Treatment of shoulder dislocations. Reduction of shoulder dislocation and rehabilitation after injury

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Shoulder dislocation is a very common injury, especially among people involved in various sports.

Most often, when this joint is injured, the head of the humerus bone falls forward, while the injured arm seems to be turned outward and moved to the side.

This condition is called an anterior dislocation or its anterior form, and it is this type of shoulder dislocation that occurs most often, in almost 96% of cases.

In the article you will learn everything about rehabilitation after a dislocation of the shoulder joint, as well as what exercises should be performed for treatment during the recovery period.

Treatment of shoulder dislocation

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

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

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

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

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

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

Why is rehabilitation necessary?

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

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

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

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

Initial recovery from a shoulder dislocation

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

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

Rehabilitation activities

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

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

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

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

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

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

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

Physiotherapy

Physiotherapy procedures are an excellent means of not only rehabilitation after injuries, but also a preventive measure to strengthen the shoulder joint. When they are used in the human body, all natural biological processes are activated, recovery from illness is accelerated, an injured joint is restored, but, in addition, the general immune system is strengthened, as well as natural defenses are activated.

Today, for the treatment of injured joints in physiotherapy, a number of techniques are used that show excellent results, in particular:

Exercise therapy

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Features of rehabilitation after surgery

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

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

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

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

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

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

What not to do during the recovery period

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

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

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

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

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A dislocated shoulder is a fairly common injury. When it is received, the surfaces of the joints partially or completely cease to contact each other.

The reasons for its appearance include mobility of the joint, a fairly large and thin joint capsule, as well as a small area of ​​​​contacting surfaces. Often a dislocation occurs when a person falls with the upper limbs abducted or extended forward.

In this article you will learn how to identify a shoulder dislocation and learn the typical symptoms of the injury.

Causes of dislocations

The most common injuries include an anterior dislocation, where the head of the humerus is pushed under the process that extends from the upper edge of the scapula. It arises as a result of:

• Indirect injuries;
• Hit from behind to the shoulder;
• Convulsive seizures;
• Problems with the tissues of the body that perform a supporting and protective function, participating in the formation of the joint capsule (more often this becomes the cause in which the muscles, blood vessels and nerves are not affected).

Posterior dislocation is less common than anterior dislocation. It appears when the shoulder joint is impacted from the front. The blow can fall not only on the forearm, but also on the elbow or wrist. In order for a posterior dislocation to occur, the arm must be in internal rotation and flexion at the time of injury.

Inferior dislocation is rare. Downward displacement of the humeral head occurs as a result of the impact on the limb when it is elevated above the head.

As a result, the humerus falls into the armpit, and the affected limb is fixed above the head. Often with such injuries, damage to nerves and blood vessels occurs.

In very rare cases, the cause of dislocation is convulsions due to epilepsy, high temperature or under the influence of electric current. The cause of habitual dislocation can be:

• Damage to tendons in the shoulder area;
• Damage to the joint capsule or ligaments of the shoulder;

After the first reduction, the joint is unstable and prone to subsequent displacement.

Chronic pathological dislocations are caused by bone tuberculosis, various tumors, osteomyelitis or osteodystrophy.

Symptoms of shoulder dislocation

Signs that indicate a shoulder dislocation has occurred:

Characteristic for anterior dislocation:

• The hand is in an abducted state;
• The shoulder is in a position of external rotation;
• The patient cannot rotate the shoulder inward, he cannot move it to the side;
• You can feel the head of the humerus under the collarbone.

Characteristic for posterior dislocation:

• The affected limb is in an adducted position and slightly elevated;
• In the anterior part of the shoulder, the protruding coracoid process of the scapula becomes noticeable;
• The head of the humerus is felt behind the lateral end of the scapula articulating with the acromial articular surface of the clavicle
• When trying to abduct or rotate a limb, resistance is felt.

Characteristic for lower dislocation:

• The forearm is located above the victim's head;
• The injured limb is bent at the elbow and abducted;
• The head of the humerus can be felt under the armpit of the chest.

Symptoms of complicated shoulder dislocation

In some cases, complications arise when the shoulder joint is dislocated, which can be determined by the following signs:

• Nerve damage. Most often, injury occurs to the axillary nerve. As a result, muscle weakness occurs during external rotation or abduction of the shoulder, and it becomes numb in the area of ​​the deltoid muscle. In some cases, the radial nerve is affected, which manifests itself in the form of weakening of the flexor muscles, numbness of the elbow joint and hand;
• Damage to blood vessels. This pathology occurs in rare cases with inferior and anterior displacement of the radius. It is more common in older people with vessels damaged by atherosclerosis. In this case, the patient’s pulse wave in the area of ​​the radial artery decreases and completely disappears;

• Damage to Bankart. It occurs when the joint capsule ruptures and a portion of the anterior labrum is torn off. It is impossible to determine this complication externally, but the patient’s pain is much higher than with an uncomplicated dislocation. Often this pathology requires surgical intervention;
• Bone fracture. When an injury occurs, a fracture of the clavicle, humerus, or lateral end of the scapula may occur. In this case, the dislocation is accompanied by severe and acute pain and the inability to move the shoulder. Due to the fact that the fragments are displaced, the bone becomes shorter. On palpation, a characteristic crunch of bone fragments occurs;
• Hill-Sachs defect. Appears when an injury causes a fracture of the posterior head of the humerus bone. Sometimes it can be determined by palpation (a characteristic crunch of bone fragments occurs). But basically, to establish the correct diagnosis, it is necessary to conduct a number of additional studies.

Only a doctor can diagnose complications based on the results of an x-ray or computed tomography. Therefore, after an injury, it is necessary to immediately seek advice.

Diagnosis of injury

In most cases, the disease is diagnosed without further testing. But to identify complications, it is necessary to use the following methods:

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First aid

If there is a suspicion that a person has dislocated the shoulder joint during an injury, the following steps should be taken:

• Rest the affected limb. The injured arm should be pressed against the body for a posterior dislocation or abducted for an anterior dislocation. The forearm must be bent at the elbow, a cushion must be placed on the side of the body on which the arm is placed;
• To keep the hand motionless, use a special bandage. For these purposes, a triangular scarf is suitable; the injured forearm is placed in it, and the ends are tied around the neck;
• Apply ice or a heating pad with cold water to the injury site, this will reduce swelling and pain;
• In order to reduce pain, the patient can take an anesthetic drug based on ibuprofen, ketorolac, diclofenac or nimesulide;
• Seek help from a doctor. If a dislocation is accompanied by severe pain, numbness or blue discoloration of the arm, you must call an ambulance.

You can read more about first aid for a dislocated shoulder.

Trying to straighten the shoulder joint on your own is not recommended, since this procedure is quite complex and, if performed incorrectly, can worsen the patient’s condition and lead to bone fractures or increased pain.

Joint reduction methods in the hospital

In order to anesthetize the reduction process, the patient is injected with a solution of Promedol intramuscularly and Novocaine inside the joint. This makes it possible to relax the muscles and reduce the risk of tendon damage.

There are about 50 ways to realign the shoulder joint. The most famous include:

• Reduction according to Dzhanelidze. This method is used quite often, since it is the least traumatic and is based on muscle relaxation. The patient is placed on a flat, hard surface so that the affected limb hangs down. Place a towel under the shoulder blade to make it fit more tightly. An assistant holds the patient's head. After the novocaine blockade relaxes the muscles, under the influence of gravity the head of the humerus approaches the glenoid cavity of the scapula. If self-reduction does not occur, the doctor bends the patient’s arm at the elbow at an angle of 90 degrees and presses on the forearm near the elbow. The other hand clasps the hand and moves the joint outward and then inward. During reduction, a characteristic click occurs;
• Reduction according to Hippocrates. The patient is placed on the floor. The doctor grabs his hand at the wrist, places his heel in the armpit and presses on the head of the humerus. At the same time, he pulls the patient’s limb along the body;
• Kocher reduction. This method is used to reduce an old shoulder dislocation or if the patient is strong enough. The patient is placed on a flat surface, the doctor grabs his hand at the wrist and bends it at the elbow. Then he pulls it along the axis of the shoulder, bringing the limb to the body. At the same time, the assistant holds the patient's forearm. In the next step, the doctor moves the patient's arm forward and then realigns the shoulder, moving it inward. In this case, the hand of the affected hand is moved to the healthy shoulder;

• Cooper method. The patient sits on a stool, and the doctor, placing his leg next to him, places his knee under his armpit. The patient's hand is grabbed at the wrist, while simultaneously pushing up the dislocated head of the humerus

With a habitual shoulder dislocation, the joint capsule is stretched, so the head of the humerus often slips out. In this case, surgical intervention is indicated to restore the ligamentous apparatus and align the head of the humerus with the glenoid cavity of the scapula.

Treatment and rehabilitation

Reduction of a dislocated shoulder should occur within a few days of the injury. If this process is delayed, the articular surfaces atrophy, and the joint itself may lose its function.

After reduction, the injured limb is immobilized using a bandage.. This makes it possible to provide her with complete rest and minimize movement.

But in order to prevent atrophy of the arm muscles, it is recommended to perform special physical exercises to improve blood circulation. This could be rotating the hand or clenching the muscles into a fist.

If the joint capsule and ligaments of the shoulder have recovered, they begin to perform other exercises, such as flexion or extension of the shoulder joint. Also, for quick rehabilitation after a dislocation of the shoulder joint, physiotherapeutic procedures are performed to quickly relieve swelling, improve blood circulation in the affected area, and speed up recovery and healing.

Complications and consequences

Complications of a shoulder dislocation include:

• Peripheral nerve damage;
• Compression or rupture of large blood vessels;
• Tendon damage;

These dislocations can only be eliminated through surgery, during which the integrity of the damaged tissue is restored. In case of fracture of bones and cartilage, it is necessary not only to correct the dislocation, but also to compare the fragments. If this cannot be done through the skin and muscles, surgery is performed. Also in some cases

You should not try to straighten the shoulder joint on your own. A person without the appropriate skills can damage the joint capsule, muscles or blood vessels. Therefore, if you suspect a dislocation, you should consult a traumatologist.

The shoulder joint is the most mobile in the human body. All types of movements are possible in it: flexion-extension, abduction-adduction, supination-pronation, rotation. The price for such freedom of movement is the significant “fragility” of this joint. This article will talk about the most common injury that awaits athletes who systematically overload their shoulder joints. This is a dislocated shoulder. In addition to the injury itself, we will touch upon issues of anatomy, biomechanics, first aid and, most importantly, preventive measures.

Anatomy of the shoulder joint

The shoulder joint is directly formed by the head of the humerus and the glenoid cavity of the scapula. The articular surfaces of the designated bones do not have absolute congruence. Simply put, they are not perfectly adjacent to each other. This moment is compensated by a large formation called the articular labrum. This is a cartilaginous body adjacent, on the one hand, to the articular cavity of the scapula, on the other, to the head of the humerus. The area of ​​the articular lip is much larger than that of the articular surface of the scapula, which ensures greater adherence of the articulating surfaces within the joint. The head of the humerus and the glenoid cavity of the scapula are covered with hyaline cartilage.

Joint capsule and clavicle

The described structure is covered on top by a thin articular capsule. It is a sheet of connective tissue that covers the anatomical neck of the humerus on one side and the entire circumference of the glenoid cavity of the scapula on the other. Fibers of the coracobrachial ligament, the tendons of the muscles that form the so-called rotator cuff, are also woven into the tissue of the capsule. These include the infraspinatus, supraspinatus, teres major and subscapularis muscles.

The listed elements strengthen the shoulder capsule. The muscles that form the rotator cuff provide a certain range of motion (read more about this below). Taken together, this formation limits the immediate joint cavity.

The clavicle also plays an important functional role in the structure of the shoulder joint. Its distal end is attached to the acromion or acromial process of the scapula. When the shoulder is abducted above an angle of 90 degrees, further movement occurs due to the mutual movement of the clavicle, the lower pole of the scapula and the chest. Looking ahead, we will also say that the main muscle serving the shoulder joint - the deltoid - is attached to the described anatomical complex.




Rotator muscles

The condition of the muscles surrounding it is important for the health of the joint. (this statement applies to all joints of the human body, not just the shoulder ones). Let us repeat that the muscles serving the shoulder joint are located, so to speak, in two layers. The deep muscles include the already mentioned muscles - rotators:

• infraspinatus - located on the body of the scapula, as you might guess from the name, under its axis and is responsible for supination of the shoulder;
• supraspinatus - located above the axis, is involved in abducting the shoulder from the body. The first 45 degrees of abduction are performed primarily by the supraspinatus muscle;
• subscapular - located on the anterior surface of the body of the scapula (between the scapula and the chest) and is responsible for performing supination of the head of the humerus;
• large round - runs from the lower pole of the scapula to the head of the humerus, woven into the capsule by a tendon. Together with the infraspinatus muscle it performs pronation of the shoulder.

Moving muscles

The tendons of the biceps and triceps brachii muscles pass over the joint capsule. Since they extend over the head of the humerus, attaching to the acromion process of the scapula, these muscles also provide certain movements in the shoulder joint:

• the biceps flexes the shoulder, bringing the body of the humerus 90 degrees to the upper shoulder girdle;
• the triceps, together with the posterior head of the deltoid muscle, extends the shoulder, moving the body of the humerus back relative to the body of the scapula;

It should be mentioned that the pectoralis major and minor muscles and the latissimus dorsi muscles are also attached to the articular tubercles of the humerus, providing the corresponding movements:

• pectoralis major and minor muscles - responsible for bringing the humerus bones towards each other;
• The latissimus dorsi muscles provide downward movement of the bodies of the humeral bones in the frontal plane.

The deltoid muscle is directly responsible for movements in the shoulder joint. It has the following attachment points:

• the scapula axis is the point of origin of the posterior portion of the deltoid muscle;
• acromion - attachment point of the middle portion of the deltoid muscle;
• The acromial end of the clavicle is the attachment point of the anterior portion of the deltoid muscle.

Each portion, in fact, performs a different function, but balanced movements in the shoulder joint require the coordinated work of all three “bundles”. This is emphasized by the fact that all three delta bundles converge into a single tendon, attached to the deltoid tuberosity of the humerus.

The large volume of the listed muscles provides an appropriate range of movements. However, practically they are the “base” of the joint. The shoulder does not have a reliable bone structure, which is why during sports activities, especially when performing amplitude movements, the shoulder joint is injured.




Mechanism of injury

A shoulder dislocation is a displacement of the head of the humerus relative to the glenoid cavity of the scapula. There are several types of shoulder dislocation based on the direction of displacement.

Anterior dislocation

This type of injury occurs most easily, since it is the posterior pole of the humeral capsule that is least strengthened by tendons and ligaments. In addition, the posterior portion of the head of the deltoid muscle must provide stability. However, it is not sufficiently developed in the vast majority of ordinary people, and athletes are no exception.

This injury can occur under the influence of a jerking effect on a limb - when practicing martial arts, performing elements on the rings, or on the uneven bars, the starting point for entering a handstand. An anterior dislocation is also possible due to a blow to the shoulder joint - when practicing striking martial arts (boxing, MMA, karate), or when landing after performing a jumping element (workout, parkour).

Posterior dislocation

Posterior shoulder dislocation and with does not occur as often as the front one, but, nevertheless, quite often in percentage terms. In this case, the head of the humerus moves to the back of the glenoid cavity of the scapula. As you might guess, such a displacement of the humeral head occurs when the anterior pole of the shoulder joint capsule is injured. Most often, the shoulder is in a flexed position, with the arms extended in front of the body. The impact occurs on the distal part of the arm. In other words, in the palm of your hand. Such an impact is possible when falling on outstretched arms, for example, with insufficient technical performance. Or when the weight of the barbell is incorrectly distributed when performing a bench press.




Lower dislocation

With an inferior dislocation, the head of the humerus is displaced under the glenoid cavity of the scapula. This type of injury is not common and occurs when the arm is raised up. Such an injury is possible when performing the “flag” exercise, when performing walking on hands, snatch and push. Snatch and push, in this case, are the most traumatic, since the shoulders are in an anatomically unfavorable position, and the load is vertical.

Habitual dislocation

There are other types of shoulder dislocations, but they are essentially combinations of the types of injury described above.

The most unpleasant consequence of a shoulder dislocation is its chronicity - the formation of a habitual dislocation. This condition is characterized by the fact that any minimal impact on a previously affected joint is enough to cause a full-fledged dislocation. Most often, this pathology develops due to improper treatment of a primary shoulder dislocation.

Signs and symptoms of a dislocation

The following unpleasant symptoms indicate an injury to the shoulder joint, namely a dislocation:

1. Sharp pain in the area of ​​the damaged joint, accompanied by a kind of “wet crunch”.
2. Inability to make active movement in any of the axes of mobility of the shoulder joint.
3. Characteristic displacement of the head of the humerus. In the deltoid region, the acromial process of the clavicle is determined, under it there is a “depression”. (With a lower dislocation, the arm remains raised upward, the head of the humerus can be felt in the chest area, under the armpit). The area itself, compared to a healthy one, looks “sunken”. In this case, the affected limb becomes relatively longer.
4. Swelling of the affected joint area. Develops due to traumatic damage to the vessels surrounding the joint area. The spilled blood permeates the soft tissues, sometimes forming a fairly large hematoma, which brings additional pain. Moreover, you will not see “blue discoloration” of the deltoid region immediately after injury; subcutaneous vessels are damaged extremely rarely, and a visible hematoma is characteristic only of direct injury to these vessels.

First aid for a dislocated shoulder

Don't try to straighten your shoulder yourself!!! In no case! Inept attempts at self-reduction of the shoulder lead to injuries to the neurovascular bundle and serious ruptures of the shoulder capsule!

First, you need to fix the limb, ensuring its maximum rest and limited mobility. If there is a painkiller (analgin, ibuprofen or diclofenac and the like), it is necessary to give the medicine to the victim to reduce the severity of the pain syndrome.

If there is ice, snow, frozen dumplings, or vegetables, it is necessary to apply an existing cold source to the damaged area. The entire deltoid region should be in the “cooling” zone. This way you will reduce post-traumatic swelling in the joint cavity.

Next, you need to immediately deliver the victim to a medical facility where there is a traumatologist and an X-ray machine. Before reducing the dislocation, it is necessary to take an X-ray of the shoulder joint to exclude a fracture of the body of the humerus and scapula.

Treatment of dislocation

As for how to treat a dislocated shoulder, we will give only a few general tips, since self-medication in this case can be very dangerous. The treatment process includes several stages:

• reduction of the dislocation by a qualified traumatologist. Better - under local anesthesia. Ideally, under anesthesia. Pain relief provides relaxation to muscles that spasm in response to injury. Thus, the reduction will be quick and painless.
• immobilization and ensuring complete immobility of the shoulder joint. The period of immobilization is 1-.5 months. During this period we try to achieve maximum healing of the shoulder capsule. For this purpose, during this period, a variety of physical therapy is prescribed to help improve blood circulation in the affected joint.
• rehabilitation.

We will talk about the rehabilitation stage for a shoulder dislocation in more detail below.

Rehabilitation

It is necessary to gradually expand the range of movements immediately after removing immobilization. Despite the fact that the connective tissues have grown together, during immobilization the muscles have weakened and cannot provide proper stability to the joint.

First stage of recovery

In the first three weeks after removing the fixing bandage, kinesio tape can be a reliable help, activating the deltoid muscle and thereby increasing the stability of the joint. During this same period, all possible presses and deadlifts should be eliminated. The remaining exercises available are:

1. Straight arm abduction to the side. The body is fixed in a standing position straight. The shoulder blades are brought together, the shoulders are separated. Very slowly and under control, we move our arm out to the side at an angle of no more than 90 degrees. We also slowly return it to its original position.
2. P ronation-supination of the shoulder. The elbow is pressed to the body, the arm is bent at the elbow joint at 90 degrees. The humerus stands still, only the forearm moves. We alternately bring and abduct it, with dumbbells clamped in the hands, left and right. The amplitude is minimal. The exercise is performed until a feeling of warmth, or even heat, appears in the inside of the shoulder joint.
3. WITH bending the arms in a machine that eliminates traction of the injured arm. Such, for example, is a block exercise machine with a built-in Scott bench.
4. R when bending the arms in a machine that simulates the French bench press, the humerus in relation to the body should not be placed at an angle of more than 90 degrees.

The weight of the weights is minimal; when performing them, you need to concentrate on the muscle sense. Barbells and dumbbells of moderate and heavy weight are completely prohibited at this moment.

Second phase

Three weeks after removing immobilization, you can include front raises and bent over flyes to engage the anterior and posterior portions of the deltoid muscle, respectively.

We begin to perform side flyes in two versions: with small dumbbells and extremely clean technique - to strengthen the supraspinatus muscle, and with slightly heavier dumbbells (preferably in a machine, but it may not be available in your gym) to target the middle portion of the deltoid muscle.

Thus, you need to train for another three weeks. And only after this period has passed, you can carefully return to your usual training regimen, gradually including pressing and pulling movements into the training program. Better - in simulators, with moderate or even light weights.

Third stage

After the four-week stage, you can move on to working with free weights. It’s better to start with a barbell, and only after that move on to working with kettlebells and dumbbells. Once you have mastered the movements with them, you can start working with your own weight again.

Prevention of shoulder dislocation involves systematically strengthening the rotator cuff muscles using the exercises described in the first stage of rehabilitation and working with each muscle bundle separately. Particular attention should be paid to the posterior portion of the deltoid muscle, which is responsible for the stability of the posterior pole of the shoulder joint capsule.

You should never start training deltoids with heavy weights and bench press exercises. As a warm-up, it is very useful to pump up each bundle individually and perform exercises for the rotator cuff.

Injurious exercises

As is not difficult to understand from what was written above, the most traumatic exercises in CrossFit are gymnastic elements performed on rings and parallel bars, snatch, clean and jerk and exercises leading to them, walking and handstands.

However, not a single exercise will harm you if you approach your exercises wisely and in a balanced manner. Avoid one-sided loads, develop your body harmoniously and be healthy!

The most mobile joints in the human body are the shoulder joints. Thanks to their design, we can raise our hand, move it to one side or another, and reach the back of our head or head with our hand. It is their amazing mobility that largely contributes to the variety of functions of our hands, which make us capable of performing many actions and acquiring a variety of skills.

Movement in the shoulder joint can be carried out in three planes. However, this joint has to pay for such special hypermobility with its low stability. It is designed in such a way that the area of ​​contact between the glenoid cavity of the scapula and the head of the humerus is small, and even the presence of a cartilaginous lip that surrounds it and slightly increases the area of ​​contact between the components of the joint does not provide the shoulder joint with sufficient stability. That is why the stability of this part of the musculoskeletal system is often disrupted and a person experiences a dislocation of the shoulder (or the head of the humerus, the shoulder joint). According to statistics, such an injury accounts for about 55% of all traumatic dislocations.

In this article, we will introduce you to the main causes, types, symptoms and methods of diagnosing and treating shoulder dislocations. This information will help you timely suspect the presence of such an injury, provide proper assistance to the victim, and make the right decision about the need to contact a traumatologist.

A little history

In 2014, in Injury magazine, the public was able to learn about one interesting scientific fact related to shoulder dislocation. A group of Italian scientists led by M. Bevilacqua conducted a study of the Shroud of Turin. Experts have noticed that there is a significant asymmetry between the level of the shoulder girdles, shoulders and forearms of the imprint of the body of Christ, and the spinal column is not deviated to the side. This arrangement of bones can only be observed with anterior-inferior dislocation of the head of the humerus from the joint. Most likely, such an injury was received by the crucified at the moment when he was taken down from the cross.

A little anatomy

The shoulder joint is formed by three bones:

• glenoid cavity of the scapula;
• head of the humerus;
• articular cavity of the clavicle.

It should be noted that the glenoid cavity of the clavicle is not anatomically connected to the shoulder joint, but its presence significantly affects its functionality.

The shape of the head of the humerus coincides with the shape of the glenoid cavity of the scapula, along the edge of which there is a roller of cartilage tissue - the articular lip. This element additionally holds the articular head of the bone in the joint.

In general, the capsule of the shoulder joint is formed from a thin capsule and a system of articular ligaments that grow tightly together with it, thickening it. The articular capsule consists of connective tissue that secures the head of the humerus in the glenoid cavity. The shoulder joint is supported by the following ligaments:

• consisting of three bundles (upper, middle and lower) articular-brachial ligament;
• coracohumeral ligament.

The muscles surrounding it provide additional stability to the shoulder joint:

• small round;
• infraspinatus;
• subscapular.

The muscles and tendons create the rotator cuff around the shoulder joint.

Causes

The most common cause of shoulder dislocation is trauma. Normally, movements of a twisting or everting nature are performed in this joint, and exceeding their amplitude leads to the exit of the articular head from the articular cavity of the scapula. Such an injury can be caused by a fall on the hand, a sudden, intense and unsuccessful movement.

Some additional factors may contribute to the occurrence of shoulder dislocation:

1. Frequently repeated. This predisposing factor is especially characteristic of athletes involved in tennis, handball, volleyball, throwing, swimming and similar sports, or people of certain professions whose work activity involves the repetition of a number of excessive movements. Frequent and repeated trauma to the ligaments of the shoulder joint leads to a significant decrease in its stability, and dislocation can occur with any minor traumatic movement.
2. Dysplasia of the glenoid cavity of the scapula. In some people, from birth, the glenoid cavity of the scapula is excessively shallow, has a poorly formed lower part (with hypoplasia), or is tilted forward or backward. Such deviations from the norm and some other rarely observed anatomical features of the structure or location lead to an increased risk of shoulder dislocations.
3. Generalized. This deviation from the norm is observed in 10-15% of people and is expressed in an excessive range of motion in the joint.

Types of dislocations

Shoulder dislocation can be:

• non-traumatic – voluntary or chronic (pathological);
• traumatic – caused by a traumatic impact.

Traumatic dislocation can be uncomplicated or complicated (in the presence of additional injuries: fractures, violation of the integrity of the skin, ruptures of tendons, great vessels or nerves).

Depending on the duration of exposure to the traumatic factor, a shoulder dislocation can be:

• fresh – no more than 3 days have passed since the damage;
• stale – up to 5 days have passed since the damage;
• old – more than 20 days have passed since the damage.

In addition, a dislocation of the shoulder joint can be:

• primary traumatic;
• recurring (pathologically chronic).

Depending on the location occupied by the bones of the joint after injury, the following types of dislocations are distinguished:

1. Anterior dislocation (subcoracoid and subclavian). Such injuries are observed in 75% of cases. With a subcoracoid anterior dislocation, the head of the humerus deviates forward and seems to extend beyond the coracoid process, located on the scapula. With a subclavian anterior dislocation, the head of the bone deviates even further and extends under the collarbone. Anterior shoulder dislocations are accompanied by the so-called Bankrat injury - during the injury, the head of the bone tears off the articular lip of the anterior part of the glenoid cavity of the scapula. In severe cases, such injuries may be accompanied by rupture of the joint capsule.
2. Posterior dislocation (infraspinatus and subacromial). Such injuries are observed very rarely - only in 1-2% of cases. They usually occur when falling on an outstretched arm. With such dislocations, the head of the bone tears off the articular lip in the posterior part of the glenoid cavity of the scapula.
3. Axillary (or lower) dislocation. Such injuries occur in 23-24% of cases. With such dislocations, the head of the humerus moves down. Because of this, the patient cannot lower the injured arm and constantly holds it above the body.

Symptoms

When the bones are displaced, the victim experiences sharp and intense pain in the shoulder joint. Immediately after this, the functions of the arm are impaired due to dislocation of the head. The joint loses its usual smoothness, and the upper limb and shoulder may deviate to the side. When palpating the area of ​​injury, the head of the humerus is not located in its usual place.

After a dislocation, the shoulder can become deformed and harden, and when comparing the injured and healthy shoulder joint, their asymmetry relative to the spine is revealed. In addition, there is a significant or complete impairment of joint mobility.

If the nerves are damaged, a dislocated shoulder may be accompanied by disturbances in the sensitivity and motor functions of other parts of the arm - the fingers and hand. In some cases, with such injuries, a weakening of the pulse in the area of ​​the radial artery is observed. This symptom is caused by the fact that the displaced head of the humerus is compressing the vessel.

The main symptoms of a shoulder dislocation:

• sharp pain during displacement of the articular surfaces and stabbing painful sensations of varying intensity after injury, intensifying with movement;
• swelling of soft tissues;
• hemorrhages under the skin in the area of ​​injury;
• joint deformity;
• significant decrease in mobility;
• loss of sensitivity in the forearm or other parts of the hand.

When a dislocation occurs, the condition of the joint capsule also suffers. If left untreated, the number of fibrous formations increases in it, and it loses its elasticity. The muscles located around the joint, non-functioning due to injury, gradually atrophy.

In some cases, dislocation of the shoulder joint is accompanied by damage to the integrity of the soft tissues. In response to such injuries, the patient experiences intense pain, but with old or frequently repeated injuries, the painful sensations are not so pronounced or are completely absent.

First aid

To reduce pain and prevent worsening of a shoulder dislocation, the victim should be provided with first aid:

1. Calm the patient and place the injured arm in the most comfortable position.
2. Carefully remove clothes.
3. Allow the patient to take an anesthetic drug (Ibuprofen, Nimesulide, Analgin, Ketorol, Paracetamol, etc.) or perform an intramuscular injection.
4. If there are wounds, treat them with an antiseptic solution and apply a sterile bandage.
5. Immobilize the damaged joint using a scarf (a piece of fabric in the shape of an isosceles triangle). It can be made from available materials. For an adult, its dimensions should be from 80/80/113 cm or more. The forearm is placed on the scarf so that its central corner slightly extends beyond the elbow. The edges of the bandage are lifted and tied behind the neck so that the bandage supports the arm bent at the elbow. The piece of fabric hanging from the side of the elbow is fixed with a pin on the shoulder girdle. In case of an axillary dislocation, it is impossible to apply such an immobilizing bandage, since the victim cannot lower his arm. In case of such injuries, the patient must be transported as gently as possible to a medical facility.
6. To reduce pain and reduce swelling, apply ice to the area of ​​injury. It should be removed every 15 minutes for 2 minutes to prevent frostbite. Remember that in case of sprains and other injuries, you cannot apply heat to the damaged area in the first days.
7. You should not try to straighten a dislocation yourself. This procedure can only be performed by a specialist.
8. Call an ambulance or carefully transport the victim in a sitting position to a trauma center or emergency room of another medical institution as quickly as possible. Do not delay visiting a doctor, even if the pain has become less severe. Remember, shoulder dislocations must be reduced within the first hours after the injury. The more time has passed since the traumatic situation, the more difficult it is subsequently to perform the reduction.

Which doctor should I contact?

If you experience sharp pain in the shoulder joint at the time of injury, swelling, or dysfunction of the arm, you should consult an orthopedic traumatologist in the first hours. After examining and interviewing the patient, the doctor will order x-rays in two projections. If necessary, the examination can be supplemented by an MRI.

Diagnostics

To identify a shoulder dislocation, the doctor interviews and examines the patient. By palpating the area of ​​injury, a specialist can detect displacement of the head of the humerus from its usual place. In addition, the doctor performs a series of tests to determine the presence of damage to nerves and great vessels.

To confirm the diagnosis, clarify the details of the injury and identify possible concomitant injuries (for example,) x-rays are prescribed in two projections. For chronic dislocations, an MRI of the shoulder joint may be recommended.

Treatment

Treatment tactics for shoulder dislocations are largely determined by the nature of the details of the injury, which are determined on x-rays. Initially, attempts are made at closed reduction of the head of the humerus, but if they are ineffective, the patient may be recommended to undergo surgical intervention.

It should be noted that in the first hours after injury, dislocations are reduced much easier. Subsequently, the muscles contract, and it becomes much more difficult to repair the damage, since they prevent the articular head from returning to the articular surface.

Closed reduction of dislocation

Various methods can be used to reduce a dislocated shoulder joint:

• according to Kocher;
• according to Dzhanelidze;
• according to Hippocrates;
• according to Mukhin-Kot;
• according to Rockwood et al.

Initially, to reduce a dislocated shoulder, attempts are made to eliminate the displacement of the bones using local anesthesia. The method of reduction is determined by the doctor individually and depends on the clinical picture of the displacement of the articular surfaces.

If an attempt at closed reduction under local anesthesia remains unsuccessful, then it is repeated after intravenous anesthesia, which ensures sufficient muscle relaxation. This effect can be achieved by administering special drugs - muscle relaxants.

After successful reduction of the shoulder joint, which should always be confirmed by a control x-ray, it is immobilized. Previously, for these purposes, the patient was given a plaster bandage according to Deso or Smirnov-Weinstein. However, wearing them for a long time caused a lot of inconvenience to a person and, as it turned out later, such total immobilization was unnecessary. Practical and comfortable slings can now be used to reliably immobilize the shoulder joint. The duration of wearing them is about 3-4 weeks.

As a rule, after the head of the humerus is reduced into place, the pain becomes insignificant, and after a few days it can disappear completely. The absence of painful sensations often leads to the patient voluntarily refusing to wear an immobilizing device, and subsequently, non-compliance with the doctor’s recommendations can lead to re-dislocation. Its occurrence is explained by the fact that the damaged part of the articular capsule does not have time to “overgrow” enough to ensure stability of the shoulder joint.

In some cases, after reduction of a dislocation, an abduction immobilization option is used to immobilize the shoulder joint. This technique is less convenient for the patient than a sling bandage, but it allows one to achieve tension in the anterior capsule and press the labrum torn off in the anterior section to the bone. During such immobilization, the likelihood of sufficient “growth” of the articular labrum increases, and the chances of repeated dislocations decrease.

After the reduction is performed, to eliminate pain and reduce inflammation, the patient is prescribed non-steroidal anti-inflammatory drugs:

• Meloxicam;
• Nurofen;
• Ortofen;
• Paracetamol;
• Nimesulide et al.

In the first 2-3 days, cold should be applied to the area of ​​injury, which helps reduce pain and swelling.

After removing the immobilizing bandage, the patient is recommended to undergo a rehabilitation program.

Surgery

If attempts at closed reduction remain unsuccessful, then the patient undergoes a surgical operation consisting of opening the joint and open reduction, followed by fixation of the articular surfaces using Mylar sutures or knitting needles.

Treatment for repeated shoulder dislocations

After a shoulder dislocation, there is always a risk of repeating the same injury in the future, even with minimal stress on the joint. Such dislocations are called repeated (habitual) or a more modern term is used - “chronic instability of the shoulder joint.” The development of this condition is explained by the fact that after the injury, the structures holding the humerus were unable to recover completely and became unable to fully perform their functions.

More often, repeated dislocations appear in people under 30 years of age, and if the first injury occurred at a more mature age, then such repeated injuries in the future are observed less frequently. However, if a dislocation occurs in adulthood, its severity may increase and subsequently a person may develop fracture-dislocations.

As a rule, if a second shoulder dislocation occurs, it is almost always followed by a third, fourth, etc. In the absence of treatment appropriate for this condition, their number can reach impressive numbers. Only a timely operation can prevent their appearance.

Surgical stabilization of the shoulder joint can be performed using different techniques. However, the Bankart operation is considered to be the gold standard for such intervention. Now it can be performed by arthroscopy and without making a classic incision. To carry it out, it is enough to make 2-3 punctures of 1-2 cm each, into which the arthroscope and the necessary instruments will be inserted. The same intervention can be performed not only for chronic instability of the joint, but also for primary dislocations (for example, for athletes to ensure a more stable recovery of the shoulder joint).

The goal of Bankart surgery is to create a new labrum. For this purpose, a roller made from the joint capsule is used, which is sutured with anchor clamps (absorbable or non-absorbable). The new labrum can be sutured from the front (if the dislocation occurs anteriorly) or from the back (if the bone is displaced posteriorly). If necessary, during the intervention, the surgeon can repair supraspinatus muscle tears or longitudinal tears of the labrum.

To fix the new labrum, 3-4 fixators are usually sufficient. Non-absorbable anchor fixators have the form of a screw and are made of titanium alloys. They are inserted into the bone canal and remain there forever. As a rule, fixators made from modern alloys are well tolerated by patients, and their presence is not accompanied by the development of complications. In addition, they are able to provide more reliable fixation.

Polylactic acid is used to make absorbable fixatives. They may take the form of a screw or wedge that, once turned, is attached to the bone. After being introduced into the bone, such fixatives dissolve within a few months and are replaced by bone tissue.

The choice of one or another type of anchor fixation is determined by the operating surgeon and depends on the clinical case. After this, the doctor must inform the patient of his choice. After completing the Bankart operation, the patient is given an immobilizing bandage, and after its removal a course of rehabilitation is recommended.

In some rarer cases, other surgical interventions are performed to eliminate habitual shoulder dislocations (for example, corrective osteotomy for acetabular dysplasia, osteosynthesis for a scapula fracture, elimination of bone depression by transplanting an implant from the iliac crest, etc.). The most appropriate type of intervention in such complicated situations is determined by the attending physician.

Rehabilitation

The recovery program after a shoulder dislocation includes physiotherapy (amplipulse therapy, paraffin applications, electrophoresis, electrical muscle stimulation, etc.), massage and therapeutic exercises. The rehabilitation course begins after removing the immobilizing bandage and consists of the following periods:

• activation of the functionality of muscles damaged and “stagnant” during immobilization – about 3 weeks;
• restoration of shoulder joint functions – about 3 months;
• The final restoration of joint function takes about six months.

The patient needs to prepare for the fact that restoration of the functionality of the shoulder joint after its dislocation will take a long time. This duration of rehabilitation is explained by the fact that the injured joint requires a long “rest” to fully recover.

All physical therapy exercises must be performed under the supervision of an experienced physician or instructor. Only gentle loads can be placed on the joint, and movements should be performed as carefully as possible.

In the first weeks of rehabilitation, it will be enough for the patient to perform 10 flexions and extensions of the arm at the elbow joint and hand. In addition, exercises can be performed to raise your arms forward and spread them to the sides. In the first stages, the injured hand can be helped by the healthy one.

After two weeks, you can add to this set of exercises abduction of the arms bent at the elbow joints to the sides and alternate raising and lowering of the shoulders. Further, the patient may be allowed rotational movements of the arms and their abduction behind the back, exercises with a gymnastic stick, etc.

Remember! If pain appears as you increase the load, you should stop exercising for a while and consult a doctor.

Shoulder dislocation is a common injury and can be accompanied by various complications. In the future, such damage can cause chronic instability of the shoulder joint, requiring surgery. That is why the appearance of a shoulder dislocation should always be a reason to immediately consult a doctor for proper treatment and a full course of rehabilitation.

Channel One, program “Live Healthy” with Elena Malysheva,” in the “About Medicine” section, a conversation about the usual dislocation of the shoulder.