Shoulder dislocation treatment after medication reduction. Shoulder dislocation - causes, symptoms and treatment

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 the 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 Hippocrates, Meshkov, Dzhanelidze and other doctors who proposed their own methods dealt with this problem. 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 during immobilization and after it, the following procedures can be used:

  • 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 in 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:

  1. Anti-inflammatory nonsteroidal drugs(Diclofenac, Ketorolac, Ketoprofen, Indomethacin; Piroxicam).
  2. Chondroprotectors(Dona, Teraflex, Alflutop, Artra, Chondrolon, Elbona).
  3. 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:

  1. After applying a plaster splint, you should provide complete rest to your hand.
  2. If there is inflammation or pain, take prescribed medications and go to physical therapy.
  3. Strengthen bones and joints by taking vitamin-mineral complexes and chondroprotectors.
  4. 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.

  1. 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.
  2. 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

  1. Pour water over the raw material and boil for about 20 minutes.
  2. Moisten the gauze with the cooled broth and apply a compress to the joint.
  3. 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.

  1. 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.
  2. 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.

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.

The shoulder joint is formed by the articular surfaces of two bones - the scapula and the humerus. The first is a flat-concave smooth platform, and the second has the shape of a ball. This spherical head is in contact with the articular surface of the scapula (as if it enters it) only a quarter, and its stability in this position is ensured by the so-called rotator cuff of the shoulder - the joint capsule and the musculo-ligamentous apparatus.

Due to its structure, the shoulder joint is one of the most mobile joints of our skeleton; all types of movements are possible in it: flexion and extension, abduction and adduction, as well as rotation (rotation). However, for the same reason, it is also the most vulnerable - more than half of all dislocations in the practice of a traumatologist are dislocations of the shoulder joint.

You will learn about what this pathology is, its types, causes and mechanisms of occurrence, as well as symptoms, principles of diagnosis and treatment tactics (including the rehabilitation period after reduction) of a dislocated shoulder joint from our article.

So, a dislocation of the shoulder joint, or simply a dislocation of the shoulder, is a persistent separation of the articular surfaces of the glenoid cavity of the scapula and the spherical head of the humerus, resulting from injury or some other pathological process.

Classification

Depending on the causative factor, the following types of dislocations are distinguished:

  1. Congenital.
  2. Purchased:
    • traumatic (or primary);
    • non-traumatic (voluntary, pathological and habitual).

We will consider each of these reasons in more detail in the corresponding section of the article.

If a traumatic dislocation occurs in isolation, not accompanied by other injuries, it is called uncomplicated. In the case where, simultaneously with a shoulder dislocation, a violation of the integrity of the skin, fractures of the clavicle, scapula, and damage to the neurovascular bundle are determined, a complicated dislocation is diagnosed.

Depending on which direction the head of the humerus is displaced, shoulder dislocations are divided into:

  • front;
  • lower;
  • rear

The vast majority of cases of this injury - up to 75% - occur in anterior dislocations, about 24% are lower or axillary dislocations, while other variants of the disease occur in only 1% of patients.

Classification depending on the time since the injury plays an important role in determining treatment tactics and prognosis. According to it, there are 3 types of dislocations:

  • fresh (up to three days);
  • stale (from three days to three weeks);
  • old (the dislocation occurred more than 21 days ago).

Causes of shoulder dislocation

Traumatic dislocation occurs, as a rule, as a result of a person falling on a straight arm abducted or extended forward, as well as due to a blow to the shoulder area from the front or back. Trauma is the most common cause of this pathology.

If, after a traumatic dislocation for some reason (often the reason is an insufficient period of immobilization of the affected limb after reduction of the dislocation), the rotator cuff is not fully restored, a habitual dislocation develops. The head of the humerus pops out of the glenoid cavity of the scapula during sports (for example, when serving a ball in volleyball or swimming) and even when a person performs simple actions in everyday life (dressing/undressing, combing, hanging clothes after washing, etc.). In some patients, this happens up to 2-3 times daily, and with each subsequent dislocation, the threshold of load required to cause injury decreases, and it becomes easier to reduce. A patient who is “experienced” in this regard no longer turns to doctors for correction, but does it on his own.

With the development of neoplasms, tuberculosis, osteodystrophies or osteochondropathy in the area of ​​the shoulder joint or surrounding tissues, pathological dislocations are possible.

Mechanism of development of dislocation

Indirect trauma - a fall on a straight abducted, raised or extended arm - leads to displacement of the head of the humerus in the direction opposite to the fall, rupture of the joint capsule in the same place and, possibly, damage to the muscles, ligaments or fractures of the bones that form the joint.

When there is pressure on the joint area of ​​a benign or malignant tumor, the head also pops out of the articular cavity - a pathological dislocation occurs.


Shoulder dislocation: symptoms

The main complaint of patients with this pathology is intense constant pain that occurs after a fall on an outstretched arm or a blow to the shoulder area. They also note a sharp restriction of movements in the shoulder joint - it completely ceases to perform its functions, and attempts at passive movements are sharply painful.

Another important sign is a change in the shape of the shoulder joint. In a healthy person, it has a round shape, without any significant protrusions. In case of dislocation, the joint is externally deformed - in front, behind or downwards from it, a clearly visible spherical protrusion is determined - the head of the humerus. In the anteroposterior dimension, the joint is flattened.

With inferior dislocations, the head of the humerus damages the neurovascular bundle that passes through the axillary region. The patient complains of numbness in certain areas of the arm (which innervate the damaged nerve) and decreased sensitivity in them.

Diagnostics

The doctor will suspect a dislocation already at the stage of collecting complaints, the patient’s life history and illness. Then he will assess the objective status: examine and palpate (feel) the affected joint. The specialist will pay attention to deformation noticeable to the naked eye, the presence of skin defects or hemorrhages in the area (which can occur when a blood vessel ruptures at the time of injury).

With a habitual dislocation, attention will be drawn to the atrophy of the deltoid muscle and the muscles of the scapular region with a normal configuration of the shoulder joint and limited movements (especially abduction and rotation) in it.

By palpation (by palpation), the head of the humerus is found in an atypical place - outward, inward or downward from the glenoid cavity. The patient cannot make active movements in the affected joint, and when trying to move passively, the so-called symptom of spring resistance is determined. Both palpation and movements in the shoulder joint are sharply painful. In the elbow and underlying joints, the range of motion is preserved, palpation is not accompanied by pain.

If during a dislocation one or more nerves of the neurovascular bundle passing through the axillary region are damaged (this usually happens with lower dislocations), upon examination the doctor determines a decrease in sensitivity in the areas of the arm innervated by these nerves.

The main method of instrumental diagnosis of shoulder dislocation is radiography of the affected area. It allows you to establish an accurate diagnosis - the type of dislocation and the presence/absence of other types of injuries in this area.

In doubtful cases, in order to clarify the diagnosis, the patient is prescribed a computer or magnetic resonance imaging of the shoulder joint, as well as electromyography, which will help detect a decrease in the excitability of atrophied muscles that occurs with habitual dislocations.


Treatment tactics

Immediately after the injury occurs, it is necessary to call an ambulance or taxi to take the patient with a dislocated shoulder to the hospital. While waiting for the car, he should be given first aid, which includes:

  • cold on the affected area (to stop bleeding, reduce swelling and ease pain);
  • pain relief (non-steroidal anti-inflammatory drugs - paracetamol, ibuprofen, dexalgin and others, and if the need for the drug is determined by the emergency doctor, then narcotic analgesics (promedol, omnopon)).

Upon admission, the doctor first of all carries out the necessary diagnostic measures. When an accurate diagnosis is made, the need to reduce the dislocation comes to the fore. A primary traumatic dislocation, especially an old one, is the most difficult to reduce, while a habitual dislocation becomes easier to reduce with each subsequent time.

Reduction of a dislocation cannot be carried out “live” - in all cases local or general anesthesia is required. Young patients with uncomplicated traumatic dislocation are usually given local anesthesia. To do this, a narcotic analgesic is injected into the area of ​​the affected joint, and then an injection of novocaine or lidocaine is given. After tissue sensitivity decreases and the muscles relax, the doctor performs a closed reduction of the dislocation. There are many proprietary methods, the most common among them are the methods of Kudryavtsev, Meshkov, Hippocrates, Dzhanelidze, Chaklin, Richet, Simon. The least traumatic and most physiological are the methods of Dzhanelidze and Meshkov. Any of the methods will be most effective with complete anesthesia and delicate manipulations.

In some cases, the patient is advised to reduce the dislocation under general anesthesia - general anesthesia.

If closed reduction is not possible, the issue of open intervention is decided - arthrotomy of the shoulder joint. During the operation, the doctor removes the tissues trapped between the articular surfaces and restores the congruence (mutual correspondence between them) of the latter.

After the head of the humerus is established in its anatomical position, the pain decreases within a few hours and disappears completely within 1-2 days.

Immediately after reduction, the doctor repeats the x-ray (to determine whether the head is in the right place) and immobilizes the limb with a plaster splint. The period of immobilization varies from 1 to 3-4 weeks, and in some cases more. It depends on the age of the patient. Young patients wear the bandage longer, despite feeling completely healthy. This is necessary so that the joint capsule, ligaments and muscles surrounding it completely restore their structure - this will reduce the risk of repeated (habitual) dislocations. In elderly patients, prolonged immobilization will lead to atrophy of the muscles around the joint, which will impair the functionality of the shoulder. To avoid this, they are not given plaster casts, but bandages or Deso bandages, and the immobilization period is reduced to 1.5-2 weeks.

Physiotherapy


Massage for a dislocated shoulder improves lymph flow and reduces tissue swelling.

Physiotherapy methods for shoulder dislocation are used both at the stage of immobilization and after removal of the immobilizing bandage. In the first case, the goal is to reduce swelling, resorption of traumatic effusion and infiltration in the area of ​​damage, as well as pain relief. At the next stage, treatment with physical factors is used to normalize blood flow and activate the processes of repair and regeneration in damaged tissues, as well as stimulate the work of periarticular muscles and restore the full range of motion in the joint.

To reduce the intensity of pain, the patient is prescribed:

  • medium wavelength at an erythemal dose.

The following are used as anti-inflammatory techniques:

  • high frequency;
  • Microwave therapy;
  • UHF therapy.

To improve the outflow of lymph from the lesion and thereby reduce tissue swelling, use:

  • alcohol compress.

The following will help to dilate blood vessels and improve blood flow in the damaged area:;

  • short-pulse electroanalgesia.

    • Physiotherapy is contraindicated in the presence of massive hemorrhage into the joint (hemarthrosis) before the fluid has been removed from there.

    Physiotherapy

    Exercise therapy exercises are indicated for the patient at all stages of rehabilitation after reduction of a dislocated shoulder. The goal of gymnastics is to restore the full range of motion in the affected joint and the strength of the surrounding muscles. A set of exercises is selected for the patient by a physical therapy doctor depending on the individual characteristics of the course of the disease. At first, the sessions should be carried out under the supervision of a methodologist, and later, when the patient remembers the technique and order of performing the exercises, he can do them independently at home.

    As a rule, in the first 7-14 days of immobilization, the patient is recommended to clench/unclench his fingers alternately and into a fist, as well as flexion/extension of the wrist.

    After 2 weeks, provided there is no pain, the patient is allowed to make gentle movements of the shoulder.

    At 4-5 weeks, movements in the joint are allowed with a gradual increase in their volume - abduction, adduction, flexion, extension, rotation until the joint fully restores its functions. After this, at 6-7 weeks, you can lift objects first with a small weight, gradually increasing it.

    You cannot force things, this can lead to weakening of the rotator cuff and repeated dislocations. If pain occurs at any stage of rehabilitation, you should temporarily stop the exercises and start them again after some time.

    Conclusion

    Shoulder dislocation is one of the most common injuries in the practice of a traumatologist. The leading cause of it is a fall on a straight arm, moved to the side, raised or extended forward. Symptoms of a dislocation are severe pain, lack of movement in the affected joint and its deformation, noticeable to the naked eye. In order to verify the diagnosis, radiography is usually performed; in difficult cases, other imaging methods are used - computed tomography and magnetic resonance imaging.

    The main role in the treatment of this condition is played by repositioning the damaged joint and restoring the congruence of its articular surfaces. The patient is also prescribed painkillers and the joint is immobilized.

    Rehabilitation is very important, a set of measures that begin immediately after applying an immobilizing bandage and continue until the functions of the joint are completely restored. It includes physical therapy techniques that help relieve pain, reduce swelling, activate blood flow and recovery processes in the damaged area, and physical therapy exercises that help restore range of motion in the joint. These procedures should be performed under the supervision of a doctor, fully observing his recommendations. In this case, the treatment will be as effective as possible, and the disease will go away in the shortest possible time.

    A specialist from the Moscow Doctor clinic talks about shoulder dislocation:

    Amazing mobility in the shoulder joint is provided by three bone formations: the head of the humerus, the socket of the scapula (glenoid) and the clavicle.

    The head of the humerus fits perfectly into the glenoid cavity of the scapula, along the edge of which there is an articular lip (suction cup), which gives stability to the head.

    As a rule, dislocation or subluxation of the shoulder joint is associated with damage to the sucker (labrum).

    If it is torn off in a small area, a slight displacement of the head of the humerus occurs.

    In such situations, it is customary to talk about instability (subluxation) of the shoulder.

    The separation of a significant portion of the suction cup, exceeding the size of the head of the humerus, leading to sliding out of the glenoid cavity and moving it to the area between the neck of the scapula and the muscles, is called a complete dislocation of the shoulder.

    In first place is - pain. It is associated with damage to muscles and ligaments - pain receptors are concentrated there.

    It is the leading one at the first dislocation, with each subsequent dislocation, the pain worries less and less.

    The second noticeable symptom is restriction of movements in the joint.

    The appearance of the victim is typical: the healthy arm involuntarily holds the sore arm in a bent position in a state of abduction, the head is tilted to the injured side.

    With a lower dislocation, it feels like the affected limb is longer. The lower the head of the shoulder moves, the more the arm is abducted. Sometimes the head is felt in an atypical place, and a recess forms in its typical place.

    A fracture in this location is characterized by pathological mobility, and a dislocation is characterized by springy fixation. When the doctor tries to return the hand to its normal position, it, like a spring, tries to take its original state.

    The third symptom is shoulder deformity. If the head of the humerus moves anteriorly, a small protruding round formation forms under the skin on the front surface of the shoulder joint.

    In the case of a posterior dislocation, the coracoid process of the scapula protrudes on the anterior surface of the shoulder joint.

    Features: movement in the fingers and elbow joint is preserved.

    Sensitivity of the skin remains if the axillary nerve is not damaged.

    To exclude damage to the great vessels, you should check the pulse on the affected limb and compare it with the pulse on the healthy arm. Weakening or absence indicates damage to the vessel.

    Secondary symptoms include swelling in the area of ​​the affected joint, numbness, crawling, and weakness in the arm.

    Kinds

    A pathology such as a dislocation in the shoulder joint is not uncommon.

    They occur from a fall on outstretched arms, from a blow to the shoulder area, or during sports activities.

    Trauma, the most common cause of dislocations, accounts for 60% of all causes.

    As a rule, damage to the joint capsule, ligaments, blood vessels and nerves is observed.

    Dislocations happen:

    1. Uncomplicated.

    2. Complicated (open with damage to ligaments, blood vessels and nerves, fracture-dislocations, repeated - habitual).

    The nature of the fall matters. If you fall on your arms outstretched forward, the head breaks the capsule along with the articular labrum and moves beyond the glenoid cavity.

    It is possible to fall on your arms placed behind your back or when twisted in the shoulder joint (wrestling).

    It has been proven that rupture occurs with a load of 21.5 kg and when the arm is abducted to 66 degrees. The cuff cannot withstand the overload and ruptures.

    Dislocations by duration of existence:

    • Fresh - 24 hours from the moment of injury.
    • Stale - 20-21 days from the moment of injury.
    • Old - over 3 weeks.

    The occurrence of chronic dislocations is associated with late seeking help or improper treatment if treated in a timely manner.

    They account for 20% of all dislocations.

    Such a large percentage suggests that the problem of late application is still relevant today. It is not uncommon to see diagnostic errors in the treatment of pathologies of the shoulder region, or attempts by doctors to correct a dislocation without proper pain relief.

    For old dislocation the capsule becomes denser, elasticity is lost, unnecessary fibrous tissue grows in the cavity, which fills all the free space.

    The most unpleasant thing is that this tissue forms on the articular surfaces, which greatly impairs their nutrition.

    A person with a chronic shoulder dislocation has two problems: damage to the axillary nerve and paralysis of the deltoid and teres minor muscles.

    In most cases this goes unnoticed.

    The second problem is the formed pathology of the rotator cuff.

    Treatment is only surgical.

    Type of operation: open reduction of the humeral head.

    Dislocations, depending on where the head of the humerus has moved, are divided into:

    Anterior dislocation

    Almost all dislocations are anterior.

    Occurs from a strong blow from behind.

    In this case, the anterior part of the articular capsule is sharply stretched, but more often it is torn off from the anterior edge of the glenoid cavity of the scapula along with the articular lip.

    The head moves under the coracoid process, under the collarbone, under the glenoid cavity or to the area of ​​the chest muscles, in a word - in front of the scapula.

    Lower dislocation

    Makes up 23% - under the articular. The head, relative to the cavity of the scapula, is located under its lower edge.

    The person is unable to lower his arm and holds it elevated above his head.

    Posterior dislocation

    The rarest, only 2%, occurs when falling on outstretched arms.

    Feature: head behind the shoulder blade. A rare but insidious dislocation, because it is often not recognized, is called a “doctor’s trap.”

    This happens because the function of the hand suffers little, the pain does not bother much, its intensity decreases every day, this forms long-standing dislocations, it is not possible to straighten it and the only option is surgery.

    The anatomical features of the shoulder contribute to dislocation. The area of ​​contact between the head of the humerus and the articular process of the scapula is too narrow, the dimensions of the head are too large in relation to it.

    The bag itself is larger in size than the bone formations located in it.

    The last weak point is the unequal strength of the joint capsule in its different places and the large range of motion. The greater the amplitude, the lower the stability.

    This is the price to pay for amazing mobility.

    Complications of a shoulder dislocation

    1) Separation of the articular lip from the glenoid cavity of the scapula;

    2) Fracture of the humerus;

    3) Damage to nerves and blood vessels (usually in the elderly due to the deposition of calcium salts in them);

    4) Joint instability;

    5) Habitual dislocation.

    A common and unpleasant complication of shoulder dislocation is the formation of instability of the joint, leading to.

    The occurrence of relapse and the risk of recurrent dislocation is 70%, especially in young people.

    After reduction, the occurrence of habitual dislocation may be facilitated by:

    1. Impaired healing of surrounding tissues; as a result of the formation of fragile scar tissue, the capsule weakens and stretches, muscle strength decreases.

    2. Disturbance of innervation and the appearance of pathological nerve impulses, which leads to impaired motor function.

    Every third patient with a shoulder dislocation experiences neurological disorders, which is associated with damage to the axillary nerve.

    It is important to correctly and strictly follow the sequence of all stages of treatment.

    Starting from the correct application of the bandage, exercises to strengthen the capsule so that it is able to withstand the pressure of the humeral head.

    A representative non-traumatic shoulder dislocation is a chronic pathological dislocation. The cause of such a dislocation is not injury, but disease, for example: osteomyelitis, osteodystrophy, osteoporosis, tuberculosis and tumors.

    Diagnostics

    Recognizing a dislocation is not difficult. Sometimes the shoulder can be adjusted on its own; in other cases, only a doctor should do it.

    Complaints and the appearance of the victim have a clear picture. It is necessary to check the pulse and skin sensitivity to exclude damage to the nerve and blood vessels.

    Then a preliminary diagnosis is made, and final conclusions are made after radiography. It should be there in any case, both before and after reduction.

    The most difficult to diagnose is the simultaneous combination of a shoulder dislocation with an impacted neck fracture. It is important to recognize it before reduction because areas may separate during reduction.

    If there are complaints of pain and injury to the shoulder, and there are no signs of displacement on the x-ray, then it is necessary to exclude a posterior dislocation of the shoulder. Or perform radiography with an electron-optical converter (EOC), magnetic resonance therapy, which will allow you to accurately and accurately make a diagnosis.

    These are additional research methods. They are carried out in cases where, after reduction, instability persists for up to 3 weeks, or there is a threat of re-dislocation. Other treatment tactics are considered erroneous.

    You cannot do without R-graphy, otherwise you may miss fractures of the humerus, scapula and posterior dislocation.

    Treatment

    Immediately after diagnosis the doctor begins the reduction dislocated segment.

    Delay is not advisable.

    An anesthesia procedure is required.

    It can be local or general. Allows you to relax the muscles as much as possible, which makes reduction much easier.

    There are a lot of methods of realignment, there is even manipulation according to Hippocrates, which has not lost its significance to this day.

    After reduction of the dislocation a rigid splint is applied for immobilization.

    Rest is necessary for a period of 4 weeks. This is important to avoid recurrent dislocation in the future.

    Prolonged immobilization is also undesirable. It can cause glenohumeral periarteritis with limited movement in the shoulder joint.

    To prevent it, 2 times a day you need to do special exercises: clench your hand into a fist, strain your wrist muscles. This will improve blood circulation and relieve stiffness.

    There are situations when a dislocation cannot be corrected.

    What remains is surgery.

    It is shown:

    1. In case of tendon damage, capsule rupture, fractures.

    These fragments get caught between the articulating surfaces and prevent the head of the humerus from moving into place;

    2. Frequent recurrences of dislocation within one year (2-3 times);

    3. Irreversible dislocations are an absolute indication for surgical treatment;

    4. Old dislocations;

    5. Posterior dislocation, in which there is a high risk of shoulder instability.

    Among the operations are:

    • Minimally invasive interventions using an arthroscope and sutures on the labrum - transglenoid sutures or anchor fixators.

    Arthroscopic operations are less traumatic and less likely to cause complications.

    • An open intervention operation with reconstruction of damaged elements.

    It is performed if the arthroscopic method is impossible, or if there is a large bone and muscle defect. The disadvantage of open surgery is a longer recovery period and a greater risk of limiting joint mobility.

    Rehabilitation

    After immobilization is removed, it is prescribed physical therapy- for the purpose of better healing, physical therapy- to restore the previous range of movements.

    Make sure that the movement in the shoulder and scapula are separated. If there is a threat of joint movement, the doctor holds the scapula during the session so that the shoulder moves independently.

    Exercises at this stage are aimed at strengthening the muscles of the shoulder and shoulder girdle.

    It is advisable, after removing rigid immobilization, to continue wearing a soft supporting bandage, which we remove during classes.

    We expand exercises to strengthen the muscles of the shoulder and shoulder girdle gradually; do not quickly move to active movements and full range of motion in the joint. This will be possible only in a year.

    The rehabilitation period lasts at least three months.

    Useful at the rehabilitation stage, water procedures, ozokerite, magnetic therapy, laser treatment.

    Massage and electrical stimulation give good results.

    Painkillers are prescribed as necessary, because movement in the joint during development may be accompanied by pain.

    Forecast

    Depends on the type of dislocation, the age of the patient and complications that arose during the dislocation.

    Anterior dislocation is more difficult to treat. It is more often complicated by habitual dislocation, which occurs in young people in 80% of cases with conservative treatment.

    This cannot be done without surgery, because the torn labrum is not able to grow back into place on its own. Surgical treatment has a better prognosis.

    In older people, eliminating a dislocation is very difficult.

    They more often develop arm sagging after reduction, which is associated with age-related changes in ligaments and muscles. They are less elastic, the capsule is more stretched, and muscle strength is weakened.

    Sagging can be the cause of contusion of the axillary nerve and its partial paresis. Their humeral head often remains in a state of subluxation, especially the lower one.

    Reduction and rehabilitation course for posterior dislocation has a more favorable outcome.

    It allows you to return to a full life, and athletes to play sports to the same extent.

    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.