How long does it take to treat a dislocated shoulder? Shoulder dislocation what to do. These materials will be of interest to you

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 tissue healing;
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.

The shoulder joint is the most mobile in the human body. All types of movements are possible in it: flexion-extension, abduction-adduction, supination-pronation, rotation. The payoff for such freedom of movement is the significant “fragility” of this joint. This article will focus on the most common injury that awaits athletes who systematically overload the shoulder joints. This is a dislocated shoulder. In addition to the injury itself, we will touch on the issues of anatomy, biomechanics, first aid and, most importantly, preventive measures.

Shoulder Anatomy

The shoulder joint is directly formed by the head of the humerus and the glenoid cavity of the scapula. The articular surfaces of the indicated bones do not have absolute congruence. Simply put, they are not perfectly adjacent to each other. This moment is compensated by a large formation called the articular lip. This is a cartilaginous body adjacent, on the one hand, to the articular cavity of the scapula, on the other, to the head of the humerus. The area of the articular lip is much larger than that of the articular surface of the scapula, which ensures a greater fit of the articulating surfaces inside the joint. Directly the head of the humerus and the articular cavity of the scapula are covered with hyaline cartilage.

Articular capsule and clavicle

From above, the described structure is covered with a thin joint capsule. It is a sheet of connective tissue covering the anatomical neck of the humerus on one side, and the entire circumference of the glenoid cavity of the scapula on the other. Fibers of the coracobrachial ligament, the tendons of the muscles that form the so-called rotator cuff of the shoulder, are also woven into the tissue of the capsule. These include the infraspinatus, supraspinatus, teres major, and subscapularis muscles.

These elements strengthen the shoulder capsule. The muscles that make up the rotator cuff provide a certain range of motion (read more about this below). Together, this formation limits the immediate cavity of the joint.

The clavicle also plays an important functional role in the structure of the shoulder joint. Its distal end is attached to the acromion or acromial process of the scapula. When the shoulder is abducted above an angle of 90 degrees, further movement occurs due to the mutual movement of the clavicle, the lower pole of the scapula and the chest. Looking ahead, we also say that the main muscle that serves the shoulder joint - the deltoid - is attached to the described anatomical complex.

Rotator muscles

The condition of the muscles surrounding it is important for the health of the joint. (This statement applies to all joints of the human body, not only to the shoulder). We repeat that the muscles serving the shoulder joint are located, so to speak, in two layers. The already mentioned muscles - rotators - belong to the deep:

infraspinatus - is located on the body of the scapula, as it is not difficult to guess from the name, under its axis and is responsible for the supination of the shoulder;
supraspinatus - located above the axis, participates in the abduction of the shoulder from the body. The first 45 degrees of abduction are performed mainly due to the supraspinatus muscle;
subscapular - located on the anterior surface of the body of the scapula (between the scapula and the chest) and is responsible for performing supination of the head of the humerus;
large round - runs from the lower pole of the scapula to the head of the humerus, is woven into the capsule by the tendon. Together with the infraspinatus muscle, it performs pronation of the shoulder.

Moving muscles

Above the joint capsule are the tendons of the biceps and triceps muscles of the shoulder. Since they are thrown over the head of the humerus, attaching to the acromial process of the scapula, these muscles also provide certain movements in the shoulder joint:

biceps flexes the shoulder, bringing the body of the humerus at 90 degrees to the upper shoulder girdle;
triceps, together with the posterior head of the deltoid muscle, unbends the shoulder, retracting the body of the humerus back relative to the body of the scapula;

It is impossible not to mention that the large and small pectoral muscles and the latissimus dorsi muscles are also attached to the articular tubercles of the humerus, providing appropriate movements:

the large and small pectoral muscles - are responsible for bringing the humerus bones to each other;
the latissimus dorsi muscles ensure the movement of the bodies of the humerus downwards in the frontal plane.

The deltoid muscle is directly responsible for movement in the shoulder joint. It has the following attachment points:

axis of the scapula - the point of origin of the posterior portion of the deltoid muscle;
acromion - attachment point of the middle portion of the deltoid muscle;
the acromial end of the clavicle is the point of attachment of the anterior portion of the deltoid muscle.

Each portion, in fact, performs a different function, however, balanced movements in the shoulder joint require the coordinated work of all three “bundles”. This is emphasized by the fact that all three bundles of the delta converge into a single tendon, attached to the deltoid tuberosity of the humerus.

A large volume of these muscles provides an appropriate range of motion. However, in practice they are the "basis" of the joint. The shoulder does not have a reliable bone structure, which is why during sports activities, especially when performing amplitude movements, the shoulder joint is injured.

The mechanism of injury

Dislocation of the shoulder is the displacement of the head of the humerus relative to the glenoid cavity of the scapula. According to the direction of displacement, several types of shoulder dislocation are distinguished.

Anterior dislocation

This type of injury occurs most easily, since it is the posterior pole of the humerus capsule that is least strengthened by tendons and ligaments. In addition, the posterior portion of the head of the deltoid muscle must provide stability. However, it is not sufficiently developed among the vast majority of the inhabitants, and athletes are no exception here.

This injury can occur under the action of a jerking effect on the limb - when doing martial arts, performing elements on the rings, or on the uneven bars, the starting point for entering the handstand. Anterior dislocation is also possible due to a blow to the shoulder joint area - when doing shock martial arts (boxing, MMA, karate), or when landing, after performing a jumping element (workout, parkour).

Posterior dislocation

Posterior shoulder dislocation a c it does not happen as often as the front one, but, nevertheless, quite often in percentage terms. In this case, the head of the humerus is displaced to the rear of the glenoid cavity of the scapula. As you might guess, such a displacement of the head of the shoulder occurs with an injury to the anterior pole of the capsule of the shoulder joint. Most often, the shoulder is in the flexion position, the arms are exposed in front of you. Impact occurs in the distal part of the hand. In other words, in the palm of your hand. Such an impact is possible when falling on outstretched arms, for example, with insufficient technical performance. Or with an incorrect distribution of the weight of the bar when performing a bench press.

lower dislocation

With inferior dislocation, the head of the humerus is displaced under the glenoid cavity of the scapula. This type of injury is not common and occurs when the hand is raised up. Such an injury is possible when performing the “flag” exercise, when walking on the hands, jerking and pushing. A jerk and a push, in this case, are the most traumatic, since the shoulders are in an anatomically unfavorable position, and the load is vertical.

Habitual dislocation

There are other types of dislocations of the shoulder joint, however, they, in essence, are combinations of the varieties of the injury described above.

The most unpleasant consequence of shoulder dislocation is its chronicity - the formation of a habitual dislocation. This condition is characterized by the fact that any minimal impact on a previously affected joint is enough to cause a full dislocation. Most often, this pathology develops with improper treatment of the primary dislocation of the shoulder.

Signs and symptoms of a dislocation

The following unpleasant symptoms speak of injury to the shoulder joint, namely, dislocation:

Sharp pain in the area of the damaged joint, accompanied by a kind of "wet crunch".
Inability to make active movement in any of the axes of mobility of the shoulder joint.
Characteristic displacement of the head of the humerus. In the deltoid region, the acromial process of the clavicle is determined, under it is a “hollow”. (In a lower dislocation, the arm remains raised up, the head of the humerus can be felt in the chest area, under the armpit). The area itself, compared to healthy, looks "sunken". In this case, the affected limb becomes relatively longer.
Swelling of the area of the affected joint. It develops due to traumatic damage to the vessels surrounding the joint area. The spilled blood impregnates the soft tissues, sometimes forming a rather large hematoma, which brings additional pain. Moreover, you will not see the "blue" of the deltoid region immediately after the injury - the subcutaneous vessels are damaged extremely rarely, and the visible hematoma is characteristic only for the direct injury of the indicated vessels.

First aid for dislocated shoulder

No need to try to straighten your shoulder yourself!!! In no case! Unskillful attempts to self-adjust the shoulder lead to injuries of the neurovascular bundle and serious ruptures of the shoulder capsule!

First you need to fix the limb, ensuring its maximum peace and limitation of mobility. If there is an anesthetic (analgin, ibuprofen or diclofenac and the like), it is necessary to give medicine to the victim in order to reduce the severity of the pain syndrome.

In the presence of ice, snow, frozen dumplings, or vegetables, it is necessary to apply an existing source of cold to the damaged area. The entire deltoid region should be in the "cooling" zone. Thus, you will reduce post-traumatic edema in the joint cavity.

Next, you need to immediately deliver the victim to a medical institution where there is a traumatologist and an X-ray machine. Before reducing the dislocation, it is necessary to take a picture of the shoulder joint in order to exclude a fracture of the body of the humerus and scapula.

Dislocation treatment

As for how to treat a dislocated shoulder, we will give only a few general tips, since self-medication in this case can be very dangerous. The treatment process includes several stages:

reduction of dislocation by a qualified traumatologist. Better under local anesthesia. Ideally, under anesthesia. Pain relief provides relaxation of muscles that spasm in response to injury. Thus, the reduction will be quick and painless.
immobilization and ensuring complete immobility of the shoulder joint. The term of immobilization is 1-.5 months. During this period, we are trying to achieve maximum healing of the shoulder capsule. For this purpose, in this period, a variety of physiotherapy is prescribed, which helps to improve the blood circulation of the affected joint.
rehabilitation.

We will talk in more detail about the rehabilitation stage for a dislocated shoulder later.

Rehabilitation

It is necessary to expand the range of motion, immediately after the removal of immobilization, gradually. Despite the fact that the connective tissues have grown together, the muscles have weakened during immobilization and cannot provide proper stability to the joint.

First stage of recovery

In the first three weeks after removing the fixing bandage, kinesiotape can become a reliable help, activating the deltoid muscle and thereby increasing the stability of the joint. In the same period, all possible bench presses and thrusts should be excluded. Of the available exercises, the following remain:

Abduction of a straight arm through the side. The body is fixed in a standing position. The shoulder blades are brought together, the shoulders are divorced. Very slowly and under control, we move the arm through the side at an angle of no more than 90 degrees. We also slowly return it to its original position.
P ronation-supination of the shoulder. The elbow is pressed to the body, the arm is bent at the elbow joint at 90 degrees. The humerus is in place, only the forearm moves. Alternately we lead and take it away, with a dumbbell clamped in the brush, to the left and to the right. The amplitude is minimal. The exercise is performed until there is a feeling of warmth, or even zhenya in the nutria of the shoulder joint.
WITH bending of the arms in the simulator, excluding the extension of the injured arm. Such, for example, is a block simulator with a built-in Scott bench.
R extension of the arms in a simulator that imitates the French bench press, the humerus in relation to the body should not be displayed at an angle of more than 90 degrees.

The weight of the weights is minimal; when performing them, you need to concentrate on the muscle feeling. Barbells and dumbbells of moderate and heavy weight at this moment are completely prohibited.

Second phase

Three weeks after the removal of immobilization, you can turn on the lifts in front of you and the wiring in the slope, to include the anterior and posterior portions of the deltoid muscle, respectively.

We begin to perform the wiring through the sides in two versions: with small dumbbells and extremely clean technique - to strengthen the supraspinatus muscle, and with slightly heavier dumbbells (better - in the simulator, but it may not be available in your gym) to influence the middle portion of the deltoid muscle.

Thus, you need to train for another three weeks. And only after this period, you can carefully return to the usual training regimen, gradually including bench press and traction movements in the training program. Better - in simulators, with moderate or even small weights.

Third stage

After the four-week phase, you can move on to working with free weights. It is better to start with a barbell, and only after that proceed to work with weights and dumbbells. After mastering the movements with them, you can again begin to work with your own weight.

Shoulder dislocation prevention consists in the systematic strengthening of the rotator cuff muscles with the help of the exercises described in the first stage of rehabilitation, and work with each muscle bundle separately. Particular attention should be paid to the posterior portion of the deltoid muscle, which is responsible for the stability of the posterior pole of the shoulder joint capsule.

You should never start training deltas with heavy weights and bench presses / D As a warm-up, it is very useful to pump each bundle separately, perform exercises for the rotator cuff.

Injury exercises

As it is not difficult to understand from what was written above, the most traumatic exercises in crossfit are gymnastic elements performed on the rings and on the uneven bars, snatch, push and exercises leading to them, walking and handstand.

However, no exercise will harm you if you approach your studies in a reasonable and balanced way. Avoid unilateral loads, develop your body harmoniously and be healthy!

Article publication date: 05/31/2016

Date of article update: 12/05/2018

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

Gradation by category	Types of dislocations
Regarding the time of purchase	Congenital
Regarding the time of purchase	Acquired
Acquired dislocations are divided according to the causes of occurrence	Traumatic (primary)
	Habitual (non-traumatic, due to insufficient strengthening of the tendons of the shoulder after traumatic dislocation)
	Pathological (occurring against the background of tumors or any diseases)
	Arbitrary (occurs spontaneously when performing ordinary activities)
According to the localization of the displacement of the head of the shoulder	Anterior (the head is displaced forward, going under the coracoid process of the scapula - subclavicular dislocation, under the collarbone - subclavian)
	Lower (displacement of the head of the bone down) Rear (shift back)

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)

Causes	Specific pathologies or diseases
	Fracture of the glenoid cavity, head of the bone, coracoid and other processes of the scapula
	Fall on the outer side of the outstretched arm
Congenital anomalies in the development of the articular elements of the shoulder joint	Underdeveloped lower glenoid cavity, rotator cuff weakness, and other defects
Joint capsule stretching	Monotonous daily repetitive movements in the shoulder joint at the limit of its capabilities (typical for athletes, tennis players, swimmers)
Generalized hypermobility is an abnormal increase in the range of motion in a joint due to weakening of the muscles and ligaments that fix it. Excessive mobility of the shoulder joint is characteristic of 10-15% of the inhabitants of the planet
Joint diseases	Arthritis, arthrosis
Systemic and other diseases	Tuberculosis, osteomyelitis, osteodystrophy, osteochondropathy

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.

Shoulder Dislocation Causes

The shoulder joint of the arm is one of the most mobile, so shoulder dislocation injury is extremely common. Dislocations are congenital and acquired. Acquired dislocation often occurs during training and games - bench presses, pull-ups, ball hits, however, the main causes of injury are:

force impact in the shoulder area;
falling on an outstretched hand;
twisting the arm with force.

The most dangerous thing about this injury, according to doctors, is that a small amount of force is enough to dislocate the shoulder. In some cases, the likelihood of injury increases many times, for example, with habitual dislocation, joint diseases. In adolescence, the shoulder joint may be in a "loose" state due to the physiological characteristics of this period. In all these cases, it is necessary to avoid dangerous situations and prevent falls and other accidents.

Shoulder dislocation - symptoms

A dislocated shoulder is so uncomfortable that it is impossible to ignore the injury, unlike, for example, some types of fractures, with which people can walk for several days without resorting to the help of a doctor. The main signs of a dislocated shoulder are:

severe pain syndrome, with damage to the nerves and blood vessels - tingling, numbness, bruising and swelling in the affected arm;
the shoulder joint looks and feels unnatural to the injured - it sticks out, drops, etc., often the injured person holds his hand like a baby.

First aid for dislocated shoulder

Adequate first aid for a dislocated shoulder injury is a guarantee of a successful recovery without complications. An ordinary person should not try to set the joint in place on his own - this requires skills that only a traumatologist has, so the victim must be sent to the hospital. Before transportation, it is necessary to fix the arm so that the shoulder does not move. If possible, it is desirable to make a cold compress. Immobilization for shoulder dislocation (depending on the complexity) should last from 1 to 4 weeks, otherwise the dislocation may become habitual.

How to correct a dislocated shoulder?

Shoulder dislocation is reduced in a variety of ways - at one time Hippocrates, Meshkov, Dzhanelidze and other doctors who proposed their own methods dealt with this problem. Before starting the procedure, anesthesia is required. In uncomplicated trauma, a non-narcotic analgesic and novocaine or lidocaine are injected into the affected area. In case of a complex injury (with tissue damage and fractures), the patient is given general anesthesia before manipulation.

One of the less traumatic and most effective is the reduction of shoulder dislocation according to Kocher. With this method, the traumatologist performs a series of sequential actions:

takes a hand by the wrist and the lower third of the shoulder;
bends the arm at the elbow at a right angle;
pulls a hand along the axis of the shoulder and at the same time presses it to the body;
turns the arm so that the elbow is turned into the stomach;
turns the arm forward (elbow in front of the stomach);
turns again so that the elbow is near the stomach.

How to correct a dislocated shoulder on your own?

In emergency cases, the question may arise how to correct a dislocated shoulder on your own. If it is not possible to resort to qualified medical assistance, you can try to carry out the manipulation developed by Hippocrates. The patient should be laid on the couch on his back, grab the injured hand by the hand, and rest his leg against the armpit of the victim. The shoulder dislocation is reduced by simultaneously pulling the arm and pushing the head of the humerus with the heel into the joint. The correctness of the procedure is controlled by radiography.

Shoulder dislocation - treatment

Light dislocations, not accompanied by fractures and damage to nerves, blood vessels, muscles and skin, after the establishment of the humerus in the anatomical position, require only a period of rest. During this time, the joint capsule, muscles and ligaments return to normal, and after the removal of the plaster splint, the habitual dislocation does not occur. The problem of how to treat shoulder dislocation arises in complex, old and habitual dislocations.

To speed up the healing of injuries, relieve swelling and restore joint mobility due to shoulder dislocation during and after immobilization, the following procedures can be used:

therapeutic massage;
magnetotherapy;
infrared irradiation;
microwave, UHF therapy;
medicinal electrophoresis;
paraffin applications.

Shoulder dislocation surgery

Surgical interventions for a shoulder joint injury are required when it occurs. The Laterjet operation for dislocations of the shoulder is prescribed for erasing the bone that forms the edge of the glenoid cavity. This surgery helps to avoid re-injuries, and it consists in replenishing the missing bone mass.

Shoulder dislocation surgery is also needed for:

impossibility to correct the joint by a conservative method;
the need to form a normal joint capsule due to stretching, ruptures;
the appearance of inflamed, fibrous tissues, growths and other formations;
ruptures of ligaments, cartilage, tendons that need to be stitched.

Habitual dislocation of the shoulder - treatment without surgery

Treatment of shoulder dislocation without surgery, if the injury has become habitual, is unrealistic. Ointments for shoulder dislocation, as well as other drugs with local action (creams, gels), only reduce the severity of symptoms. To increase shoulder stability, strengthen ligaments and cartilage, the following medicines are used:

Anti-inflammatory nonsteroidal drugs(Diclofenac, Ketorolac, Ketoprofen, Indomethacin; Piroxicam).
Chondroprotectors(Don, Teraflex, Alflutop, Artra, Chondrolon, Elbona).
Vitamin and mineral complexes(ArtriVit, Orthomol Artro plus, SustaNorm, Collagen Ultra).

How to treat a dislocated shoulder at home?

After reduction of the dislocation in the hospital, it is necessary to continue treatment at home. What to do if you dislocate your shoulder

After applying a plaster splint, the hand should be completely at rest.
In the presence of inflammation or pain syndrome - take prescribed medications, go to physiotherapy.
Strengthen bones and joints by taking vitamin and mineral complexes, chondroprotectors.
After removing the cast, carefully develop the arm and shoulder.

Shoulder dislocation - folk remedies

Numerous folk remedies for shoulder dislocation are effective in relieving inflammation and painkillers.

With swelling of the joint, an alcohol compress helps well. Gauze is moistened with vodka or alcohol diluted in half, applied to the joint and covered with compress paper and a towel. Hold the compress for 30 minutes.
To speed up the healing of the joint, traditional medicine recommends warm milk compresses. The gauze folded 4 times is moistened with warm milk and applied to the shoulder joint, wrapping the compress with a film and a towel on top. Change the compress after cooling, repeating the procedure for 30 minutes.

A decoction of wormwood (or tansy) for severe pain

Ingredients:

fresh leaves of wormwood (or tansy);
0.5 l of water.

Preparation and consumption

Pour the raw material with water and boil for about 20 minutes.
Moisten gauze with cooled broth, apply a compress to the joint.
Wet gauze as it warms up. The duration of the procedure is 20-30 minutes.

Shoulder dislocation - consequences

the occurrence of habitual dislocation;
degenerative changes in the joint;
damage to peripheral nerves, which leads to a decrease in arm mobility, sensitivity disorders.

Exercises After a Dislocated Shoulder

The fastest recovery after a shoulder dislocation necessarily includes physical exercises, and the longer the immobilization lasted, the more important this stage of rehabilitation is. Exercises after a shoulder injury are aimed at increasing mobility. For the best effect, you need to start with the most simple exercises and a small number of repetitions. After strengthening the muscles, you can add repetitions and introduce a load. At the first stage, you can:

bend and unbend the elbow and fingers of the injured hand;
perform rotational movements with a small amplitude, take the arm to the side;
raise a sick hand, insuring her healthy.

The purpose of the following exercises is to form a strong muscular corset around the damaged joint.

Sitting on a hard chair, place your hands on your waist, spread your elbows in opposite directions. Raise your shoulders as high as possible, pulling your head in, then slowly lower them.
Sitting on a chair, press your back against the back. Place your palms on your waist, spread your elbows. Make slow movements with your shoulders back and forth to the maximum possible level.

At the next stage (after 1-2-3 months after immobilization due to well-being), you can proceed to more complex exercises, including swings with a wide amplitude, training with a load. The third set of exercises helps to build strength in the deltoid, biceps and triceps, which in turn restores stability to the joint and minimizes the possibility of relapses.

With a dislocation of the shoulder joint, the doctor may order a CT scan in the following cases:

if radiography does not accurately determine the extent of joint damage;
if a fracture of the humerus or scapula is suspected, which are not displayed on a conventional radiograph;
with suspicion of damage to the vessels of the shoulder ( CT with contrast);
when planning shoulder surgery.

Magnetic resonance imaging ( MRI)

Magnetic resonance imaging is a modern high-precision method for studying the internal organs and tissues of the body, which is considered absolutely safe and harmless to humans. The procedure itself is identical to computed tomography, but unlike CT, where X-rays are used to obtain an image, MRI uses the effect of nuclear magnetic resonance, which allows you to get more accurate images of soft tissues, ligaments, cartilage surfaces, joint capsules, blood vessels. The main advantage over CT is the complete absence of radiation, so the only contraindication for MRI is the presence of metal parts in the patient's body ( implants, metal fragments after injuries).

Indications for MRI with dislocation of the shoulder joint:

clarification of the results of conventional radiography in the presence of contraindications to CT;
doubtful data obtained from CT;
determination of the volume of damage to periarticular tissues ( rupture of the joint capsule, ligaments, muscles);
for the diagnosis of compression of the vessels of the shoulder ( no contrast needed).

Ultrasonography ( ultrasound) shoulder joint

Ultrasound is a modern, safe examination method based on the use of ultrasonic waves. This study is usually ordered when fluid accumulation is suspected ( blood) in the cavity of the shoulder joint. However, according to ultrasound data, the nature of the lesion of periarticular tissues can also be determined ( ruptures of the capsule, ligaments, muscles), and when using ultrasound in Doppler mode ( a mode that allows you to judge the speed and quality of blood flow) the presence and degree of compression of the shoulder vessels can be determined.

First aid for suspected shoulder dislocation

First aid for suspected dislocation of the shoulder should be to limit movements in the area of the damaged joint, eliminate the traumatic factor, and seek medical help in a timely manner.

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

ensure complete rest of the joint ( stop all movement);
apply ice or any other cold ( reduces inflammation and tissue swelling);
call an ambulance.

It is highly not recommended to correct a dislocated shoulder on your own, since, firstly, it is extremely difficult to do this without proper qualifications, and secondly, this can lead to damage to nearby muscles, nerves and blood vessels.

Do I need to call an ambulance?

If you suspect a dislocation of the shoulder joint, it is recommended to call an ambulance, since, firstly, the ambulance doctor can relieve the pain of the victim, and secondly, it can eliminate some serious complications. However, provided there are no signs of damage to the nerves or blood vessels, you can do without calling an ambulance. However, it should be understood that the treatment of dislocation can only be carried out in a medical institution and only by qualified personnel. Thus, if after an injury that caused a dislocation of the joint, the patient's condition is stable and an ambulance was not called, you should contact the local trauma center as soon as possible. It should be borne in mind that the sooner the dislocation is reduced, the higher the chances of a full restoration of joint function.

What is the best position for the patient?

The victim must provide maximum rest to the damaged joint. This is achieved by positioning the free upper limb in the abduction position ( posterior dislocation adduction). At the same time, the forearm is bent at the level of the elbow and rests on a roller pressed against the side of the body. In this case, to ensure complete immobility, it is recommended to use a bandage that supports the arm ( a triangular kerchief into which the forearm is placed and which is tied around the neck).

It is not recommended to lean or rest on the injured shoulder or free upper limb, as this can provoke even greater displacement of the articular surfaces, rupture of the ligamentous apparatus and damage to the vascular bundle.

Is it necessary to give pain medication?

Self-administration of medications is not recommended, however, if it is impossible to get prompt medical care, the victim can take some painkillers, thereby reducing negative experiences from pain. In most cases, non-steroidal anti-inflammatory drugs should be used, which, due to their effect on the synthesis of certain biologically active substances, can reduce the intensity of pain.

You can take the following drugs:

paracetamol at a dose of 500 - 1000 mg ( one or two tablets);
diclofenac in a daily dose of 75 - 150 mg;
ketorolac at a dose of 10 - 30 mg;
ibuprofen in a daily dose of up to 1200 - 2400 mg.

Applying ice to the affected joint can also reduce pain.

Shoulder dislocation treatment

How is a dislocation reduced?

There are more than 50 ways to reduce a dislocated shoulder. Regardless of the chosen reduction technique, the patient needs sedation ( drug sedation) and anesthesia, which are achieved by introducing 1-2 ml of a 2% solution of promedol intramuscularly and intra-articular injection of 20-50 ml of a 1% solution of novocaine. Thanks to the action of these drugs, partial muscle relaxation is achieved, which facilitates reduction and eliminates the risk of damage to tendons and muscles.

In trauma practice, the following methods of reduction of shoulder dislocation are used:

Reduction according to Dzhanelidze. The classical method of Janelidze is based on the gradual relaxation of the muscles. It is the least traumatic and therefore the most preferred in modern traumatology. The patient is placed in the supine position on a flat horizontal surface ( couch, table), so that the dislocated limb hangs down from the edge of the table. A sandbag or towel is placed under the shoulder blade to ensure its tighter fit to the surface. The patient’s head is held by an assistant, but you can do without him by placing the victim’s head on a small table, bedside table or a special Trubnikov tripod. After about 15-25 minutes, novocaine blockade relaxes the muscles of the shoulder girdle and, under the influence of gravity, the head of the humerus approaches the glenoid cavity of the scapula. In some cases, reduction may occur on its own. If this does not happen, the traumatologist takes a position in front of the patient, bends his hanging arm in the elbow joint at an angle of 90 degrees, with one hand presses down on the forearm in the area of the elbow bend, while with the other hand, covering the patient’s forearm at the hand, rotates in the shoulder joint outward and then inward. The moment of reduction is accompanied by a characteristic click.
Reduction according to Kocher. This method is more traumatic than the previous one and is used for anterior dislocations of the shoulder in physically strong individuals, with stale dislocations. The patient is in the supine position. The traumatologist grabs the limb by the lower third of the shoulder at the wrist joint, bends it at the elbow joint to an angle of 90 degrees, and carries out traction along the axis of the shoulder, bringing the limb to the body. The assistant at this time fixes the patient's shoulder girdle. While maintaining traction along the axis of the shoulder, the traumatologist brings the elbow as far forward and medially as possible, and then, without changing the position of the limb, rotates the shoulder inward, while the hand of the injured limb moves to a healthy shoulder joint, and the forearm lies on the chest. When the dislocation is reduced, a characteristic click is felt. After that, a plaster splint is applied with a hanging bandage and a gauze roller. After removing the splint, the patient is prescribed a physiotherapy complex of exercises in order to restore the tone of the muscles that fix the articular bag.
Reduction according to Hippocrates. This method is considered the most ancient and simple, along with the Cooper method. The patient is in the supine position. The traumatologist sits or stands facing the patient from the side of the dislocation and grabs the forearm in the area of the wrist joint with both hands. The doctor places the heel of his open leg, the same name as the victim's dislocated arm, in his armpit and presses on the head of the humerus that has shifted into it, simultaneously stretching the arm along the axis. The displaced head of the humerus is reduced into the articular cavity. Traction ( tension) is made along the body.
Cooper method. The patient is in a sitting position on a stool or a low chair. Putting his foot on the same stool or chair, the traumatologist puts his knee into the armpit, the dislocated arm is captured with both hands in the wrist area, the shoulder is simultaneously traction down and the dislocated head of the humerus is pushed up with the knee.
Chaklin method. The patient is in the supine position, the traumatologist grabs the outer third of the pre-bent forearm with one hand and abducts and tractions the limb along its axis, with the other hand, pressure is applied to the head of the humerus in the axillary fossa.
Shulyak method. Produced by two traumatologists. The patient is in the supine position. The first of them rests his forearm against the lateral surface of the chest so that his fist looks into the axillary region and comes into contact with the dislocated head of the humerus, and the second traumatologist performs traction while bringing the arm to the body. The emphasis of the head in the fist and the adduction of the limb creates a lever that promotes reduction.

Do I need to immobilize the hand after reduction?

After reduction for 3 weeks, immobilization is necessary ( immobilization) of the injured limb, in order to minimize movement in the affected joint and thus provide complete rest and optimal conditions for healing and recovery. Without proper immobilization, the healing process of the joint capsule and ligamentous apparatus can be disrupted, which is fraught with the development of habitual dislocations.

In the presence of associated fractures of the humerus, clavicle, or scapula, much longer immobilization may be required ( from 2 - 3 weeks to several months), which will depend on the type of fracture, the degree of displacement of bone fragments, and also on the way these fragments are compared ( surgical or conservative).

Surgical treatment of dislocation of the shoulder joint

The main indication for surgical intervention is the formation of habitual dislocation or chronic instability of the head of the humerus. In connection with repeated and habitual dislocations, the joint capsule is stretched, hypermobility and instability appear. The pockets formed in the capsule become habitual places for the head of the shoulder to slip off.

Surgical treatment has the following goals:

restoration and strengthening of the ligamentous apparatus;
comparison of the articular cavity of the scapula with the head of the humerus;
elimination of the habitual dislocation of the shoulder.

For surgical treatment of shoulder dislocation, the following types of operations are used:

Operation Turner. The Turner operation is a minimally invasive operation, that is, it is performed by introducing a special optical instrument and a number of small manipulators into the joint area through several small skin incisions. The meaning of the operation is to excise the elliptical flap of the capsule in the region of the lower pole, followed by tight suturing of the articular capsule. The operation is complicated by the proximity of the neurovascular bundle. The main advantage of this operation is minimal injury to soft tissues, a relatively small cosmetic defect ( a small, barely noticeable scar forms in the incision area) and rapid recovery after the intervention.
Operation Putti. The Putti operation is more traumatic than the Turner operation, but it is used in the absence of the necessary equipment, as well as in the need for wider access in the presence of associated injuries. With this intervention, a T-shaped incision is made to access the shoulder joint, followed by dissection of a number of muscles. During the operation, the capsule is sutured, which significantly strengthens it. The operation is extremely traumatic and requires a long recovery period.
Operation Boychev. Boychev's operation is in many ways similar to Putti's operation. It also involves a wide T-shaped incision of the skin, followed by dissection of the underlying muscles. However, with this intervention, the joint capsule is sutured after the preliminary removal of a small triangular fragment - this allows not to increase the thickness of the capsule.
Operation Bankart. The Bankart operation is a minimally invasive operation during which a special instrument is inserted into the joint cavity ( arthroscope), which stabilizes the shoulder joint. Thanks to this intervention, it is possible to achieve a comprehensive elimination of several factors that implement dislocation of the head of the humerus and recovery in the shortest possible time. However, due to the lack of necessary equipment and sufficient qualifications of doctors, this operation is not widely used in modern traumatology.

The duration of the recovery period after surgery depends on the volume and type of surgery, the age of the patient, and the presence of concomitant pathologies. On average, recovery after surgical treatment takes from one to three to six weeks.

Therapeutic exercises after reduction of dislocation

Immediately after reduction of the dislocation for 4-6 weeks, immobilization of the shoulder joint is indicated using a special bandage ( Deso bandage). During this time, movements in the shoulder joint should be avoided, however, in order to prevent atrophy of the muscles of the arm and to improve blood circulation in the relevant area, some light exercises with movement in the wrist are recommended.

Within a month after the reduction of the dislocation, it is recommended to practice the following exercises:

brush rotation;
clenching fingers into a fist without load ( exercises with a carpal expander can provoke muscle contractions in the shoulder area with a violation of the immobilization regimen);
static contraction of the shoulder muscles ( a short tension of the biceps, triceps muscles of the shoulder, as well as the deltoid muscle, improves blood circulation and maintains tone).

Starting from 4-5 weeks after the reduction of the dislocation, when the articular bag and ligaments of the shoulder have partially restored their integrity, the bandage is removed for the duration of the session, and the patient begins to perform a series of movements in the shoulder joint. Initially, these movements may be passive in nature ( carried out with the help of another limb or by a doctor), but gradually become active.

4 to 6 weeks after the reduction of the dislocation, the following exercises are recommended:

joint flexion ( forward shoulder movement);
joint extension ( back shoulder movement).

These gymnastic exercises should be repeated 5-6 times a day for half an hour at a slow pace. This allows you to restore the function of the joint in the most sparing and optimal mode and ensure the most complete restoration of the ligamentous apparatus.

5-7 weeks after the reduction of the dislocation, the immobilizing bandage is removed completely. At this stage, the importance of therapeutic exercises is extremely high, since properly selected exercises allow you to restore joint mobility without the risk of damage to the joint capsule, muscles and ligaments.

The task of therapeutic exercises in the period of joint recovery is:

restoration of range of motion in the shoulder joint;
strengthening of muscle structures;
elimination of adhesions;
joint stabilization;
restoration of the elasticity of the joint capsule.

To restore joint mobility, the following exercises are used:

active abduction and adduction of the shoulder;
external and internal rotation of the shoulder.

At this stage, you should gradually restore the range of motion, but you should not rush, since the full restoration of joint function takes about one year. To strengthen the muscles during movements, various weighting agents can be used ( dumbbells, expanders, rubber bands).

Physiotherapy after reduction of dislocation

Physiotherapy is a set of measures aimed at restoring the structure and function of the joint and its stabilization, which are based on various methods of physical impact.

Through the influence of physical factors ( heat, direct or alternating electric current, ultrasound, magnetic field, etc.) achieve various therapeutic effects, which, to one degree or another, contribute to the acceleration of healing and recovery.

Physiotherapy has the following effects:

eliminate tissue edema;
reduce the intensity of pain;
promote the resorption of blood clots;
improve local blood circulation;
improve tissue oxygen saturation;
activate the protective reserves of the body;
accelerate recovery and healing;
facilitate the delivery of drugs to the affected area.

Physiotherapy used to treat shoulder dislocation

Type of procedure	Mechanism of therapeutic action	Contraindications	Duration of treatment
*High Intensity Pulsed Magnetic Therapy*	The impact is based on the occurrence of a torque for biological molecules under the influence of a magnetic field. This leads to a change in the permeability of cell membranes, to an increase in a number of anabolic and catabolic reactions, to an intensification of the oxidation of free radicals. The result is a significant anti-inflammatory effect. It should be noted that this type of physiotherapy has the most pronounced analgesic effect, which is established after the first session ( or during the first two or three procedures). In addition, magnetotherapy stimulates the regeneration of damaged tissues, providing a pronounced healing effect.	With low blood pressure, with blood pathologies, with a tendency to form blood clots, with bone fractures until the fragments are stabilized.	6 - 10 procedures for 10 - 15 minutes each.
*Low intensity pulsed magnetotherapy*	It is based on a change in the electronic potential of biological molecules, which leads to an increase in metabolism, an acceleration of redox reactions, and an increase in the permeability of biological membranes. The local and general protective potential increases due to the stimulation of antibody production, the activity of the autonomic nervous system stabilizes. An anti-inflammatory effect develops. The swelling of tissues in the affected area decreases, the growth and regeneration of damaged areas improves.	During bleeding, with low blood pressure, in the presence of metal implants and a pacemaker.	10 - 15 procedures for half an hour daily.
*diadynamic therapy*	It is based on the impact on the body of pulsed currents with a frequency of 50 - 100 Hz. These currents irritate the peripheral nerve endings, which leads to disruption of the conduction of pain signals. Impact on the vegetative ( autonomous) the nervous system leads to the expansion of peripheral capillaries with improved blood circulation at the level of peripheral tissues. An analgesic effect develops, local blood circulation improves significantly, the processes of nutrition and respiration of tissues are normalized. During exposure to currents, muscle contraction of the skeletal muscles occurs, which maintains its tone.	In the presence of purulent diseases of the skin and subcutaneous fatty tissue, with bleeding, epilepsy, in the presence of pacemakers.	9 - 10 daily sessions.
*inductothermy*	It is a method of influencing tissues using a high-frequency magnetic field. Under the action of the eddy currents formed in this field, tissues are heated to a depth of about 5–10 cm. This leads to the fact that blood circulation improves in the corresponding area, tissue respiration and nutrition increase, and the immune system normalizes. An analgesic, anti-inflammatory effect develops. With repeated exposure, muscle spasm is eliminated, the function of skeletal muscles improves.	With malignant tumors, inflammatory diseases of the gastrointestinal tract, during pregnancy, as well as with tuberculosis and during myocardial infarction.	10 procedures for 10 - 20 minutes each.
*Applications with paraffin*	They allow you to evenly and for a long time warm up the damaged areas of the body. This improves tissue nutrition, normalizes blood circulation, reduces swelling and inflammation.	In acute infectious and inflammatory diseases, diseases of the kidneys and blood, as well as in malignant tumors.	10 procedures for 25 - 30 minutes each.
*Local cryotherapy*	It is based on short-term exposure to cold air ( temperature down to minus 30 degrees) on the injured part of the body. As a result, local metabolism slows down, oxygen consumption decreases. In deeper tissues, a reflex reaction occurs, which is aimed at normalizing the work of the corresponding area and protecting against possible damage. Thus, under the influence of low temperature, the healing process is accelerated, immunity function is normalized, and blood circulation improves.	In diseases of the peripheral vessels, as under the influence of cold, a spasm may occur with impaired blood circulation in the peripheral tissues. In addition, this physiotherapy is contraindicated for children under five years of age.	10 daily treatments, each taking five to ten minutes.

Physiotherapy procedures are a fairly effective method of additional treatment, which allows you to speed up the recovery process and is able to eliminate some unwanted symptoms without the use of pharmacological drugs. However, it should be understood that, like any other medical procedures and means, physiotherapy has a number of side effects and contraindications. For this reason, all of them must be agreed with the attending physician.

It should be noted that physiotherapy cannot cure a dislocated joint without appropriate reduction or surgery. The combination of various physiotherapy procedures with therapeutic exercises allows you to achieve a speedy recovery and return to normal daily activities.

Answers to frequently asked questions

What is a habitual shoulder dislocation?

A habitual dislocation of the shoulder is a pathological situation in which, under the influence of a traumatic factor of low intensity or as a result of contraction of the own muscles of the shoulder girdle, repeated dislocations occur in the shoulder joint. In other words, a habitual dislocation is such a dislocation of the shoulder, which subsequently occurs again.

The shoulder joint is the most mobile joint in the human body. This articulation allows movement in three mutually perpendicular planes with a fairly large amplitude, and due to the non-rigid connection of the upper limb belt with the body, the free limb can perform even more movements than the joint provides.

It is the shoulder joint that is the key element in the movement of the free upper limb. This structure is formed by two bones and a number of connective tissue ligaments, which, due to their tension, stabilize and strengthen the joint.

The shoulder joint is formed by the following anatomical structures:

Shoulder blade. On the lateral surface of the scapula there is an articular notch, along the perimeter of which there is an articular lip, which is involved in the formation of the shoulder joint. Due to the presence of a cartilaginous articular lip, the area of the articular surface slightly increases without loss of possible movements. The labrum helps stabilize the joint by preventing the head of the humerus from sliding back and forth.
Brachial bone. The head of the humerus is spherical, due to which it is able to rotate in all planes. Normally, it is in contact with the articular notch of the scapula. The area of the head of the humerus is much larger than the area of the articular notch, which allows to increase the range of motion in the joint, but which reduces the strength of the joint itself.
Articular bag. The joint bag is a connective tissue capsule stretched between the lateral surfaces of the articular notch of the scapula and the anatomical neck of the shoulder, which closes the joint space. It maintains the anatomical integrity of the joint by providing some tension to the elastic fibers, as well as by maintaining negative pressure within the joint.
Shoulder ligaments. The shoulder joint strengthens a relatively small number of ligaments, which allows it to maintain a large degree of mobility.

When a primary dislocation occurs in the shoulder joint, the articular bag ruptures and the articular lip breaks. After the dislocation is reduced, some restoration and healing of these structures occurs, however, they become less elastic and stabilize the joint worse. As a result, some time after recovery, re-dislocation may develop due to slipping of the head of the humerus anteriorly ( or posteriorly in case of posterior dislocation). As a result, habitual dislocation develops, that is, dislocation in the shoulder joint occurs at much lower loads than a healthy joint requires.

Habitual dislocation is accompanied by a slightly poorer clinical picture than the first one. However, in most cases there is a deformity of the shoulder with displacement of the head of the humerus anteriorly or posteriorly. The pain syndrome may initially be severe, but over time, its intensity decreases.

Treatment of habitual dislocation of the shoulder is exclusively surgical. This is due to the fact that conservative methods cannot restore the structural integrity of the articular lip and articular capsule. Modern traumatological operations allow this surgical intervention to be performed with minimal damage to surrounding tissues. However, in some cases, a wide incision of the joint area is required for adequate suturing of the capsule. The choice of the type of surgical intervention largely depends on the type of human activity, since after some of the operations the range of motion in the shoulder joint may be somewhat reduced.

Can you fix a dislocated shoulder on your own?

It is categorically not recommended to correct a dislocated shoulder on your own, because without proper equipment, preparation of the victim and the necessary qualifications, a number of large vessels and nerves can be damaged, as well as provoke irreversible deformation of the articular surfaces with subsequent disability.

Correct reduction of the dislocation of the shoulder joint requires compliance with the following rules:

Examination of the joint for fractures. Often a dislocation in the shoulder joint is accompanied by a fracture of the humerus, scapula or collarbone. The presence of these fractures requires a completely different approach and in many cases involves surgery. To check the integrity of the bone skeleton of the upper limb, X-rays in two projections, computed tomography, and magnetic resonance imaging are used. Magnetic resonance imaging also allows you to identify the degree of damage to the joint capsule, nerves and blood vessels, as well as muscles.
Examination of the upper limb for damage to the nerves and blood vessels. It is carried out during a clinical examination, by identifying areas with lost sensitivity, as well as by comparing the pulse on the radial artery of both hands. Also, the examination of blood vessels is carried out by introducing a contrast agent during radiography.
Adequate anesthesia. The pain syndrome provokes a reflex muscle spasm, which does not allow the joint to be repositioned. In addition, pain causes discomfort and significant suffering to the victim.
Muscle relaxation. Muscle relaxation is achieved by injecting a local anesthetic into the brachial plexus ( the place of passage of large nerve trunks that give motor and sensory impulses to the muscles of the shoulder girdle) or by intravenous administration of drugs that cause muscle relaxation during general anesthesia.
Joint control. After repositioning the joint, it is necessary to perform X-ray control of the correctness of the comparison of the articular surfaces.

Reduction of the shoulder joint can be done in several ways. The most commonly used is reduction according to the Janelidze method, since it is the least traumatic and most convenient. Reduction is carried out only after adequate anesthesia and muscle relaxation. The victim lies on a horizontal surface on his side, his dislocated shoulder hangs from the edge of the table, his head rests on a small table. At the moment of complete relaxation of the muscles, the doctor presses on the forearm bent at an angle of 90 degrees, while simultaneously performing external rotation in the shoulder joint. At the moment when the head of the humerus falls into place, a characteristic click can be heard.

Reduction of the shoulder joint at home is associated with a high risk of damage to the joint capsule, stretching and rupture of muscles, nerves and blood vessels. It is necessary to carry out this procedure only in a medical institution. It should be understood that the reduction of a dislocated joint must be carried out within the first few days, otherwise the articular surfaces begin to atrophy and the joint loses its original function.