Repeated shoulder dislocation treatment. Shoulder dislocation: treatment after reduction, physiotherapy

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Shoulder dislocation is a common injury in which the congruence of the articular surfaces (shoulder and scapula) is disrupted. After injury, painful sensations arise, the shoulder is deformed, and the mobility of the injured limb is impaired.

The shoulder joint is the most mobile joint and is often injured. Displacement of the humerus occurs as a result of a fall on a limb extended forward or retracted to the side. After traumatic exposure, there is a risk of rupture of the joint sac and ligaments of the shoulder joint.

In the article you will learn everything about the treatment of shoulder dislocation after shoulder reduction and rehabilitation after injury.

Causes of shoulder dislocation

According to statistics, this injury is diagnosed in 60% of the total number of dislocations. This is explained by the structure of the movable joint, which allows movements in a wide range and different planes.

The main causes of humerus displacement are:

  • High degree of mobility of the shoulder joint;
  • Minimum area of ​​connection between joint surfaces;
  • Relatively large or thin joint sac;
  • Frequent injury to the hand during a fall.

Most often, the shoulder is injured due to traumatic force on the arm or the joint itself. Injury occurs as a result of a fall on an exposed, extended or abducted limb.

If the injury was present in the past, then the likelihood of repeated or habitual displacement of the bone increases. This is explained by the fact that during the first injury the joint sac or ligamentous apparatus is torn. Also, a similar problem arises as a result of incorrect treatment of a dislocation.

Types of Shoulder Dislocation

As already mentioned, a shoulder dislocation occurs due to a traumatic effect on one of the elements of the joint. Injury can be caused by a blow, a fall, or a strong and sharp muscle spasm. As a result, the articular surfaces are displaced and the capsule is partially or completely torn.

Doctors distinguish the following types of dislocations, depending on the direction of displacement of the humeral head in relation to the surface of the scapula:

Thus, most often, shoulder dislocation occurs as a result of direct or indirect traumatic impact on the joint.

Signs of a shoulder dislocation

An injury can be identified by pain, shoulder deformation, and impaired motor function of the limb.

Main signs of a shoulder dislocation:


Doctors prohibit self-reduction of a dislocation, as there is a risk of damage to muscles, nerves and blood vessels.

It is important to ensure complete rest for the injured arm in the shoulder area. To do this, you need to fix the hand in the position of abduction (with anterior displacement) or adduction (with posterior displacement). The limb is bent at the elbow and placed on a bolster, which is pressed to the side of the torso. To ensure full immobility, a bandage (for example, a triangular scarf) is applied to the arm, which holds the forearm and is held on the neck. A bandage for a dislocated shoulder joint can be made from a scarf, scarf, towel, etc.

To relieve pain, you can take an analgesic, for example, Paracetamol, Diclofenac, Ibuprofen, etc. Nonsteroidal anti-inflammatory drugs relieve pain and inflammation.

Further actions should be performed by a doctor. Therefore, the victim must be transported to the nearest emergency room. Self-treatment can lead to dangerous complications. A qualified specialist will conduct the necessary research, prescribe competent treatment, and adjust the dislocation so that the joint recovers faster.

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Methods for reducing dislocation

There are more than 50 ways to realign a displaced joint. Regardless of the treatment method, the victim is administered a solution of Promedol and Novocaine. Painkillers relax the muscles, making it easier for the doctor to realign the displaced joint. In addition, after sedation with medication, the likelihood of tendon and muscle damage is reduced.

Methods for reducing shoulder dislocation:

  • Dzhanelidze method. The victim is placed on his side on the couch so that the injured arm hangs from it. Place a roller under the spatula so that it fits tightly to the surface. An assistant holds the patient's head. The procedure begins 20 minutes after the muscle relaxant injection, after which the muscles relax and the head of the shoulder approaches the articular cavity. Sometimes bone reduction occurs spontaneously. Otherwise. The traumatologist stands in front of the patient, bends the hanging limb at the elbow at a right angle. With one hand he presses on the forearm in the elbow area, and with the other he clasps the hand and turns the injured arm at the shoulder outwards and then inwards. At the moment of reduction, a characteristic click sounds;
  • Kocher method. The patient lies on his back, the doctor clasps the arm at the wrist joint, bends the elbow to 90° and extends the shoulder along the axis, bringing the limb to the torso. The assistant at this moment fixes the victim’s shoulder girdle. The doctor moves the elbow as far forward and medially as possible, without changing position, he turns the shoulder inward. Reduction of the dislocation is accompanied by a characteristic click;

  • Hippocratic method. The victim lies on his back, the doctor stands in front of him near the damaged limb, clasps it with both hands. With the heel of his foot (previously unshod), he rests on the armpit and at the same time extends his arm along the axis;
  • Cooper reduction. The patient sits on a chair, the doctor puts his foot on the same chair, rests his knee on the armpit of the dislocated arm. The traumatologist grabs the injured limb by the wrist, pulls the shoulder down and at the same time pushes the head up with the knee.

There are many more methods for repositioning a displaced humeral head, for example, reduction according to Chaklin, Shulyak, etc. The decision on the choice of treatment method is made by a traumatologist.

Self-reduction of dislocation

Doctors categorically do not recommend resetting a dislocation on your own, as this increases the likelihood of damage to large blood vessels and nerve endings. In addition, there is a risk of deformation of the articular surfaces, which can lead to disability.

To correct a dislocation correctly, you must follow the following rules:

  • First, you need to make sure the integrity of the humerus, scapula and collarbone. If a fracture is present, surgery will most likely be needed. This can be checked using MRI;
  • Secondly, it is necessary to check the hand for the presence or absence of damage to nerves and blood vessels. To do this, non-sensitive areas are determined and the pulse rate in the radial arteries of the arms is compared. Also for this purpose, an x-ray is performed using a contrast agent;
  • Thirdly, you need to take a pain reliever. Otherwise, due to pain, the muscles contract and prevent the dislocation from being corrected;
  • Fourth, relax your muscles. An anesthetic is injected into the brachial plexus, which relaxes the muscles. Intravenous administration of muscle relaxants is possible;
  • Fifthly, you cannot do without X-ray control. After reducing the dislocation, you need to take an x-ray to make sure the alignment of the joint surfaces is correct.

Self-reduction of a dislocation is extremely undesirable, but in emergency cases it can be done at home. The safest and most convenient method is the Dzhanelidze reduction. In other cases, it is better to carry out this procedure in a medical facility.

Rehabilitation after injury

Immediately after reduction of a dislocated shoulder, a special bandage (Dezo type) is applied to the arm to immobilize the shoulder joint. The period of wearing it ranges from 4 to 6 weeks. This is necessary so that the damaged joint heals and recovers faster. Otherwise, the healing process of the joint capsule and ligamentous apparatus is disrupted, and as a result, the likelihood of developing a habitual dislocation increases.

Physiotherapy restores the structure and functionality of the damaged joint and stabilizes it. Physiotherapy eliminates swelling, reduces pain, resolves blood clots, and stimulates local blood flow. In addition, the tissues are saturated with oxygen, the immune system is strengthened, and the damaged joint is restored faster.

The following procedures are used to treat the shoulder joint after a dislocation:

Physiotherapy is used as part of complex treatment to accelerate the regeneration of a damaged joint and eliminating some symptoms without the use of medications.

However, for severe pain, non-steroidal anti-inflammatory drugs are used, for example, Ibuprofen, Diclofenac, Ketanov, etc.

Exercise and massage during rehabilitation

Rehabilitation after a dislocation of the shoulder joint includes gymnastic exercises, but the patient must strictly follow the doctor’s instructions. The diseased joint should be at rest, but at the same time it is necessary to train its muscles. This especially applies to the muscles that are responsible for rotating the shoulder.

A set of exercises to restore motor function of the shoulder joint:


Exercise therapy helps strengthen muscles and helps achieve joint stability. With proper and regular exercise, the likelihood of repeated dislocations is reduced.

Massage is recommended from the first days after reduction of the dislocation. During the period of immobilization, the back and healthy arm are massaged. After removing the plaster, a gentle massage is performed. The procedure stimulates blood circulation, stops the full range of movements, prevents muscle atrophy, and strengthens the ligamentous apparatus.

Folk remedies

As part of the complex treatment of shoulder dislocation at home, you can use folk remedies. However, before using them, you should consult your doctor.

Recipes for treating shoulder dislocation:

  • Mix flour and vinegar until the consistency of a thick dough. Apply the cake to the affected area and wrap it with an elastic bandage;
  • Grind the leaves of fresh wormwood, apply to the sore shoulder, and wrap a wet cold bandage on top;
  • Grind the leaves and flowers of lavender, pour in sunflower oil in a ratio of 1:5. Let the oil steep for 30 days, stirring it occasionally. This medicine will help relieve pain from sprains and sprains;
  • Grind the dry bryonia root, take 6 g of powder, pour in 1 liter of hot water, put on low heat and boil for 15 minutes. Strain the broth and use for compresses;
  • Pour 5 g of crushed root of crime into 100 ml of olive oil, sunflower oil, flax oil, etc. Rub the sore joint with medicinal oil;
  • Pour 3 tbsp. spoons of tansy 200 ml of boiling water and leave for 1 hour, strain and cool. The decoction is used for compresses on the injured shoulder. The plant restores joint mobility;
  • Brew 100 g of cuff with 500 ml of boiling water, let the liquid brew, and strain after 4 hours. The prepared decoction is used for compresses, which are applied to the damaged shoulder for half an hour. When used regularly, the cuff prevents the consequences of dislocation.

Before using any product, you should consult your doctor.

Complications of improper treatment

The most dangerous complication of a shoulder dislocation is damage to the peripheral nerves. The brachial plexus is compressed by the displaced head of the humerus, and the nerve in the armpit is also injured.

It is important to identify in time whether the patient was delivered with such a complication or whether it arose during treatment, since further actions depend on this. The period of hand rehabilitation after nerve damage depends on the severity of the injury and its duration.

Closed reduction of chronic displacement has a better prognosis than open reduction. However, during treatment, gross violence should be avoided, as the likelihood of a fracture of the humeral neck and other serious injuries increases. With open treatment of a dislocation, there is a possibility that the shoulder joint will not fully recover.

Habitual dislocation is a pathological condition in which repeated dislocations occur as a result of the traumatic impact of a small force or contraction of the shoulder girdle’s own muscles. This condition may occur due to a violation of the principles of treatment or the timing of immobilization of the damaged limb.

Thus, a dislocation of the shoulder joint is a dangerous injury that requires timely and competent treatment. Otherwise, the likelihood of dangerous complications in the form of functional disorders and pain in the damaged joint increases. For this reason, the patient must strictly follow the doctor's recommendations in order for the shoulder joint to fully recover.

Now you know how to treat a dislocated shoulder at home after realignment of the shoulder joint.

It just so happens that the most common dislocation that a person encounters is a dislocated shoulder. And on the eve of summer holidays and active fun in nature, it is worth remembering what you should do when you dislocate your shoulder, and what you should not do under any circumstances.


How to pump up your shoulders at home

Why does the shoulder “fly out”? Because nature, while ensuring the mobility of the shoulder joint, sacrificed its strength. The large head of the humerus is placed in a very shallow socket (capsule) of the joint, and the ligaments that hold them there are few and weak. Therefore, when you fall on an arm extended to the side (football, volleyball, excessive drinking - there are many reasons), the head of the humerus simply pops out of the glenoid cavity.

If this happens, then the future fate of your hand now depends on what first aid you were given. If, after watching enough movies, someone tries to pull your hand, trying to return the joint to its place, drive him away from you with all your remaining limbs, or, as a last resort, run away. Otherwise, you risk getting an injury worse than the one that has already occurred - not only ligaments and tendons, but also nerves and blood vessels will tear.

So it’s better to treat yourself according to the rules.

Rule one (providing assistance on the spot)

Secure the joint with a bandage or splint, and immediately go to the emergency room or hospital. An x-ray must be taken there to rule out or confirm bone damage. Then, under local anesthesia, the dislocation will be gently reduced and a plaster splint will be applied for 3 weeks. This is necessary for soft tissue tears to heal.

You cannot remove the splint on your own ahead of schedule, even if nothing hurts, and even more so you cannot begin to slowly “develop” the joint. As a result, the fragile capsule and ligaments cannot withstand the load and you get a repeated dislocation. Over time, the joint becomes so loose that the dislocation turns from primary to habitual. The shoulder will pop out when putting on a coat and even when turning from side to side in bed. And habitual dislocation can only be treated surgically.

Rule two (immobility for 3 weeks)

Once your joint has been immobilized (immobilized) using a splint, immediately begin doing isometric exercises (without moving the joint) for the muscles surrounding the shoulder joint. Use the bend of your elbow to press the splints onto the wall or onto the hand of your other hand. Each tension initially lasts 1-2 seconds, but gradually this time increases to 6-8 seconds. Repeat until tired 2-3 times a day.

After the splint is removed, it is best to undergo a comprehensive rehabilitation course - electrical stimulation of the arm muscles, massage, therapeutic exercises, exercises in water). If this is not done, then a repeated dislocation, followed by a habitual one, will not keep you waiting.

Rule three (comprehensive rehabilitation)

The goal of rehabilitation is not only to restore joint mobility, but also to prevent recurrent dislocations. You need to strengthen the entire complex of arm muscles with the help of special exercises. Limiting yourself to strengthening only the well-known biceps, triceps and deltoid muscles is generally pointless; it will tear where it is thin.

After all, the main role in stabilizing the shoulder joint belongs not to large muscles, but to small rotator muscles that rotate the shoulder in and out. Their tendons weave around the perimeter of the shoulder joint. So, it’s best to spend money on a good rehabilitation doctor in a good center and then not know how to save money and periodically visit the trauma department of the clinic.

We thank the manager for his help in preparing the material. Department of Rehabilitation Therapy of the Moscow Scientific and Practical Center for Sports Medicine Mark Gershburg.

The first step after realigning the joint is to avoid any physical activity. The arms, back and shoulders should not bear any weight after surgery. Any tension on these parts will lead to unpleasant consequences. Athletes are prohibited from engaging in major sports for about 6 months.

First days of rehabilitation

After the shoulder dislocation is reduced, the patient is given a bandage to immobilize the sore spot. It should be worn for more than 1 week. If complications arise in the form of soft tissue problems, a fracture or repeated dislocation, the shoulder, arm and back are fixed for a longer period.

Returning to usual physical activity should occur gradually and evenly. This will ensure the safety of damaged parts. To develop the hand, you can use dumbbells or an expander. Full use of the entire arm is prohibited.

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

Surgical intervention

It may be that complications from a shoulder dislocation require surgery. Main reasons for surgery:


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

Surgery may be performed to strengthen the ligaments.

Medications

Dislocation is accompanied by severe pain. To eliminate them, analgesics (Tempalgin) are prescribed. When reducing a dislocated shoulder, an antispasmodic (Spazmalgon) must be prescribed. It should relax the muscles and remove spasms for proper alignment of the joint, and additionally relieves pain.

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

Stages of recovery after a dislocation

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

Don't neglect exercise therapy. It provides:


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

During exercise therapy, the bandage or splint is removed.

Subsequent treatment is divided into the following stages:


  • Ensuring immobility of the affected area of ​​the body. This reduces pain and prevents fractures and dislocations. This stage lasts about a week. In case of damage, the time of immobilization of the shoulder increases. The doctor may prescribe anti-inflammatory drugs. It is allowed to apply ice for severe pain and swelling. Perform simple exercises for the wrist and hand: rotating the hand, squeezing the fingers. They will keep muscles toned and increase blood circulation.
  • Creating primary activity in the shoulder area. Over the course of a month, the shoulder joint gradually develops in the absence of any pain in the damaged area. Choose simple exercises to develop mobility. Compound movements are strictly prohibited, as there is a high risk of re-dislocation. If swelling occurs, apply ice.
  • Strengthens muscles and develops mobility of the shoulder, arm and back. The duration of the stage is 1-1.5 months. If you feel well, the fixation bandage is discarded. You can perform some strength exercises and statistical loads.
  • At this transitional stage, measures are taken to bring the diseased joint to the level of a healthy one. Duration more than 2 months. If you neglect the recommendations of this period, then there is a high probability of re-dislocation after some time.
  • The longest and most important period of rehabilitation. It will ensure proper recovery and preservation of the result. To develop and strengthen muscles, strength exercises are performed with dumbbells. Functional training of the back, shoulder and arm is allowed. The load should increase gradually.

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

Physiotherapy

During the rehabilitation period the following will be useful:


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

Shoulder dislocation or dislocation is a displacement of the head of the humerus from the glenoid cavity of the scapula, due to a pathological process or physical violence.

In cases where the contact of the articulating surfaces is preserved, but congruence is broken, shoulder subluxation.

Many traumatologists consider a dislocation of the shoulder joint to be a simple and reversible injury, but, unfortunately, serious complications often occur.

For example, damage or even destruction of the adjacent bone may occur, and as a result, injury to the surrounding ligaments, blood vessels, nerves, and tendons.

Anatomy of the shoulder joint

The shoulder joint is the most mobile among the joints of the human body. It is formed by the head of the humerus and the glenoid cavity of the scapula.

The surfaces of the joints are covered with hyaline cartilage and do not correspond to each other.

The glenoid cavity is shaped like a saucer; the head of the humerus is spherical.

The surface area of ​​the humeral head is much larger than the area of ​​the glenoid cavity, so dislocations and subluxations often occur.

Structure of the shoulder joint (front view):

  1. shoulder blade;
  2. acromion;
  3. coracoid process;
  4. brachial bone;
  5. greater tubercle of the humerus;
  6. lesser tubercle of the humerus;
  7. shoulder joint (capsule).

The structure of the shoulder joint has a number of features, among which are the processes of the scapula, especially the acromion. It begins with a spine, that is, a wide horizontal plate perpendicular to the posterior surface of the scapula, and divides it into the infraspinatus and supraspinatus regions.

Further, the plate becomes significantly narrower, it is directed outward and upward, where it bends in the form of a hook above the shoulder joint. The acromion is connected to the clavicle at the anterior end using the acromioclavicular joint.

The supraspinatus tendon passes through the subacromial space, located between the acromion and the head of the humerus.

In shape, the shoulder joint is a ball-and-socket joint and is triaxial. Due to the fact that the shoulder joint is the most mobile in the human body, the arm has almost unlimited freedom of movement.

Causes

The main causes of shoulder joint dislocations are direct or indirect blows to the joint area.

Also, shoulder dislocation occurs due to a fall on outstretched arms, or an intense rotational movement with the application of force.

In athletes during strength training, especially beginners who are not accustomed to increased loads, shoulder dislocation occurs while performing bench presses, weighted pull-ups, and other types of exercises that involve the shoulder joint.

Symptoms

The first thing the victim feels immediately after a shoulder dislocation is acute joint pain, and a feeling of unnatural shoulder position.

Outwardly, this is manifested by a violation of the symmetry of the relatively healthy shoulder, the former rounded contour is lost, the joint becomes sharp, somewhat drooping.

The victim tries to press the injured arm to the body with his healthy arm to avoid inaccurate movements and not cause even more harm.

If the dislocation causes damage to nerves and/or blood vessels, the victim feels a stabbing pain, the hand may become numb, and bruises appear in the area of ​​injury.

Classification of shoulder dislocations

Shoulder dislocations are divided into anterior, subclavian, inferior and posterior.

It is especially worth noting. When the shoulder is dislocated, the ovality of the contour of the shoulder joint is lost. It acquires swiftness and resembles the outline of an epaulette.

Front

With anterior shoulder dislocations, the subclavian fossa is smoothed out.

Subclavian

With subclavian dislocations, the fossa becomes oval-convex. The shoulder, visually, appears shorter, it is slightly abducted, its axis shifts inward in the frontal plane.

When palpating the area of ​​the shoulder joint from the outside, the finger can easily be placed under the supra-brachial process, and the head of the humerus is palpated under the collarbone or below it.

Lower

Inferior shoulder dislocations are characterized by noticeable abduction of the shoulder, which often reaches a right angle; the head of the humerus is palpated in the axillary fossa.

Rear

In posterior dislocations, the upper limb is adducted and internally rotated. The shoulder also becomes slightly shorter, and its axis is often shifted posteriorly in the sagittal plane. Along the anterolateral surface, the area of ​​the shoulder joint is significantly flattened, and under the skin protrudes the contour of the anterior edge of the suprahumeral process of the scapula, and the apex of the coracoid process and the anterior edge of the suprahumeral process of the scapula. An oval bulge appears on the back surface of the shoulder joint, in place of the infraspinatus fossa.

Upon palpation, the head of the humerus is determined.

If the head of the humerus is displaced, it can injure the brachial plexus, which is manifested by paresthesia, paresis, and paralysis of the injured limb.

Traumatic dislocations can be complicated not only by injury to the brachial plexus. Together with them, avulsions of the muscles attached to the greater tubercle, as well as the latter, are also diagnosed.

Habitual shoulder dislocation

Habitual or repeated shoulder dislocation is an unstable condition of the shoulder joint, in which dislocation occurs even with a slight load. For example, when swinging for a throw, putting your hands behind your head, putting on clothes, and even in your sleep. Incorrect treatment of primary dislocation and rehabilitation leads to the development of habitual dislocation.

Reduction

Shoulder dislocations are reduced using the method Kocher, Hippocrates, Dzhanelidze, Mota and etc..

Kocher method

Anterior dislocations are best reduced using the Kocher method.

Depending on the method of anesthesia, the dislocation is reduced while lying on your back or sitting.

The assistant fixes the scapula to the table, and if the victim is sitting, then to the back of the chair.

The surgeon grabs the injured arm of the victim above the elbow with his left hand, and with his right hand - by the forearm, bends it at the elbow joint to a right angle and gradually, without jerking or violence, performs the following actions (stages):

  • Stage I— smoothly, with increasing strength, the surgeon performs traction (traction) of the shoulder along the downward axis, overcoming contraction (contraction) of the muscles.
  • Stage II- rotates the shoulder outward. In this position, the head has the smallest diameter, the angle between the head and the diaphysis is leveled. Thanks to this, they prevent it from clinging and additional injury to nearby muscles when the head is displaced towards the articular fossa.
  • Stage III- the surgeon, without reducing the traction along the axis of the shoulder, brings the shoulder in the direction of the midline to the body so that it rests against the chest at the level of the lower and middle third, and the shoulder becomes a double-armed lever. The long arm of the lever is the upper and middle third, and the short arm is the lower third of the arm. Next, the surgeon, maintaining traction along the axis, presses the outer surface of the elbow joint (short lever) from top to bottom. At this time, a force develops at the end of the long lever, which brings the head of the humerus to the level of the glenoid fossa of the scapula.
  • Stage IV— having felt the displacement of the head of the humerus and seen the contour of the shoulder joint, the surgeon performs vigorous internal rotation of the shoulder and, in a pronated position, places the forearm on the chest at an acute angle. At this time, the head of the humerus is reduced with a characteristic sound. As soon as the head is reduced, “elastic mobility” immediately disappears, and the ovality of the contour of the shoulder joint is restored. Immobilization is carried out with a Deso bandage, which is additionally strengthened with plaster bandages, for at least 3 weeks (the time required for the joint capsule to fuse). Treatment without immobilization or early removal of it leads to a serious complication - habitual shoulder dislocation.

Reduction of dislocation according to Hippocrates

This method is also called military field. The victim lies on his back on a table or floor. The surgeon sits on the side facing him and takes the injured arm with both hands by the forearm above the wrist joint. He then inserts the midfoot (not the heel) of his leg into the armpit so that the arch of the foot overlaps it. In this case, the outer edge of the middle foot rests against the lateral surface of the chest, and the inner edge rests against the medial surface of the upper third of the shoulder. A two-armed lever is formed, the short arm of which becomes the head and the upper third of the arm, and the lower arm - the middle and lower third of the arm. Having fulfilled the conditions described above, the surgeon begins to gradually, without jerking, increase the traction along the axis of the arm, bringing it to the body. At this time, according to the principle of the lever, the head is gradually brought out to the level of the articular fossa of the scapula and its reduction occurs. The contour of the shoulder joint takes on its normal shape, the symptom of elastic movement disappears, passive movements become free and not limited. All these signs indicate that the dislocation has been reduced. Immobilization is performed with a Deso bandage.

Dzhanelidze method

An effective way to reduce lower shoulder dislocations is the Dzhanelidze method. The victim is placed on the table on the injured side so that the shoulder blade is fixed to the table and does not go beyond its edge, and the arm hangs freely. The victim's head is held by an assistant or placed on an additional table. A prerequisite is to fix the shoulder blade to the table. Only under this condition, after 10-15 minutes, it is possible to achieve relaxation of the muscles of the upper limb girdle. After making sure that the muscles are relaxed, the surgeon bends the forearm at the elbow joint to an angle of 90 ° and gradually, with increasing force, presses down on the upper third of the forearm. Small rotational movements are carried out, due to which the head is reduced.

Treatment and rehabilitation after reduction of a dislocated shoulder

  • Complete lack of movement in the shoulder joint for a week. To do this, the doctor applies a fixing bandage or splints.
  • In case of complications such as fractures or soft tissue damage, immobilization is required for a longer period.
  • To relieve or relieve pain and eliminate pain, you may need to take non-steroidal anti-inflammatory drugs, such as ibuprofen or ketans.
  • It is necessary to include the shoulder in work gradually, and only after a period of complete immobilization.
  • To prevent repeated dislocations, it is necessary to strengthen the ligaments that support the shoulder joint.
  • At the initial stages of rehabilitation of shoulder dislocations, it is recommended to use exercises with light dumbbells and an expander.

Operation

Surgical intervention is required in cases where, due to dislocation of the humerus, serious damage to the joint, muscles, tendons, and nerve endings has occurred. The operation should be performed as soon as possible after the injury.

Habitual dislocations are subject to surgical treatment, since conservative methods in this case are ineffective. The operation is aimed at stabilizing the joint by strengthening the ligamentous apparatus. A number of different techniques can be proposed for these purposes. To choose the right technique, the surgeon must take into account the patient’s lifestyle and type of activity. Some techniques have disadvantages that manifest themselves in limiting the function of the shoulder joint. Such operations are not suitable for athletes who participate in competitions such as projectile throwing, or tennis, where the athlete is forced to make a strong swing to hit the ball.

Rehabilitation

After reduction of a dislocated shoulder, rehabilitation recovery includes four stages:

First stage. Using a Deso-type bandage for immobilization helps prevent further damage, reduces pain, inflammation, and creates the necessary conditions for scarring. The duration of immobilization is about four to five weeks after the initial dislocation. The patient needs to perform simple exercises: clenching his hand into a fist, rotating his fingers, in order to maintain blood flow in the area fixed by the bandage. Use cold compresses and ice to reduce pain and swelling. The doctor prescribes anti-inflammatory and painkillers.

Second phase. This stage begins immediately after the cessation of immobilization and continues for two to three weeks, during which time the patient continues to wear a soft supporting bandage. Exercises begin to strengthen the muscles of the shoulder girdle and shoulder. The amplitude and weight of the weights should be selected in such a way as not to cause pain. The starting position provides shoulder support. To avoid re-injury, it is necessary to avoid combined movements - abducting the arm to the sides, turning the shoulder outward. If swelling occurs after training, you can apply ice.

Third stage. The duration of the third stage is about three months. The patient's actions are aimed at further strengthening the shoulder muscles. It is recommended to perform exercises that restore the functions of the shoulder flexors, rotators and shoulder abductors. Important do not rush to restore the full range of motion, which will be fully restored only a year after the injury. At the third stage, you can begin to remove the bandage and gradually stop wearing it altogether. You can also increase the weight of the weight when performing exercises, including resistance exercises.

Fourth stage. This stage is aimed at returning the patient to usual activities and sports activities. It is allowed to increase the weight of the weights that the patient uses during exercises to strengthen the muscles of the shoulder joint. At this final stage of rehabilitation, fundamental exercises specific to a particular sport can be performed if the patient is an athlete. The load must be increased gradually, concentrating on the execution technique. Important monitor the coordination of movements to avoid stretching the joint capsule.

The shoulder in the human body is located between the shoulder and elbow joints and is the most mobile part in the body. The shoulder performs flexion-extension movements, lifts objects, and you can reach various surfaces with your hands thanks to the properties of the shoulder joint. At the same time, the unique mobility of the shoulder joint puts it at risk for injury. Dislocations of the shoulder bones are a common occurrence in medicine. Statistics show that half of all dislocations are shoulder injuries.

The shoulder joint is formed by the head of the humerus and the glenoid cavity of the scapula. Both bone elements correspond 100% to each other in shape. In order for the shoulder to make movements in different planes, its structure requires the presence of a distance between the elements of the articulation. Muscles, tendons, articular ligaments and connective tissue provide some stabilization to the head of the humerus. In this case, the glenoid cavity has virtually no bone support, which leads to frequent injuries.

Taking into account the structure of the shoulder joint, shoulder dislocation is a loss of connection between the articulating surfaces of the head of the humerus and the glenoid cavity. As a result, the normal functioning of the shoulder region stops. Adults experience symptoms of varying severity. The shoulder looks unnatural, asymmetrical to a healthy one. It may be too low or, conversely, too high above the normal position.

Symptoms


Shoulder dislocations occur for a variety of reasons. The symptoms are the same for all types of similar injuries, but with some features. First of all, it is worth highlighting the symptoms of fresh injuries that have just occurred:

  • limitation or inability to move the arm in the shoulder area - painful sensations occur even with passive movements, there is a feeling of springy resistance;
  • swelling of the soft tissues around the injured area;
  • pain syndrome depending on the severity of the injury - both the shoulder and the shoulder blade, collarbone, and arm can hurt;
  • unnatural appearance of the injured limb;
  • numbness of the fingers, loss of sensitivity, bruising, which indicate that the nerve endings have been pinched.

The cause of old injuries is unreduced dislocation. In such situations, a chronic inflammatory process develops, as well as independent fusion of bone tissue in the area of ​​damage. As a result of such improper fusion, connecting growths are formed - fibrous cords, which fix the shoulder joint in the wrong position from an anatomical point of view. The injured area does not cause pain or swelling. All this limits or prevents normal movement in the joint and limb.

If a subluxation of the shoulder joint occurs, then in addition to pain and limited motor activity, the victim is also worried about redness of the skin and an increase in temperature in the area of ​​​​the injury.

How to Identify a Shoulder Dislocation

It does not matter which side of the arm the injury occurred on: the right shoulder or the left. Symptoms and signs are the same on both sides. To determine the presence of a dislocation, first of all, the doctor examines the shoulder by palpation and determines a presumptive diagnosis. The doctor also checks the pulse in both hands to prevent injury to the blood vessels. After this, the victim is sent for an x-ray. If necessary, additional diagnostic methods are prescribed.

Causes of dislocation


The causes of dislocation of the bones of the shoulder joint can be divided into traumatic and pathological. Pathological reasons:

  1. diseases affecting the condition of bones and joints: arthritis, arthrosis;
  2. features of the anatomical structure of bones and their joints;
  3. congenital anomalies, such as joint hypermobility.

Traumatic causes include:

  • blows, falls on straightened, straightened or abducted arms;
  • sudden movements of the shoulder joint;
  • improper performance of physical exercises, injuries during training.

Athletes who actively and regularly load the shoulder girdle are at risk: swimmers, tennis players, volleyball players.

Classification

Types of damage are classified according to many characteristics, mechanism of action, time.

By degree of displacement:

  • dislocation;
  • subluxation of the shoulder joint or dislocation of the articulation of the head of the humerus and the glenoid cavity (in this case, the points of contact between the surfaces of the shoulder joint remain).

Depending on the time of acquisition of injuries, the following are distinguished:

  1. congenital dislocation, which occurred either as a result of abnormalities in intrauterine development, or due to birth injuries in the newborn;
  2. acquired.

Purchased ones are divided into:

  • traumatic, resulting from injury;
  • a habitual dislocation that occurs due to poor strengthening of the muscles and tendons of the shoulder after injury.

Based on the location of the displaced head of the humerus, the following are distinguished:

  1. anterior shoulder dislocation;
  2. posterior shoulder dislocation;
  3. lower dislocation.

By time of impact on the shoulder:

  • old dislocation: the injury occurred more than three weeks ago;
  • stale dislocation: from three days to three weeks;
  • fresh: up to three days have passed since the injury.

Also classified into:

  1. primary dislocation;
  2. pathologically chronic shoulder dislocation.

Diagnostics


The diagnosis can be assumed based on the data of the initial examination. To establish an accurate diagnosis and determine the type of dislocation, it is important to conduct hardware studies.

Diagnostic methods include:

  1. X-ray (two projections) is mandatory. Without it, it is impossible to reduce a dislocation or perform other treatment procedures.
  2. Computed tomography determines the location and displacement of the head of the humerus, fracture or crack of the bones.
  3. MRI helps to see surfaces of interest more accurately and clearly.
  4. An ultrasound is done if pinched blood vessels are suspected, to visualize the fluid in the joint.

It is important to undergo an examination after a dislocation, because a neglected injury can heal incorrectly and lead to surgery to normalize functioning.

Treatment of shoulder dislocations

Treatment depends on what the x-ray shows, the timing of treatment, and the presence of complications. The goal of traumatologists is to restore joint function and minimize consequences.

After examination, the doctor reduces the dislocation if the victim’s condition allows it. There are many methods for reducing a dislocation, depending on the clinical picture and condition of the patient.

If you see a doctor in the first hours after receiving an injury, it will be much easier and faster to straighten your shoulder. When help is sought later, the muscles around the joint contract and it becomes more difficult to straighten it. If the primary method does not produce results, as well as in case of an old injury, the victim requires surgical intervention. Shoulder subluxation is treated in the same way.

After reduction, it is important to immobilize the injured arm with a plaster splint or bandage. As soon as the plaster is removed, patients are required to undergo a mandatory recovery course.

First aid


First aid for suspected dislocation is provided immediately after injury to the limb. The main steps will be:

  1. Place the victim in a level position, immobilize the limb;
  2. in case of an acute condition, call an ambulance or immediately go to a traumatology center;
  3. provide the person with painkillers;
  4. fix the injured arm and tie it to the body with a scarf, scarf, or other available fabric;
  5. if possible, apply ice or otherwise cool the damaged part of the body, make sure that frostbite does not occur to the tissues of the limb, to do this, remove the cooling object every quarter of an hour.

Under no circumstances should you adjust your shoulder yourself. Such actions can cause even greater harm to the victim.

Which doctors should you contact?

When an ambulance call is not required, the victim must be taken to the trauma department immediately after the incident. Shoulder dislocations are the responsibility of an orthopedic traumatologist. If there are complications, consultation with a neurologist or surgeon is required.

Conservative treatment

Measures to restore the motor functions of the shoulder include closed reduction of the dislocation and the application of a special bandage or plaster.

Effective methods of reduction: the method of Dzhanelidze, Kocher, Hippocrates, Mukhin-Mota. They are performed from different body positions - both lying on your back, sitting or standing.

First, the procedure is performed under local anesthesia. If this does not produce results, an attempt is made to perform a closed reduction under general anesthesia.

After this, immobilization of the limb is required for up to one month using a plaster cast or Deso bandage. This important stage of treatment creates conditions for rapid tissue healing in a state of complete rest. Anti-inflammatory medications are also prescribed and a cooling bandage is applied to reduce pain. After reduction, the pain usually goes away quickly. The last, but no less important step towards recovery is rehabilitation.

The situation with the reduction of habitual dislocations is much more complicated. The essence of the problem is instability of the joint due to its insufficient restoration. The shoulders are not ready for the usual loads, which causes second and further repeated injuries. This pathology can only be treated surgically.

Surgical treatment

Dislocation of the shoulder joint in children can be congenital or traumatic. In cases where there were birth injuries, or during intrauterine development the child developed joint pathology, they speak of a congenital injury.

If a child’s shoulder dislocation occurs as a result of injury or a careless fall or blow, then we are talking about a traumatic type of injury. In children, such injuries occur during active play or during sports. Additional causes of such ailments can be the child’s excess weight and heredity.

The symptoms are similar to those that appear in adults. Therapy is carried out according to the same principles. Rehabilitation plays an important role in helping the joint fully recover.

Complications

The most common complication is re-dislocation. Often people neglect rehabilitation. This error prevents the joint from completely recovering, and as a result, repeated damage is inevitable, which leads to its usual appearance. The only option for cure is surgery.

Prevention

The stronger the shoulder girdle, the lower the risk of injury. Therefore, the main directions in the prevention of these pathologies will be regular exercise, a healthy lifestyle, and the inadmissibility of self-medication in the event of injuries. Training should be carried out with all muscle groups to form a strong muscular core.