocation of the shoulder joint is a serious injury that requires urgent medical attention.. The specialist will adjust the affected joint and give recommendations for recovery.

At home, you need to do therapeutic exercises and use effective folk remedies.

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The most mobile joints in the human body are the shoulder joints. Thanks to their device, we can raise our hand, take it in one direction or another, reach out with a brush to the back of the head or head. It is their amazing mobility that largely contributes to the presence of the variety of functions of our hands, which make us capable of performing many actions and acquiring various skills.

Movement in the shoulder joint can be carried out in three planes. However, for such a special over-mobility, this joint has to pay with its low stability. It is designed in such a way that the area of ​​contact between the articular cavity of the scapula and the head of the humerus is small, and even the presence of a cartilaginous lip that surrounds it and slightly increases the area of ​​contact of the joint components does not provide sufficient stability to the shoulder joint. That is why the stability of this part of the musculoskeletal system is often disturbed and a person has a dislocation of the shoulder (or head of the humerus, shoulder joint). According to statistics, such an injury is about 55% of all traumatic dislocations.

In this article, we will introduce you to the main causes, types, symptoms, and methods for diagnosing and treating shoulder dislocations. This information will help to suspect the presence of such an injury in time, to correctly provide assistance to the victim and make the right decision on the need for a mandatory visit to a traumatologist.

A bit of history

In 2014, in the journal Injury, the public was able to learn about one interesting scientific fact related to shoulder dislocation. A group of Italian scientists headed by M. Bevilacqua conducted a study of the Shroud of Turin. Experts noticed that there is a significant asymmetry between the level of the shoulder girdle, shoulder and forearm of the imprint of the body of Christ, and the spinal column is not deviated to the side. Such an arrangement of bones can only be observed with anterior-inferior dislocation of the head of the humerus from the joint. Most likely, such an injury was received by the crucified at the moment when he was taken down from the cross.

A bit of anatomy

The shoulder joint is formed by three bones:

• articular cavity of the scapula;
• head of the humerus;
• articular cavity of the clavicle.

It should be noted that the glenoid cavity of the clavicle is not anatomically related to the shoulder joint, but its presence significantly affects its functionality.

The shape of the head of the humerus coincides with the shape of the articular cavity of the scapula, along the edge of which there is a roller of cartilaginous tissue - the articular lip. This element additionally holds the articular head of the bone in the joint.

In general, the capsule of the shoulder joint is formed from a thin capsule and a system of articular ligaments, which fuse tightly with it, thickening it. The articular capsule consists of connective tissue that provides fixation of the head of the humerus in the articular cavity. The shoulder joint is supported by the following ligaments:

• consisting of three beams (upper, middle and lower) articular-shoulder ligament;
• coracobrachial ligament.

Additional stability to the shoulder joint is given by the muscles surrounding it:

• small round;
• infraspinatus;
• subscapular.

Muscles, together with tendons, create a rotator cuff around the shoulder joint.

The reasons

The most common cause of shoulder dislocation is trauma. Normally, in this joint, movements of a twisting or eversing nature are made, and exceeding their amplitude leads to the exit of the articular head from the glenoid cavity of the scapula. Such an injury can be caused by a fall on the arm, a sharp, intense and unsuccessful movement.

Some additional factors can contribute to the appearance of a dislocation of the shoulder joint:

1. Frequently recurring sprains and joint capsules. Such a predisposing factor is especially characteristic of athletes involved in tennis, handball, volleyball, projectile throwing, swimming and similar sports, or people of certain professions whose labor activity is associated with the repetition of a number of excessive movements. Frequent and repeated traumatization of the ligaments of the shoulder joint leads to a significant decrease in its stability, and dislocation can occur with any minor traumatic movement.
2. Dysplasia of the articular cavity of the scapula. In some people, from birth, the glenoid cavity of the scapula is excessively shallow, has a poorly formed lower part (with hypoplasia), or tilts forward or backward. Such deviations from the norm and some other rarely observed anatomical features of the structure or location lead to an increased risk of shoulder dislocations.
3. Generalized joint hypermobility. Such a deviation from the norm is observed in 10-15% of people and is expressed in an excessive range of motion in the joint.

Varieties of dislocations

Shoulder dislocation can be:

• non-traumatic - arbitrary or chronic (pathological);
• traumatic - caused by traumatic impact.

Traumatic dislocation can be uncomplicated or complicated (in the presence of additional injuries: fractures, violation of the integrity of the skin, ruptures of tendons, main vessels or nerves).

Depending on the duration of the impact of the traumatic factor, dislocation of the shoulder can be:

• fresh - no more than 3 days have passed since the damage;
• stale - up to 5 days have passed since the damage;
• old - more than 20 days have passed since the damage.

In addition, dislocation of the shoulder joint can be:

• primary traumatic;
• recurring (pathologically chronic).

Depending on the location occupied by the bones of the joint after injury, the following types of dislocations are distinguished:

1. Anterior dislocation (subclavicular and subclavian). Such injuries are observed in 75% of cases. With a subcoracoid anterior dislocation, the head of the humerus deviates forward and, as it were, goes beyond the coracoid process located on the scapula. In subclavian anterior dislocation, the head of the bone deviates even further and goes under the collarbone. Anterior dislocations of the shoulder are accompanied by the so-called Bankrat injury - during an injury, the head of the bone tears off the articular lip of the anterior glenoid cavity of the scapula. In severe cases, such injuries may be accompanied by a rupture of the joint capsule.
2. Posterior dislocation (infraspinatus and subacromial). Such injuries are observed very rarely - only in 1-2% of cases. They usually occur when falling on an outstretched hand. With such dislocations, the head of the bone tears off the articular lip in the posterior part of the glenoid cavity of the scapula.
3. Axillary (or lower) dislocation. Such injuries occur in 23-24% of cases. With such dislocations, the head of the humerus falls down. Because of this, the patient cannot lower the injured arm and constantly keeps it above the body.

Symptoms

At the moment of displacement of the bones, the victim develops a sharp and intense pain in the shoulder joint. Immediately after this, due to the dislocation of the head, the functions of the hand are impaired. The joint loses its usual smoothness of its forms, and the upper limb and shoulder may deviate to the side. When palpating the area of ​​injury, the head of the humerus is not determined in the usual place.

After receiving a dislocation, the shoulder can be deformed and hardened, and when comparing the injured and healthy shoulder joint, their asymmetry relative to the spine is revealed. In addition, there is a significant or complete impairment of joint mobility.

If the nerves are damaged, dislocation of the shoulder may be accompanied by impaired sensitivity and motor functions of other parts of the arm - fingers and hands. In some cases, with such injuries, a weakening of the pulse in the region of the radial artery is observed. This symptom is caused by the fact that the displaced head of the humerus is compressing the vessel.

The main symptoms of a dislocated shoulder joint are:

• sharp pain during the displacement of the articular surfaces and stabbing pains of varying intensity after injury, aggravated by movement;
• swelling of soft tissues;
• hemorrhages under the skin in the area of ​​damage;
• joint deformity;
• a significant decrease in mobility;
• violation of sensitivity in the forearm or other parts of the hand.

With a dislocation, the condition of the joint capsule also suffers. If left untreated, it increases the number of fibrous formations, and it loses its elasticity. Non-functioning due to injury, the muscles located around the joint gradually atrophy.

In some cases, dislocation of the shoulder joint is accompanied by damage to the integrity of the soft tissues. In response to such injuries, the patient develops intense pain, but with chronic or frequently recurring injuries, pain is not so pronounced or completely absent.

First aid

Providing first aid will alleviate the patient's condition in case of dislocation of the shoulder.

To reduce pain and prevent aggravation of shoulder dislocation, the victim should be given first aid:

1. Calm the patient and give the injured hand the most comfortable position.
2. Remove clothing carefully.
3. Let the patient take an anesthetic (Ibuprofen, Nimesulide, Analgin, Ketorol, Paracetamol, etc.) or perform an intramuscular injection.
4. If there are wounds, treat them with an antiseptic solution and apply a bandage from a sterile bandage.
5. Immobilize the damaged joint with a kerchief bandage (a piece of fabric in the shape of an isosceles triangle). It can be made from improvised means. For an adult, its dimensions should be from 80/80/113 cm or more. The forearm is placed on the scarf so that its central angle slightly extends beyond the elbow. The edges of the bandage are lifted and tied behind the neck so that the bandage supports the arm bent at the elbow. The section of tissue hanging from the side of the elbow is fixed with a pin on the shoulder girdle. With an axillary dislocation, such an immobilizing bandage cannot be applied, since the victim cannot lower his arm. With such injuries, the patient must be transported as sparingly as possible to a medical institution.
6. To reduce pain and reduce swelling, apply ice to the area of ​​injury. It should be removed every 15 minutes for 2 minutes to prevent frostbite. Remember that with dislocations and other injuries, it is impossible to apply heat to the damaged area in the early days.
7. You should not try to correct the dislocation yourself. This procedure can only be performed by a specialist.
8. Call an ambulance or, as soon as possible, carefully transport the victim in a sitting position to a trauma center or emergency room of another medical institution. Do not postpone a visit to the doctor, even if the pain has become less pronounced. Remember, dislocations of the shoulder should be reduced in the first hours after the injury. The more time has passed since the traumatic situation, the more difficult it is to perform reduction afterwards.

Which doctor to contact

If there is a sharp pain in the shoulder joint at the time of injury, swelling, dysfunction of the hand, you should contact an orthopedic traumatologist in the first hours. After examining and questioning the patient, the doctor will prescribe x-rays in two projections. If necessary, the examination can be supplemented by the appointment of an MRI.

Diagnostics

To identify a dislocation of the shoulder, the doctor conducts a survey and examination of the patient. On palpation of the area of ​​injury, a specialist can detect a displacement of the head of the humerus from its usual place. In addition, the doctor performs a series of tests to determine the presence of damage to the nerves and great vessels.

To confirm the diagnosis, clarify the details of the injury and identify possible concomitant injuries (for example, a fracture), x-rays are performed in two projections. In chronic dislocations, an MRI of the shoulder joint may be recommended.

Treatment

The tactics of treatment for shoulder dislocations is largely determined by the nature of the details of the injury, which are determined on x-rays. Initially, attempts are made to close the reduction of the head of the humerus, but if they are ineffective, the patient may be recommended to perform surgical intervention.

It should be noted that in the first hours after the injury, dislocations are reduced much easier. Subsequently, the muscles contract, and it becomes much more difficult to repair the damage, because they prevent the articular head from returning to the articular surface.

Closed reduction of dislocation

There are various ways to correct a dislocated shoulder joint:

• according to Kocher;
• according to Janelidze;
• according to Hippocrates;
• according to Mukhin-Kot;
• by Rockwood et al.

Initially, to reduce the dislocation of the shoulder, attempts are made to eliminate the displacement of the bones with local anesthesia. The method of reduction is determined by the doctor individually and depends on the clinical picture of the displacement of the articular surfaces.

If an attempt at closed reduction under the influence of local anesthesia remains unsuccessful, then it is repeated after intravenous anesthesia, which provides sufficient muscle relaxation. This effect can be achieved by the introduction of special drugs - muscle relaxants.

After successful reduction of the shoulder joint, which must always be confirmed by a control x-ray, it is immobilized. Previously, for these purposes, a plaster bandage was applied to the patient according to Dezo or Smirnov-Weinstein. However, wearing them for a long time caused a lot of inconvenience to a person and, as it turned out later, such total immobilization was unnecessary. Now practical and comfortable sling bandages can be used for reliable immobilization of the shoulder joint. The duration of their wearing is about 3-4 weeks.

As a rule, after repositioning the head of the humerus into place, the pain becomes insignificant, and after a few days it can disappear completely. The absence of painful sensations often leads to the fact that the patient arbitrarily refuses to wear an immobilizing device, and subsequently non-compliance with the doctor's recommendations can lead to re-dislocation. Its occurrence is explained by the fact that the damaged part of the joint capsule does not have time to “overgrow” enough to ensure the stability of the shoulder joint.

In some cases, after reduction of the dislocation, a variant of immobilization with abduction is used to immobilize the shoulder joint. This technique is less convenient for the patient than a sling bandage, but it is it that allows you to achieve tension in the anterior capsule and press it against the bone of the articular lip torn off in the anterior section. During such immobilization, the probability of sufficient “growth” of the articular lip increases, and the chances of re-dislocations decrease.

After the reduction is performed, non-steroidal anti-inflammatory drugs are prescribed to the patient to eliminate pain and reduce inflammation:

• Meloxicam;
• Nurofen;
• Ortofen;
• Paracetamol;
• Nimesulide and others.

In the first 2-3 days, cold should be applied to the area of ​​injury, which helps to reduce pain and swelling.

After removing the immobilizing bandage, the patient is recommended a rehabilitation program.

Surgery

If attempts at closed reduction remain unsuccessful, then the patient undergoes a surgical operation, which consists in opening the joint and open reduction, followed by fixation of the articular surfaces with the help of lavsan sutures or knitting needles.

Treatment for recurrent dislocations of the shoulder

After dislocation of the shoulder, there is always a risk of recurrence of the same injury in the future, even with minimal stress on the joint. Such dislocations are called repeated (habitual) or use a more modern term - "chronic instability of the shoulder joint." The development of this condition is explained by the fact that after the injury, the structures holding the humerus could not recover completely and became unable to perform their functions to the fullest.

More often, repeated dislocations occur in people under 30 years of age, and if the first injury occurred at a more mature age, then such repeated injuries in the future are less common. However, when a dislocation occurs in adulthood, its severity may increase and subsequently a person may develop fractures and dislocations.

As a rule, if a second dislocation of the shoulder occurs, then it is almost always followed by a third, fourth, etc. In the absence of appropriate treatment for such a condition, their number can reach impressive numbers. Only a timely operation can prevent their appearance.

Surgical stabilization of the shoulder joint can be performed using different methods. However, the Bankart operation is considered to be the gold standard of such intervention. Now it can be performed by arthroscopy and without making a classic incision. To carry it out, it is enough to make 2-3 punctures of 1-2 cm each, into which the arthroscope and the necessary instruments will be inserted. The same intervention can be performed not only for chronic instability of the joint, but also for primary dislocations (for example, for athletes to ensure a more stable recovery of the shoulder joint).

The purpose of the Bankart operation is to create a new articular lip. For this, a roller made from the joint capsule is used, which is sutured with anchor fixators (absorbable or non-absorbable). A new articular lip can be sutured in front (if an anterior dislocation occurs) or behind (if the bone is displaced posteriorly). If necessary, during the intervention, the surgeon can repair ruptures of the supraspinatus muscle or longitudinal ruptures of the articular lip.

To fix a new articular lip, 3-4 fixatives are usually sufficient. Non-absorbable anchors have the form of a screw and are made of titanium alloys. They are inserted into the canal of the bone and remain there forever. As a rule, fixators made of modern alloys are well tolerated by patients, and their presence is not accompanied by the development of complications. In addition, they are able to provide a more secure fixation.

Polylactic acid is used to make absorbable fixatives. They may take the form of a screw or a wedge, which, after turning, is attached to the bone. After insertion into the bone, such fixators dissolve after a few months and are replaced by bone tissue.

The choice of one or another type of anchor fixators is determined by the operating surgeon and depends on the clinical case. After that, the doctor must inform the patient of his choice. After the completion of the Bankart operation, an immobilizing bandage is applied to the patient, and after its removal, a rehabilitation course is recommended.

In some more rare cases, other surgical interventions are performed to eliminate habitual dislocations of the shoulder (for example, corrective osteotomy for acetabular dysplasia, osteosynthesis for a fracture of the scapula, elimination of bone depression by transplantation of an implant from the iliac crest, etc.). The most appropriate type of intervention in such complicated situations is determined by the attending physician.

Rehabilitation

The recovery program after shoulder dislocation includes physiotherapy (amplipulse therapy, paraffin applications, electrophoresis, electrical muscle stimulation, etc.), massage and therapeutic exercises. The rehabilitation course begins after the removal of the immobilizing bandage and consists of the following periods:

• activation of the functionality of damaged and "stagnant" muscles during immobilization - about 3 weeks;
• restoration of the functions of the shoulder joint - about 3 months;
• the final restoration of joint functions is about six months.

The patient needs to be prepared for the fact that the restoration of the functionality of the shoulder joint after its dislocation will take a long time. This duration of rehabilitation is explained by the fact that the injured joint needs a long “rest” for full recovery.

All physical therapy exercises should be carried out under the supervision of an experienced doctor or instructor. Only gentle loads can be applied to the joint, and movements should be performed as carefully as possible.

In the first weeks of rehabilitation, it will be enough for the patient to perform 10 flexions and extensions of the arm in the elbow joint and hand. In addition, exercises can be carried out by raising the arms forward and breeding to the sides. At the first stages, the injured hand can be helped by a healthy one.

Two weeks later, to this set of exercises, you can add the abduction of the arms bent at the elbow joints to the sides and the alternate raising and lowering of the shoulders. Further, the patient may be allowed rotational movements of the arms and their abduction behind the back, exercises with a gymnastic stick, etc.

Remember! If, when increasing the load, pain appears, then classes should be stopped for a while and consult a doctor.

Shoulder dislocation is a common injury and can be accompanied by various complications. In the future, such damage can cause chronic instability of the shoulder joint, requiring surgery. That is why the appearance of a dislocated shoulder should always be the reason for an immediate visit to the doctor for competent treatment and a full course of rehabilitation.

Channel One, the program “Live Healthy” with Elena Malysheva”, in the section “About Medicine”, a conversation about habitual dislocation of the shoulder:

Habitual dislocation of the shoulder. How to return the shoulder to its place

Orthopedist-traumatologist I. Zasadnyuk talks about habitual dislocation of the shoulder:

A specialist at the Moscow Doctor clinic talks about shoulder dislocation.

Article publication date: 05/31/2016

Date of article update: 05.12.2018

Dislocation of the shoulder joint is an extremely painful condition in which the head of the humerus comes out of the glenoid cavity, due to which contact between the articulating surfaces is lost and the functioning of the entire shoulder is disrupted.

The mechanism of development of dislocation of the shoulder is similar to this pathology in other joints; The key difference between a shoulder joint injury is that it occurs much more often, accounting for more than 50% of all diagnosed dislocations. This is due to the complex anatomical structure of the joint and a large range of motion in different projections, which is why the shoulder is more likely to be injured.

The main causes of this pathology are various injuries, weakening of the capsular-ligamentous apparatus and diseases of both the joint itself and general diseases affecting large and small articular joints.

With a shoulder dislocation, the quality of a person’s life suffers greatly, since the damaged arm practically ceases to function. Relapses are also possible, and repeated dislocations can occur more than once, but from 2 to 10 times a year. Repeated prolapse of the head of the bone from the glenoid cavity causes the destruction of the elements of the shoulder joint - arthrosis or arthritis may occur.

The dislocation is successfully treated. A favorable prognosis after setting the head of the shoulder bone into place largely depends on the timely provision of qualified medical care, and whether such a pathology occurs again in the patient depends on the patient's compliance with medical recommendations.

This pathology is handled by a traumatologist.

Types of pathology

In trauma practice, in 75% of cases of the total number of all dislocations of the shoulder, anterior traumatic is diagnosed. In second place is the lower dislocation of the shoulder joint - it accounts for about 20% of cases.

Click on photo to enlarge

Common Causes

(if the table is not fully visible, scroll to the right)

Repeated shoulder injuries lead to weakening of the ligaments, as a result, the stability of the joint itself also weakens. Insufficient recovery of the muscles of the rotator cuff after a traumatic type of dislocation leads to another dislocation - the usual one.

The recurrence of this problem can be provoked by ordinary daily movements: cleaning a house or apartment, washing floors, trying to put some thing on a high shelf, etc. relapses are reduced, and lesions occur more frequently.

Characteristic symptoms

The symptoms of a dislocated shoulder joint are in many ways similar to those of other joints.

Immediately after the exit of the head of the shoulder from the articular bed, there is a sharp severe pain in the corresponding place. The arm sags, the shoulder is deformed. Any movement in the joint is impossible due to increased pain and disruption of its functioning. When trying to make a passive movement, a springy resistance is felt.

Visually noticeable is such a symptom as the asymmetry of the shoulder joints. The articulation itself is deformed: angular, concave or sunken. When probing, the doctor determines the protruding head of the bone that has emerged from the articular bed.

• An anterior dislocation is characterized by a downward and forward displacement of the head.
• For the anteroinferior - displacement to the anterior armpit or down the coracoid process of the scapula. In this case, the person is forced to keep the hand in the most favorable position: retracted and turned outward or bent.
• In the lower form of the pathology, the head is displaced into the armpit. A distinctive feature of the lower dislocation from others is the likelihood of numbness of the entire arm or certain sections (fingers or forearm) due to compression of the nerves located under the armpit. It is possible to immobilize the muscles that were "connected" to the central nervous system by a pinched nerve.
• With a posterior dislocation, the head is displaced towards the scapula.

With relapses of the pathology, the pain syndrome is usually moderate or mild. But the reduction of chronic recurring dislocation becomes difficult due to the compaction of the joint capsule and the gradual filling of the cavity and nearby free areas with fibrous tissue (special connective tissue).

Other symptoms are swelling of the shoulder joint, a crawling sensation on the arm, pain not only in the area of ​​injury, but also along the pinched nerve.

Diagnostics

Diagnostic methods for dislocations of any joints are almost identical.

The traumatologist determines dislocation of the shoulder joint according to the data of visual examination, palpation, the results of radiography in two projections (confirming the presence of pathology) and, if necessary, the results of computed or magnetic resonance imaging.

In case of obvious damage to the vessels, a consultation with a vascular surgeon is mandatory, if a rupture or compression compression of the nerves is suspected, a neurosurgeon should be consulted.

First aid for dislocation

Completely exclude any movement of the injured limb.

Give the victim pain medication.

Apply ice or a cold compress to the affected area.

Make a splint to immobilize the hand from improvised means and fix the limb with a scarf, scarf or other object. Or, if possible, place a roll of rolled towel under the armpit and fix the bent arm with bandages to the torso or to the shoulder girdle of the other arm.

Call an ambulance or take the victim to an emergency room immediately.

Basic treatment (3 stages)

Treatment takes place in three stages.

The first stage - reduction

Reduction can be closed (non-surgical) and open (surgical). Closed reduction of a fresh (several hours old) dislocation of the shoulder is performed under local anesthesia, for this the affected area is chipped with novocaine. One of the muscle relaxants is injected intramuscularly to relax the muscles, and with severe pain, a narcotic analgesic. An old dislocation of the shoulder joint (more than a day) is eliminated under general anesthesia.

The most common options for repositioning the shoulder joint: the method of Janelidze, Mukhin-Mota, Hippocrates, Kocher. Which one to use, the traumatologist chooses depending on the type of damage.

The reduction of habitual repeatedly occurring lesions or those that could not be eliminated by the closed method is performed surgically with fixation of the head of the humerus with special needles or lavsan sutures in the articular cavity.

Symptomatic drug treatment at this stage consists of taking non-steroidal anti-inflammatory drugs, non-narcotic analgesics.

The second stage is temporary immobilization

Immobilization (immobilization) is necessary after reduction to fix the joint in the desired position, heal the capsule and prevent relapses. A special Deso bandage or splint is applied to the arm for about a month. As soon as the joint assumes a physiologically correct position, the symptoms of injury quickly disappear.

Bandage Deso

It is important to adhere to the recommended period of wearing the Deso bandage, even if the swelling, pain and other symptoms of the disease have disappeared. If the shoulder immobilization is terminated early, the joint capsule will not have time to heal, which will inevitably lead to habitual dislocation with injury to surrounding tissues.

The third stage is rehabilitation

Rehabilitator undertakes to restore joint functions after immobilization. Physiotherapy (massage, electrical muscle stimulation) and exercise therapy help to strengthen the ligaments and muscles of the shoulder.

Rehabilitation is conditionally divided into three periods:

The first 3 weeks are aimed at increasing muscle tone, activating their functions after immobilization.

The first 3 months are spent on the development of the joint, the restoration of its performance.

Up to six months is allotted for the full restoration of the functioning of the shoulder joint.

The above stages of treatment are relevant for dislocations of any joints, there is a difference only in some nuances (for example, when the knee is damaged, not a Deso bandage is used for immobilization, but a bandage, side splint or other orthopedic device).

Summary

If a dislocation of the shoulder joint occurs, seek medical attention immediately. The sooner you get to the traumatologist, the easier it will be for him to fix the problem.

After reduction, it is imperative to observe the recommended period of immobilization and rehabilitation, otherwise relapses of dislocation cannot be avoided, each of which will be accompanied by an increase in pathological changes in the articular elements.

Owner and responsible for the site and content: Afinogenov Alexey.

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According to statistics, a large number of patients suffering from dislocation of the shoulder joint do not receive full medical care. This is due to the fact that a person after an injury, feeling pain in the shoulder, falsely refers it to an ordinary bruise. As a result, over time, pain disappears, but motor functions are not fully restored.

Content:
1. Habitual shoulder dislocation
2. Shoulder subluxation
3. How to reset your shoulder

For this reason, it is necessary to understand well not only how to treat a dislocated shoulder joint, but also to diagnose this kind of injury.

Habitual shoulder dislocation

With this pathology, destruction of the cartilaginous structure is observed, provoking dislocation at the slightest load on the joint. As a rule, a chronic form of injury occurs due to delayed therapy, chronic injuries or concomitant diseases. The primary dislocation of the shoulder reminds of itself with a constant threat of displacement.

According to medical practice, re-dislocation is observed in 16% of cases. The frequency of injury is about 6 months. The intensity is increasing all the time, and the time between dislocations is decreasing.

Seeing a surgeon due to an injury more than 2 times within 1 year is an absolute indication for a surgical operation. Treatment without surgery is aimed at strengthening the muscular corset and restoring full mobility of the shoulder casing.

Shoulder subluxation

The severity of the injury in this case is significantly lower than in the case of traumatic or habitual dislocation. For this reason, the patient often does not attach importance to such injuries of the shoulder. It is not surprising that chronic subluxation is recorded in almost a third of patients who seek help due to discomfort in the shoulder case, several months after the injury itself.

Causes and symptoms of shoulder dislocation

Treatment of dislocation of the shoulder joint is required for patients in whom, as a result of a sharp directed blow during a fall or push, as well as due to pathological changes, the anatomically correct arrangement of the articulated bones is disturbed. The head of the bone comes out of the joint bag with simultaneous destruction of the capsule and damage to the soft tissues.

The etiology of injuries allows us to divide all dislocations into two groups:

1. Habitual or chronic - there can be many causes of pathology: birth trauma, dysplasia, illiterate assistance with primary dislocation, concomitant diseases and metabolic disorders.
2. Traumatic - begins solely due to blows, pushes and exposure to great physical force. Treatment after reduction of the shoulder as a result of an injury requires a long time. In 20% of cases it becomes chronic.

External signs of dislocation of the shoulder joint are:

• Pain syndrome. The intensity of the pain is often so severe that the patient may lose consciousness. Often there is a darkening in the eyes, vomiting.
• Mobility restrictions. The position of the head of the humerus during dislocation does not allow even simple movements. The rupture of the tissues that accompanies the injury leads to hemorrhage and swelling.
• limb position. A person intuitively presses his hand to the body, trying to immobilize the joint. The limb is omitted. After dislocation, the arm does not rise up.

What to do with a dislocated shoulder

Self-adjusting the shoulder is prohibited. This can lead to serious damage to the ligaments and tissues. As a result, the rehabilitation of the shoulder joint after dislocation will take longer. The victim must be given first aid and taken to the surgical or trauma department.

Since complications after dislocation are quite common, it is recommended to observe the following rules:

• First aid for dislocated shoulder. A fixing bandage is applied. The victim can be given an anesthetic and apply ice to the injury site.
• transport immobilization. To reduce the likelihood of re-injury, a fixing bandage is applied that completely immobilizes the arm.

In case of dislocation of the shoulder joint, it is necessary to immediately deliver the person to a medical specialized institution. Doctors will conduct a complete examination, establish the type of injury and, if necessary, perform further procedures.

How to reset your shoulder

To date, two main methods of reduction are used. Before starting the procedure, promedol is administered intramuscularly to a person, the joint is anesthetized with a solution of novocaine. This measure allows you to relax the muscle tissue and carry out manipulations in the most painless and effective way.

1. Reduction of a dislocated shoulder according to Kocher is one of the most difficult techniques. It is fraught with consequences and a difficult recovery period after the procedure. The Kocher method is used when other methods have failed.
2. Shoulder dislocation reduction according to Janelidze is the most effective and simple technique. Allows you to achieve the desired effect in 80-90% of cases. It is necessary that sufficient anesthesia of the shoulder body occurs and, accordingly, proper relaxation of the muscles. Only in this case, the Janelidze method will be successful.

After the procedure, a second X-ray examination is performed. Based on the results, a bandage is applied for the shoulder joint, which allows you to keep the shoulder in the correct anatomical position for the entire period of rehabilitation.

The duration of recovery, depending on the severity of the damage, is 2-3 months. Fixation of the shoulder joint is left for a period of 7 to 14 days.

Shoulder reconstruction after dislocation

As the tissues heal, the patient is prescribed exercises to strengthen the shoulder. Initially, classes include movements with a small amplitude. In the process of restoring exercise therapy, exercises become more difficult, the load is added and gradually increases.

• Strengthen the muscle corset and prevent the joint from falling out of the bag again.
• Restore full functionality.
• Return the lost household functions.

Exercises for the development and recovery of the shoulder joint after dislocation are developed for each patient, taking into account his characteristics. Age, health, concomitant diseases are taken into account. Therapeutic exercise helps to cope with contracture and fully restore the lost health of the joint.

Methods of traditional medicine for dislocation of the shoulder joint are aimed at preventing re-injury. In most cases, stable remission can be achieved.

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Anatomy of the shoulder joint: why does dislocation occur?

A feature of the shoulder joint is considered to be the most complete of all human bone joints, the range of motion in all possible planes, which occurs due to:

• a relatively flat and wide surface of the articular cavity of the scapula, limited only by a special protruding cartilage (articular lip) along its edges;
• a clear rounded shape of the head of the humerus;
• elasticity of the joint capsule, hermetically limiting the joint cavity from the surrounding tissues.

This makes it possible:

• carry out rotation in the joint in various axes and volumes;
• adduct and abduct the humerus in relation to the body;
• perform flexion and extension.

However, the reverse side of the ability to make such movements was the great instability of the shoulder joint, which, under certain conditions, leads to separation of the communicating surfaces of the bones, followed by dislocation.

The clavicle (not directly included in the shoulder joint, but located in close proximity to the articulation capsule from above), as well as the ligamentous and muscular apparatus covering the shoulder joint from the front, top and back sides, sharply reduce instability and serve as a powerful protection against dislocation with minor and normal loads or movements.

Causes of dislocation in the shoulder joint

• Out-of-bounds movement in a rotational type joint (around an axis)

Most often, they occur under the action of external forces, for example, when a heavy object is held by the hand or when the hand is twisted, which is carried out by an outside force.

Most often occurs when falling on an outstretched arm or with a direct blow directly to the shoulder joint.

• Routine, repetitive, repeated over a long period of time from day to day within the limits of the joint, accompanied by stretching of the capsule.

They are found in some professions that require significant physical exertion in the shoulder girdle. In addition, it is a common sports injury in athletes using throwing movements, swimmers and tennis players.

• Congenital anatomical features of the joint, providing excessive mobility

1. Changes in the glenoid cavity of the scapula in the form of a flatter surface without the presence of restrictions on the periphery in the form of an articular lip (scapular dysplasia).
2. Underdevelopment (hypoplasia) of the lower third of the glenoid fossa of the scapula, combined with underdevelopment (immaturity) of the capsule of the shoulder joint.
3. Changed position of the scapula in the form of deviation back or forward.
4. Underdevelopment and weakness of the rotator cuff muscle.

• Severe pain in the joint immediately after the traumatic impact

It is due to:

1. damage to the tendon capsule, along the entire diameter of the head of the humerus;
2. rupture of the ligaments surrounding the joint;
3. damage to the muscular apparatus;
4. squeezing or rupture of blood vessels;
5. infringement of large nerves and its sensitive endings.

When a dislocation occurs for the first time, the pain is so intense that the victim may faint with nausea and vomiting, he may also lose consciousness.

As a manifestation of the severity of the pain syndrome, hemodynamic parameters may change (fall or increase in blood pressure, changes in the nature of the pulse).

With repeated (habitual) dislocations, which occur, as a rule, due to insufficient treatment of the first, the pain syndrome is already less pronounced, if not completely absent.

• Limitation of movement in the joint

Most often observed when the head of the humerus falls below the articular surface of the scapula (lower dislocation).

The patient at the same time cannot lower the hand laid aside due to the occurrence of springy movements and sharp pain. The second, healthy hand, he supports it in the allotted position.

With posterior and anterior dislocation, movement restrictions occur in other planes, and in various variations.

• Changing the appearance of the shoulder joint

The rounded shape of the shoulder is lost, in its place a small fossa appears with a protrusion of the coracoid process of the scapula above it. The head of the humerus is determined in an atypical place for it, for example, in the armpit.

The soft tissues surrounding the joint become edematous, their hemorrhagic impregnation is possible (bruises appear).

In cases where the head of the humerus infringes on the trunk of a large nerve, some disorders develop sensitivity of the upper limb.

• Paresthesia (sensations of "crawling").
• Severe pain along the entire nerve from the shoulder to the hand.
• Complete lack of sensitivity of the hand to various stimuli.

These symptoms make it possible to diagnose shoulder dislocation with a high degree of certainty.

However, it should be remembered that dislocations can often be accompanied by fractures. And, if a fracture of the humerus is easy to establish by a kind of “grinding” of the fragments that the victim complains about, then damage to the scapula (the most common) cannot be detected without additional research methods.

Therefore, before providing medical care (especially in cases where the dislocation happened for the first time), radiation confirmation of the diagnosis is required.

1. Banal x-ray examination is sufficient in most cases.
2. If damage to large vessels and nerves is suspected, CT and MRI are used.

First aid for dislocation

At the stage before hospitalization, it is important to properly provide first aid to the victim. This will allow him to more easily endure transportation and protect him from possible additional damage to the joint and surrounding tissues.

1. You should not forcefully change the forced position of the limb.
2. If the dislocation allows, then, having previously inserted a cotton-gauze roller into the armpit, the limb is fixed to the body with bandaging. This is done to immobilize the joint.

For this purpose, you can use long stair metal tires. They have a feature in the form of the possibility of individual modeling of their contour. The contour in this case is created by circling the half-bent bend of the elbow and shoulder joint of the affected limb together with the opposite shoulder joint.

The tire thus modified is applied to the body of the injured person and fixed with bandages.

1. With the help of improvised means (bandage, scarf, outerwear) the hand and forearm of the dislocated arm are suspended from the opposite shoulder girdle.
2. If possible, if there are no other injuries (head with loss of consciousness or damage to the chest and abdominal cavities), the victim should be given painkillers in tablet form or by injection.
3. If you have access to cold, then you can put ice on the joint having previously wrapped pieces of ice with a towel or a piece of clothing (scarf, T-shirt, etc.) so as not to cause local frostbite.

This will help relieve swelling, stop internal bleeding and significantly reduce pain. For this purpose, you can also use chilled water in plastic bottles from the refrigerator.

See also: Symptoms of cervical osteochondrosis

How to treat?

The decision on the method of treatment is made by a specialist, a traumatologist, to whom it is necessary to deliver the victim.

Shoulder dislocation treatment includes a number of steps.

1 . Reduction of dislocation

It is carried out both conservatively and with the help of surgical intervention.

Conservative treatment consists in manual reduction of the dislocation.

During the operation, the fixation of the joint in the physiological position is carried out instrumentally (using special needles).

Indications for surgical treatment are:

• repeated re-dislocations;
• complex dislocations, accompanied by fractures of the head of the humerus and scapula;
• chronic dislocations (when there was no manual treatment within 2-3 weeks after the injury).

2. Immobilization

It is performed after the reduction of the dislocation by additional fixation of the joint with special bandages or plaster bandages.

The average duration of immobilization will be 3-6 weeks.

3. Drug therapy

It consists in taking anti-inflammatory and analgesic drugs (otrofen, ibuprofen, pentalgin, etc.), as well as drugs that improve local blood circulation and relieve swelling.

Medication is limited to three to four days after the reduction of the dislocation.

4. Restoration (rehabilitation) and preservation of the health of the damaged shoulder joint

This is carried out by methods of physical therapy, physiotherapy and massage in combination, taking into account the individual characteristics of the injury.

Rehabilitation begins already in the first days of immobilization by activating the muscles of the injured arm so that they retain their functionality until the bandage is removed.

1. The first exercises are prescribed for the fingers of the hand and the wrist joint.
2. The next step is the impact on the joint itself, the articular bag and the muscles covering it. The purpose of these actions is to relax the muscles that were spasmodic for the first time after removing the bandage and improve mobility in the joint with the help of a gentle load and massage according to a special program.

In the exercises, additional objects are used - a ball, a stick, dumbbells. This period lasts up to three months from the moment of injury.

Full restoration of the joint with the possibility of obtaining the previous loads is quite feasible six months after the reduction of the dislocation.

Independent (or with the help of outsiders) reduction of a dislocation of the shoulder joint is possible only in cases where such a dislocation in a patient has previously occurred repeatedly, and seeking professional help is currently impossible.

Most often, such (habitual) dislocations occur already with a slight load on the joint. Their frequency, occurring six months after the reduction of the previous one, increases to a dozen per year, reaching in some situations (washing, scratching) up to several times a day.

This condition requires mandatory surgical correction of the defect to prevent dislocations in the future.

Self-reduction is feasible in various ways, and each patient chooses for himself his own

• Clutching the wrist of the injured hand between the knees, he leans the torso back.
• A healthy hand pulls a dislocated arm.
• Independently rotates and abducts the arm in the required (opposite in the location of the dislocated head of the humerus) direction.

With outside help, it is possible to correct a dislocation if a certain procedure is followed (Hypocrates' method).

1. The patient lies on his back, preferably on a hill (bench, table).
2. The caregiver comes up from the side of the injury and firmly grasps the victim’s hand with his own hands, pulling on the injured limb.
3. At the same time, he sets the heel of his foot into the armpit of the patient and presses on the head of the humerus that has shifted down.

This is enough for reduction, which is characterized by a “click” sensation.

Movements should be smooth, and in no case should unexpected jerks be allowed, which will only aggravate the dislocation.

Exercise therapy or therapeutic exercises

In the period of immobilization, a set of exercises includes:

1. passive (with the help of a healthy hand) and active finger movements with subsequent transfer of load to the wrist joint4
2. sequential, following one after another, tension of the muscles of the hand in the first days after the injury, supplemented by tension in the muscles of the forearm at the end of the first week after the injury and the muscles of the shoulder in the next two to three weeks.

The transition to the load on the next joint of the dislocated arm or muscle group does not at all cancel the set of exercises started earlier, but only complements them.

In the post-immobilization period, after the removal of the cast, certain exercises are included in the rehabilitation of the joint.

• Light rocking movements of the limb back and forth.
• Abduction of the arm bent at the elbow to the side.
• Lifting first with the help of a healthy, and then without it, the injured arm forward.
• Dosed pressure with the fingertips of a straightened arm on the horizontal (table) and side (wall) surfaces.
• Rotation with the palm of a free-hanging arm.
• Bringing together and breeding both shoulder blades.
• Raising the arm up (or putting the arm behind the back).

General principles of physiotherapy exercises for shoulder dislocation

• Paired and simultaneous execution of exercises with a healthy hand.
• A gradual increase in the pace and number of exercises and approaches to them.
• The presence of visual control over the joint and movements with the help of a large mirror.
• After 4 weeks after the injury, it is necessary to include additional sports equipment in classes: gymnastic stick, mace, ball, dumbbells, expander.

In addition to physical exercises, self-service skills are practiced at each stage.

As the patient recovers, the patient should be included in homework.

Massage and physiotherapeutic procedures (hydrotherapy, UHF, magnetotherapy) are also considered important components of rehabilitation. They are prescribed in the first days after conservative or surgical treatment. Their goal is to relieve pain and improve blood supply in the area of ​​dislocation.

Basic principles of massaging the affected limb

Features of the habitual dislocation of the shoulder joint and its surgical treatment

The main feature of the habitual dislocation of the shoulder joint, which develops due to incorrect manual reduction of the previous one or inferiority of the articular surfaces, is an increasing increase in its instability after each episode of repeated prolapse of the humeral head.

In cases where the dislocation has already occurred repeatedly, only surgical intervention can stop this chain of injuries. Physical exercises that the patient begins to perform to strengthen the joint after repeated dislocations will no longer increase the stability of the operation and, on the contrary, may cause subsequent dislocations with further destruction of the joint.

There are numerous surgical options. However, with the widespread introduction of endoscopic, minimally invasive technologies into practice, the most common manipulation has become Bankart operation.

1. Under the control of optical (arthroscope) instruments, surgical instruments are inserted through holes pierced in the joint wall.
2. With its help, plastic methods create a new articular lip along the periphery of the articular surface of the scapula to replace the one lost after numerous injuries or completely absent.
3. For the reconstruction of the lips, special screw-in small needles (fixators) are used, which can be metal, remaining forever, or from a material that dissolves over time.

For the use of each type of fixators, there are indications, and their choice is made by a trauma surgeon.

In addition to using an arthroscope, operations can be performed in an open way when the articular bag is opened and all manipulations are carried out under the direct visual control of the doctor.

The final stage of both types of operations on the joint are actions to directly strengthen the tendons and muscles that cover it.

Positive results of surgical treatment with a complete absence of re-dislocations after it can be achieved in 85-92% of cases.

Life after surgery: rehabilitation and recovery

According to the methods and terms of rehabilitation after surgical correction of the habitual dislocation of the shoulder, the management of the patient after the operation completely coincides with the periods described above after manual reduction of the shoulder.

The peculiarity, perhaps, is only the special care for postoperative sutures and intra-articular drainage, which can be left for some time after the operation for additional control and administration of drugs that accelerate reparative processes.

The sutures are removed 7-9 days after the operation.

See also: Types and degrees of scoliosis in the medical classification

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Definition and general characteristics of dislocation of the shoulder of the right or left arm

The terms “shoulder dislocation” or “shoulder dislocation” are also often used to refer to shoulder dislocation. All three terms are synonymous and refer to the same pathological condition of the shoulder joint.

Shoulder dislocation is understood as a condition in which there is a divergence of the surfaces of the head of the humerus and the glenoid cavity of the scapula, which are normally quite close to each other. If normally there is only a small gap between the surfaces of the head of the humerus and the glenoid cavity of the scapula, which ensures free movement in the joint, then with dislocation this small gap becomes much larger. As a result, the range of motion in the joint is significantly reduced, since the incorrect position of the articulating surfaces does not allow them to be performed. Indeed, in the joint, all surfaces in shape and size are carefully adjusted to each other, and if their relative position changes even slightly, the articular joint ceases to function normally.

Such a definition of dislocation is classical and fully reflects the general essence of the pathological condition of the joint. However, in order to have a good and clear idea of ​​what constitutes a dislocation of the shoulder joint, it is necessary to know its anatomical structure.

So, the shoulder joint is formed by two surfaces - the head of the humerus and the glenoid cavity of the scapula. The head of the humerus is a spherical formation at one of its ends, and the cavity of the scapula is a rounded notch. Moreover, the size and shape of the notch of the scapula corresponds to those of the head of the humerus. Due to its shape and size, the head of the humerus fits perfectly into the glenoid cavity of the scapula, like a ball into a bearing (see Figure 1), and therefore can perform a variety of movements.

Picture 1- The structure of the shoulder joint.

To be able to move, the head of the humerus and the articular surface of the scapula are not tightly connected, between them there is a narrow gap filled with a special liquid that acts as a kind of physiological lubricant. The joint is reinforced with ligaments and tendons that hold the articulating surfaces of the head and recess in the required position.

But if, for some reason, the head of the humerus and the glenoid cavity of the scapula diverge in different directions and the gap between them increases, then the joint loses the ability to move normally. It is this condition that is called a dislocation (see Figure 2).

Figure 2- Dislocation of the shoulder joint (the picture on the right shows the normal structure of the joint, and on the left - its dislocation).

Since the left and right shoulder joints are arranged in exactly the same way, dislocations in them are also formed in the same way. Moreover, dislocations of the right and left shoulder joints do not differ from each other and do not have any features, so we will consider them together.

Shoulder dislocations occur in adults in half of all fixed dislocations, which is due to the structural features of the joint and the large range of motion in it.

Shoulder dislocation - photo

This photograph shows the appearance of a dislocated right shoulder.

Classification and brief description of various types of shoulder dislocations

Depending on the causes, nature and presence of complications, the entire set of dislocations of the shoulder joint is classified into the following varieties:
1. Congenital dislocations of the shoulder;
2. Acquired shoulder dislocations:

Acquired dislocations of the shoulder are divided into:
1. Traumatic dislocations:

• Uncomplicated dislocations;
• Complicated dislocations.

2. Non-traumatic dislocations (habitual):

• Arbitrary dislocation;
• Chronic pathological dislocation.

Congenital dislocations of the shoulder are relatively rare and are the result of a birth injury received by the child when passing through the pubic joint. Diagnosis and treatment of congenital dislocations of the shoulder is carried out directly in the delivery room immediately after the birth of the child by a neonatologist or pediatric traumatologist.

Acquired dislocations of the shoulder compared to congenital ones make up an incomparably larger group, since they are more common and are caused by various factors, and not just birth injuries. It is the acquired dislocations that make up about 80% of all cases, and the remaining 20% ​​are congenital.

Acquired dislocations, in turn, depending on the nature of the factor that provoked them, are divided into two large groups - traumatic and non-traumatic. Non-traumatic include arbitrary and pathological (chronic) dislocation of the shoulder. And traumatic are divided into two varieties - complicated and uncomplicated shoulder dislocations. Accordingly, uncomplicated dislocations represent an isolated injury of the shoulder joint, in which the surrounding tissues and anatomical structures are not damaged, which allows the problem to be eliminated by simple reduction. Complicated dislocations constitute a much more diverse group, which includes dislocations that are combined with damage to surrounding tissues and structures, which makes simple reduction impossible. So, the following possible options are classified as complicated traumatic dislocations of the shoulder:

• Open dislocation with damage to nerves and blood vessels;
• Dislocation with damage to the tendons;
• Dislocation with a fracture of bones or cartilage (fracture dislocation);
• Pathological recurrent dislocations;
• Old dislocation;
• Habitual dislocation.

Depending on the prescription of the injury, dislocations are divided into three types:
1. Fresh dislocation (the injury was received within the next three days);
2. Stale dislocation (the injury was received within the next three weeks);
3. Chronic dislocation (the injury was received more than three weeks ago).

Depending on the location and direction of the divergence of the articulating surfaces, shoulder dislocations are divided into the following three varieties:
1. Anterior dislocation(noted in 90% of cases) is a displacement of the head of the humerus in the direction of the clavicle and deep under the scapula. Since the head of the humerus in this type of dislocation comes under the coracoid process of the scapula, it is often called subcoracoid. However, if the head of the humerus is more strongly displaced into the region of the clavicle, and not under the scapula, then this type of damage is called subclavian dislocation. With this dislocation, the shoulder is somewhat retracted to the side.
2. Posterior dislocation(occurs in 2% of cases) is a detachment of the head of the humerus from the ligaments and tendons that hold it in its normal position, and displacement simultaneously upwards (towards the head) and towards the back. This dislocation usually occurs when you fall on an outstretched arm. With this dislocation, the shoulder is abducted, bent and slightly turned outward.
3. lower dislocation(occurs in 8% of cases) is a downward displacement of the head of the humerus towards the legs. With such a dislocation, a person cannot lower his arm down and is forced to hold it above his head. With a lower dislocation, the arm is pulled away from the body, and the person slightly tilts the body in its direction, holding it with a healthy hand.

Consider a brief description of the various types of dislocations in the shoulder joint.

Traumatic shoulder dislocation

Traumatic dislocation of the shoulder is always caused by some damaging factor, for example, a fall on a straight arm, a blow to the shoulder joint from the back or chest, etc. As a result of exposure to a damaging factor, a rupture of the joint capsule occurs with its subsequent dislocation.

Primary shoulder dislocation

A primary dislocation of the shoulder is a first-time injury. In this case, the type of dislocation (traumatic or non-traumatic) does not matter, but only its occurrence for the first time.

Shoulder dislocation

An old shoulder dislocation is an injury more than three weeks old that has not been properly repaired. In fact, an old dislocation of the shoulder is understood as such a condition that has formed for some time after the dislocation without subsequent reduction. In other words, if a person received a dislocation of the shoulder and did not adjust it, then after a few weeks the pain will subside, the muscles and ligaments will atrophy, the limb will take a forced position, and its mobility will be significantly limited. It is this condition that is called chronic dislocation of the shoulder.

Habitual shoulder dislocation

A recurrent dislocation of the shoulder is the repeated, often occurring dislocation of a joint that has been previously injured. Habitual dislocation of the shoulder usually develops with damage to the neurovascular bundle, fracture of the glenoid cavity, fissure of the articular lip, etc. Also, the cause of habitual dislocation is often the incorrect treatment of primary traumatic dislocation, as a result of which the capsule, muscles and ligaments heal with the formation of scars that violate the normal anatomical structure and ratio of joint structures. The result of such a violation of the normal anatomy of the joint is the development of its instability with habitual dislocations.

Habitual dislocations exist for a long time - for months and years. Moreover, the more often they occur, the less effort is required to form a subsequent dislocation. However, at the same time, the method of their reduction is also simplified.

Open dislocation with damage to nerves and vessels or tendons

With such dislocations, the bones rapidly diverging to the sides break the nerves, blood vessels and tendons. A dislocation with such complications must be eliminated exclusively with the help of a surgical operation, during which the doctor will restore the integrity of all torn tissues and give the joint the correct anatomical position.

Dislocation with broken bones or cartilage (fracture dislocation)

Fracture dislocation is relatively rare and is a severe injury. In such cases, it is necessary to resort to the reduction of the dislocation and the simultaneous comparison of broken bones or cartilage. If possible, then these manipulations are performed without surgery. But if the restoration of the correct position of the joint and broken parts of the bone or cartilage through the skin and muscles is impossible, then they resort to a surgical operation.

Pathological recurrent dislocations

Pathological recurrent dislocations are usually associated with some disease of the connective tissue, bones or joint, which are the causes of its instability. In this case, after the reduction of the dislocated joint and the complete restoration of the tissue structure, they do not acquire the proper strength and elasticity, which is the causal factor in the formation of re-dislocation when an appropriate impact occurs, for example, a sharp swing movement with a large amplitude, a fall on an outstretched arm, etc. .

Arbitrary dislocation

Arbitrary dislocation is a non-traumatic injury to the joint, caused by any ordinary actions or movements. In this case, the causes of dislocation are various factors that make the joint unstable, such as sprains, fractures of bones, etc.

Chronic pathological dislocation

Chronic pathological dislocation is formed against the background of damage to the tissues of the shoulder joint in any diseases, for example, tumors, osteomyelitis, tuberculosis, osteodystrophy, etc.

Shoulder dislocation symptoms

Despite the fairly wide range of shoulder dislocations, their symptoms are almost always the same. Certain differences in symptoms are present only in recent and chronic dislocations. Therefore, we will divide the symptoms of shoulder dislocation into two large groups - with recent and with chronic damage.

Any fresh or recent dislocation of the shoulder is accompanied by pain of varying degrees of intensity, which is a mandatory symptom of damage. Moreover, the greater the amount of damage to the tissues of the joint, the stronger the pain that a person experiences during a dislocation. Because of pain, a person tries to keep his hand on the side of the injury, trying to fix it in a slight abduction from the body with a simultaneous anterior deviation.

The other most characteristic signs of shoulder dislocation are the limitation of its functions and deformation. A deformed joint can take on various shapes - convex, sunken, angular, etc. The appearance of the joint is abnormal, different from an intact shoulder, which is noticeable to the naked eye. However, the most common deformity of the shoulder during dislocation is its flattening in the anterior-posterior direction with a simultaneous strong protrusion of the scapula with a depression under it. This deformity gives the joint a very characteristic appearance.

With a shoulder dislocation, a person cannot make any hand movements associated with this joint. If you try to make simple passive movements, then a characteristic springy resistance will appear.

Summarizing the above, we can say that most common symptoms of shoulder dislocation are the following symptoms:

• Pain in the shoulder, arm, shoulder blade and collarbone;
• Swelling of the shoulder joint;
• Limitation of movements in the joint (a person can only perform springy movements, small in volume and amplitude);
• Deformed appearance of the shoulder joint, different from that of the other uninjured shoulder;
• Swelling in the joint area;
• If the nerves are pinched or damaged, stabbing pain, numbness of the arm and bruising in the immediate vicinity of the joint may occur;
• Violation of sensation in the hand, shoulder and forearm of the arm connected to the dislocated joint.

With chronic dislocation, the joint capsule thickens, as a result of which the tissues become thicker and denser, and lose their elasticity. In addition, unreduced dislocation is a source of a chronic sluggish inflammatory process, as a result of which a large number of fibrous bands are formed in the joint cavity. These strands, as it were, overgrow the surfaces of the bones that form the shoulder joint, and form a dense fusion of the entire internal cavity of the articular capsule. As a result of the fusion of the bones that form the joint, it completely loses its functions and is fixed in the wrong anatomical position. Such an old dislocation no longer hurts, but does not allow normal movements in the joint. Therefore, the main signs of chronic dislocation are joint deformity and limitation of movements in it. In addition, such a dislocation cannot be corrected without surgery, since a large number of fibrous cords have formed that prevent the bones from moving to a normal anatomical position.

Shoulder Dislocation Causes

The causes of dislocation of any kind can be as follows:

• Trauma (for example, a blow, a fall on the arm, etc.);
• Joint diseases that occur with the destruction of the articular surfaces of the articulating bones;
• Congenital anomalies of bones and joints, for example, hypermobility, small scapular cavity, etc.;
• Incorrect reduction of dislocation.

Pain after shoulder dislocation

Pain after dislocation of the shoulder can be quite strong, acute, but localized in the joint area and practically does not spread to the surrounding tissues. The pain sensation increases when trying to make any movement with the arm or shoulder.

Directly in the process of reducing the dislocation, a person can feel very strong, acute and almost unbearable pain, therefore it is recommended to perform this manipulation using anesthesia. If anesthesia is not used, then due to severe pain, the person will instinctively strain the muscles, and the reduction of the dislocation may become incomplete or incorrect, which will create conditions for habitual dislocations in the future.

After the dislocation is reduced, the pain will decrease, but it will completely subside only after 2 to 4 months. Moreover, the pain sensation will decrease gradually, slowly fading away. After reduction of the dislocation, the remaining pain is associated with stretching of the ligaments and tendons. And until these structures, which strengthen and hold the joint in a normal position, are not reduced to their usual size, the pain will be felt by a person. That is, after a dislocation of the joint, the pain will be the same as after stretching the muscles or ligaments.

How to identify a dislocated shoulder (diagnosis)

Diagnosis of shoulder dislocation is based on the results of examination, palpation and X-ray of the damaged joint. In doubtful cases, computed and magnetic resonance imaging are used to clarify the dislocation.

On examination, the doctor reveals a visible deformity of the shoulder joint and tries to establish where its parts are. After a visual examination, the traumatologist proceeds to gently palpate the dislocated shoulder joint in order to locate the head of the humerus. The head has a rounded spherical shape, therefore it is clearly visible and palpable under the skin. With any dislocation, the head of the humerus may be shifted to the back under the shoulder blade, to the chest under the collarbone or down.

Then the doctor takes the hand with the damaged joint and tries to make some small movement with it. When dislocated, a springy resistance will be felt. When you try to make a straight hand lowered along the body in a circular motion counterclockwise, a simultaneous rotation of the protruding, dislocated head of the humerus occurs. The movements of the fingers and in the elbow joint do not suffer from dislocation of the shoulder and are preserved in full.

In the course of diagnosing a dislocation of the shoulder joint, it is imperative to check its reaction to movement and skin sensitivity, since such an injury is often complicated by nerve damage. In addition, it is imperative to feel the pulse on the artery of the forearm in the immediate vicinity of the palm and determine its strength. If the pulse is weaker than on a healthy arm, then this indicates damage to the blood vessels, which also often happens with shoulder dislocations.

Thus, the signs that make it possible to recognize a shoulder dislocation are the following:

• Deformed shoulder joint;
• Characteristic springy resistance when trying to make a movement in a dislocated joint;
• Rotation of the head of the humerus simultaneously with rotation around its axis of an outstretched and straight arm;
• Preservation of movements in the fingers and elbow joint.

However, to clarify the diagnosis of shoulder dislocation, established on the basis of the above signs, it is necessary to take an x-ray, which, in addition to confirming the diagnostic assumption, will allow you to accurately see the location of the bones relative to each other. This, in turn, will allow the doctor to determine the most effective and less traumatic tactics for the subsequent reduction of the dislocation.

With a habitual dislocation of the shoulder, as a rule, the configuration of the joint is not deformed, but the movements in it are significantly limited. Signs of habitual dislocation are various restrictions on movement in the shoulder joint, called the symptoms of Weinstein, Babich and Stepanov.

Weinstein's symptom is that a person is asked to raise both arms to the sides by 90 o, and then bend them at the elbows at a right angle. The person is then asked to try to raise the forearm as high as possible. With habitual dislocation of the shoulder, the range of motion is less than on the uninjured side. Babich's symptom is that when a doctor tries to make movements with a person's hand, he counteracts and tries to control them on his own. Stepanov's symptom is checked in the position of a person lying on his back. The patient is asked to stretch his arms along the body and put them with his palms on the surface of the couch. Then they ask the person to turn their hands so that the back of the palms touches the surface of the couch. In the presence of a habitual shoulder dislocation, a person does not reach the couch with the back of his hand.

In addition, with a habitual dislocation of the shoulder, a doctor or other person will easily be able to lower the arm raised to the side, despite active attempts to resist. An arm with a healthy shoulder joint cannot be lowered to the body if the person actively opposes it.

To confirm a dislocation of the shoulder, suspected on the basis of the listed signs, it is imperative to take an x-ray.

General principles of treatment

Shoulder dislocation treatment is aimed at restoring the normal structure of the shoulder joint. This goal of treatment can be achieved by various methods of reducing the dislocation or with the help of surgical intervention, therefore, the entire set of methods for treating shoulder dislocations is divided into two large categories - conservative and operative. Conservative methods include several ways to reduce a dislocation, and surgical methods include various types of plastic surgery, during which the doctor removes excess damaged or inflamed tissues and forms a normal joint from the remaining ones.

After reduction or surgery, when the shoulder joint has acquired its normal anatomical structure, it is necessary to limit its movements until complete healing and restoration of all tissues, which takes from 4 to 6 weeks. To immobilize the joint (limit its mobility), a Turner longuet or a scarf bandage is applied to a person for 3 to 6 weeks, and for the speedy recovery of tissues, a course of physiotherapy is prescribed (UHF, electrophoresis with anesthetics, exercise therapy, etc.).

Consider the methods of reduction of dislocation, the production of a surgical operation and subsequent rehabilitation in separate sections.

Shoulder dislocation reduction

Shoulder dislocation should be corrected as soon as possible after its formation. The reduction of the dislocation must be done with the use of anesthesia. Depending on the condition of the person, general or local anesthesia may be used.

The simplest and most effective method of anesthesia for the reduction of shoulder dislocation is conduction anesthesia according to Meshkov. For its production, a person is seated on a chair, asked to turn his head to a healthy shoulder and find a point under the lower edge of the collarbone on the border of its middle and outer thirds. A solution of Novocaine is injected into this point, wait 5-10 minutes until anesthesia sets in, after which they begin to reduce the dislocation by any available method.

There are more than ten ways to reduce a dislocated shoulder, among which the most simple, minimally traumatic and most effective are the following:

• Kocher method. First, the doctor grabs the injured arm by the lower third of the shoulder and the wrist, bends it at a right angle at the elbow, and then, while pulling along the axis of the shoulder, presses it to the body. The assistant at the time of the movement must hold the person’s shoulder so that it does not rise. Then the doctor turns the forearm bent at the elbow outward, so that the elbow is directed towards the abdomen. After that, they again turn the arm so that the elbow is directed forward (in front of the stomach). At the end, the arm is again rotated so that the elbow is near the abdomen.
• Janelidze method. The person is offered to lie on the edge of the couch, table or bed, or sit on a chair so that the injured arm hangs freely from the edge down. In this position, a person should lie down for 10-15 minutes to relax the muscles, after which the doctor bends the arm at the elbow at a right angle and pulls it down, simultaneously pressing on the forearm and turning it alternately inward and outward.
• Mukhin-Mota method applicable for any type of dislocation. A person is seated on a chair or laid on a couch, after which the shoulder blade from the side of the damaged joint is tied with a towel to the back, throwing it over the armpit. Then the doctor bends the arm at the elbow and raises it to the side to shoulder level. In this position, the doctor gently pulls the arm along the axis of the shoulder, while gently shaking and rotating it from side to side.
• Hippocratic way. The person is laid on his back, the doctor grabs the hand on the side of the damaged joint by the hand and rests the leg on the armpit. Then, at the same time, he pulls the arm and pushes the head of the humerus with the heel towards the joint.

Shoulder dislocation reduction according to Kocher - video

Shoulder dislocation reduction according to Hippocrates - video

Shoulder dislocation dressing

After the dislocation is reduced, the arm in the position of abduction away from the body by 30-45 o must be fixed with a plaster cast according to Turner (Figure 3) or a scarf bandage (Figure 4). Before applying a bandage or splint, a cotton-gauze roller is inserted into the armpit.

Figure 3- Longueta according to Turner.

Figure 4- Bandage.

A longuet or kerchief bandage is applied for at least 4 weeks in adults and for 3 weeks in the elderly (over 65 years old) and children under 12 years old. Elderly people and children are advised to apply kerchief bandages instead of splints for 10 to 14 days.

After removing the splint or kerchief bandage, it is imperative to perform special exercises aimed at strengthening the joint and muscles, which will prevent shoulder dislocations in the future.

Habitual dislocation of the shoulder: causes, symptoms, tests, treatment (reduction), bandage - video

Surgical treatment of shoulder dislocation

In case of traumatic dislocation of the shoulder of any prescription, its conservative reduction is not always possible, and in this case, the doctor resorts to a surgical operation, which consists in opening the joint capsule, returning the bones to their place and subsequent stitching together the torn tissues. Such an operation is not difficult, but is performed only after an attempt at conservative reduction of the dislocation has not been successful.

A completely different type of surgery is the treatment of habitual joint dislocation, since in their course the surgeon has to re-form the normal joint capsule, matching the surfaces of the bones, removing inflamed tissues, fibrous cords and formed growths, and sewing together torn ligaments, tendons and cartilage.

Surgery to treat habitual dislocation of the shoulder

Surgery to treat habitual dislocation of the shoulder is aimed at addressing its cause. For example, if a person has a too large and stretched capsule of the shoulder joint, then it is partially excised and sutured. With stretched ligaments, they are shortened and new ones are formed from those available in the immediate vicinity. If there are fibrous bands and thickenings that do not allow the bones to come close enough to each other, the doctor will excise and remove them.

Most often, to eliminate habitual dislocation, operations on the shoulder capsule are used, during which excess tissues are removed, followed by corrugation and suturing. The second most popular is the operation to create new tendons and ligaments that strengthen the head of the humerus and prevent the joint from dislocating. In this case, the doctor cuts off small pieces of ligaments and tendons from closely spaced muscles and sews them to the necessary points in the shoulder joint.

The third common variant of operations for the treatment of habitual dislocation of the shoulder are the Eden or Andin techniques, based on giving the bones a new shape with numerous points of support that prevent the joint from dislocating.

Unfortunately, all operations for the treatment of habitual dislocation of the shoulder have disadvantages and the risk of recurrence, so each person must be mentally prepared for the fact that they will have to perform surgery more than once. The minimum number of recurrences was noted for the Boichev-M operation.

After a dislocated shoulder - rehabilitation

Rehabilitation after dislocation of the shoulder takes place over three stages, corresponding to a consistent change in treatment methods, and consists in performing certain exercises and physiotherapy procedures.

At the first stage, which continues during the first week after the reduction of the dislocation, it is necessary to perform the following rehabilitation actions:

• Limitation of any movements in the shoulder joint;
• Warming up the hands and wrists to ensure normal blood flow in them;
• Cold compresses on the joint for pain relief;
• Taking drugs from the group of non-steroidal anti-inflammatory drugs (Nimesulide, Ibuprofen, Diclofenac, etc.);
• Electrophoresis with Novocaine.

At the second stage rehabilitation, lasting from 2 to 4 weeks after the reign of dislocation inclusive, you must perform the following steps:

• Light and smooth warm-up movements with the shoulder;
• If during the warm-up movements the shoulder does not feel pain, then you can smoothly move the joint in different directions;
• After doing the exercises, it is recommended to apply cold to the joint.

At this stage, it is strictly forbidden to perform any combined movements, such as, for example, moving the arms forward, to the sides and back and turning the shoulder outward, as this can provoke a second dislocation.

The third stage of rehabilitation begins from 3 to 4 weeks after the reduction of the dislocation. It is during this period that the bandage or splint is removed and the following actions begin:

• Leading the arms to the sides;
• Smooth warm-up movements of the shoulder in different directions.

Exercises at the third stage should be aimed at restoring the full range of motion in the joint, so they begin to be performed after removing the splint or bandage and continue to be done for 2-3 months.

Rehabilitation after dislocation of the shoulder consists not only in performing a certain set of exercises aimed at strengthening the muscles and ligaments that hold the joint, but also in stopping the inflammatory process and providing conditions for the best and fastest restoration of the structure of damaged tissues. Therefore, in addition to exercises, it is recommended to conduct courses of the following types of physiotherapy rehabilitation:

• Galvanization of the muscles of the shoulder and forearm;
• Novocaine electrophoresis;
• Ozokerite;
• Laser therapy;
• Magnetotherapy.

The listed methods of physiotherapy can be used alternately or selectively on the recommendation of a rehabilitation doctor.

Exercises After a Dislocated Shoulder

A set of exercises is aimed at restoring circular movements and abduction of the shoulder, so they begin to perform it at the third stage of rehabilitation, that is, after removing the bandage or splint. It is recommended to select the complex individually, under the supervision of a physiotherapist, but you can also use the standard option, which includes the following exercises:

• Shrugs;
• Tilt the torso forward with simultaneous spreading of the arms to the sides;
• Raising the arms to the sides in a standing position;
• Raise your arms in front of you in a standing position;
• Abduction of arms bent at a right angle at the elbow to the sides;
• Leading the arms, bent at the elbow at a right angle, up;
• Rotation of hands forward;
• Hand rotation back.

Each exercise must be repeated 20 times. This complex should be performed every day for 2 to 3 months.

Dislocated Shoulder - First Aid

The dislocation must be corrected as soon as possible, but this should be done by a traumatologist or surgeon. Therefore, in case of dislocation of the shoulder, it is necessary to call an ambulance, or to deliver the injured person to the nearest medical facility using your own strength and means.

Until a person is delivered to a medical facility, first aid should be given to him, which, in case of shoulder dislocation, consists in immobilizing the joint with a scarf bandage. It is optimal to simply apply a kerchief, as shown in Figure 5.

Reset Shoulder Elbow Sprain Treatment at Home

After the joint has been set, you need to say goodbye to any physical activity. Immediately after a dislocation of the shoulder joint and surgery, it is strictly forbidden to strain your back, shoulders and arms. Any physical activity can lead to undesirable consequences. Professional athletes will have to say goodbye to big sport for six months.

First days after reposition

First of all, after reduction, a bandage is applied to fix the shoulder. This will provide peace and rest for the affected area, which will take at least a week. If complications are observed (problems with soft tissues, repeated dislocation or fracture), then the back, arm and shoulder will be immobilized for a longer period.

In the future, the doctor will tell you how to treat a dislocation of the shoulder node. The doctor may prescribe anti-inflammatory medications.

The return to normal physical activity should be carried out for a long time and systematically. This will protect the damaged parts of the body after a shoulder dislocation. At a certain point, you can use the expander and dumbbells: this will help develop the hand until you can fully use the arm after dislocating the shoulder joint. When receiving a dislocation of the shoulder, treatment is used, as a rule, varied, which largely depends on the degree of complexity of the injury.

Surgical intervention for dislocation of the shoulder joint

In the very first days, complications after dislocation of the shoulder joint can be detected. At this time, you need to perform a surgical operation. There are the following reasons:

• re-dislocation;
• fracture after shoulder dislocation;
• strengthening a loose joint to prevent re-dislocation;
• soft tissue injury after shoulder dislocation;
• damage to blood vessels after dislocation of the shoulder joint;
• tendon injury;
• damage to nerve endings.

The operation may be offered as one of the methods for strengthening the ligaments.

Medical treatment after shoulder dislocation

Since the victim experiences quite severe pain, it is first necessary to drink an analgesic (for example, Tempalgin). Further, during the process of repositioning the joint, it is necessary to give an antispasmodic to drink. Spazmalgon will do. This medicine will not only relax the muscles and remove the spasms that prevent the joint from being properly adjusted, but also anesthetize the affected area.

Among the relaxants for muscles after dislocation of the shoulder, the following medications are distinguished:

• Lorazepam;
• diazepam;
• Mindazolap.

As an anesthetic drug, you can use one of the following:

• fentanyl;
• morphine hydrochloride;
• Hydromorphone
• lidocaine (only in those rare cases when the pain is unbearable and other drugs do not help).

Stages of rehabilitation after dislocation

For each patient, the doctor prescribes certain exercises for muscle development and. The duration of the period of immobilization and the period of exercise therapy varies depending on the age, lifestyle of the patient and the severity of damage to the shoulder joint. Rehabilitation can take up to six months.

Physical therapy has the following positive properties:

• acceleration of the healing process of tissues;
• acceleration of the recovery process of the affected area;
• reduction of pain;
• reduction of puffiness;
• resorption of hematomas and improvement of the blood circulation process;
• improving the supply of oxygen to tissues;
• more rapid entry of drugs into the required areas.

During gymnastics, the splint or support bandage is removed.

The whole process of further treatment of shoulder dislocation after reduction can be divided into several stages:

The physical exercises used at each stage of rehabilitation contribute to the speedy recovery of the damaged shoulder joint and increase its motor activity.

Physiotherapy procedures during rehabilitation

In addition to exercise, massage and physiotherapy may be prescribed.

Physiotherapy useful in the rehabilitation process:

1. Cryotherapy - cold treatment of affected areas. The temperature should be around minus 30 degrees. Thanks to such cold compresses, blood circulation improves, the immune functions of the body increase, which help to heal the wound. Such a procedure is contraindicated if there are violations of peripheral vessels, because. spasm may occur, which will block the flow of blood through the body. This procedure is not recommended for children under five years of age.
2. Paraffin applications help warm damaged tissues. This leads to a decrease in swelling, improved blood circulation. With malignant tumors, kidney disease, blood diseases and infectious diseases, you should refrain from such procedures.
3. Diadynamic therapy is the use of currents with a frequency of up to 100 Hz to influence the human body. Such electric shocks affect the nerve endings and block pain sensations. Here is such an extraordinary pain reliever that can be used if drug treatment no longer helps. It is worth abandoning diadynamic therapy if pacemakers are installed in the victim's body, and there are also fatty deposits, abscesses, bleeding or epilepsy.
4. Inductotherapy is the use of a magnetic high-frequency field. It improves metabolism, has an anti-inflammatory effect. But with cancer, heart disease, tuberculosis, pregnancy and gastrointestinal diseases, it is better to abstain.
5. magnetic therapy. It removes pain and swelling, and also strengthens the body as a whole, improves metabolism. With bleeding, low blood pressure, with a tendency to form blood clots, with fractures, in the presence of implants, such procedures should be abandoned.

Many people believe that shoulder dislocation is not such a terrible disease and is treated with only one skillful reduction. But in fact, treating a dislocation of the shoulder joint is quite long and difficult. The recovery process cannot be ignored, otherwise it may threaten the incapacity of the back, arm or shoulder. Rehabilitation after a dislocation is a very long process, which can take up to six months.

Dislocation of the shoulder joint, the rehabilitation of which took place in full accordance with the requirements of the attending physician, is an ailment that is easily corrected.

First of all, after repositioning the joint, any physical activity is excluded. Arms, back and shoulders should not bear any load after the operation. Any stress on these parts will backfire. Athletes are prohibited from playing sports for about 6 months.

First days of rehabilitation

After repositioning the dislocation of the shoulder, a bandage is applied to the patient to immobilize the affected area. It should be worn for more than 1 week. If complications arise in the form of soft tissue problems, a fracture or repeated dislocation, fixation of the shoulder, arm and back is performed for a longer period.

The return to the usual physical activity should occur gradually and evenly. This will ensure the safety of damaged parts. To develop a brush, you can use dumbbells or an expander. Full-fledged work of the whole hand is prohibited.

Treatment for a dislocated shoulder depends on the severity of the injury.

Surgical intervention

It can happen that complications from a dislocated shoulder require surgery. The main reasons for the operation:

• damaged nerve endings;
• tendons are damaged;
• damaged blood vessels;
• soft tissues are damaged;
• fixation of the loose composition to prevent re-dislocation;
• fracture.

Surgery may be done to strengthen the ligaments.

Medications

The dislocation is accompanied by severe pain. To eliminate them, analgesics (Tempalgin) are prescribed. When reducing the dislocation of the shoulder, an antispasmodic (Spasmalgon) must be prescribed. It should relax the muscles and remove spasms for the correct reduction of the joint, additionally anesthetizes.

Relaxers can help treat a dislocated shoulder. Treatment after reduction may consist of the following drugs: Mindazolap, Diazepam, Lorazepam. During periods of exacerbation of pain, you can take Hydromorphone, morphine hydrochloride, Fentanyl, in rare cases, lidocaine.

Stages of recovery after a dislocation

The patient must perform certain exercises that develop muscles and joints. The duration of exercise therapy and immobilization will depend on the severity of the injuries, the age and lifestyle of the patient.

Do not neglect exercise therapy. It provides:

• removal of puffiness;
• improves blood circulation and resolves hematomas;
• reduces pain;
• restores the affected area;
• leads to rapid healing of tissues;
• increases the supply of oxygen to the affected areas;
• speeds up the delivery of drugs to the desired area.

During exercise therapy, the bandage or splint is removed.

Subsequent treatment is divided into the following stages:

• Ensuring immobility of the affected area of ​​the body. This reduces pain, prevents fracture and dislocation. This stage lasts about a week. With injuries, the time of immobilization of the shoulder increases. The doctor may prescribe anti-inflammatory drugs. It is allowed to apply ice with severe pain and swelling. Perform simple exercises for the wrist and hand: rotation of the hand, squeezing the fingers. They will keep the muscles in good shape and increase blood circulation.
• Creation of the primary activity of the shoulder area. Within a month, the shoulder joint is gradually developed in the absence of any pain in the damaged area. Exercises are chosen simple for the development of mobility. Compound movements are strictly prohibited, as the probability of re-dislocation is high. Apply ice if swelling occurs.
• Muscle strengthening and development of shoulder, arm and back mobility. The duration of the stage is 1-1.5 months. With good health, refuse the fixing bandage. You can perform some strength exercises and statistical loads.
• At this transitional stage, measures are taken to bring the diseased joint to the level of a healthy one. Duration more than 2 months. If you neglect the recommendations of this period, then there is a high probability of re-dislocation after a while.
• The longest and most important period of rehabilitation. It will ensure proper recovery and preservation of the result. To develop and strengthen muscles, strength exercises are performed with dumbbells. Functional training of the back, shoulder and arm is allowed. The load should increase gradually.

Physical exercise at each stage will speed up recovery and increase the motor activity of the damaged parts.

Physiotherapy

During the rehabilitation period, the following will be useful:

• cryotherapy - the affected areas are treated with cold at minus 30 degrees;
• paraffin applications warm the affected areas, reducing swelling and increasing blood circulation;
• diadynamic therapy - electric shocks up to 100 Hz, which block pain and affect the nerves;
• inductotherapy - treatment with a magnetic high-frequency field;
• magnetic therapy reduces pain and swelling, improves metabolism in the body.