Shoulder dislocation what to do symptoms. Shoulder dislocation - symptoms, treatment

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:

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.
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.
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:

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.
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.
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 joints, 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

Providing first aid will alleviate the patient's condition when a shoulder is dislocated.

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

Calm the patient and place the injured arm in the most comfortable position.
Carefully remove clothes.
Allow the patient to take an anesthetic drug (Ibuprofen, Nimesulide, Analgin, Ketorol, Paracetamol, etc.) or perform an intramuscular injection.
If there are wounds, treat them with an antiseptic solution and apply a sterile bandage.
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.
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.
You should not try to straighten a dislocation yourself. This procedure can only be performed by a specialist.
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.

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

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

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

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

Anatomy of the shoulder joint

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

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

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

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

Structure of the shoulder joint (front view):

shoulder blade;
acromion;
coracoid process;
brachial bone;
greater tubercle of the humerus;
lesser tubercle of the humerus;
shoulder joint (capsule).

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

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

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

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

Causes

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

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

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

Symptoms

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

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

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

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

Classification of shoulder dislocations

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

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

Front

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

Subclavian

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

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

Lower

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

Rear

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

Upon palpation, the head of the humerus is determined.

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

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

Habitual shoulder dislocation

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

Reduction

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

Kocher method

Anterior dislocations are best reduced using the Kocher method.

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

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

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

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

Reduction of dislocation according to Hippocrates

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

Dzhanelidze method

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

Treatment and rehabilitation after reduction of a dislocated shoulder

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

Operation

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

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

Rehabilitation

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

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

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

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

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

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

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

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

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

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

Shoulder dislocation: symptoms and causes

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

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

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

Shoulder dislocation: treatment

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

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

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

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

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

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

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

Shoulder dislocation surgery

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

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

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

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

Immediately after reduction or surgery at the initial stage:

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

At the next second stage:

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

The third stage provides:

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

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

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

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 is 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 range 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.

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:

Anterior shoulder dislocation. This is the most common type of dislocation and typically results from a fall on an outstretched arm or shoulder.
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:

Sudden, very severe pain in the shoulder area.
Large swelling or hematoma.
Limitation of joint mobility.
Distortion of the outline of the joint, the absence of the head of the humerus is felt, which moves to the armpit area.
The pain increases when trying to move the joint (so the patient holds the arm closer to the body).
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:

Avoid sudden movements of the shoulder joint for a short time after removing the cast.
Use cold compresses to reduce swelling.
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.
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).
Massaging the tissues adjacent to the joint relieves tension and also improves blood circulation and nutrition.
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 to 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.