What is a dislocation of the shoulder joint (shoulder) and what procedures are used to treat it. Dislocations of the shoulder (shoulder joint) - types, causes and symptoms, diagnosis, methods of reduction, surgical treatment and rehabilitation

It just so happens that the most common dislocation that a person faces 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.

Why does the shoulder “fly out”? Because nature, while ensuring the mobility of the shoulder joint, sacrificed its strength. Large head humerus placed in a very shallow cavity (capsule) of the joint, and the ligaments that hold them there are few and weak. Therefore, when falling on an arm extended to the side (football, volleyball, overindulgence alcohol - there are many reasons) the head of the humerus from glenoid cavity it just pops out.

If this happened, then further fate 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 it away from you with all your remaining limbs, to 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 will be torn, but also nerves and blood vessels.

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. There must be done X-ray to exclude or confirm bone damage. Then under local anesthesia They will perform a gentle reduction of the dislocation and apply a plaster splint for 3 weeks. This is necessary for soft tissue tears to heal.

You cannot remove the splint yourself ahead of schedule, even if nothing hurts, and even more so you can’t start 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 treat habitual dislocation It's only possible through surgery.

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 trauma department clinics.

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.

Shoulder dislocation or dislocation is a fairly common injury, especially among athletes. Most often it falls out top part shoulder forward, then the arm turns outward and to the side. This dislocation is called anterior dislocation of the shoulder joint; it occurs in 90% of cases of dislocation.

Some traumatologists believe that dislocation of the shoulder joint is a completely simple reversible injury, but, unfortunately, in many cases it can occur serious problems and complications. This can lead to damage or destruction of the adjacent bone, causing injury to surrounding ligaments, tendons, nerves, and blood vessels.

Dislocation of the shoulder joint can be posterior, lower, upper and intrathoracic; these options are less common, but can cause serious complications, damaging surrounding tissues and organs, muscles and tendons. A posterior dislocation of the humerus can cause a fall on an outstretched arm (as in the photo below).

The shoulder joints are especially prone to dislocation due to their high mobility.

A separate type of dislocation is the habitual dislocation of the shoulder, in which the shoulder joint is in an extremely unstable state, and dislocation can occur even under light loads. After primary dislocation due to trauma, with improper treatment and subsequent recovery may develop chronic stage diseases.

Shoulder dislocation: symptoms and causes

The main causes of shoulder dislocation can be direct blows to the shoulder joint, falls on an outstretched arm, or rotational movements of the arms with the application of force. However, humerus dislocation is a significant problem during constant strength training and can be repeated many times during bench presses, pull-ups, and other types of exercises that involve the shoulder joint.

When diagnosed with a dislocated shoulder, symptoms may include the following:

a sharp attack of acute pain, and a feeling that the shoulder is in an unnatural position,
the shoulder joint looks unnaturally sharp and as if dropped,
the victim presses his hand to his body,
If nerves are affected or blood vessels are damaged, the pain may be stabbing, the arm may feel numb, and there may be bruising in the joint area.

Shoulder dislocation: treatment

When a shoulder is dislocated, treatment is carried out in several successive stages. First of all, first aid is provided, if you are not a doctor, do not try to disturb the patient, the best thing is to call and wait ambulance or take him to the hospital straight away.

First aid for a dislocated shoulder, which can be done before being examined by a doctor, includes:

cold compress on the shoulder, maybe ice,
cessation of shoulder movement
call a doctor immediately,
fixing garter.

After confirmation of the diagnosis, treatment is prescribed according to severity. Sometimes anti-inflammatory drugs are prescribed for severe pain. When required time immobilization ends, a course of recovery is prescribed.

Reduction of a dislocated shoulder can only be performed by a qualified specialist under anesthesia or general anesthesia. You should never do this yourself, as you can seriously damage the joint. But, if you still set the shoulder yourself, seek advice from a traumatologist to exclude the possibility of a fracture or other complications.

In the best case, immediately after a visit to a traumatologist, the victim takes an X-ray, which determines the type of dislocation.

To prevent the possibility of re-dislocation, it is necessary to strengthen the ligaments that support the shoulder joint. To do this, a number of exercises with light dumbbells and an expander are recommended.

Shoulder dislocation surgery

Surgery is sometimes required to prevent re-dislocation of the joint. Also, direct intervention, namely shoulder dislocation surgery, is performed in cases of serious damage to muscles, tendons and joints. The operation is performed immediately after the injury.

If there is a risk of developing the chronic variety, surgery can stabilize and strengthen the ligamentous apparatus. As a rule, when the shoulder joint is dislocated, surgery does not lead to a decrease in mobility, which is very important for athletes.

After the operation, the person goes through several stages of rehabilitation and easily returns to a normal lifestyle.

Rehabilitation and recovery after a shoulder dislocation usually takes place in four main stages. It is in the patient's best interest to go through them all.

Immediately after reduction or surgery at the initial stage:

Immobilization of the shoulder for up to 7 days,
Warm-up exercises with the wrist and hand for normal blood flow to the immobile part of the body,
Cold compresses to reduce pain and swelling.
Anti-inflammatory drugs.

At the next second stage:

First light shoulder movements 2-4 weeks,
If there is no pain, you can begin warm-up exercises for joint mobility,
It is forbidden! Perform combined movements, such as abducting the arms to the sides or turning the shoulder outward - this can cause re-dislocation of the joint,
The bandage can be removed
After training, apply ice if there is swelling.

The third stage provides:

Full mobility of the shoulder and shoulder joint 4-6 weeks,
If there is no pain, you can begin to move your arm to the side,
Continue exercises to develop mobility,
Strive to achieve full range of motion.

At the final fourth stage of recovery after a shoulder dislocation, a return to normal activities occurs. It is already possible to lift light weights, and athletes can begin to work with strength equipment, gradually increasing the load.

Video of the program “Live Healthy” about the usual dislocation of the shoulder and its reduction:

A shoulder dislocation is a fairly serious and usually reversible injury to the joint. Trauma requires urgent and qualified medical care. Depending on the type of pathology, the cause and duration of the displacement, as well as the presence or absence of complications, the tactics of medical care and further treatment at home. A delay in providing qualified assistance can lead to the development of an old or habitual dislocation of the shoulder joint, which will require surgery.

According to medical statistics, dislocation of the humeral head is quite common. This is explained anatomical structure articulations. Being spherical in its configuration, the joint is designed to perform movements in different planes, which is the reason for its instability.

Initially, shoulder dislocations are divided into congenital and acquired.

Congenital shoulder misalignments are uncommon and are usually associated with joint dysplasia in infants. During birth, the child receives a birth injury in which the head of the humerus falls out of the articular capsule. Identification and treatment of congenital abnormalities usually occurs in the delivery room immediately after the baby is born.

Acquired shoulder dislocation is much more common. It accounts for 80–85% of all injuries to this joint. Pathology is divided into two types:

Traumatic dislocation.
Non-traumatic (habitual) dislocation.

Based on the direction of shift of the humeral head, they are distinguished:

anterior dislocation, in which the head of the humerus protrudes forward (most common);
posterior dislocation occurs when the head moves backward;
inferior dislocation when the head moves down.

In addition, there is a division of injuries according to the statute of limitations:

acute (3 days from the moment of injury);
subacute (4 weeks from the date of dislocation);
old (more than a month after injury).

In children, subluxation of the shoulder joint is most often recorded, when the ligaments are stretched, but the joint remains fixed in the joint capsule. This displacement is usually easily reduced, so negative consequences, as a rule, does not happen.

Any shoulder injury accompanied by pain, swelling and changes in the configuration of the joint requires urgent medical attention.

Subluxation and habitual dislocation

IN medical practice In addition to dislocation, two more types of joint displacement often occur:

subluxation;
habitual dislocation.

Subluxation

Subluxation is characterized by not a complete release of the head from the joint capsule, but only a slight shift to the side. This pathology is not accompanied by rupture of ligaments and tendons or bone fractures. The functionality of the joint is partially preserved and is restored quite quickly after reduction.

If the head of the bone periodically comes out of the joint capsule without visible traumatic injuries, this condition is called habitual shoulder dislocation. Displacement can occur with circular rotation of the arms or simply lifting the limb upward.

As a rule, this pathology occurs against the background of untimely or incorrect treatment of various types of injuries, which lead to weakening of the ligaments and instability of the joint. In addition, the cause of joint prolapse can be structural features: discrepancy between the sizes of the joint capsule and the head of the humerus, an overly stretched capsule or weakness of the periarticular muscles.

Slipping of the humeral head is often observed in athletes or in people performing repetitive, monotonous movements with their hands. In such patients, damage to the right shoulder joint is diagnosed much more often than to the left. A person can straighten the joint independently by pulling the hand down or moving the arm to the side. However, without adequate therapy displacement of joints occurs more and more often, acquiring a pathological character.

Delaying the treatment of a habitual dislocation is very dangerous. With each loss of the head and subsequent reduction, damage occurs. cartilage tissue, which leads to the formation of arthrosis.

As a rule, habitual dislocation does not respond to conservative treatment. Therefore, the patient is offered surgery.

Symptoms of shoulder dislocation

Despite the variety of displacements of the shoulder joint, their symptoms are practically no different. Some difference in symptoms is observed only in acute and chronic forms of dislocation.

The following clinical picture is typical for acute injury:

Old (chronic) dislocations are characterized by intracavitary growth connective tissue, which fills the articular capsule and surrounding areas. The shoulder muscles atrophy and cease to perform their function. Primary displacement of a joint is always very painful, as the ligaments and joint capsule rupture. With repeated injuries, there is slight discomfort in the shoulder area, external deformation and limited movement in the damaged joint.

An old dislocation is very difficult to correct, since the connective tissue that has grown inside the articular cavity prevents the free return of the head of the humerus to its normal position. In this case, surgical intervention is necessary.

Diagnosis and first aid for shoulder dislocation

Diagnostic measures begin with collecting anamnesis, then an examination of the victim is carried out and a medical history is compiled. Then the patient is given an x-ray in two projections to clarify the diagnosis and exclude fractures. To determine the degree of damage to the ligaments and tendons, computed tomography or magnetic resonance imaging is performed.

First aid

To provide pre-medical medical care You must immediately immobilize the injured arm by bending it at the elbow and securing it with a bandage. The victim should be taken to a medical facility as quickly as possible for treatment. specialized assistance. It is strictly forbidden to adjust the shoulder yourself.

Before transporting to the hospital, the patient should be given a pain reliever and immediately apply cold (crushed ice, a cold compress, or a heating pad with ice water) to the injury site.

Methods for treating shoulder dislocation, rehabilitation at home

the main objective therapeutic activities consists in restoring the structure and performance of joints. This is achieved through the following activities:

joint fixation;
reduction of dislocation, including through surgery;
full rehabilitation.

Reduction is carried out only by a qualified specialist in a hospital setting, after diagnostic measures and the use of local or general anesthesia.

Conservative treatment

Conservative therapy includes several types of reduction. In addition to the procedure are:

All these activities are carried out at home after the reduction procedure.

Today, there are several types of closed joint reduction. Like any minor operation, it must be performed by a traumatologist or a group of specialists. The following methods are the most effective and least traumatic:

Kocher method;
reduction using the Dzhanilidze method;
Hippocratic method;
Mukhin-Mota technique (used for all types of displacement).

The traumatologist performs the reduction until a click is heard. This indicates that the head of the humerus has entered the glenoid cavity. The reduced joint must be immobilized with a tight bandage or orthosis.

The intervention is carried out under the mandatory supervision of an anesthesiologist. The simplest and in an effective way pain relief technique proposed by V.A. Meshkov.

If the patient is diagnosed with a habitual dislocation or has an accompanying fracture, surgery is prescribed. In case of traumatic displacement of the humerus, intervention involves eliminating the dislocation, suturing damaged tissues and aligning the bones. Then a plaster cast is applied to the affected joint, and a treatment plan for the rehabilitation period is drawn up.

To restore the structure and stability of joints when diagnosing habitual dislocation, the Bankart operation is used. The procedure is performed using an atroscope. During the intervention, the surgeon removes damaged tissue and, if necessary, sutures the joint capsule.

Extra-articular surgeries for plastic surgery and strengthening of the ligaments and tendons of the periarticular muscles are very popular among specialists. During the treatment, the humeral head is strengthened in its physiological position in order to prevent its subsequent displacement.

Another common method of surgical intervention is the Eden method or its variant proposed by Andina. During the procedure, the head of the humerus is given new form, maximally facilitating its fixation in the joint capsule.

All types of operations considered and their modifications give the least number of complications.

Treatment at home

When they talk about therapy at home, this means a set of measures carried out at home after reduction, aimed at restoring the functionality of the joint. All activities are carried out only as prescribed by the attending physician and under his supervision. Not bad conservative treatment add .

The recovery period is divided into several stages, for each of which appropriate therapeutic measures have been developed.

First stage

The period begins 21 days after reduction and lasts no more than three months. During this time, damaged tissues heal and scars form in the area of the joint capsule and cartilaginous lip.

At the first stage of rehabilitation, the patient is prescribed simple warm-up movements in wrist joint and joints of the hand of the affected limb, cold compresses on the affected area, taking painkillers and anti-inflammatory drugs, electrophoresis sessions with novocaine on the area of the sore shoulder.

Second stage of recovery

This period lasts 1–1.5 months and includes light warm-up movements of the shoulder in different sides. If pain occurs, all exercises should be stopped and rest for 2-3 days. After gymnastics, a cold compress is applied to the joint area.

To more quickly restore performance, the patient is prescribed physiotherapy sessions: magnetic therapy, UHF, electrophoresis with analgesics and anti-inflammatory drugs.

The third stage begins 4–5 months after conservative or surgical intervention. At this time, the patient is allowed to increase the load on the arm. You can perform smooth abduction of the limb to the side, careful circular rotations of the shoulder.

At the later stage of rehabilitation, it should include a variety of hand movements in all planes. It is better to do exercises for 10–15 minutes several times a day. As the muscles and tendons strengthen, the patient is allowed to use dumbbells to increase the load. Sports equipment will help restore muscle strength and ligament elasticity.

Therapeutic gymnastics is necessary measure during the rehabilitation period. It will help restore blood circulation and nutrition of cartilage and muscle tissue.

Careful adherence to the doctor’s recommendations will allow the patient to fully recover no later than six months after the injury and not fear re-dislocation of the shoulder joint. Competent treatment at home is intended to prevent such serious complications as arthrosis, arthritis, as well as eliminate possible joint contracture.

Shoulder dislocations are a fairly common and, as a rule, reversible injury to the shoulder joint, as a result of which the patient loses the ability to perform the entire range of movements of the upper limb.

General

The shoulder joint is the most mobile joint in the human body. It allows you to raise your arms, put them behind your back, and reach the back of your head. It is generally accepted that only thanks to work and one’s own hands did a person become a person, but it would not be an exaggeration to say that all the diversity of functions human hand comes precisely from the amazing mobility of the shoulder joint.

Movement in the shoulder joint occurs in three planes, but people have to pay for the increased range of motion in the joint with a decrease in its stability. The area of contact between the bones of the head of the humerus and the glenoid cavity of the scapula is not so large, even taking into account the cartilaginous lip that surrounds it and expands the friction area of the joint surfaces and its stability.

The joints themselves are formed by the glenoid socket, the head of the humerus, which is identical in shape to the socket, and the clavicle. The head of the humerus bone is fixed in the desired position thanks to the cartilaginous cushion located along the edge of the glenoid cavity and the connective tissue that forms the articular capsule. The strength and stability of the joint is provided by the muscles and tendons with which it is surrounded on all sides.

The tough tissue that forms the joint capsule is the ligament system of the shoulder joint, which helps the head stay in an anatomical position relative to the socket of the scapula. The veins are firmly fused with thin capsule and they consist of the coracobrachial and articular-brachial ligaments, and have three bundles - upper, middle, lower. The shoulder joint is also surrounded by powerful muscles and tendons that provide stability through their forces. These include the supraspinatus, infraspinatus, teres minor and subscapularis muscles. They form the rotator cuff.

Causes of damage

Shoulder dislocations have different factor occurrence, but the most common is injury or force.

Trauma is a fall on an outstretched arm or on the shoulder and entails a fracture of the glenoid cavity, head of the bone, coracoid and other processes of the scapula.
Congenital anomalies in the shoulder joint - an anatomical feature of the development of the articular cavity in the scapula is characterized by small depth and inferior shape.
Increased joint activity or generalized hypermobility is a pathology in which unusual movements appear in a joint. Excessive mobility of the shoulder joint occurs in 10–15% of the world's inhabitants.
Stretching of the joint capsule is provoked by the implementation of identical repetitive movements. They cause constant stretching of the capsule and ligaments. Athletes most often suffer from this, namely swimmers and tennis players.
Diseases of the shoulder joint such as arthritis, arthrosis.
Systemic and other pathologies - tuberculosis, osteomyelitis, osteodystrophy, osteochondropathy.

Repeated injuries to the shoulder cause the ligaments to weaken, and as a result, the stability of the joint itself also weakens. A habitual shoulder dislocation is caused by the fact that the rotator cuff muscle was unable to fully recover after the patient dislocated the shoulder due to an injury.

The recurrence of a shoulder dislocation can be triggered by ordinary daily movements: cleaning the apartment, washing the floors, trying to put something on the top shelf. Moreover, each subsequent dislocation of the head of the humerus more and more disrupts the stability of the joint, as a result of which the intervals between relapses are reduced, and subluxations or dislocations occur more and more often.

Classification of dislocation

This injury to the shoulder joint is divided into several types. This can be either a dislocation of the shoulder or a subluxation of the shoulder joint. It can be habitual, as well as primary and others with the same, almost identical symptoms.

But in any case, first aid for a dislocated shoulder should be provided in a timely manner, and consist of applying a bandage and other actions. This will significantly reduce the risk of developing consequences. To make a diagnosis, it is necessary to take into account not only the causes, but also the types of injury.

By time of occurrence

Congenital dislocation - diagnosed in a child, can be detected even in a newborn or in the first year of his life.
Acquired dislocation or subluxation of the shoulder is typical for adults and school-age children. Also seen in older people.

Classification of shoulder dislocations based on their causes

Acquired dislocations are divided into two types - habitual and traumatic.

Habitual shoulder dislocation is characterized by disruption of this area of the bone, even under minor loads. This happens when there is an untreated injury, irritation of a bundle of blood vessels and nerves, and other violations of joint integrity.

Traumatic shoulder dislocation occurs much more often. It can lead to consequences, but it can pass without them. Complications include rupture of the capsule, tendons, soft tissues, blood vessels and nerves. There are several types of traumatic dislocation.

By location of humeral head displacement

Anterior shoulder dislocation. The most common injuries in this area are anterior dislocations, which are the result of direct impact to the bone when the shoulder is struck from behind. Less commonly, such dislocation occurs due to convulsions.
Posterior shoulder dislocation. Direct or indirect injury is necessary for a posterior dislocation to occur. Usually such an injury upper limb occurs if the blow fell on the shoulders, which were bent or in a position of internal rotation.
Inferior dislocation occurs infrequently and is due to impact on the shoulder, which is too far abducted, that is, the arm is above the horizontal level.
Posteroinferior and anteroinferior dislocations are very rare and are a combination of the above forms.

There are also such concepts as primary shoulder dislocation and secondary or repeated dislocation.

Primary dislocations are the concept of when a dislocation occurs for the first time. The likelihood that after this injury the shoulder will dislocate again increases, especially if first aid for a dislocated shoulder was provided unskilled or when treatment for a dislocated shoulder did not give the desired effect, or the patient did not follow the doctor’s instructions.

In traumatological practice, in 75% of cases from total number For all shoulder dislocations and subluxations, an anterior injury is diagnosed. In second place is the lower dislocation of the shoulder joint of the right or left arm—about 20% of cases.

Important! Shoulder dislocation - serious injury which requires urgent action. The main symptoms and treatment of the injury can only be determined by a specialist. The diagnosis is made in accordance with ICD 10 in the clinic after examination. But before that it is necessary to recognize characteristic symptoms dislocated shoulder and provide first aid the victim, fix it with a bandage and take other first aid actions necessary for a dislocated shoulder based on the symptoms.

Symptoms

Signs of a dislocation of the shoulder joint, if the injury is primary, are pain, which is mostly caused by rupture of soft tissues. With repeated dislocations, there is much less pain or no pain at all. This is due to the fact that the structures that stabilize the joint have been damaged by a previous injury.

The symptoms of a shoulder dislocation are in many ways similar to those of other joints.

Symptoms of subluxation of the shoulder joint, like dislocation, are characterized by sharp pain in the corresponding place. One of the signs is shoulder deformity and drooping arm. Any movement is impossible due to increased pain and disruption of its functioning. During passive movement, springy resistance is felt.

The asymmetry of the shoulder joints is visually noticeable. The joint itself becomes angular, concave or sunken. Upon palpation, the doctor determines the protruding head of the bone emerging from the bed.

Anterior dislocation is characterized by downward and forward movement of the head.
For the anteroinferior – displacement in anterior section axilla or down the coracoid process of the scapula. The victim is forced to keep his arm in a comfortable position: abducted and turned outward or bent.
In the lower form of the pathology, the head is displaced in armpit, the hand goes numb completely or in certain areas.
With a posterior dislocation, the head moves towards the scapula.

A dislocated shoulder may have other symptoms.

swelling of the shoulder joint;
feeling of goosebumps on the arm;
pain not only in the area of injury, but also along the pinched nerve.

If a shoulder dislocation is severe, complications can develop. The greatest danger is damage to the neurovascular bundle, open damage bone structure and soft tissues, closed fracture shoulder bones.

Habitual shoulder dislocation can be complicated by other pathological situations. Among them is a Bankart injury, when the joint capsule ruptures and a section of the articular labrum is torn off. External manifestations no, but there is severe pain, and the consequences are unpleasant.

How to identify a shoulder dislocation? Knowing the listed signs of damage, this will not be difficult to do.

First aid

What to do if you have a dislocated shoulder? When providing assistance, the main thing is not to try to straighten the joint yourself. The joint should only be adjusted by a specialist; a non-professional may cause damage to nerves or blood vessels.

Completely avoid any movement of the injured arm.
Use painkillers.
Apply a cold compress to the affected area.
Suspend your hand on a scarf.
Call a medical team.

Diagnostics

How to treat a dislocated shoulder? The attending physician will answer this question only after he receives the diagnostic results.

The diagnosis of humeral dislocation is made after examination and additional methods. During the examination, the specialist will ask about the circumstances of the injury and symptoms. The doctor will conduct a series of tests, examine the area of the shoulder joint, prescribe x-rays in two projections, and then prescribe treatment.

To clarify the diagnosis and determine treatment tactics for a dislocation of the right or left shoulder, the doctor may prescribe a CT, MRI, ultrasound examination. Based on the data obtained, one can understand the need to wear a bandage and undergo surgery.

In case of damage to blood vessels, before prescribing treatment, a consultation with a vascular surgeon is required; if a rupture or compression of the nerves is suspected, a consultation with a neurosurgeon is required.

After diagnosis, the doctor will tell you about treatment, if present. comminuted fracture, then he will explain about the reposition of fragments. He will also answer how long the injury takes to heal, what consequences the injury may have, and how long the rehabilitation lasts.

Treatment

Treatment for a dislocated shoulder occurs in three stages.

The first stage is reduction

Reduction can be closed or open - respectively, non-surgical and with the help of surgery.

Closed reduction of a fresh shoulder dislocation is done under local anesthesia To do this, the affected area is injected with novocaine. To relax muscles, a muscle relaxant is administered intramuscularly, and when severe pain- narcotic analgesic. Old habitual dislocation of the shoulder joint is eliminated under general anesthesia.

The most common options for reducing the joint are the Dzhanelidze, Mukhin-Mota, Hippocrates, and Kocher methods. Which one is used depends on the type of damage.

Reduction of habitual, repeated injuries or those that could not be eliminated by the closed method is performed using surgical intervention with fixation of the head of the humerus with special knitting needles and sutures in the glenoid cavity.

Treatment of habitual dislocation performed operationally, at this stage consists of taking non-steroidal anti-inflammatory drugs, non-narcotic analgesics.

The second stage is immobilization

Treatment after shoulder reduction involves immobilization. This is necessary to secure the joint in the desired position, heal the capsule and prevent relapses. A special bandage or splint is applied to the arm for a period of one month. As soon as the joint accepts correct position– signs of injury will disappear.

It is important to adhere to the recommended period of wearing the bandage, even if swelling, pain and other symptoms have disappeared. Joint capsules do not heal if shoulder immobilization is stopped prematurely. This provokes habitual dislocation, with subsequent damage to surrounding tissues.

The third stage – rehabilitation

A rehabilitation specialist is responsible for restoring the functions of a dislocated joint after immobilization. Physiotherapy helps to strengthen the ligaments and muscles of the shoulder - massage, electrical muscle stimulation and exercise therapy.

Rehabilitation is also divided into three periods:

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

A set of exercises after a dislocation of the shoulder joint begins with circular movements in the wrist joint, followed by flexion-extension movements of the hand, followed by clenching the fingers into a fist. Sending a mental impulse to shoulder muscles By resting your elbow on the bandage, you can achieve rhythmic tension in the shoulder muscles.

At this stage, physiotherapeutic procedures can be carried out aimed at pain relief, swelling and resorption of hematomas.

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

If the shoulder joint is dislocated, it is at this time that it is recommended to carry out a massage, which warms up the limb before a complicated set of exercises.

All exercise therapy for dislocation of the shoulder joint is performed in a scarf and all movements associated with the load on the shoulder are carried out in a passive mode with the help of a healthy arm. At this time, swinging, swinging and circular movements of the shoulder, and hanging on the arms are not allowed. Only non-sharp movement of the shoulder girdle muscles up and down is allowed.

Six months are allotted for full recovery after a dislocation.

After treatment for a dislocated shoulder joint has stopped, they begin to gradually return the full load to the shoulder. It is recommended to perform exercises with reasonable weights and prescribe a special massage.

Important! If medical instructions are not followed or the rehabilitation period is ignored, the preconditions are created for the occurrence of a habitual shoulder dislocation. And due to the fact that habitual shoulder dislocation is not accompanied by pain, and the frequency of its occurrence pushes patients to treat shoulder dislocation at home, without resorting to specialized help. All this leads to negative consequences.

Surgical intervention

The ease of self-recovery after a dislocation should not make the victim want to refuse medical care in favor of home treatment. Further pathological changes periarticular tissues worsen, the shoulder loses its mobility, and the frequency of dislocations reaches a large number.

IN in this case If you turn to a doctor for help, they can only cure the damage with the help of surgery, since neither immobilization and subsequent massage can give the desired results. Such treatment significantly increases the rehabilitation period and is much more expensive.

Complication

A dislocation of the shoulder joint is quite serious damage. Rehabilitation and therapy without accurate diagnosis can lead to the following complications:

Joint instability.
Damage to peripheral nerves.
The range of motion in the joint is limited.
Relapses after the slightest injury.
Degenerative changes in the joint.

Important! Dislocation of the shoulder joint, treatment at home can be carried out only after a specialist has done everything necessary actions. After a shoulder dislocation, you must follow all doctor’s prescriptions at home. Only in this case will treatment and rehabilitation provide positive results. It should be remembered that you cannot immediately load the damaged joint - physical activity should be given to it gradually.

Do not delay diagnosis and treatment of the disease!

Make an appointment with a doctor!

Shoulder dislocation is one of the types of injuries in which complete separation of the articulating surfaces of the bones occurs. The shoulder joint is most susceptible to dislocation due to certain anatomical features:

intensity of movements in the joint;
large joint bursa;
small surface for bone articulation.

Another reason for frequent injuries is frequent damage to the shoulder girdle during falls.

Shoulder dislocations are classified into anterior and posterior. Anterior is characterized by displacement of the head of the humerus forward. This often happens when falling, if the blow falls on the hand or elbow.

The posterior one is characterized by the fact that the cartilaginous layer of the capsule moves back. This situation arises in the event of a fall on straight outstretched arms.

Symptoms of shoulder dislocation

Acute pain in the area of the joint location. The development of pain is associated with stretching of the capsule, which contains a large number of nerve endings. Compression of the endings leads to pain. The pain is especially felt if the shoulder joint has been injured for the first time.
Limitation of range of motion. This is due to the fact that the articular surfaces no longer touch and movement in the joint does not occur. This is precisely the reason why the victim cannot make his usual movements.
Positive symptom springy resistance. This sign is associated with muscle contraction in response to painful stimulation. That is, the doctor, when pressing on the axis of the joint, notes the resistance to any of its movements.
Change in joint shape and swelling. Deformation is directly related to the development of edema or hematoma. That is, the joint is externally changed compared to the healthy half.
Development of swelling. The occurrence of edema is directly related to inflammatory reaction in response to damage. It occurs due to the action of inflammatory mediators, namely vasopressors and vasodilators. The plasma passes along a gradient into the joint space.
Forced pose. What is meant here is that the dislocated shoulder, namely the arm on the side of the injury, is not in a natural position. That is, the position in which the pain becomes less.

All these symptoms indicate damage to the shoulder joint. In addition to subjective complaints to determine accurate diagnosis, doctors carry out X-ray examination.

What to do if you have a shoulder dislocation?

If you suspect a shoulder joint injury, you should call an ambulance. Before her arrival, first aid for a dislocated shoulder is as follows:

it is necessary to ensure complete rest for the victim;
apply ice to the damaged area;
if you have the skills to reduce the shoulder, try to put it in place, this will bring significant relief to the victim;
without reduction, you should not apply a scarf bandage;
give painkillers in the form of analgesics.

Method of reducing the shoulder joint using the Chaklin method:

it is necessary to place the victim on his back;
the hand must be placed along the body;
then you should carefully pull the victim’s arm and at the same time lift it up parallel to the body;
When you lift it up, there should be a characteristic click indicating that the joint has been realigned.

This method is the least traumatic of all the techniques that exist for reversing a dislocation.

Special attention should be given to the force with which the shoulder is reduced. The movements must be smooth and not rough, otherwise a relapse of shoulder joint dislocation will subsequently develop.

Applying a scarf bandage

After reduction, a bandage must be applied to immobilize the limb as follows:

bend your arm at the elbow;
take the scarf with the base of the triangle down in both hands;
place the victim’s forearm on a scarf so that the triangle is behind the elbow;
then you need to tie the free edges around the victim’s neck.

After applying the scarf, analgesics should be given and the victim transported to the hospital.

It is important to remember about such an injury as a fracture of the shoulder girdle. Another article will tell about that.

Habitual shoulder dislocation

This pathology occurs due to improper and untimely treatment of shoulder joint injuries. For this reason, restoration of muscle tissue does not occur, as it is necessary. Scar changes develop on their surface. These pathological destructions lead to weakening muscular-ligamentous apparatus and the development of joint failure. That is, the supporting apparatus of the joint does not support it adequately. This leads to the development of new injuries.

Habitual shoulder dislocation is characterized by the occurrence of new injuries even in the absence of physical activity.

Shoulder dislocation in a child

Joints in children have greater elasticity compared to adults. Because of this, hand injury in a child occurs very rarely, only when strong influences.

Symptoms of a dislocated shoulder in a child are as follows:

spicy pain syndrome at the site of damage;
swelling and development of edema;
restriction of movements due to pain;
the hand takes a strange, unnatural position.

If the child is small, it is difficult to explain to him what hurts. Therefore, the tactics should be like this:

should be assessed general state child, a rise in temperature is possible;
you need to inspect the damaged part and compare it with the other side;
on the affected side there will be swelling and deformation, i.e. it will be sharply different from the healthy half;
It is necessary to pay attention to the position of the child’s hand; it will be in the wrong position, perhaps it will be pulled back or to the side.

More detailed information You can read about the symptoms of a dislocated arm in a child in the following article.

Symptoms and treatment of shoulder dislocation

In certain cases, damage results serious consequences. These include neurovascular bundle injury, shoulder fracture, and soft tissue injury.

Symptoms of complicated shoulder dislocation include the following:

intense pain that does not go away for a long time may be a sign of rupture of the joint capsule. This condition requires prompt resolution.
if damaged, a collision of the humerus with the socket of the joint may develop. This leads to the presence of crepitation, i.e. crunching.
strong sharp pain, pathological mobility, deformation, crepitus - all this is characteristic of a fracture of the bones above the shoulder girdle. This complication is quite possible with a dislocated shoulder.
damage to the nerve passing through the area of the upper limb is accompanied by a feeling of numbness in the deltoid muscle. This indicates damage to the axillary nerve fiber.
damage ulnar nerve accompanied by loss of sensitivity along its fibers. This is accompanied by numbness in the muscles of the forearm and shoulder.

These symptoms are typical for complications of shoulder injury. Some consequences take a long time drug therapy.

Damage to soft tissues due to injury to the shoulder girdle is often accompanied by sprains. The following article contains information about that.

Therapeutic measures

Treatment of upper limb injury depends on each specific situation. If the dislocation can be reduced upon admission to the hospital, then after reduction a plaster cast is applied for several weeks. If the dislocation cannot be reduced, then surgery.

There are many ways to realign a shoulder. Less traumatic method according to Chaklin. It is used as the first method in shoulder reduction. Any reduction is accompanied by anesthesia.

Surgical treatment is used for habitual dislocation and unstable head of the shoulder joint. Thanks to surgical intervention the ligamentous complex is restored, the condition of the joint capsule is improved, and habitual dislocation is eliminated.

One of the operations is open reduction. Due to certain anatomical obstacles, it is not possible to reduce it using the Chaklin method or other methods. In this case, resort to such an operation. It is carried out under anesthesia. After surgery, a thoracobrachial bandage is applied. After a week, you can already perform passive movements.

Rehabilitation

After immobilization, movement of the shoulder joint should be avoided. But to reduce muscle atrophy, you need to perform the following movements:

rotational and circular movements of the hand;
clenching and unclenching a fist;
short-term muscle tension of the upper limb.

A month after the injury, you can perform movements such as flexion and extension in the joint.

In addition to therapeutic exercises, physiotherapy is widely used.

This includes:

magnet therapy;
cryotherapy, exposure low temperatures;
mud therapy;
paraffin application.

Physiotherapy has next effect:

reduction of swelling of soft tissues;
decrease pain;
improvement of tissue vascularization;
acceleration of regenerative processes.

Rehabilitation is one of important points in the treatment of injuries. Since muscles and ligaments atrophy due to prolonged immobility, they require restorative procedures. That is why it is so widely used therapeutic exercises. The muscle frame strengthens, and the joint becomes stabilized in the articular capsule. Another advantage of rehabilitation is the prevention of habitual dislocation.