Treatment of shoulder dislocations. Shoulder dislocation - diagnosis, treatment and rehabilitation

Damage and injury to joints is a problem faced not only by athletes, but also by many people who have nothing to do with sports. After all, it is enough to stumble or perform an awkward movement, and the connective tissues of the musculoskeletal system may suffer. One of these common and complex injuries is Treatment after reduction is quite long and consists of several stages.

Medical care for a dislocated shoulder

This injury is very painful, so medical care is provided to the victim under local anesthesia, and in difficult cases, under general anesthesia. A qualified orthopedic surgeon realigns the joint and applies an immobilizing bandage for a period of time, depending not only on the complexity of the injury, but also on the age of the patient. Thus, young patients are recommended to wear an immobilizing product longer than older patients. This is explained by the fact that in elderly patients, prolonged immobilization of the joint can lead to atrophy of muscle tissue, and consequently to partial or complete loss of shoulder functionality.

It is a little different when the patient is diagnosed with a bone fracture and dislocation after reduction. In such cases, plaster is the only option for fixing the injured shoulder. However, after the bone tissue has healed and the plaster cast is removed, rehabilitation of the injured joint should continue.

The first stage of treatment for dislocation

From what was described above, it is clear that the important thing at the first stage of treatment for this type of injury is rest and immobilization of the injured shoulder. This will allow the cartilage tissue of the joint to recover. However, compliance with the rest regime at this stage of treatment is not as easy to ensure as it seems at first glance. After all, the patient still experiences severe pain for some period of time. Therefore, the doctor prescribes medication, if a person has had a dislocated shoulder, treatment after reduction. Medicines are selected depending on the complexity of the injury and the individual characteristics of the patient, such as age, the presence of allergic reactions and others. In addition, ice should be applied to the injured shoulder several times a day to relieve swelling and reduce pain.

The duration of immobilization is about 4-5 weeks. During this period, the patient needs to perform movements of the hand and wrist. Such gymnastics will help maintain normal blood flow in the arm and prevent muscle tissue atrophy.

What medications can be prescribed for a dislocated shoulder?

Considering that a dislocated shoulder is accompanied by severe pain, the first group of drugs that will be needed in the process of treating the injury are, of course, painkillers. Most often, with such an injury, the doctor prescribes medications such as Ketanov, Ibufen, Diclofenac and others. In most cases, these drugs are recommended to be taken in tablet form, but in especially severe cases, a specialist may prescribe painkillers in the form of injections.

Even when taking anti-inflammatory drugs, many patients complain of constant aching pain in the first days of treatment, which causes discomfort and causes insomnia. Therefore, in case of injury, doctors prescribe medications such as Lorazepam or Midazolam. These drugs not only have a sedative effect, but also have an excellent muscle relaxant effect.

Physiotherapy for shoulder dislocation

To activate biochemical processes, and therefore speed up the recovery process for joint injuries, patients are prescribed various physiotherapeutic procedures. This method of treatment and rehabilitation has proven itself very well over years of practice. In addition, it is completely safe, since it does not involve the use of medications, so it can be used to treat even infants.

So, if a patient has a dislocated shoulder, treatment after reduction (the bandage is not a hindrance) may include hardware physiotherapy methods such as electrical stimulation, phonophoresis, UHF, magnetic therapy, ultrasound and laser therapy. The duration of therapy is determined solely by the doctor.

The second stage of treatment for shoulder dislocation

After the doctor removes the plaster, the second phase of rehabilitation will begin, which lasts 2-3 weeks. During this period, it is necessary to begin light physical exercises that will restore the functionality of the shoulder. It would be better if the physical activity of the patient’s day is regulated by a professional. Therefore, if a doctor suggests taking a course of exercise therapy at a medical institution, you should not refuse. If it is not possible to perform gymnastics under the supervision of a professional, then you should consult with a specialist and determine what movements need to be performed at this stage of rehabilitation and how to do it correctly so as not to re-dislocate your shoulder.

Treatment after reduction involves very smooth and short-term exercises so as not to overload the damaged joint. In addition, for another two weeks after the immobilization stage, it is recommended to wear a soft supporting arm bandage.

Exercise therapy at the second stage of treatment of dislocation

After the shoulder and arm have not moved for a long period, it is quite natural that the patient experiences some discomfort. Many people complain that the muscles have atrophied too much and even the simplest movements cannot be achieved right away. But you shouldn’t be upset, you need to be patient and get to work.

So, those people who have had a dislocated shoulder should begin treatment after reduction in the second stage with simple exercises. In this case, the amplitude of movements should be small. As for the starting position when performing exercises, it should provide support for the shoulder. It is also worth noting that during gymnastics, combined movements should be avoided so as not to re-injure the damaged joint.

After performing gymnastics, slight swelling may appear, which should be relieved with an ice compress.

Third stage of treatment

This period is very important for a patient who had a shoulder dislocation a couple of months ago. Treatment after reduction at this stage should be aimed at strengthening the muscle tissue of the forearm and shoulder. However, there is no need to rush to restore the full range of motion, since the joint has not yet fully recovered. You can no longer use the arm support bandage, but to fix the injured shoulder, you should use an elastic bandage. This will protect the joint capsule from stretching.

During this period, active exercises are recommended aimed at restoring the functionality of the abductor and shoulder flexor muscles, as well as the rotators. You can also include movements with resistance and weights in your gymnastics routine. But it is important not to overdo it and not have a second appointment with an orthopedic surgeon with a diagnosis of “shoulder dislocation.”

Treatment after repositioning the ointment involves using it at this stage only to warm the muscle and relieve swelling. The patient does not require any other medications during this period, which lasts from 2 to 3 months.

Fourth stage of treatment

The goal of this period is to gradually return to the activities that were performed before the shoulder dislocation occurred. Treatment after reduction (the first 3 stages) should already produce results, and it is only necessary to restore the full amplitude of motor activity. To do this, during gymnastic exercises it is necessary to gradually increase the weight of weights and dumbbells, but do not forget to control the execution technique.

The duration of this stage of treatment ranges from 5 to 12 months.

Thank you

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Definition and general characteristics of shoulder dislocation of the right or left hand

Shoulder dislocation is understood as a condition in which there is a divergence of the surfaces of the head of the humerus and the glenoid cavity of the scapula, which are normally quite close to each other. If normally there is only a small gap between the surfaces of the head of the humerus and the glenoid cavity of the scapula, allowing free movement in the joint, then with dislocation this small gap becomes much larger. As a result, the range of movements in the joint is significantly reduced, since the incorrect position of the articulating surfaces prevents them from being performed. After all, in a joint, all surfaces in shape and size are carefully adjusted to each other, and if their relative position changes even slightly, the articular joint ceases to function normally.

This definition of dislocation is classic and fully reflects the general essence of the pathological condition of the joint. However, in order to have a good and clear idea of ​​what a dislocation of the shoulder joint is, you need to know its anatomical structure.

So, the shoulder joint is formed by two surfaces - the head of the humerus and the glenoid cavity of the scapula. The head of the humerus is a spherical formation at one of its ends, and the socket of the scapula is a rounded notch. Moreover, the size and shape of the notch of the scapula corresponds to those of the head of the humerus. Due to the matching shape and size, the head of the humerus fits perfectly into the glenoid cavity of the scapula, like a ball into a bearing (see Figure 1), and therefore can perform a variety of movements.

Picture 1– The structure of the shoulder joint.

To be able to move, the head of the humerus and the articular surface of the scapula are not tightly connected; between them there is a narrow gap filled with a special liquid that acts as a kind of physiological lubricant. The joint is strengthened by ligaments and tendons that hold the articulating surfaces of the head and notch in the required position.

But if, for some reason, the head of the humerus and the glenoid cavity of the scapula diverge in different directions and the gap between them increases, then the joint loses the ability to move normally. This is exactly the condition that is called dislocation (see Figure 2).

Figure 2– Dislocation of the shoulder joint (the picture on the right shows the normal structure of the joint, and on the left – its dislocation).

Since the left and right shoulder joints are constructed in exactly the same way, dislocations in them also form in the same way. Moreover, dislocations of the right and left shoulder joints are no different from each other and do not have any special features, so we will consider them together.

Shoulder dislocations occur in adults in half the cases of all recorded dislocations, which is due to the structural features of the joint and the large range of movements in it.

Shoulder dislocation - photo

Classification and brief characteristics of various types of shoulder dislocations

Acquired shoulder dislocations are divided into:
1. Traumatic dislocations:

• Uncomplicated dislocations;
• Complicated dislocations.

• Voluntary dislocation;
• Chronic pathological dislocation.

Acquired shoulder dislocations, compared to congenital ones, constitute an incomparably larger group, since they are more common and are caused by various factors, and not just birth injuries. It is acquired dislocations that make up about 80% of all cases, and the remaining 20% ​​are congenital.

Acquired dislocations, in turn, depending on the nature of the factor that provoked them, are divided into two large groups - traumatic and non-traumatic. Non-traumatic ones include voluntary and pathological (chronic) shoulder dislocations. And traumatic ones are divided into two types - complicated and uncomplicated shoulder dislocations. Accordingly, uncomplicated dislocations represent an isolated injury to the shoulder joint, in which the surrounding tissues and anatomical structures are not damaged, which allows the problem to be eliminated by simple reduction. Complicated dislocations constitute a much more diverse group, which includes dislocations that are combined with damage to surrounding tissues and structures, which makes simple reduction impossible. Thus, the following possible options are classified as complicated traumatic shoulder dislocations:

• Open dislocation with damage to nerves and blood vessels;
• Dislocation with tendon damage;
• Dislocation with fracture of bones or cartilage (fracture dislocation);
• Pathological repeated dislocations;
• Old dislocation;
• Habitual dislocation.

Depending on the location and direction of divergence of the articulating surfaces, shoulder dislocations are divided into the following three types:
1. Anterior dislocation(noted in 90% of cases) is a displacement of the head of the humerus towards the clavicle and deep under the scapula. Since the head of the humerus in this type of dislocation extends under the coracoid process of the scapula, it is often called subcoracoid. However, if the head of the humerus shifts more towards the clavicle area and not under the scapula, then this type of injury is called a subclavian dislocation. With such a dislocation, the shoulder is slightly retracted to the side.
2. Posterior dislocation(occurs in 2% of cases) is a separation of the head of the humerus from the ligaments and tendons that hold it in its normal position, and a displacement simultaneously upward (towards the head) and towards the back. This type of dislocation usually occurs when falling on an outstretched arm. With this dislocation, the shoulder is abducted, flexed, and slightly rotated outward.
3. Lower dislocation(occurs in 8% of cases) is a displacement of the head of the humerus downwards towards the legs. With such a dislocation, a person cannot lower his arm down and is forced to hold it above his head. With a lower dislocation, the arm is abducted from the body, and the person slightly tilts the torso towards it, holding it with the healthy arm.

Let's look at a brief description of the different types of dislocations in the shoulder joint.

Traumatic shoulder dislocation

Primary shoulder dislocation

Old shoulder dislocation

Habitual shoulder dislocation

Habitual dislocations exist for a long time - for months and years. Moreover, the more often they occur, the less force is required to form a subsequent dislocation. However, at the same time, the method of their reduction is also simplified.

Open dislocation with damage to nerves and blood vessels or tendons

Dislocation with fracture of bones or cartilage (fracture dislocation)

Pathological repeated dislocations

Arbitrary dislocation

Chronic pathological dislocation

Symptoms of a shoulder dislocation

Any fresh or recent shoulder dislocation is accompanied by pain of varying degrees of intensity, which is a mandatory symptom of damage. Moreover, the greater the amount of damage to the joint tissue, the stronger the pain that a person experiences during a dislocation. Because of the pain, the person tries to hold the arm on the side of the injury, trying to fix it in a slight abduction from the body while simultaneously deviating anteriorly.

The other most characteristic signs of a shoulder dislocation are limited function and deformity. A deformed joint can take on different shapes - convex, sunken, angular, etc. The appearance of the joint is abnormal, different from an intact shoulder, which is noticeable to the naked eye. However, the most common deformation of the shoulder during dislocation is its flattening in the anteroposterior direction with simultaneous strong protrusion of the scapula with a depression under it. This deformation gives the joint a very characteristic appearance.

When a shoulder is dislocated, a person cannot make any movements of the arm associated with this joint. If you try to make simple passive movements, a characteristic springy resistance will appear.

Summarizing the above, we can say that the most characteristic symptoms of a shoulder dislocation are the following signs:

• Pain in the shoulder, arm, shoulder blade and collarbone;
• Swelling of the shoulder joint;
• Limitation of movements in the joint (a person can only make springy movements that are small in volume and amplitude);
• A deformed appearance of the shoulder joint that is different from that of the other uninjured shoulder;
• Swelling in the joint area;
• If nerves are pinched or damaged, stabbing pain, numbness of the hand and bruising in the immediate vicinity of the joint may occur;
• Loss of sensation in the hand, shoulder and forearm of the arm connected to the dislocated joint.

Causes of shoulder dislocation

• Trauma (for example, a blow, a fall on your hand, etc.);
• Diseases of the joints that occur with the destruction of the articular surfaces of the articulating bones;
• Congenital anomalies of bones and joints, for example, hypermobility, shallow scapular cavity, etc.;
• Incorrect reduction of dislocation.

Pain after a shoulder dislocation

Directly during the process of reducing a dislocation, a person may feel very strong, acute and almost unbearable pain, so it is recommended to perform this manipulation using anesthesia. If anesthesia is not used, then due to severe pain the person will instinctively tense the muscles, and the reduction of the dislocation may become incomplete or incorrect, which will create conditions for habitual dislocations in the future.

After the dislocation is reduced, the pain will decrease, but will completely subside only after 2 to 4 months. Moreover, the pain sensation will decrease gradually, slowly fading away. After the dislocation is reduced, the remaining pain is associated with sprained ligaments and tendons. And until these structures, which strengthen and hold the joint in a normal position, are not reduced to their normal size, pain will be felt by the person. That is, after a dislocated joint, the pain will be the same as after a muscle or ligament sprain.

How to identify a shoulder dislocation (diagnosis)

During the examination, the doctor identifies a visible deformation of the shoulder joint and tries to determine where its parts are located. After a visual examination, the traumatologist begins to carefully palpate the dislocated shoulder joint in order to determine the location of the head of the humerus. The head has a rounded spherical shape, so it is clearly visible and palpable under the skin. With any dislocation, the head of the humerus may be shifted to the back under the shoulder blade, to the chest under the collarbone, or down.

Then the doctor takes the hand with the damaged joint and tries to make some small movement with it. When dislocated, spring resistance will be felt. When you try to make a counterclockwise circular movement with your arm straight down along the body, a simultaneous rotation of the protruding, dislocated head of the humerus occurs. Movements in the fingers and in the elbow joint do not suffer when the shoulder is dislocated and are preserved in full.

When diagnosing a shoulder dislocation, be sure to check its response to movement and skin sensitivity, since such an injury is often complicated by nerve damage. In addition, it is necessary to feel the pulse on the artery of the forearm in the immediate vicinity of the palm and determine its strength. If the pulse is weaker than in the healthy arm, this indicates damage to the blood vessels, which also often occurs with shoulder dislocations.

Thus, the signs that allow you to recognize a dislocated shoulder are the following:

• Deformed shoulder joint;
• Characteristic spring resistance when trying to make a movement in a dislocated joint;
• Rotation of the head of the humerus simultaneously with rotation of the outstretched and straight arm around its axis;
• Preservation of movements in the fingers and elbow joint.

With habitual shoulder dislocation, as a rule, the configuration of the joint is not deformed, but movements in it are significantly limited. Signs of habitual dislocation are various restrictions of movement in the shoulder joint, called Weinstein, Babich and Stepanov symptoms.

The Weinstein symptom is that a person is asked to raise both arms to the sides by 90 o, and then bend them at the elbows at a right angle. The person is then asked to try to raise the forearm as high as possible. With a habitual shoulder dislocation, the range of motion is less than on the uninjured side. Babich's symptom is that when a doctor tries to make movements with a person's hand, he resists and tries to control them on his own. Stepanov's sign is checked with the person lying on his back. The patient is asked to extend his arms along the body and place them with his palms on the surface of the couch. Then they ask the person to turn their hands so that the backs of their hands touch the surface of the couch. If there is a habitual dislocation of the shoulder, the person cannot reach the couch with the back of his hand.

In addition, with a habitual shoulder dislocation, a doctor or other person will easily be able to lower the arm raised to the side, despite active attempts to resist. An arm with a healthy shoulder joint cannot be lowered to the body if a person actively resists this.

To confirm a shoulder dislocation suspected based on the listed signs, it is necessary to take an x-ray.

General principles of treatment

After reduction or surgery, when the shoulder joint has acquired its normal anatomical structure, it is necessary to limit its movements until complete healing and restoration of all tissues, which takes from 4 to 6 weeks. To immobilize the joint (limit its mobility), a person is given a Turner splint or a scarf bandage for 3 to 6 weeks, and for rapid tissue restoration, a course of physical therapy is prescribed (UHF, electrophoresis with anesthetics, physical therapy, etc.).

Let's consider methods of reversing a dislocation, performing a surgical operation and subsequent rehabilitation in separate sections.

Reduction of shoulder dislocation

The simplest and most effective method of pain relief for the reduction of a dislocated shoulder is conduction anesthesia according to Meshkov. To produce it, a person is seated on a chair, asked to turn his head towards the healthy shoulder and find a point under the lower edge of the collarbone at the border of its middle and outer thirds. Novocaine solution is injected into this point, wait 5-10 minutes until anesthesia sets in, after which they begin to reduce the dislocation by any available method.

There are more than ten ways to reduce a dislocated shoulder, among which the simplest, least traumatic and most effective are the following:

• Kocher's method. First, the doctor grabs the injured arm by the lower third of the shoulder and wrist, bends it at the elbow at a right angle, and then simultaneously pulls it along the axis of the shoulder and presses it to the body. The assistant must hold the person’s shoulder while performing the movement so that it does not rise. Then the doctor turns the forearm bent at the elbow outward, so that the elbow is directed towards the abdomen. After this, turn the arm again so that the elbow is directed forward (in front of the stomach). Finally, the arm is turned again so that the elbow is near the stomach.
• Dzhanelidze's method. The person is asked to lie on the edge of a couch, table or bed, or sit on a chair so that the injured arm hangs freely over the edge. In this position, a person must lie down for 10–15 minutes to relax the muscles, after which the doctor bends the arm at the elbow at a right angle and pulls it down, while simultaneously pressing on the forearm and turning it alternately inward and outward.
• Mukhin-Mota method applicable for any type of dislocation. The person is seated on a chair or laid on a couch, after which the shoulder blade on the side of the damaged joint is tied with a towel to the back, thrown over the armpit. Then the doctor bends the arm at the elbow and raises it to the side to shoulder level. In this position, the doctor gently pulls the hand along the axis of the shoulder, while lightly shaking and rotating it from side to side.
• Hippocrates' method. The person is placed on his back, the doctor grabs the hand on the side of the damaged joint by the hand and rests the leg against the armpit. Then he simultaneously pulls the arm and pushes the head of the humerus toward the joint with the heel.

Reduction of shoulder dislocation according to Kocher - video

Reduction of shoulder dislocation according to Hippocrates - video

Shoulder dislocation bandage

Figure 3– Longueta according to Turner.

Figure 4- Headband.

A splint or bandage is applied for a minimum of 4 weeks in adults and for 3 weeks in the elderly (over 65 years of age) and children under 12 years of age. Elderly people and children are recommended to wear scarves instead of splints for 10 to 14 days.

After removing the splint or scarf, it is imperative to perform special exercises aimed at strengthening the joint and muscles, which will prevent shoulder dislocations in the future.

Habitual shoulder dislocation: causes, symptoms, tests, treatment (reduction), bandage - video

Surgical treatment of shoulder dislocation

A completely different type of operation is the treatment of habitual joint dislocation, since in their course the surgeon has to re-form the normal joint capsule, matching the surfaces of the bones, removing inflamed tissue, fibrous cords and formed growths, and stitching torn ligaments, tendons and cartilage.

Surgeries to treat recurrent shoulder dislocation

Most often, to eliminate habitual dislocation, operations are performed on the shoulder capsule, during which excess tissue is removed, followed by crimping and suturing. The second most popular is surgery to create new tendons and ligaments that strengthen the head of the humerus and prevent the joint from dislocating. In this case, the doctor cuts small pieces of ligaments and tendons from nearby muscles and sews them to the necessary points in the shoulder joint.

The third common option for operations to treat habitual shoulder dislocation is the Eden or Andin technique, based on giving the bones a new shape with numerous points of emphasis that prevent dislocation of the joint.

Unfortunately, all operations for the treatment of habitual shoulder dislocation have disadvantages and the risk of recurrence, so every person should be mentally prepared for the fact that they will have to undergo surgical intervention more than once. The minimum number of relapses was noted for the Boychev-M operation.

After a dislocated shoulder – rehabilitation

At the first stage which continues during the first week after reduction of the dislocation, the following rehabilitation actions must be performed:

• Limitation of any movements in the shoulder joint;
• Warm up the hands and wrists to ensure normal blood flow in them;
• Cold compresses on the joint for pain relief;
• Taking drugs from the group of non-steroidal anti-inflammatory drugs (Nimesulide, Ibuprofen, Diclofenac, etc.);
• Electrophoresis with Novocaine.

• Light and smooth warm-up movements of the shoulder;
• If you do not feel pain during warm-up movements with your shoulder, then you can smoothly move the joint in different directions;
• After performing the exercises, it is recommended to apply cold to the joint.

Third stage of rehabilitation begins 3–4 weeks after reduction of the dislocation. It is during this period that the bandage or splint is removed and the following actions begin:

• Retraction of arms to the sides;
• Smooth warm-up movements of the shoulder in different directions.

Rehabilitation after a shoulder dislocation consists not only in performing a certain set of exercises aimed at strengthening the muscles and ligaments that hold the joint, but also in stopping the inflammatory process and providing conditions for the best and fastest restoration of the structure of damaged tissues. Therefore, in addition to exercises, it is recommended to conduct courses of the following types of physiotherapeutic rehabilitation:

• Galvanization of the muscles of the shoulder and forearm;
• Electrophoresis of Novocaine;
• Ozokerite;

Exercises after a shoulder dislocation

• Shrugs;
• Bend the torso forward while simultaneously spreading your arms to the sides;
• Raising your arms to the sides in a standing position;
• Raising your arms in front of you in a standing position;
• Abduction of the arms, bent at a right angle at the elbow, to the sides;
• Abduction of the arms, bent at the elbow at a right angle, upward;
• Rotation of arms forward;
• Rotate your arms backwards.

Shoulder dislocation - first aid

Until a person is taken to a medical facility, he should be given first aid, which, in case of a dislocated shoulder, consists of immobilizing the joint with a scarf. It is optimal to simply apply a scarf bandage, as shown in Figure 5.

Figure 5- Headband.

If possible, you should put cold on the joint and give the person a tablet of any painkiller (Nimesulide, Analgin, Trigan, Baralgin, Sedalgin, MIG, etc.).

You should not attempt to correct the dislocation yourself, as this can worsen the situation if the technique is incorrect.

Emergency care for a child with a dislocated shoulder - video

Dislocation is a painful displacement or prolapse of the end of a bone beyond the boundaries of the articular joint. Sometimes it occurs with rupture of ligaments and joint capsule. The most common dislocations of the shoulder and elbow joints are observed - they account for about 55% of all bone displacements encountered.

The shoulder joint is the most mobile in the human skeleton. It can perform six types of movement: flexion, extension, abduction, adduction, internal rotation, external rotation.

You will learn

Anatomy

The shoulder joint consists of bones, tendons, muscles, ligaments and articular capsules and is a rather complex mechanism.

At the base of the shoulder are three bones:

• shoulder;
• shoulder blade;
• collarbone.

Watch all about the anatomy of the shoulder joint and its possible injuries in this video.

Causes

A dislocation is considered to be the release of the head of the humerus from the glenoid cavity of the scapula. There can be several reasons for such an injury. Most often it occurs due to external mechanical influence - a person falling on an arm extended forward or backward:

• According to statistics, these injuries mainly occur in heavy industries, when falling from a height. More often, shoulder injuries are observed in middle-aged men. Mechanical dislocations usually occur with rupture of the joint capsule and surrounding tissues.

• Also, displacement of the bones in the shoulder can occur as a result of strong muscle contractions (convulsions, uremic seizures, etc.), negative processes in neighboring parts of the body, and physiological changes.
• Dislocations can be congenital - as a result of anomalies in the anatomical development of the child or painful processes during the first time of the baby’s life.
• Another reason for the displacement of the bones in the shoulder is the large amount of movement that it undergoes.
• The risk group includes athletes - they are the ones who can be susceptible to frequent shoulder injuries due to the fact that they constantly carry out the same type of movements. As a result, their ligaments and joint capsule are stretched and can no longer prevent the head of the humerus from moving.

For bodybuilders, there are three most traumatic exercises that can lead to shoulder injuries: the bench press, the overhead press, and the chest row.

Symptoms of a shoulder dislocation: how to distinguish it from a fracture

The main signs of a shoulder dislocation are:

• sharp pain;
• inability to move the shoulder normally;
• edema;
• shoulder deformity;
• asymmetry of the shoulder joints.

The victim cannot carry out all movements of the arm. It is also possible to experience numbness in the forearm or other parts of the arm and bruises.

When observing the described symptoms, it is necessary to hang your hand in a scarf, apply a cold compress to the injured area and contact a traumatologist as soon as possible to make a diagnosis and decide on the necessary treatment. The final diagnostic conclusion is possible only after an X-ray of the shoulder is taken.

An X-ray is also necessary to rule out a fracture. You can distinguish between two injuries - dislocation and fracture - by the following signs:

1. When a fracture occurs, unnatural mobility is usually observed, and when the bone is displaced, on the contrary, movement is limited.
2. When palpating, in case of displacement, you can find that the bone is not in place. The length and shape of the arm does not change. When a fracture occurs, the limb often takes on a different length and shape.
3. When the bone is displaced, swelling appears in the area of ​​the entire shoulder. When a fracture occurs, it forms above the injury, and subsequently the entire joint swells.

Classification

Dislocations are divided into two main groups: congenital and acquired.

Purchased, in turn, are divided into:

• traumatic (complicated and uncomplicated);
• non-traumatic (voluntary and chronic).

Traumatic observed in 60% of cases. Depending on how the humerus is placed in relation to the scapula during dislocation, they are classified:

• front;
• rear;
• lower dislocation.

The most common is the anterior one - found in 75% of injuries; rear is in second place - 24%. Lower displacements occur only in 1% of cases.

Dislocations are classified according to time:

• primary;
• chronic.

• fresh (those that happened no more than three days ago);
• stale (from three days to three weeks ago);
• old (more than three weeks ago).

Diagnostics

As we have already noted, a dislocation can be diagnosed by a traumatologist or a surgeon who makes a diagnostic conclusion based on the victim’s complaints, palpation of the location of the head of the humerus, as well as tests for damage to nerves and blood vessels.

For a final conclusion it will be necessary to undergo additional research:

1. radiography in two projections;
2. computer and magnetic resonance imaging;

Treatment

A dislocated shoulder requires medical attention and treatment.

Self-reduction and delay in receiving medical help lead to negative consequences that aggravate the situation.

The main method used in the treatment of this injury is reduction with preliminary local or general anesthesia using drugs: novocaine, icecaine, promedol. Reduction is carried out using several methods:

• lever;
• push;
• physiological.

They can be produced either individually or in combination with each other. In total, there are over fifty ways to realign the shoulder joint. The most famous of them: the method of Kocher, Hippocrates, Cooper, Janelidze, Rockwood and others.

The result of the reduction is controlled by x-ray.

After successful reduction, a Deso plaster cast or sling is applied to the shoulder, which will fix the joint for a period of three to four weeks. The victim is also prescribed anti-inflammatory and painkillers, as well as cold application.

A dislocation is a very dangerous injury, as it often leads to repeated dislocations. Habitual or chronic dislocation is treated with surgery - the joint is fixed with knitting needles and sutures.

Repeated dislocation may be accompanied by less pain or painlessness.

Rehabilitation period

After treatment, the following rules must be observed:

1. After removing the plaster cast, the victim will need to undergo a rehabilitation period, which involves restoring the functions of the shoulder joint with the help of special exercises, massages, and physiotherapy (UHF, ozokerite, mud applications).
2. The duration of the rehabilitation period will depend on the age and type of activity of the victim: for example, for athletes it will take much longer than for people of other professions. The nature of the procedures will be prescribed by the attending physician depending on the clinical picture of the injury.
3. Usually, at the first stage, muscle function is restored within three weeks, then the work of the shoulder joint as a whole, which will take about three months. Next six months will be required to fully restore the functionality of the shoulder organ.
4. In the first two weeks, the following exercises are recommended after a shoulder dislocation: flexion and extension of the arm at the elbow and hand (up to 10 times a day).

You can also watch a video where they talk about a set of exercises for restoring shoulder joints.

At the first stage of rehabilitation, exercises should be carried out under the supervision of a doctor or instructor.

After two weeks, the following are added to the set of exercises:

• abduction of the arms bent at the elbow;
• raising and lowering the shoulders;
• forward and backward movement of the shoulder.

A little later, the injured person will be asked to perform rotational movements with his arms, placing them behind his back, using a gymnastic stick as an apparatus, etc. Exercises in water are very effective.

If any exercise causes pain, you should notify your doctor.

Prevention

In order to prevent this injury, you should strengthen the muscles of the shoulder joint and the muscles surrounding it, improve the flexibility of the joint, thereby making it less susceptible to injury.

You can learn 3 exercises to strengthen and prevent shoulder injuries by watching this video.

Shoulder dislocation is the most common problem affecting the musculoskeletal system. The reason is a unique design that provides the greatest range of motion of any joint in our body. In this article we will look at how to recognize shoulder dislocations and the symptoms of the disease. Prevention and treatment as important measures to prevent and get rid of the consequences of this type of injury will also be described in the presented material.

What is a dislocation?

We call a dislocation the loss of contact of articular surfaces with each other. Injuries most often occur during sports or traffic accidents. People involved in volleyball, hockey, handball and winter sports are especially susceptible to this. When correct diagnosis is necessary.

One of the most complex types of shoulder injury is a dislocation. The causes and treatment are determined by the doctor after a careful examination of the victim. Further therapy consists of restoring the functioning of the joint and preventing complications.

Why does this problem happen?

The most common causes of shoulder dislocation are injuries during physical activity and a fall on the outer (side) arm. The problem may be caused by a strong blow. Sometimes the injury occurs as a result of a fall from a height, for example, while working on a construction site. When an impact occurs, the head of the shoulder bone is displaced. Depending on the direction in which it has moved, shoulder dislocations can be divided into:

1. Anterior shoulder dislocation. This is the most common type of dislocation and typically results from a fall on an outstretched arm or shoulder.
2. Posterior shoulder dislocation. This kind of displacement can be caused by a direct blow or sharp rotations of the shoulder.

Symptoms of the problem

A shoulder dislocation can cause damage to other structures in the shoulder area. How to identify the problem and what to do after a diagnosis of shoulder dislocation? Symptoms and treatment (first aid) depend on the severity of the injury.

Shoulder joint:

1. Sudden, very severe pain in the shoulder area.
2. Large swelling or hematoma.
3. Limitation of joint mobility.
4. Distortion of the outline of the joint, the absence of the head of the humerus is felt, which moves to the armpit area.
5. The pain increases when trying to move the joint (so the patient holds the arm closer to the body).
6. Fainting and elevated body temperature.

Therapeutic measures and diagnostics

A dislocated shoulder joint is considered a very serious injury. First aid and medical intervention are prerequisites for rapid rehabilitation and the patient’s return to a normal lifestyle. Anesthesia of the shoulder joint is necessary, which is performed under general anesthesia, in order to prevent other injuries during the doctor’s work. Treatment is based on manual factors and radiography.

Afterwards, a plaster cast is applied to the shoulder (where the scapular joints are) using a bandage. This limb immobilization usually lasts about 4 weeks. After removing the plaster bandage and examining the x-ray, if re-dislocation of the shoulder joint is not observed, rehabilitation becomes a necessary condition for restoring the function of the sore shoulder. It is also recommended to refrain from physical activity for another two to three months.

Sometimes, to treat a doctor's diagnosis of “habitual dislocation of the shoulder joint,” surgery is a necessary part of the recovery process, as other problems may be identified, such as:

• fracture of the shoulder bones;
• muscle or joint capsule injuries;
• damage to blood vessels or nerves.

Typically, arthroscopy is performed. The surgeon makes very small tissue incisions through which the camera and instruments are inserted. If the patient has multiple and habitual dislocations of the shoulder joint, the operation becomes quite a difficult task for the surgeon, after which the patient must avoid moving the upper limb for a long time (6 weeks).

Rehabilitation

Rehabilitation is necessary for further treatment. You also need to consider the following nuances:

1. Avoid sudden movements of the shoulder joint for a short time after removing the cast.
2. Use cold compresses to reduce swelling.
3. Pharmacological treatment, which consists of taking anti-inflammatory drugs. If the pain is intense, you can ask your doctor to prescribe analgesics. The drug "Nurofen Plus" must be taken every 6 hours, 15 ml.
4. Perform therapeutic procedures. They promote analgesic and anti-inflammatory effects (cryotherapy), restoration of damaged soft tissues (magnetic therapy, laser therapy, ultrasound), increase muscle mass and strength (electrical stimulation), improve blood supply and tissue nutrition (whirlpool bath for the upper limb).
5. Massaging the tissues adjacent to the joint relieves tension and also improves blood circulation and nutrition.
6. Mobilization of the shoulder joint.

It is best to perform therapeutic exercises in the initial stage of rehabilitation with a psychotherapist. It is necessary to select light manipulations without stress on the sore joint, for example: isometric exercises and stretching tasks that stimulate the neuromuscular tissue. Strengthening exercises are gradually introduced to strengthen muscle strength and improve stability and elasticity of soft tissues. The final stage of treatment uses exercises for the entire upper limb to increase strength, control movement and function, and improve the dynamics of the shoulder joint.

Kinesiotherapy involves wrapping the joint with special elastic bandages. They have a sensory effect and improve the functioning of joints. Plasters applied to the scapular joints provide stability, improve healing processes and reduce the risk of injury during exercise.

Complications

Unfortunately, the diagnosis of “dislocation of the shoulder joint” is quite serious. Rehabilitation and treatment without accurate diagnosis can lead to numerous complications. These include:

Ways to treat shoulder injuries at home

A little relief comes from applying a cold compress to the damaged area, if a shoulder dislocation occurs and severe injuries are impossible without qualified medical care. The victim must be taken to a doctor, who will take the necessary measures after taking x-rays. During transportation, the arm must be secured: it can be slightly bent at the elbow, pressed to the chest and wrapped in a bandage against the body.

To relieve pain, you should give an analgesic or a non-steroidal anti-inflammatory drug (Nurofen Plus or Ibuprofen, 15 ml every 6 hours). Recovery usually takes 3-6 weeks.

Then it is recommended to perform exercises on the shoulders. After a series of such activities, when the limb is fully functional, you can return to sports, but only in special clothing so that in the event of a fall, it will prevent dislocation of the shoulder joint. Treatment at home and rehabilitation after injury are possible with systematic stretching exercises so that the muscles are elastic and less susceptible to damage. If your muscles become overstrained, for example after an intense workout, you can apply ice to your shoulder.

Shoulder dislocation

This is a serious injury associated with the inability to move the arm due to the dislocation of the shoulder joint. Treatment at home (first aid): take painkillers in the dosage indicated in the instructions, tie your arm to your body, and then urgently visit an orthopedist or traumatologist. This type of injury is a very serious injury that can lead to the death of nerves and blood vessels.

Tendon sprain

What to do if a shoulder sprain or dislocation occurs? Treatment at home involves the use of a cold compress (applied for half an hour), drugs with analgesic and anti-inflammatory effects (gels, ointments). They are applied in a thin layer to the damaged area several times a day. It is also necessary to give your hand a rest, that is, limit movement.

Shoulder contusion

Typically occurs as a result of a sudden fall, which leads to soft tissue damage. Signs of a bruise: gradually increasing pain, hematoma, swelling. It is necessary to quickly apply ice to the injury site. This will limit hematoma and swelling of the soft tissues, unless, of course, the joint has dislocated.

And treatment with folk remedies in this case will not be superfluous: several times a day for 20 minutes, apply cooling compresses or ice cubes wrapped in foil or wrapped in cloth. Relief also comes from ointments with analgesic and anti-inflammatory effects. They are applied several times a day. However, if the pain persists, you should consult an orthopedist, as the injury may be much more serious than you think.

Folk remedies

There are a lot of home remedies to eliminate the consequences associated with a diagnosis of “joint dislocation.” Treatment with folk remedies is aimed at relieving pain. It is recommended to use compresses made from hot milk: it must be heated, bandages should be soaked in it and applied to the sore joint. Finely chopped onions or a “dough” made from a glass of flour and a spoon of vinegar help. They need to be applied to the damaged area and left for half an hour.

Traumatic injury to the musculoskeletal system is one of the most common pathologies today. The shoulder joint is often affected due to its anatomical and functional characteristics. In the structure of shoulder joint pathology, dislocations are the most common disease. However, sometimes in medical practice there are also cases that are very painful and difficult to treat.

Dislocation of the shoulder joint is a pathological condition, which is based on a mismatch of articular surfaces, with impaired motor function.

Causes and mechanisms of development

It all depends on the type of disease, the condition of the joint ligaments, and the general condition of the body. Typically, a primary dislocation in the shoulder occurs from a strong blow, or excessive rotation of the shoulder. The occurrence of repeated dislocations is associated with throwing back the arm. In this case, the humeral head emerges from the glenoid cavity. This is accompanied by severe stretching of the joint capsule, tendons and ligaments, which are the strengthening component of the shoulder. Damage to the hyaline cartilage occurs, with possible complete or partial tearing of the labrum.

A little bit of anatomy

The articulation is part of a group of large joints, spherical in shape, and consists of the head of the humerus and the articular. The rubbing surfaces are lined with hyaline cartilage, which has a grooved structure on the scapula, with a marginal elevation. It is called the labrum, which holds the head in a stable position. All articular structures are enclosed in a capsule attached to the edges of cartilaginous formations. Since it carries out movements in all planes, it is additionally strengthened externally by ligaments, muscles and their tendons, which form the rotator cuff of the shoulder.

Symptoms

The main symptoms depend on the type of dislocation.

There are the following types:

1. Primary – arose for the first time;
2. Habitual. Represents repeated dislocations of the same joint;
3. Obsolete. Occurs when the dislocation is not recognized and is not corrected for a long time.
4. Half-dislocation, or partial. Occurs when the dislocation is not completely reduced, as a result of the capsule getting between the articular surfaces. It can become a habitual or chronic dislocation.

Depending on the location of the head in relation to the articular cavity during dislocation:

1. Front;
2. Rear;
3. Upper;
4. Lower;

Mixed forms in the form of anteroinferior and posteroinferior dislocations are more common.

Clinical manifestations and symptoms

The main symptoms of shoulder dislocation are pain, impaired movement of the affected limb, and deformity in the joint area.

The more recent the dislocation, the more severe the pain. With old or habitual dislocations, it can be represented by minor pain.

Inability to move. It also depends on the type of dislocation, and can manifest itself from complete absence - in the case of primary processes, to a slight limitation in the case of habitual dislocation.

Deformation. With any type of dislocation, a confluence is determined under the acromial end of the clavicle, which is not present on the opposite side.

The video shows the diagnosis and basic treatment methods for shoulder dislocation

Types of dislocations

Primary dislocation of the shoulder can occur in absolutely any healthy person when falling on an outstretched arm or receiving a strong blow. In this case, the head of the humerus emerges from the glenoid cavity. Stretching of the ligaments and capsule occurs with possible rupture and penetration between the articular surfaces, which keeps the head in an incorrect position. At the moment of dislocation, severe pain appears in the joint with a characteristic click. During examination, the patient spares his hand, since any movements cause increased pain. The shoulder is pressed to the body. Deformation in the form of retraction is determined. The head of the humerus can be palpated in the subclavian region. There is marked shoulder muscle tension and swelling. Any movement in the joint is impossible. For diagnosis, conventional radiography is used in two projections, which provides comprehensive information.

There is also habitual shoulder dislocation which is more difficult to diagnose and treat. Its formation depends on many factors: the severity of the primary dislocation, the individual anatomical and functional characteristics of the joint, the correctness of the reduction, and compliance with the recommendations after eliminating the dislocation. As a rule, the formation of this type of pathology is associated with poor muscle relaxation during the first reduction. The result is incomplete reduction, with the capsule sandwiched between the articular surfaces. Movement is partially restored, which creates a false impression of complete recovery. But, over time, the joint heals in an incorrect position, damaging the capsule and rotator cuff, which are responsible for its stability. In addition, the articular labrum is damaged, which is unable to hold the head in a physiological position.

Clinically, the disease manifests itself as frequent dislocations in the form of clicks (possibly even several times a day) when trying to raise an arm, put it behind the head, turn it outward, or even. Such dislocations occur even during sleep. Typically, they are corrected independently, or by the patient himself. Only if they do not happen often, you have to resort to the help of specialists.

Treatment of dislocation

The video talks about the newest method of treating dislocations:

For primary dislocations, its reduction is used. Main conditions:

1. Complete muscle relaxation. Achieved by hanging your arm from a high couch while lying on your back or stomach for 20-30 minutes;
2. Adequate pain relief. The best result is obtained with general anesthesia, since this achieves complete relaxation of the muscles with easy and complete reduction of the dislocation. Local anesthesia may be used.
3. No rough manipulations. Strong sudden movements can cause damage to the articular lip of the scapula, which will lead to habitual dislocation.
4. Remember that the safer the dislocation looks on the picture, the more difficult it is to reduce it.

Reduction of the shoulder joint - Hippocratic method

The first method of reduction was proposed by Hippocrates, who reduced dislocations by pressing with his heel in the armpit, while simultaneously pulling the arm toward himself. The method is still used today.

The most effective way to realign a joint is the Kocher method:

1. Bringing the shoulder towards the body with simultaneous downward pressure, bending the arm at the elbow joint at a right angle;
2. Without releasing the pull, rotate (turn) the shoulder outward, using the forearm as a lever;
3. Without releasing the pull, move your elbow to ;
4. Place the hand and forearm on a healthy joint.

The video shows how a dislocated shoulder is reduced by Kocher

After reduction of the dislocation, fixing and scarf bandages (Dezo, Velpo) are applied for 2-3 weeks. The longer the period of immobilization, the better the restoration of the joint.

Operations for dislocation

There are about 400 types of surgical methods. But they can be classified as follows:

By execution method

1. Arthroscopic. To carry out this procedure, an arthroscope (a special illuminated camera) is used, which is inserted into the joint using punctures, without incisions. In the same way, special manipulators are introduced to carry out the intervention itself. The advantage of this type of surgery is low trauma, good cosmetic effect and rapid postoperative recovery of patients. The possibilities of these operations include: plastic and restoration of articular cartilage and labrum, plastic surgery of the rotator cuff and joint capsule.
2. Open method. In this type of surgery, an incision is made above the shoulder joint to provide good access to the affected area. There are many operations from a mini-access, the length of which is only 3-4 cm, which also gives good results in all respects.

In this video, surgery is performed to correct a habitual shoulder dislocation:

How to strengthen the shoulder joint

1. Plastic capsule and ligaments. With this type of surgery, the articular labrum is restored, and tears in the articular cartilage can be sutured, as well as strengthening the stability of the joint by double fixation of the capsule.
2. Tendon plastic surgery. In this type of surgery, joint stability is achieved by moving and fixing the tendon of the long head of the biceps.
3. Muscle plasticity. It involves moving and fixing overstretched elements of the rotator cuff.
4. Bone grafting. The method is based on the reconstruction of the labrum when it is completely destroyed, from iliac or iliac grafts.

Rehabilitation

The entire system of recovery and rehabilitation measures for dislocations consists of immobilization, physiotherapeutic treatment, exercise therapy and gymnastics.

Physiotherapy, after eliminating the dislocation, uses electrophoresis with calcium chloride, magnetic therapy, water procedures, paraffin baths, and massage. Strict immobilization is required, especially in the postoperative period for 3-4 weeks. These methods help restore impaired function of the injured shoulder.

Exercises and exercise therapy after reduction of dislocation

They are divided into 3 types:

1. Aimed at maintaining limb function during joint fixation, after reduction, or surgery. They include flexion and extension of the hand and forearm;
2. Aimed at restoring movements after removing the fixation of the joint. Consist of the previous exercises and gentle movements in the shoulder joint. Raising the shoulder upward is excluded;
3. Complete restoration of possible movements in the joint. Includes all segments of the limb, without restrictions. Their goal is to adapt the joint to normal living conditions. Performed daily and for a long period of time.

Video instructions on how to carry out rehabilitation procedures and restore joint mobility after a dislocation:

First aid

Providing first aid to the victim is as follows:

1. Fixing the shoulder to the body with any available materials, or hanging the forearm on a scarf. Immobilizing the joint will reduce pain.
2. Application of cold locally. Helps reduce swelling and pain.
3. Administration of any painkillers and anti-inflammatory drugs (analgin, ketalgin, paracetamol, dexalgin).