Bandage after a shoulder dislocation. Shoulder dislocation - its symptoms and treatment options. Numbness of fingers after shoulder dislocation

Shoulder dislocation – loss (dislocation) of the shoulder joint. The most common type is the anterior one, although there are posterior, superior, inferior and intrathoracic varieties. Despite the reversibility of the injury, it may be accompanied by damage to ligaments, tendons, nerves and blood vessels.

Causes of shoulder dislocation

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

force impact on 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 over, for example, with habitual dislocation or joint diseases. During 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 causes such discomfort that it is impossible to ignore the injury, unlike, for example, some types of fractures with which people can walk for several days without seeking the help of a doctor. Main signs of a shoulder dislocation:

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

First aid for a dislocated shoulder

Adequate emergency care for a shoulder dislocation injury is a guarantee of a successful recovery without complications. An ordinary person should not try to set the joint back into place on their own - this requires skills that only a traumatologist possesses, so the victim must be sent to the hospital. Before transporting, it is necessary to fix the arm so that the shoulder does not move. If possible, it is advisable to apply a cold compress. Immobilization for a shoulder dislocation (depending on the complexity) should last from 1 to 4 weeks, otherwise the dislocation may become habitual.

How to fix a dislocated shoulder?

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

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

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

How to fix a dislocated shoulder yourself?

In emergency cases, the question may arise of how to straighten a dislocated shoulder yourself. If it is not possible to resort to qualified medical assistance, you can try the manipulation developed by Hippocrates. The patient should be laid on the couch on his back, the injured arm should be grabbed by the hand, and your leg should be rested against the victim’s armpit. Reduction of a dislocated shoulder occurs by simultaneously stretching the arm and pushing the head of the humerus into the joint with the heel. The correctness of the procedure is controlled by radiography.

Shoulder dislocation - treatment

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

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

therapeutic massage;
magnetic therapy;
infrared irradiation;
Microwave, UHF therapy;
medicinal electrophoresis;
paraffin applications.

Surgeries for shoulder dislocation

Surgical interventions for shoulder joint injuries are required when they occur. The Laterger operation for shoulder dislocations is prescribed when the bone that forms the edge of the glenoid cavity is worn away. This surgical intervention helps to avoid repeated injuries, and it consists of replenishing the missing bone mass.

Surgeries for shoulder dislocation are also necessary for:

inability to straighten the joint using a conservative method;
the need to form a normal joint capsule due to sprains and ruptures;
the appearance of inflamed, fibrous tissues, growths and other formations;
ruptures of ligaments, cartilage, tendons that need to be stitched.

Habitual shoulder dislocation - treatment without surgery

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

Anti-inflammatory nonsteroidal drugs(Diclofenac, Ketorolac, Ketoprofen, Indomethacin; Piroxicam).
Chondroprotectors(Dona, 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 the dislocation has been reduced in the hospital, treatment must continue at home. What to do if you dislocate your shoulder:

After applying a plaster splint, you should provide complete rest to your hand.
If there is inflammation or pain, take prescribed medications and go to physical therapy.
Strengthen bones and joints by taking vitamin-mineral complexes and chondroprotectors.
After removing the cast, carefully develop the arm and shoulder.

Shoulder dislocation - folk remedies

Numerous folk remedies for shoulder dislocation are effective as relievers of inflammation and pain relievers.

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

Decoction of wormwood (or tansy) for severe pain

Ingredients:

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

Preparation and consumption

Pour water over the raw material and boil for about 20 minutes.
Moisten the gauze with the cooled broth and apply a compress to the joint.
Wet the gauze as it warms. 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 decreased hand mobility and sensitivity disorders.

Exercises after a shoulder dislocation

A speedy recovery from a shoulder dislocation necessarily includes physical exercise, and the longer the immobilization lasts, 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 simplest exercises and a small number of repetitions. After strengthening the muscles, you can add repetitions and introduce load. At the first stage you can:

bend and straighten the elbow and fingers of the injured hand;
make rotational movements with small amplitude, move your arm to the side;
raise the sore arm, belaying it with the healthy one.

The goal of the following exercises is to form a strong muscle corset around the damaged joint.

Sitting on a hard chair, place your hands on your waist and 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, elbows apart. Make slow movements of your shoulders back and forth to the highest possible level.

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

What is a dislocation? This is the impossibility of achieving a full range of movements in the shoulder joint due to the lack of contact of the articular surfaces of the bones included in it. In cases where there is at least some minimal area of contact between the bones, this injury is called a subluxation.

Anatomy of the shoulder joint: why does dislocation occur?

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

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

This makes it possible:

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

However, the downside of the ability to perform such movements has become greater instability of the shoulder joint, which, under certain conditions, leads to separation of the communicating surfaces of the bones with subsequent dislocation.

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

Causes of development of dislocation in the shoulder joint

Movements beyond the normal limits of a rotational type joint (around an axis)

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

It most often occurs when falling on an outstretched arm or from a direct blow directly to the shoulder joint.

Routine, repeated movements that are repeated over a long period of time from day to day at the limits of the joint, accompanied by stretching of the capsule.

They are found in some professions that require significant physical activity in the shoulder girdle. It is also a common sports injury among throwing athletes, swimmers, and tennis players.

Congenital anatomical features of the joint that provide excessive mobility

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

Severe joint pain immediately after traumatic impact

It is due to:

damage to the tendon capsule along the entire diameter of the head of the humerus;
rupture of the ligaments surrounding the joint;
damage to the muscular system;
compression or rupture of blood vessels;
pinching of large nerves and its sensory endings.

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

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

With repeated (habitual) dislocations, which usually arise due to insufficient treatment of the first one, the pain syndrome is less pronounced, or even completely absent.

Limitation of movements in the joint

It is most often observed when the head of the humerus prolapses below the articular surface of the scapula (inferior dislocation).

In this case, the patient cannot lower his arm to the side due to the occurrence of springing movements and sharp pain. With his second, healthy hand, he supports her in the abducted position.

With posterior and anterior dislocation, restrictions in movement arise in other planes, and in different variations.

Change in appearance of the shoulder joint

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

The soft tissues surrounding the joint become swollen and may become hemorrhagic (bruises appear).

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

Paresthesia (feelings of “crawling goosebumps”).
Severe pain along the entire nerve from the shoulder to the hand.
Complete lack of hand sensitivity to various stimuli.

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

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

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

A simple x-ray examination is quite sufficient in most cases.
If damage to large vessels and nerves is suspected, CT and MRI are used.

First aid for sprain

At the stage before hospitalization, it is important to correctly provide first aid to the victim. This will make it easier for him to endure transportation and protect him from possible additional damage to the joint and surrounding tissues.

You should not forcefully change the forced position of the limb.
If the dislocation allows, then, after placing a cotton-gauze roller in the armpit, The limb is fixed to the body using bandaging. This is done to immobilize the joint.

How to treat?

The decision on the method of treatment is made by a specialist, a traumatologist, to whom the victim must be taken.

Treatment for a dislocated shoulder involves a number of steps.

1 . Reduction of dislocation

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

Conservative treatment consists of manual reduction of the dislocation.

During surgery, the joint is fixed in a physiological position instrumentally (using special pins).

Indications for surgical treatment are:

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

2. Immobilization

It is performed after the dislocation has been reduced by additional fixation of the joint with special bandages or plaster casts.

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

3. Drug therapy

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

Medication intake is limited to three to four days after the dislocation is reduced.

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

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

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

The first exercises are prescribed for the fingers and wrist joint.
The next stage is the impact on the joint itself, the joint capsule and the muscles covering it. The purpose of these actions is to relax the muscles that are spasming during the first time after removing the bandage and improve mobility in the joint with the help of a gentle load and massage according to a special program.

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

Complete restoration of the function of the joint with the possibility of receiving the same loads is quite feasible six months after the reduction of the dislocation.

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

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

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

Self-reduction is possible in various ways, and each patient chooses his own

Clamping the hand of the injured arm between the knees, tilts the torso back.
He stretches his dislocated arm with his healthy hand.
Independently rotates and abducts the arm in the required direction (opposite to the location of the dislocated head of the humerus).

With outside help, you can straighten a dislocation if you follow a certain procedure (the Hippocratic method).

The patient lies on his back, preferably on a hill (bench, table).
The person providing assistance approaches from the side of the injury and firmly grasps the victim’s hand with his own hands, stretching the injured limb.
At the same time, he places the heel of his foot in the patient’s armpit and presses on the head of the humerus that has shifted downward.

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

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

Exercise therapy or therapeutic exercises

During the immobilization period, a set of exercises includes:

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

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

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

Light rocking movements of the limb back and forth.
Abduction of the arm bent at the elbow to the side.
Raising, first with the help of the healthy, and then without it, the injured arm forward.
Measured pressure with the fingertips of a straightened hand on a horizontal (table) and lateral (wall) surface.
Rotation of the palm of a freely hanging hand.
Bringing both shoulder blades together and spreading apart.
Raising your arm up (or placing your arm behind your back).

General principles of physical therapy for shoulder dislocation

Paired and simultaneous exercises with the healthy hand.
Gradual increase in the pace and number of exercises and approaches to them.
Availability of visual control of the joint and movements using a large mirror.
After 4 weeks after the injury, it is necessary to include additional sports equipment in your classes: gymnastic stick, mace, ball, dumbbells, expander.

In addition to physical exercises, self-care skills are developed at each stage.

As recovery progresses, the patient should be involved in homework.

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

Basic principles of massage of the affected limb

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

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

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

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

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

Each type of fixator has its own indications for use, and their choice is made by a trauma surgeon.

In addition to the use of an arthroscope, operations can be performed openly , when the joint capsule is opened and all manipulations are carried out under the direct visual supervision of a doctor.

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

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

Life after surgery: rehabilitation and recovery

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

Perhaps the only special feature is special care for postoperative sutures and intra-articular drainage, which can be left for some time after surgery for additional control and administration of medications that accelerate reparative processes.

Sutures are removed 7-9 days after surgery.

Article publication date: 05/31/2016

Article updated date: 12/05/2018

Shoulder dislocation is an extremely painful condition in which the head of the humerus comes out of the socket, causing loss of contact between the articulating surfaces and disruption of the entire shoulder.

The mechanism of development of shoulder dislocation is similar to such pathology in other joints; The key difference between shoulder joint injuries is that they occur much more often, accounting for more than 50% of all diagnosed dislocations. This is explained by the complex anatomical structure of the joint and a large range of motion in different projections, which is why the shoulder is more often subject to injury.

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.

When a shoulder is dislocated, a person’s quality of life suffers greatly, as the injured arm practically ceases to function. Relapses are also possible, and repeated dislocations can occur not just once, but from 2 to 10 times a year. Repeated loss of the head of the bone from the glenoid cavity causes destruction of the elements of the shoulder joint - arthrosis or arthritis may occur.

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

This pathology is dealt with by a traumatologist.

Types of pathology

Gradation by category	Types of dislocations
Regarding the time of acquisition	Congenital
Regarding the time of acquisition	Acquired
Acquired dislocations are divided according to the causes of occurrence	Traumatic (primary)
	Habitual (non-traumatic, resulting from insufficient strengthening of the shoulder tendons after a traumatic dislocation)
	Pathological (occurring against the background of tumors or any diseases)
	Voluntary (occurs spontaneously when performing everyday actions)
By location of humeral head displacement	Anterior (the head is shifted forward, going under the coracoid process of the scapula - subcoracoid dislocation, under the collarbone - subclavian)
By location of humeral head displacement	Inferior (downward displacement of the head of the bone) Rear (backward shift)

In traumatological practice, in 75% of cases of the total number of all shoulder dislocations, 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 reasons

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

Reasons	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 an outstretched arm
Congenital anomalies of development of the articular elements of the shoulder joint	Insufficiently formed lower part of the glenoid cavity, rotator cuff weakness and other defects
Stretching the joint capsule	Monotonous daily repeated movements in the shoulder joint at the limit of its capabilities (typical of 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 typical for 10–15% of the planet's inhabitants
Joint diseases	Arthritis, arthrosis
Systemic and other diseases	Tuberculosis, osteomyelitis, osteodystrophy, osteochondropathy

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

The repeated occurrence of this problem can be provoked by ordinary everyday movements: cleaning a house or apartment, washing floors, trying to put something on a high shelf, etc. Moreover, each repeated loss of the head of the humerus from the bed increasingly disrupts the stability of the joint, resulting in an interval between relapses are decreasing, and lesions are occurring more frequently.

Characteristic symptoms

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

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

A visually noticeable symptom is asymmetry of the shoulder joints. The articulation itself is deformed: angular, concave or sunken. When palpating, 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 part of the axilla or down the coracoid process of the scapula. In this case, the person is forced to hold his hand in the most advantageous position: abducted and turned outward or bent.
In the lower form of the pathology, the head is displaced into the armpit. A distinctive feature of a lower dislocation from others is the likelihood of numbness of the entire arm or certain parts (fingers or forearm) due to compression of the nerves located under the armpit. It is possible to immobilize muscles that were “connected” to the central nervous system by a pinched nerve.
In a posterior dislocation, the head is displaced towards the scapula.

When the pathology recurs, the pain syndrome is usually moderate or mild. But the reduction of an old, repeatedly occurring dislocation becomes difficult due to the compaction of the articular 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 the injury, but also along the pinched nerve.

Diagnostics

Diagnostic methods for dislocations of any joints are almost identical.

A traumatologist determines a dislocation of the shoulder joint based on visual examination, palpation, X-ray results in two projections (confirming the presence of pathology) and, if necessary, the results of computed tomography or magnetic resonance imaging.

If there is obvious damage to the blood vessels, consultation with a vascular surgeon is required; if a rupture or compression of the nerves is suspected, a consultation with a neurosurgeon is required.

First aid for a sprain

Completely avoid any movement of the injured limb.

Give the victim pain medication.

Apply ice or a cold compress to the affected area.

Make a splint from available materials to immobilize the arm and use a scarf, scarf or other object to secure the limb. Or, if possible, place a rolled-up towel under your armpit and secure the bent arm with bandages to your torso or to the shoulder girdle of your other arm.

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

Basic treatment (3 stages)

Treatment takes place in three stages.

The first stage is reduction

Reduction can be closed (non-surgical) or open (surgical). Closed reduction of a fresh (several hours ago) shoulder dislocation is carried out under local anesthesia; for this, the affected area is injected with novocaine. One of the muscle relaxants is injected intramuscularly to relax the muscles, and in case of severe pain, a narcotic analgesic is administered. Old dislocation of the shoulder joint (more than a day) is eliminated under general anesthesia.

The most common options for realigning the shoulder joint are: the Dzhanelidze, Mukhin-Mota, Hippocrates, and Kocher methods. The traumatologist chooses which one to use depending on the type of injury.

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 knitting needles or Mylar sutures in the glenoid cavity.

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

The second stage is temporary immobilization

Immobilization (immobilization) is necessary after reduction to secure 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.

Deso bandage

It is important to follow the recommended period of wearing the Deso bandage, even if the swelling, pain and other symptoms of the disease have disappeared. If shoulder immobilization is stopped 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 – rehabilitation

A rehabilitation specialist is responsible for restoring the functions of the joint after immobilization. Physiotherapy (massage, electrical muscle stimulation) and exercise therapy help strengthen the ligaments and muscles of the shoulder.

Rehabilitation is divided into three periods:

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

The first 3 months are spent developing the joint and restoring its functionality.

Up to six months are allotted for complete 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, if the knee is affected, they do not use a Deso bandage for immobilization, but a bandage, side splint or other orthopedic device).

Resume

If a shoulder dislocation occurs, seek medical help immediately. The sooner you get to a 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.

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Treatment of shoulder dislocation

When receiving an injury accompanied by a dislocation of the shoulder, it is important to quickly provide (receive) first aid, since further treatment, its complexity, effectiveness and the occurrence of possible consequences depend on this. It is important to immediately call a doctor or an ambulance, but if possible, it is better to take the person to the nearest clinic yourself.

Before the doctor arrives, certain measures can be taken as first aid to the victim, in particular:

Apply a kerchief fixing bandage, which will remove the load from the damaged joint and ease the pain.
Apply ice to the injury site to prevent swelling, which will complicate reduction.
Try to keep the injured arm still.

Treatment for a dislocation is always prescribed according to its severity, as well as the type of injury received, which is usually determined by taking an x-ray. As a rule, treatment always begins with reduction of the injury, which can be done in several ways under general anesthesia or local anesthesia.

The choice of reduction method depends mainly on the characteristics of the injury., the location of the dislocated joint, as well as the physique of the victim. It is important to exclude the presence of possible bone damage.

Afterwards, the patient is given a bandage for a certain time, after which a course of rehabilitation measures begins, the duration of which in most cases depends on the correctness of first aid and the speed of reduction.

Why is rehabilitation necessary?

After reduction, the next step of therapy is proper and adequate rehabilitation. It is important to consider the point that after reduction, especially if surgical intervention by a surgeon is required, the shoulder must be at rest for a certain period of time, which is always determined by the doctor, based on the patient’s condition and the characteristics of the corrected injury.

In older people, this period can be quite long, and sometimes it reaches 1.5 - 2 months. In younger people, immobilization may take less time, depending on the nature of the injury and how it was reduced.

After this, activities aimed at rehabilitation begin, the goal of which is always to restore as completely as possible the functions of the joint lost due to injury. That is why, after the end of the period of immobility, it is so important to properly warm up the joint, develop it and strengthen the muscles, primarily those responsible for the ability to rotate the shoulder.

For rehabilitation, the doctor prescribes a number of exercises to the patient after a dislocation of the shoulder joint for the entire rehabilitation course, starting with easier exercises and gradually moving on to more complex ones. But it is important to start such a course only after it has been prescribed by a doctor, and to strictly follow all instructions.

Initial recovery from a shoulder dislocation

Initial recovery is the period of time that begins immediately after reduction of a dislocated shoulder joint and continues until the prescription of physical exercises aimed at restoring mobility and strengthening muscles.

Immobilization of the reduced joint for about a week, which is achieved by applying a special bandage that fixes the shoulder in the required correct position. In addition, splints can be used for fixation, as well as plaster application if necessary. It is important that the injured arm is kept at rest for a week.
If there are complications in the form of damage to muscles, soft tissues or bones (including their fractures), fixation of the reduced shoulder may be required for a longer time.
In some cases, the doctor may prescribe the use of special anti-inflammatory drugs belonging to the non-steroidal group, in particular Ibuprofen, which not only eliminate the inflammatory process, but also relieve pain.
At the end of the period of immobility, the joint should be gradually put back into use, starting with a low load and exercises prescribed by the doctor. It is important that the load increases gradually and evenly.
To prevent re-dislocation, you should not forget about strengthening the ligaments.
It is also recommended to use special preparations and supplements designed to strengthen ligaments and restore the structure of joints, containing the necessary vitamins. You can also use some types of ointments.
In the early stages of rehabilitation, light exercises are most often prescribed, for example, with a soft expander, as well as light dumbbells.

Rehabilitation activities

As a rule, after the reduction of a dislocated shoulder, rehabilitation measures are carried out in 4 successive stages, and it is very important that the patient goes through all of them.

At the second stage(from the 2nd to the 4th week) rehabilitation measures are considered to be:

Instructing gentle movements of the shoulder joint that should not cause severe pain.
If there is no pain, the doctor prescribes more serious warm-up exercises that restore the mobility of the damaged joint.
You are allowed to remove the bandage.
After training, it is important to apply cold to the joint to prevent swelling.
Under no circumstances should you perform any combined movements at this stage, such as rotating the shoulder, especially outward, or raising the arms to the sides. Such actions can lead to re-dislocation and many complications.

At the third stage(from the 4th to the 6th week) rehabilitation procedures are as follows:

To ensure full mobility of the damaged joint and perform exercises regularly.
At the beginning of moving the arm to the side, but only if the damaged joint does not hurt and the exercise does not cause suffering.
Carrying out regular exercises to restore previous mobility.
It is important to try to achieve the fullness of the movements performed.

The fourth stage of rehabilitation after a shoulder dislocation and recovery is the patient’s return to his usual activities and lifestyle, and the ability to lift light weights. If a person was involved in strength sports before getting injured, then at this stage he can return to training, starting with light loads and gradually increasing them.

Now you know how to strengthen the shoulder joint after a dislocation and do it correctly.

Physiotherapy

Exercise therapy

Let's look at how to develop the shoulder joint after a dislocation with the help of physical therapy.

Exercise therapy after a dislocation of the shoulder joint is usually represented by a whole set of elementary exercises, thanks to which a person gradually restores the lost motor activity of the damaged joint.

During classes, the strength of the deltoid muscle, as well as the biceps and triceps, is replenished, which gradually leads to a stable state of the injured joint itself. Proper execution of the doctor-recommended exercises for a shoulder dislocation is not only the key to a complete recovery, but also the prevention of a possible relapse (re-dislocation).

Treatment and training begin after the shoulder dislocation has been reduced and the period of rest of the joint has ended. The first sessions always consist of light and very simple exercises, the purpose of which is to generally increase the muscle tone of the injured arm and ensure sufficient blood flow. Gradually, on the doctor’s recommendation, the load on the arm and the joint itself should be increased, and the range of exercises performed should be expanded.

It is important to remember that even simple exercises after an injury, if performed incorrectly, can lead to complications and prolong the recovery period.

Extreme caution should be exercised when performing power loads after reduction of a dislocation, since such exercises, if performed incorrectly or the load is inadequate, can lead not only to stretching of weakened ligaments, but also to their rupture. Therefore, for a successful and complete recovery, you should fully follow the doctor’s recommendations and not self-medicate.

During the rehabilitation period after reduction of a dislocated shoulder, the main attention is focused on restoring lost muscle strength, since it is thanks to strong muscles that the joint is stabilized, and the head of the bone is set in the correct position. Stabilization of the head also occurs in the anteroposterior direction, which further prevents its slipping and exit from the articular area.

Rehabilitation measures of physical therapy for shoulder dislocation are usually carried out in 3 stages:

Initial recovery is the period during the first 3 weeks after reduction.
Restoration of performance – the period of the first 3 months after injury.
A period of complete recovery, which can take up to 6 months (depending on the complexity of the injury and its characteristics).

This classification is usually conditional, since the periods of each stage can be increased or decreased by the doctor individually, based on the patient’s condition and the characteristics of the injury.

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In the initial stage, which begins almost immediately after reduction of the injury and fixation of the joint and lasts about 3 weeks, it is allowed and recommended to perform exercises that will prepare the damaged joint and muscles for more complex loads in the future. Also, exercises during this period are performed to stabilize metabolic processes and normalize blood circulation in the arm and joint. As a rule, during this period the doctor recommends doing:

Careful and very careful movements of the fingers of the injured hand and the entire hand, including the wrist joint.
Light exercises aimed at periodically tensing the muscle blocks of all parts of the arm.

With the beginning of the second stage, the exercises become more complicated, and the load gradually increases, which is necessary to eliminate muscle contracture, strengthen them, and increase endurance:

You can not only move your fingers and hand freely, clench your hand into a fist, but also perform flexion actions at the elbow.
It is recommended to carefully lift the injured arm while holding it with your healthy arm.
You can carefully and slowly move the injured arm to the side.
Carefully moving the injured arm behind the back, this exercise is gradually performed without support, synchronously, with both hands.
Smooth swing of the arm.
After the doctor allows it, you can perform rotational movements with both hands.

It is important that the recommended exercises are performed with both hands at the same time to ensure an even load. Of course, at first the exercises are difficult and require the support of a healthy hand, but gradually you need to move on to performing the complex with both hands.

As a rule, you can begin performing exercises to restore the shoulder joint after a dislocation with some kind of load, for example, light dumbbells, in the period 4–5 weeks after the injury has been reduced. For exercise, you can use other devices, in particular, a special gymnastic stick, small balls, expanders, gradually moving on to exercise machines. If all recommendations are followed correctly, full restoration of former mobility occurs within 5–6 months.

Features of rehabilitation after surgery

Generally, surgery is rarely required for shoulder dislocations, but in some cases there is no other way to prevent the possibility of subsequent injury. Most often, surgery is required in cases where the injury caused damage to the great vessels, tendons, bones, muscles or nerve endings. Surgery is performed if necessary as soon as possible after injury.

Sometimes doctors suggest surgery for ordinary primary dislocations in order to optimally stabilize the joint by strengthening the ligaments. There are many methods for performing such an operation, and the choice of a particular one usually depends on the patient’s physique, the characteristics of his activity and lifestyle.

Rehabilitation after surgery mainly depends on the choiceof the method and the patient’s condition. As a rule, the stages of recovery are almost the same as with non-operative injury reduction, but their overall period, like each of them, can be significantly delayed, and the procedures and exercises themselves will require greater accuracy and caution when performed.

An important point here is the restoration of muscles damaged during surgery, for which special preparations of the enzyme category can be prescribed, especially if the person was involved in sports before the injury. A mandatory step after such an operation is cryotherapy procedures, carried out 5 to 7 times a day for 15 minutes in the first phase of rehabilitation when the joint is immobilized.

It is important that rehabilitation procedures begin immediately after such an operation and are carried out together with the main treatment. The first exercises in the initial stage of recovery should be performed for a few seconds with mandatory relaxation and a gradual increase in time, under the strict supervision of a doctor or exercise therapy instructor. An increase in load occurs only with the permission of the supervising specialist.

The final recovery period in this case begins between 12 and 15 weeks after the operation; in some cases, complete recovery of the joint and return to normal activities, as well as sports, occurs after approximately 6 to 9 months.

What not to do during the recovery period

Of course, the first thing that is not recommended to do when receiving such an injury is to try to straighten the joint yourself without having the necessary qualifications for this, especially if it is possible to receive adequate medical care. You can only reset a dislocated shoulder in emergency cases.

After the dislocation has been reduced, you should not self-medicate. It is very important to strictly follow the doctor’s recommendations and prescriptions. You cannot neglect performing basic exercises in the initial stage of rehabilitation, since this period is very important.

You should not increase the load without permission, trying to speed up recovery, because in this case, instead of benefit, you can cause harm to yourself and provoke not only the occurrence of many complications, but also repeated dislocation of the joint.

During the first and second stages of rehabilitation, it is impossible to perform strength exercises without prior preparation, even if the person has previously been involved in a similar sport. Such actions can lead to severe stretching of weakened ligaments and even their rupture, which will significantly complicate the condition and may provoke further limitation of mobility.

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

This condition may be accompanied by rupture of the ligaments and joint capsule in the affected area.

If symptoms of a disorder appear, you should contact a specialist who will straighten the joint.. After this, you can treat a dislocated shoulder joint at home.

Classification

Depending on the characteristics of the injury, the head of the humerus may shift in different directions from the glenoid cavity. Based on this feature, the following types of dislocations are distinguished:

Front– occur in 80% of cases and are the result of a fall on a straight arm that is pulled back. If the head is severely displaced, fractures of the scapula or separation of the greater tuberosity of the humerus may occur.
Lower– account for approximately 18% of pathologies and are the result of injuries on the horizontal bar. The problem can also occur in a child when adults lift him by the hand. In this case, the head of the bone moves into the armpit. It can be felt by palpation.
Rear– make up no more than 2% and arise as a result of a direct impact. In this case, the head of the humerus moves towards the scapula. Often this condition is accompanied by a fracture of the surgical neck of the humerus.

Symptoms

Before treating a dislocated shoulder joint, you need to analyze the clinical picture of this pathology. The main manifestations of the disease include the following:

First aid

First aid for a dislocated shoulder joint consists of reducing motor activity in the affected area, eliminating the traumatic factor and promptly seeking help from a doctor.

If you suspect a dislocation, you need to take the following measures:

Ensure joint rest– completely abandon physical activity. For this purpose, a special bandage is used for dislocation of the shoulder joint.
Apply ice or other cold– this will help reduce inflammation and swelling of tissues.
Call a doctor.

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

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

After complete recovery, care must be taken. To do this, you should avoid putting any stress on your injured arm and try to eliminate situations in which you could get injured.

Rehabilitation

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

gradual increase in the volume of motor activity of the shoulder muscles - 3-4 weeks;
normalization of normal performance of the shoulder joint – 2-3 months;
restoration of full shoulder function – up to six months.

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

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

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

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

In difficult cases it is necessary to wear a rigid shoulder orthosis. It securely fixes the bones and shoulder. This device is made of a metal frame and is complemented by range of motion regulators.

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

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

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

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

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

At this stage it is useful to make the following movements:

bend and straighten fingers, elbow;
lift the injured arm and support it with the healthy limb;
move one or both hands to the side;
perform rotational movements;
move your hand behind your back;
make pumping movements with your hands.

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

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

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

The most effective home remedies include the following:

When a shoulder joint is dislocated, a nutritious and balanced diet helps speed up recovery.. It should be aimed at strengthening bone tissue, ligaments and joints.

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

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

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

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

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

In order for the body to receive sufficient energy, it is necessary to eat carbohydrates.. It is important to eat foods that contain complex carbohydrates. These include vegetables, fruits and grains.

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

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

When creating a menu, you must follow these rules:

Complications

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

These include the following:

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

A shoulder dislocation is a serious injury that requires urgent medical attention.. The specialist will realign the affected joint and give recommendations for recovery.

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