The most mobile joints in the human body are the shoulder joints. Thanks to their design, we can raise our hand, move it to one side or another, and reach the back of our head or head with our hand. It is their amazing mobility that largely contributes to the variety of functions of our hands, which make us capable of performing many actions and acquiring a variety of skills.
Movement in the shoulder joint can be carried out in three planes. However, this joint has to pay for such special hypermobility with its low stability. It is designed in such a way that the area of contact between the glenoid 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 between the components of the joint does not provide the shoulder joint with sufficient stability. That is why the stability of this part of the musculoskeletal system is often disrupted and a person experiences a dislocation of the shoulder (or the head of the humerus, the shoulder joint). According to statistics, such an injury accounts for about 55% of all traumatic dislocations.
In this article, we will introduce you to the main causes, types, symptoms and methods of diagnosing and treating shoulder dislocations. This information will help to promptly suspect the presence of such an injury, provide proper assistance to the victim and make the right decision about the need for mandatory contact with a traumatologist.
A little history
In 2014, in Injury magazine, the public was able to learn about one interesting scientific fact related to shoulder dislocation. A group of Italian scientists led by M. Bevilacqua conducted a study of the Shroud of Turin. Experts have noticed that there is a significant asymmetry between the level of the shoulder girdles, shoulders and forearms of the imprint of the body of Christ, and the spinal column is not deviated to the side. This 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 little anatomy
The shoulder joint is formed by three bones:
- glenoid 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 connected 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 glenoid cavity of the scapula, along the edge of which there is a roller of cartilage 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 that grow tightly together with it, thickening it. The articular capsule consists of connective tissue that secures the head of the humerus in the glenoid cavity. The shoulder joint is supported by the following ligaments:
- consisting of three bundles (upper, middle and lower) articular-brachial ligament;
- coracohumeral ligament.
The muscles surrounding it provide additional stability to the shoulder joint:
- small round;
- infraspinatus;
- subscapular.
The muscles and tendons create the rotator cuff around the shoulder joint.
Reasons
The most common cause of shoulder dislocation is trauma. Normally, movements of a twisting or everting nature are performed in this joint, and exceeding their amplitude leads to the exit of the articular head from the articular cavity of the scapula. Such an injury can be caused by a fall on the hand, a sudden, intense and unsuccessful movement.
Some additional factors may contribute to the occurrence of shoulder dislocation:
- Frequently repeated. This predisposing factor is especially characteristic of athletes involved in tennis, handball, volleyball, throwing, swimming and similar sports, or people of certain professions whose work activity involves the repetition of a number of excessive movements. Frequent and repeated trauma to the ligaments of the shoulder joint leads to a significant decrease in its stability, and dislocation can occur with any minor traumatic movement.
- Dysplasia of the glenoid 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 is tilted 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.
- Generalized. This deviation from the norm is observed in 10-15% of people and is expressed in an excessive range of motion in the joint.
Types of dislocations
Shoulder dislocation can be:
- non-traumatic – voluntary or chronic (pathological);
- traumatic – caused by a 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, great vessels or nerves).
Depending on the duration of exposure to the traumatic factor, a shoulder dislocation 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, a 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:
- Anterior dislocation (subcoracoid and subclavian). Such injuries are observed in 75% of cases. With a subcoracoid anterior dislocation, the head of the humerus deviates forward and seems to extend beyond the coracoid process, located on the scapula. With a subclavian anterior dislocation, the head of the bone deviates even further and extends under the collarbone. Anterior shoulder dislocations are accompanied by the so-called Bankrat injury - during the injury, the head of the bone tears off the articular lip of the anterior part of the glenoid cavity of the scapula. In severe cases, such injuries may be accompanied by rupture of the joint capsule.
- 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 arm. With such dislocations, the head of the bone tears off the articular lip in the posterior part of the glenoid cavity of the scapula.
- Axillary (or lower) dislocation. Such injuries occur in 23-24% of cases. With such dislocations, the head of the humerus moves down. Because of this, the patient cannot lower the injured arm and constantly holds it above the body.
Symptoms
When the bones are displaced, the victim experiences sharp and intense pain in the shoulder joint. Immediately after this, the functions of the arm are impaired due to a dislocation of the head. The joint loses its usual smoothness, and the upper limb and shoulder may deviate to the side. When palpating the area of injury, the head of the humerus is not located in its usual place.
After a dislocation, the shoulder can become deformed and harden, and when comparing the injured and healthy shoulder joints, 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, a dislocated shoulder may be accompanied by disturbances in the sensitivity and motor functions of other parts of the arm - fingers and hand. In some cases, with such injuries, a weakening of the pulse in the area 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 shoulder dislocation:
- sharp pain during displacement of the articular surfaces and stabbing painful sensations of varying intensity after injury, intensifying with movement;
- swelling of soft tissues;
- hemorrhages under the skin in the area of injury;
- joint deformity;
- significant decrease in mobility;
- loss of sensitivity in the forearm or other parts of the hand.
When a dislocation occurs, the condition of the joint capsule also suffers. If left untreated, the number of fibrous formations increases in it, and it loses its elasticity. The muscles around the joint that are not functioning due to injury 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 experiences intense pain, but with old or frequently repeated injuries, the painful sensations are not so pronounced or are completely absent.
First aid
Providing first aid will alleviate the patient's condition when a shoulder is dislocated. To reduce pain and prevent worsening of a shoulder dislocation, the victim should be given first aid:
- Calm the patient and place the injured arm in the most comfortable position.
- Carefully remove clothes.
- Give the patient to take an anesthetic drug (Ibuprofen, Nimesulide, Analgin, Ketorol, Paracetamol, etc.) or perform an intramuscular injection.
- If there are wounds, treat them with an antiseptic solution and apply a sterile bandage.
- Immobilize the damaged joint using a scarf (a piece of fabric in the shape of an isosceles triangle). It can be made from available materials. 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 corner 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 piece of fabric hanging from the side of the elbow is fixed with a pin on the shoulder girdle. In the case of an axillary dislocation, it is impossible to apply such an immobilizing bandage, since the victim cannot lower his arm. In case of such injuries, the patient must be transported as gently as possible to a medical facility.
- To reduce pain and reduce swelling, apply ice to the injured area. It should be removed every 15 minutes for 2 minutes to prevent frostbite. Remember that in case of sprains and other injuries, you cannot apply heat to the damaged area in the first days.
- You should not try to straighten a dislocation yourself. This procedure can only be performed by a specialist.
- Call an ambulance or carefully transport the victim in a sitting position to a trauma center or emergency room of another medical institution as quickly as possible. Do not delay visiting a doctor, even if the pain has become less severe. Remember, shoulder dislocations must be reduced within the first hours after the injury. The more time has passed since the traumatic situation, the more difficult it is subsequently to perform the reduction.
Which doctor should I contact?
If you experience sharp pain in the shoulder joint at the time of injury, swelling, or dysfunction of the arm, you should consult an orthopedic traumatologist in the first hours. After examining and interviewing the patient, the doctor will order x-rays in two projections. If necessary, the examination may be supplemented by an MRI.
Diagnostics
To identify a shoulder dislocation, the doctor interviews and examines the patient. By palpating the area of injury, a specialist can detect 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 nerves and great vessels.
To confirm the diagnosis, clarify the details of the injury and identify possible concomitant injuries (for example,) x-rays are prescribed in two projections. For chronic dislocations, an MRI of the shoulder joint may be recommended.
Treatment
Treatment tactics for shoulder dislocations are largely determined by the nature of the details of the injury, which are determined on x-rays. Initially, attempts are made at closed reduction of the head of the humerus, but if they are ineffective, the patient may be recommended to undergo surgical intervention.
It should be noted that in the first hours after injury, dislocations are reduced much easier. Subsequently, the muscles contract, and it becomes much more difficult to repair the damage, since they prevent the articular head from returning to the articular surface.
Closed reduction of dislocation
Various methods can be used to reduce a dislocated shoulder joint:
- according to Kocher;
- according to Dzhanelidze;
- according to Hippocrates;
- according to Mukhin-Kot;
- according to Rockwood et al.
Initially, to reduce a dislocated shoulder, attempts are made to eliminate the displacement of the bones using 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 local anesthesia remains unsuccessful, then it is repeated after intravenous anesthesia, which ensures sufficient muscle relaxation. This effect can be achieved by administering special drugs - muscle relaxants.
After successful reduction of the shoulder joint, which should always be confirmed by a control x-ray, it is immobilized. Previously, for these purposes, the patient was given a plaster bandage according to Deso 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. Practical and comfortable slings can now be used to reliably immobilize the shoulder joint. The duration of wearing them is about 3-4 weeks.
As a rule, after the head of the humerus is reduced into place, the pain becomes insignificant, and after a few days it can disappear completely. The absence of painful sensations often leads to the patient voluntarily refusing 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 articular capsule does not have time to “overgrow” enough to ensure stability of the shoulder joint.
In some cases, after reduction of a dislocation, an abduction immobilization option is used to immobilize the shoulder joint. This technique is less convenient for the patient than a sling bandage, but it allows one to achieve tension in the anterior capsule and press the labrum torn off in the anterior section to the bone. During such immobilization, the likelihood of sufficient “growth” of the articular labrum increases, and the chances of repeated dislocations decrease.
After the reduction is performed, to eliminate pain and reduce inflammation, the patient is prescribed non-steroidal anti-inflammatory drugs:
- Meloxicam;
- Nurofen;
- Ortofen;
- Paracetamol;
- Nimesulide et al.
In the first 2-3 days, cold should be applied to the area of injury, which helps reduce pain and swelling.
After removing the immobilizing bandage, the patient is recommended to undergo a rehabilitation program.
Surgical treatment
If attempts at closed reduction remain unsuccessful, then the patient undergoes a surgical operation consisting of opening the joint and open reduction, followed by fixation of the articular surfaces using Mylar sutures or knitting needles.
Treatment for repeated shoulder dislocations
After a shoulder dislocation, there is always a risk of repeating the same injury in the future, even with minimal stress on the joint. Such dislocations are called repeated (habitual) or a more modern term is used - “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 were unable to recover completely and became unable to fully perform their functions.
More often, repeated dislocations appear 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 observed less frequently. However, if a dislocation occurs in adulthood, its severity may increase and subsequently a person may develop fracture-dislocations.
As a rule, if a second shoulder dislocation occurs, it is almost always followed by a third, fourth, etc. In the absence of treatment appropriate for this 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 techniques. However, the Bankart operation is considered to be the gold standard for 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 goal of Bankart surgery is to create a new labrum. For this purpose, a roller made from the joint capsule is used, which is sutured with anchor clamps (absorbable or non-absorbable). The new labrum can be sutured from the front (if the dislocation occurs anteriorly) or from the back (if the bone is displaced posteriorly). If necessary, during the intervention, the surgeon can repair tears of the supraspinatus muscle or longitudinal tears of the labrum.
To fix the new labrum, 3-4 fixators are usually sufficient. Non-absorbable anchor fixators have the form of a screw and are made of titanium alloys. They are inserted into the bone canal and remain there forever. As a rule, fixators made from 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 more reliable fixation.
Polylactic acid is used to make absorbable fixatives. They may take the form of a screw or wedge that, once turned, is attached to the bone. After being introduced into the bone, such fixatives dissolve within a few months and are replaced by bone tissue.
The choice of one or another type of anchor fixation is determined by the operating surgeon and depends on the clinical case. After this, the doctor must inform the patient about his choice. After completion of the Bankart operation, the patient is given an immobilizing bandage, and after its removal a course of rehabilitation is recommended.
In some rarer cases, other surgical interventions are performed to eliminate habitual shoulder dislocations (for example, corrective osteotomy for acetabular dysplasia, osteosynthesis for a scapula fracture, elimination of bone depression by transplanting 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 a shoulder dislocation includes physiotherapy (amplipulse therapy, paraffin applications, electrophoresis, electrical muscle stimulation, etc.), massage and therapeutic exercises. The rehabilitation course begins after removing the immobilizing bandage and consists of the following periods:
- activation of the functionality of muscles damaged and “stagnant” during immobilization – about 3 weeks;
- restoration of shoulder joint functions – about 3 months;
- The final restoration of joint function takes about six months.
The patient needs to prepare for the fact that 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 requires a long “rest” to fully recover.
All exercise therapy exercises should be performed under the supervision of an experienced physician or instructor. Only gentle loads can be placed on 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 at the elbow joint and hand. In addition, exercises can be performed to raise your arms forward and spread them to the sides. In the first stages, the injured hand can be helped by the healthy one.
After two weeks, you can add to this set of exercises abduction of the arms bent at the elbow joints to the sides and 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 pain appears as you increase the load, you should stop exercising 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 shoulder dislocation should always be a reason to immediately consult a doctor for competent treatment and a full course of rehabilitation.
Channel One, program “Live Healthy” with Elena Malysheva,” in the “About Medicine” section, a conversation about the usual dislocation of the shoulder.
After the joint has been adjusted, you need to say goodbye to any physical activity. Immediately after a shoulder dislocation 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-time sports for six months.
The first days after reduction
First of all, after reduction, a bandage is applied to fix the shoulder. This will provide peace and rest for the sore spot, 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 dislocated shoulder joint. Your doctor may prescribe anti-inflammatory medications.
Returning to normal physical activity should be carried out over a long period of time and systematically. This will help protect damaged parts of the body after a shoulder dislocation. At a certain point, you can use an expander and dumbbells: this will help develop the hand, while you cannot fully use the arm after dislocating the shoulder joint. When a shoulder is dislocated, treatment is usually varied, which largely depends on the degree of complexity of the injury.
Surgical intervention for shoulder dislocation
In the very first days, complications after a dislocation of the shoulder joint can be detected. At this time, surgery must be performed. The following reasons are identified:
- repeated dislocation;
- fracture after shoulder dislocation;
- strengthening a loose joint to prevent re-dislocation;
- soft tissue damage after shoulder dislocation;
- damage to blood vessels after shoulder dislocation;
- tendon damage;
- damage to nerve endings.
Surgery may be offered as one of the methods to strengthen ligaments.
Drug treatment after shoulder dislocation
Since the victim is experiencing quite severe pain, the first thing you need to do is take an analgesic (for example, Tempalgin). Next, during the process of realigning the joint, you need to give an antispasmodic to drink. Spazmalgon will do. This medicine will not only relax the muscles and remove spasms that prevent the joint from being properly adjusted, but will also numb the affected area.
Among the muscle relaxants after a shoulder dislocation, the following medications are distinguished:
- Lorazepam;
- Diazepam;
- Mindazolap.
You can use one of the following as a pain reliever:
- 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
The doctor prescribes certain exercises for each patient to develop muscles and. The duration of the immobilization period and the exercise therapy period varies depending on the age, lifestyle of the patient and the severity of injuries to the shoulder joint. Rehabilitation can take up to six months.
Exercise therapy has the following positive properties:
- accelerating the tissue healing process;
- accelerating the recovery process of the affected area;
- reduction of pain;
- reduction of swelling;
- resorption of hematomas and improvement of blood circulation;
- improving the supply of oxygen to tissues;
- faster delivery of medicinal substances to the required areas.
During gymnastics, the splint or support bandage is removed.
The entire process of further treatment of shoulder dislocation after reduction can be divided into several stages:
Physical exercises used at each stage of rehabilitation contribute to the speedy restoration of the damaged shoulder joint and increase its motor activity.
Physiotherapeutic procedures during rehabilitation
In addition to physical exercise, massage and physiotherapeutic procedures may be prescribed.
Physiotherapy procedures useful in the rehabilitation process:
- Cryotherapy is cold treatment of affected areas. The temperature should be about minus 30 degrees. Thanks to such cold compresses, blood circulation improves, the body's immune functions increase, which help heal the wound. This procedure is contraindicated if there are peripheral vascular disorders, because A spasm may occur that will block the flow of blood throughout the body. This procedure is not recommended for children under five years of age.
- Paraffin applications help warm damaged tissue. This leads to reduced swelling and improved blood circulation. In case of malignant tumors, kidney diseases, blood diseases and infectious diseases, you should refrain from this type of procedure.
- Diadynamic therapy is the use of currents with a frequency of up to 100 Hz to influence the human body. Such electric shocks affect nerve endings and block pain sensations. This extraordinary pain reliever can be used if drug treatment no longer helps. It is worth refusing diadynamic therapy if pacemakers are installed in the victim’s body, and there are fatty deposits, ulcers, bleeding or epilepsy.
- Inductotherapy is the use of a high-frequency magnetic field. It improves metabolism and has an anti-inflammatory effect. But in case of cancer, heart disease, tuberculosis, pregnancy and gastrointestinal diseases, it is better to abstain.
- Magnetic therapy. It relieves pain and swelling, and also strengthens the body as a whole and improves metabolism. In case of bleeding, low blood pressure, a tendency to form blood clots, fractures, or the presence of implants, you should avoid this type of procedure.
Many people believe that a dislocated shoulder is not such a terrible disease and can be treated only with skillful reduction. But in fact, treating a dislocated shoulder joint is quite long and difficult. The recovery process cannot be ignored, otherwise it may result in incapacity of the back, arm or shoulder. Rehabilitation after a dislocation is a very long process that can take up to six months.
A 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.
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The shoulder joint in the human body is one of the most mobile, thanks to which each of us is able to turn our arms almost any way and swing them in any direction.
But often this advantage turns into a problem for a person, since the joint is at high risk of dislocation if the load is not distributed correctly.
In this article you will learn how to straighten a shoulder after a dislocation in the hospital and on your own.
Symptoms of a shoulder dislocation
After receiving an injury that causes a dislocation, a person complains of limited mobility and acute pain when moving his arm. In this case, relief occurs if the injured arm is taken away from the body at a certain angle, holding it and fixing it in this position with the healthy arm.
During an external examination, the doctor can see a pronounced thickening of the joint area, as well as the marking of the acromion under the skin and its protrusion beyond the usual boundaries, while upon palpation a retraction is observed under it.
After an injury and dislocation, the joint area begins to quickly swell and the arm becomes weak. The tissues of the arm and shoulder become numb, and bruising may appear on the surface. Ligament ruptures, nerve and tendon damage can only occur in severe cases.
After a medical examination and confirmation of the dislocation, the patient can be sent for an x-ray to obtain a complete picture of the condition and determine the type of dislocation, which is necessary to select an adequate treatment method and further rehabilitation measures.
Moreover, during the examination, the doctor must determine the level of skin sensitivity, as well as the motor ability of the damaged joint, in order to have an idea of whether the axillary nerve has been damaged.
The pulse in the affected arm is also checked, which is necessary to identify possible damage to the arteries and other major vessels.
First aid for sprain
It is important that first aid for such an injury is provided correctly and in a timely manner, since in this case the risk of complications in the form of injury to muscle tissue, bones and peripheral nerves is significantly reduced. Not only the level and speed of restoration of mobility, but also the prevention of the formation of a condition called primary shoulder dislocation depends on the correctness and adequacy of treatment, as well as rehabilitation.
It is very important to immediately take the victim to the hospital if such an injury occurs. You should not try to reduce the resulting dislocation yourself on the spot, since such an injury can also cause bone damage, including fractures, and not just cracks.
Without the necessary qualifications and medical knowledge, and without an idea of the internal features of the dislocation and its type, you should not try to put the joint in place, since such actions, instead of help, can lead to many complications.
The first step is to call an ambulance or try to take the person to the nearest hospital yourself. As first aid for a shoulder dislocation, several measures can be taken before the doctor arrives or the patient is taken to a medical facility:
- You can carefully apply a simple scarf bandage, using available means at hand, for example, a towel, scarf, shirt, bandage. Such a bandage will help fix the injured arm in a position that is less painful for the person and will relieve the load on the shoulder joint.
- If there are no visible wounds on the surface of the skin, you can apply ice or any cold object, such as a store-bought freezer or a chilled bottle of water. This measure will reduce swelling and slightly reduce the intensity of pain.
- If possible, you can give the person any painkiller, for example, Analgin or Ketorol.
Methods for reducing shoulder dislocation
Most often, a shoulder dislocation occurs due to indirect injuries, in most cases from a fall, if the arm was extended forward or in any way moved to the side. Dislocation can be of different types, but in almost 90 - 97% of cases anterior dislocation occurs, and only in isolated cases - posterior dislocation. In this case, anterior dislocations are divided into intracoracoid, subcoracoid and subclavian types.
Treatment of such an injury always begins with reduction of the dislocated shoulder, which is usually performed under anesthesia., local or even general, if the need arises. With local anesthesia, the patient is given a drug for general anesthesia, for example, morphine or Pantopon 1% concentration in an amount of 1 ml. After this, the damaged joint is anesthetized with a solution of novocaine at a concentration of 1%, with the main part of this drug being injected into the joint capsule.
There are several methods for reducing shoulder dislocation, but most often 4 methods are used in medical practice.
Reduction of shoulder dislocation according to Hippocrates
The patient is placed on his back on a hard couch, while the doctor is positioned facing the victim on the side of the damaged joint. The doctor then places the heel of his foot in the patient’s armpit, using his hands to grasp the hand of the affected arm.
Next, the doctor simultaneously presses the displaced head of the bone in the armpit with the heel and pulls the arm, ensuring its axial extension. Thanks to such actions, the displaced head of the joint moves into place.
Reduction of shoulder dislocation according to Kocher
In this way, a dislocated shoulder is reduced mainly to people of strong build in the presence of an anterior dislocation without tearing off the greater tubercle, as well as without breaking the neck of the shoulder. This method should not be used to eliminate injury in older people, especially those with osteoporosis.
The victim is placed on a hard high couch or table, on his back, so that the place of dislocation extends beyond the edge of the table. Reduction of a dislocated shoulder is carried out in 4 stages:
- With one hand, the doctor grabs the lower part of the forearm of the patient’s injured arm (if the dislocation is on the right, then with the right hand, and if on the left, with the left). With the other hand, the doctor takes the patient’s elbow, bent at an angle of 90°, and carefully brings it towards the person’s body to ensure the necessary traction along the shoulder axis. In this case, the assistant fixes the shoulder girdle.
- Next, the doctor, continuing to press his hand to the body and without weakening the tension along the shoulder axis, makes slow rotational movements of the shoulder joint outward until the forearm moves to the plane (frontal) of the lying body. With this action, the humeral head rotates so that its articular surface is in front. If at this stage the resulting dislocation is completely reduced, which happens quite often, you can hear a characteristic click.
- If complete reduction does not occur at stage 2, the doctor moves on to stage 3. At the same time, he does not weaken the extension and continues rotational movements in the same direction, but begins to gradually raise the forearm, slightly turning it upward. In this case, the patient’s elbow, pressed to the body, slowly moves to the solar plexus area (to the midline of the body). During such actions, the head of the joint usually ends up near the site of rupture of the joint capsule, or rather, against it. In some cases, after this the joint can completely return to its proper place.
- They proceed to this stage if the dislocation was not reduced during the previous ones. The doctor continues to carry out rotational movements, but at the same time the forearm is used as a lever for sharp reduction inward. With this movement, the forearm moves to the person’s chest, and the hand of the injured hand moves to the healthy shoulder joint, located on the other side. In most cases, reduction occurs at this moment. But if this does not happen, then all stages are repeated again, avoiding sudden and rude actions.
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Reduction of shoulder dislocation according to Janelidze
After anesthetic procedures, the patient must be placed on a table or a high hard couch so that his injured arm hangs down and the edge of the table is at the level of the armpit of the damaged joint. In this case, the patient’s head is placed on another table, which is moved towards the worker so that the hand is in the opening between them.
Once the patient is positioned correctly, he should be left in this position for approximately 20 minutes. This is necessary to relax the muscles of the torso and shoulder girdle. Reduction cannot be performed immediately.
To carry out the reduction, the doctor stands in front of the patient, takes his forearm with his hand, bends the injured arm at the elbow and applies pressure to the lower third of the forearm (near the elbow), while making careful rotational movements in the shoulder joint. When the joint is moved into place, a characteristic click is heard.
After reversing the dislocated shoulder, a plaster cast is applied, the purpose of which is to fix the affected arm to the body. After realigning the joint, it is important to undergo an x-ray examination and examine the internal situation in the joint, and also make sure that there are no bone damages inside.
After about a week, the patient is prescribed therapeutic exercises, as well as some physiotherapy procedures, but restoration of full working capacity occurs no earlier than a month later.
To prevent shoulder dislocation from happening again, the patient is prohibited from heavy physical activity for 3 to 4 months after the injury is reduced.
Chaklin's technique
The patient is placed on his back, while the doctor stretches the arm brought to the body. The doctor places the second hand in the patient’s armpit and, at the same time as traction, tries to push the head of the joint outward.
This method is much less traumatic. Reduction is performed under anesthesia. Most often, the indication for reduction using this method is the presence of a dislocation with a fracture.
How to straighten your shoulder yourself
It is important to remember that you can only adjust a dislocated shoulder joint yourself in an emergency, when it is not possible to quickly get to a hospital or emergency room. An emergency situation can be considered to be an injury while relaxing in nature, at the dacha, during a trip, as well as any other situation where it will take more than 10 to 12 hours to get to the hospital and medical help.
In these cases, you should not delay time; it is important to straighten the joint as quickly as possible, no later than 5–10 minutes after the injury, since after this time a muscle spasm occurs, complicating the procedure.
There are several ways to reduce a dislocated shoulder, but they should be used only if it is not possible to get help from a qualified doctor.
First method
It can be used standing as well as sitting. The arm must be bent at the elbow and extended forward at a right angle to the body. After this, maintaining this position of the forearm, you should move your arm to the side as much as possible.
Then, from this position, you need to raise your hand up so that your palm is slightly higher than your head. You need to perform all actions slowly, trying to make the main movements in the joint. If everything was done correctly, the dislocated joint will quickly return to its place.
Second method
It is necessary to sit on the bed, on the floor or on the ground so that there is significant free space behind. On the side of the shoulder dislocation, you need to tuck your knee and do it as close to your body as possible. You should clasp your knee with your hands and clasp your fingers together, positioning your hands so that your thumbs point up.
After this, you need to start leaning back, making movements slowly and carefully, without opening your arms. When performing such deviations, it is important to make efforts in the injured arm, ensuring its traction. No sudden movements should be made, since in this case, instead of the expected relief and help, you can cause very serious harm and complicate an existing injury. It is necessary to lean back until a characteristic click is heard, indicating the reduction of the joint.
Rehabilitation after a shoulder dislocation
It is important to remember that the provision of medical care should in no case be limited to just repositioning the damaged joint. Even if the joint was quickly and successfully put in place, after that it will take quite a long time for the damaged arm to again be able to perform all the functions assigned to it.
With any dislocation, not only the joint itself is displaced, but also damage to the muscles and ligaments surrounding it. After some time, the duration of which the doctor determines individually, the patient is prescribed some rehabilitation measures that speed up the recovery of the damaged joint.
Proper treatment after reduction of a dislocated shoulder will avoid complications.
The first exercises, as a rule, are the simplest and easiest, having a small range of motion, but gradually the patient moves on to more complex exercises.
In addition to physical therapy, a person is also prescribed therapeutic massage sessions, as well as physiotherapy procedures, and sometimes traditional recovery methods. A set of exercises and all recovery measures is always selected by a doctor, taking into account not only the characteristics of the injury, but also the patient’s physique, age and physical characteristics.
It is important to strictly follow all the doctor’s recommendations and instructions, without letting recovery take its course. In most cases, shoulder dislocation, if corrected and quickly reduced, has a very favorable prognosis. With proper implementation of rehabilitation measures, all functions of the joint are restored in full, which allows a person to return to an absolutely fulfilling life, without limiting himself in any way in the future.
An important point is that the rehabilitation period always depends on how quickly the victim received medical care. The sooner the person was taken to the hospital, the sooner the joint was realigned, the shorter the recovery period will be.
Possible complications and consequences
Any shoulder dislocation always affects the tissues surrounding it. In this case, not only partial, but also complete rupture of the capsule can be observed, which should be remembered when immobilizing the damaged area after reducing the injury. It is important to position the hand in such a way that the tension is distributed evenly throughout all parts of the damaged capsule for its proper healing.
With dislocations of a traumatic nature, damage to the ligaments almost always occurs, both in full (complete rupture) and partially. This causes a sideways displacement of the dislocated segment, which not only complicates the reduction of the dislocation, but can also affect further mobility of the joint. Diagnosis of such conditions may require an MRI or ultrasound. Surgery is usually performed to treat such cases.
A serious complication when receiving a dislocation is the danger of rupture, as well as severe compression of the blood vessels passing in the shoulder area. In this case, the condition may be complicated by serious blood loss, which, in the case of a latent course, cannot always be recognized in time.
It is also important to remember that the appearance of even a small hemorrhage at the site of such an injury creates an adverse effect, especially on the synovial membrane, which is saturated with blood. In this case, the person may subsequently develop deforming atherosclerosis, which causes limited mobility.
Now you know how to realign the shoulder joint in the hospital and on your own, as well as about rehabilitation after a dislocation. You can find out about a fracture of the shoulder joint.
Shoulder dislocation or dislocation is a fairly common injury, especially among athletes. Most often, the upper part of the shoulder falls forward, then the arm turns outward and is pulled to the side. This dislocation is called anterior dislocation of the shoulder joint; it occurs in 90% of cases of dislocation.
Some traumatologists believe that shoulder dislocation is a completely simple, reversible injury, but, unfortunately, in many cases serious problems and complications can arise. This can lead to damage or destruction of the adjacent bone, causing injury to surrounding ligaments, tendons, nerves, and blood vessels.
Dislocation of the shoulder joint can be posterior, lower, upper and intrathoracic; these options are less common, but can cause serious complications, damaging surrounding tissues and organs, muscles and tendons. A posterior dislocation of the humerus can cause a fall on an outstretched arm (as in the photo below).
The shoulder joints are especially prone to dislocation due to their high mobility.
A separate type of dislocation is the habitual dislocation of the shoulder, in which the shoulder joint is in an extremely unstable state, and dislocation can occur even under light loads. After a primary dislocation due to injury, with improper treatment and subsequent recovery, a chronic stage of the disease can develop.
Shoulder dislocation: symptoms and causes
The main causes of shoulder dislocation can be direct blows to the shoulder joint, falls on an outstretched arm, or rotational movements of the arms with the application of force. However, humerus dislocation is a significant problem during constant strength training, and can be repeated many times during bench presses, pull-ups, and other types of exercises that involve the shoulder joint.
When diagnosed with a dislocated shoulder, symptoms may include the following:
- a sharp attack of acute pain, and a feeling that the shoulder is in an unnatural position,
- the shoulder joint looks unnaturally sharp and as if dropped,
- the victim presses his hand to his body,
- If nerves are affected or blood vessels are damaged, the pain may be stabbing, the arm may feel numb, and there may be bruising in the joint area.
Shoulder dislocation: treatment
When a shoulder is dislocated, treatment is carried out in several successive stages. First of all, first aid is provided, if you are not a doctor, do not try to disturb the patient, the best thing is to call and wait for an ambulance or immediately take him to the hospital.
First aid for a dislocated shoulder, which can be done before being examined by a doctor, includes:
- cold compress on the shoulder, maybe ice,
- cessation of shoulder movement
- call a doctor immediately,
- fixing garter.
After confirmation of the diagnosis, treatment is prescribed according to severity. Sometimes anti-inflammatory drugs are prescribed for severe pain. When the required immobilization time ends, a recovery course is prescribed.
Reduction of a dislocated shoulder can only be performed by a qualified specialist under anesthesia or general anesthesia. You should never do this yourself, as you can seriously damage the joint. But, if you still set the shoulder yourself, seek advice from a traumatologist to exclude the possibility of a fracture or other complications.
In the best case, immediately after a visit to a traumatologist, the victim takes an X-ray, which determines the type of dislocation.
To prevent the possibility of re-dislocation, it is necessary to strengthen the ligaments that support the shoulder joint. To do this, a number of exercises with light dumbbells and an expander are recommended.
Shoulder dislocation surgery
Surgery is sometimes required to prevent re-dislocation of the joint. Also, direct intervention, namely shoulder dislocation surgery, is performed in cases of serious damage to muscles, tendons and joints. The operation is performed immediately after the injury.
If there is a risk of developing the chronic variety, surgery can stabilize and strengthen the ligamentous apparatus. As a rule, when the shoulder joint is dislocated, surgery does not lead to a decrease in mobility, which is very important for athletes.
After the operation, the person goes through several stages of rehabilitation and easily returns to a normal lifestyle.
Rehabilitation and recovery after a shoulder dislocation usually takes place in four main stages. It is in the patient's best interest to go through them all.
Immediately after reduction or surgery at the initial stage:
- Immobilization of the shoulder for up to 7 days,
- Warm-up exercises with the wrist and hand for normal blood flow to the immobile part of the body,
- Cold compresses to reduce pain and swelling.
- Anti-inflammatory drugs.
At the next second stage:
- First light shoulder movements 2-4 weeks,
- If there is no pain, you can begin warm-up exercises for joint mobility,
- It is forbidden! Perform combined movements, such as abducting the arms to the sides or turning the shoulder outward - this can cause re-dislocation of the joint,
- The bandage can be removed
- After training, apply ice if there is swelling.
The third stage provides:
- Full mobility of the shoulder and shoulder joint 4-6 weeks,
- If there is no pain, you can begin to move your arm to the side,
- Continue exercises to develop mobility,
- Strive to achieve full range of motion.
At the final fourth stage of recovery after a shoulder dislocation, a return to normal activities occurs. It is already possible to lift light weights, and athletes can begin to work with strength equipment, gradually increasing the load.
Video of the program “Live Healthy” about the usual dislocation of the shoulder and its reduction:
A dislocation of the shoulder joint occurs due to sudden pressure on the humerus when falling on an outstretched arm, excessive rotation of the shoulder using force, or under the influence of a direct blow.
In this case, the head of the bone moves beyond the glenoid cavity, the shape of the shoulder is deformed, and movements become limited and painful. When palpating the affected area, a sharp pain is felt, and the sensitivity of the hand is impaired.
There are four types of such damage:
- Front. The head of the bone moves forward; in addition, the cartilage cushion may be damaged and the joint capsule may rupture.
- Rear. The bone moves back with a rupture of the cartilaginous element.
- Lower. The displacement is directed downward, making it impossible to lower the arm from a raised position.
- Habitual. An untreated dislocation becomes chronic. The joint capsule does not heal completely, which leads to an increase in injury - dislocations can happen up to 10 times a year.
you should be careful and protect your joints from dislocation If a person has a dislocated shoulder joint, treatment should be carried out as soon as possible. The sooner you contact an orthopedic traumatologist, the easier it will be to restore your shoulder and prevent habitual dislocations. In the complete absence of treatment, the motor function of the arm will be limited, muscle atrophy will begin due to compression of blood vessels and immobility, and the chances of recovery will be significantly reduced even with surgical treatment.
First aid for a dislocated shoulder joint is to fix the arm with a bandage (the elbow is bent at a right angle, the bandage goes under the arm and is tied behind the neck). If there is significant swelling, you can apply ice or frozen food to the injured area. The victim should then be taken to the nearest traumatologist.
Treatment of shoulder dislocation
To confirm the diagnosis, the doctor examines the shoulder and refers the patient to X-rays, CT scans and MRIs. This determines the direction of the dislocation and the presence of complications: fractures of the humerus or glenoid cavity of the scapula, damage to cartilage, joint capsule and soft tissue.
Shoulder dislocation is treated in four stages:
- Administration of local anesthesia;
- Reduction of the humerus;
- Fixing the hand in a stationary state;
- Rehabilitation.
After reduction, the arm pressed to the body is secured in a bent position with a splint or bandage. Rest must be maintained for about a month while all the damage heals. Then comes the rehabilitation period (1-3 months), during which the muscles and ligaments are strengthened to prevent the occurrence of habitual dislocations.
Rehabilitation for shoulder dislocation
Rehabilitation takes about 3 weeks for children, 1-2 months for adults, and up to 3 months for athletes. Active physical exercises cannot be performed, but when the pain and swelling subside, you should do gymnastics that strengthen the muscular-ligamentous system.
The recovery complex includes rotational-translational, non-sharp movements of the shoulders, hands and elbows. It is very effective to perform the following exercises 1-2 times a day, 5 times each:
- Move your shoulders up and down while standing with your arms down and relaxed.
- In the same position, perform circular movements with your shoulders.
- Raise your shoulders as far as possible (pull your shoulder blades together), stop for a second and return to the starting position.
- Bend your elbows, press your hands to your shoulders and rotate your shoulders back and forth.
- Clasp your hands and raise them above your head, rotate them in a circle in one direction, then in the other.
- Clench your fists, bend and straighten your elbows.
- Bring your palms together with your fingers facing upward and press them firmly together. Relax your hands, then tighten them again.
- Repeat the exercise, but move your palms from the center, first to one shoulder, then to the other.
In addition to the indicated physical exercises, I can recommend yoga classes from personal experience. I remember long ago, when there was practically no information at all on this rather specific area at that time. I had to find notes in notebooks, copy them by hand, redraw pictures... Yes, yes! There was such a time. The main thing that we managed to understand and test for ourselves is the functionality of the system!
But nowadays there are many video yoga lessons on the Internet. From the point of view of my experience, I can safely say that such yoga lessons can give you a simple and effective system for the speedy rehabilitation of a dislocated shoulder joint. After working on yourself, you will quickly forget the problem that arose. Moreover, these lessons can be done at home, in a comfortable environment. Although I see a group of yoga lovers in a nearby fitness club who also gather for group classes. But whoever likes it. The main thing is that your shoulder joints can be restored after injury.
If a dislocation of the shoulder joint has been diagnosed, treatment during the rehabilitation period also includes light massage of the damaged area and physiotherapy (current and ultrasound therapy, paraffin, ozokerite). Traditional recipes also help speed up healing:
Compresses and lotions will also help restore the functionality of the shoulder joint. - For severe pain, a dough made from flour and vinegar or a paste made from fresh wormwood leaves will help. These products are applied to the injured area, secured with a bandage and held until the pain subsides.
- Lavender has a good pain-relieving effect. You need to mix vegetable oil with crushed leaves and flowers, leave for 1.5 months and rub the affected areas.
- Tansy helps restore mobility of the injured shoulder. 3 tbsp. l. The flowers are brewed in a glass of boiling water and left to infuse for an hour. During the rehabilitation period, a compress soaked in this infusion is applied to the shoulder every day.
- Compresses made from sugar and onion pulp (in a ratio of 1:10) will help speed up tissue regeneration. The compress is kept for 4-6 hours, then removed.
With timely treatment, a dislocated shoulder joint heals successfully and does not recur.
The main thing is not to put off visiting a doctor, not to be lazy and do all the rehabilitation exercises and not to overdo it with physical activity.