Dislocated arms: what to do?
The human hand has a very complex anatomical structure, thanks to which it is able to perform various movements. In childhood, the joint capsule and ligaments are very elastic, so a dislocation can rarely occur. The older a person becomes, the coarser his ligaments become, which can no longer fully perform their functions.
The risk group for getting a dislocation of the hand includes people who are involved in active sports that are accompanied by frequent falls (football, volleyball, basketball, pole vaulting, etc.). According to existing statistics, the probability of dislocation for pedestrians increases with the arrival of the winter season. During icy conditions, the number of victims increases sharply, and when they fall, they receive dislocations of the upper limbs.
- Dislocation classification
- Types of hand dislocations
- Causes and symptoms of arm dislocation
- First aid to the victim
- Hand dislocation treatment
- Reduction of a dislocated arm
Dislocations of the upper limbs are classified as follows:
By origin: Dislocations of the arms are:
- acute traumatic;
- habitual traumatic;
By volume: Dislocations of the upper limbs are:
By localization: Dislocations of the arms are:
- shoulder dislocation;
- dislocation of the elbow joint;
- dislocation of the forearm;
- dislocation of the hand;
- dislocated finger.
By type of injury: Dislocations of the upper limbs are:
By duration: Dislocations of the arms are:
- fresh (no more than 3 days have passed since the injury was received);
- stale (from the moment of injury to the upper limb, from 3 to 4 weeks have passed);
- old (more than 30 days have passed since the dislocation was received).
Types of hand dislocations
Modern medicine has identified a large number of types of dislocations of the upper limb hand:
- peritrihedral lunar;
- dislocation of fingers, etc.
Causes and symptoms of arm dislocation
The main causes of hand dislocation include the following:
- the fall;
- lifting weights;
- massage by a cheerleader, etc.
Sometimes dislocations (pathological) can occur against the background of the progression of various diseases:
- tuberculosis of the bones;
- arthropathy (of various origins);
- arthritis and other diseases in which there is a change in the joint capsule.
When a hand is dislocated, regardless of the place of injury, a person experiences severe pain. He may lose some or all of his arm mobility. Almost immediately after injury, edema forms in the area of the injured joint. Some patients lose sensitivity in the lower part of the limb (this is due to the fact that the median nerve was compressed during the dislocation). When probing the pulse, the victims may have both an accelerated and a slowed down rhythm. Another indicator of hand dislocation is the “springy fixation symptom”. It is quite easy to confirm the presence of this symptom by making a passive movement with the lower arm.
Most often, dislocation occurs in the shoulder joint of the upper limbs. When this joint is injured, the risk of damage to the nerves and arteries increases, so patients with such a dislocation must be urgently taken to the hospital.
In this category of patients, the following symptoms may appear:
- severe pain;
- violation of motor function in the injured upper limb, etc.
First aid to the victim
Every person should be able to help a patient who has a dislocated arm. The first thing to do is to apply a cold compress to the injured upper limb (it can be a hot water bottle with ice or cold water) and give an analgesic drug from the class of analgesics.
You cannot set your hand on your own, as you can cause even more harm to the patient. It is advisable to fix the injured human hand in a forced position. To do this, you can use any means at hand (a board, rags, etc.). In this position, the victim should be taken to the nearest medical facility.
A patient who has suffered a hand injury must be urgently taken to a medical facility, where specialists will diagnose and provide emergency assistance. The doctor of the trauma center will carefully examine the injured arm, palpate, and interview the patient. During probing of the damaged area, the specialist determines not only the sensitivity of the skin, but also the motor function of the upper limb. Careful palpation will reveal any abnormalities in the neurovascular bundle, as well as check the rhythm of the artery pulsating.
After a personal examination, the patient will be sent for an X-ray, thanks to which it will be possible to determine if, in addition to the dislocation, there are any other injuries (fracture, bone fracture, etc.) of the upper limb. Usually X-rays are done in two or three projections, and its results are stored in a medical institution (they should be issued to patients upon request).
If during the diagnostic measures serious injuries of the limbs were detected, the patient is sent to the surgical department, where he will undergo an emergency operation. Sometimes there are cases when the patient was diagnosed with dislocation of the same joint more than 3 times. This category of patients needs surgical treatment, after which they will be assigned a disability group. The male half of the population with such a diagnosis will automatically be released from the obligation to serve in the Army.
When diagnosing a traumatic dislocation, a specialist during palpation determines how much the shape of the joint has changed. It is equally important to determine whether a depression has occurred in the locations of the articular endings. During palpation, the trauma surgeon may feel a springy resistance in the damaged area.
With traumatic dislocation of the upper extremities, patients may have:
- tear or complete rupture of the tendons;
- extensive rupture of the capsule;
- compression of nerves;
- rupture of blood vessels, etc.
Hand dislocation treatment
Since a dislocation, like any other injury, is accompanied by a severe pain syndrome, the patient's treatment begins with anesthesia (for severe injuries, general anesthesia is performed). In most cases, this category of patients is prescribed potent analgesic drugs, since after the removal of the pain syndrome, the dislocated segments of the upper extremities are reduced to the patient. After complete relaxation of the muscles, the traumatologist proceeds to the reduction procedure, which is carried out very carefully, without sharp and rough movements. The directed limb is fixed in the correct position by means of a plaster cast, which must be worn for a certain time (over several weeks).
As soon as the patient has been removed from the plaster cast, he needs to undergo a rehabilitation course that will help restore the mobility and functionality of the arm.
For these purposes, the following may be assigned:
- physiotherapy procedures;
- mud therapy;
- mechanotherapy, etc.
Each of the rehabilitation methods is aimed at normalizing blood circulation in the injured limb, relieving pain, etc. Thanks to a properly selected complex of physiotherapy, patients can quickly increase the elasticity of muscle tissues.
Some patients, self-medicating, waste precious time for dislocation of the joints of the upper extremities without surgical repositioning. They often arrive at the hospital several weeks after the injury.
In such a situation, specialists are forced to carry out treatment in several stages:
- First of all, a distraction apparatus is applied to the patient, the functions of which are to stretch the wrist joint.
- After the wrist joint has been stretched, the surgeons perform an open reduction of the dislocation and remove the distraction apparatus. This procedure can take 8-10 days, depending on the complexity of the dislocation.
- The damaged wrist joint is fixed with Kirschner wires.
- After the operation, such a category of patients will have to undergo physiotherapy.
When performing surgical treatment of chronic dislocation, in which deforming arthrosis has developed, specialists perform arthrodesis of the wrist joint. Patients who have undergone such an operation need a long course of rehabilitation therapy.
Reduction of a dislocated arm
To correct the dislocation of the upper limb, a specialist may need the help of one or two medical staff.
When choosing a technique according to which the shoulder joint will be adjusted, traumatologists give preference to:
- the Hippocratic method;
- Kocher's method;
- the Mota-Mukhina method.
When reducing the dislocation of the hand, it is necessary to achieve a certain flexion angle in the elbow joint - 90 ° C. One assistant should firmly fix the shoulder joint and hold it in this position throughout the procedure. At this time, the surgeon stretches the hand joint of the upper limb along the axis of the forearm. When the hand is set, the traction is carried out with one hand for 1 finger, and with the other hand for the remaining fingers. Once the stretching of the joint has been completed, the surgeon applies physical pressure to the hand. Press on the joint until the dislocation of the protruding part of the hand is completely eliminated.
After elimination of the dorsal dislocation of the hand of the upper extremity, the doctor must fix the arm at a certain angle of flexion (40 ° C) and apply a plaster cast. In order to make sure that the chosen treatment method is correct, the patient is sent for repeated X-ray.
In the case when the hand joint is unstable, the specialist can choose another method of treatment, in which fixation is carried out using Kirschner wires. Each wire is inserted at an angle and passes through the distal end of the outer surface of the radius. The spokes also pass through the fifth metacarpal bone and the wrist joint.
Currently, many specialists carry out the reduction of dislocations when using distraction devices.
This technique is shown in the following cases:
- if the surgeon cannot correct the dislocation with his hands;
if the patient does not have symptoms indicating that anatomical structures have been compressed in the articular canal of the wrist;
- if the patient sought medical help a week (or more) after receiving the dislocation.
Surgical reduction of dislocations of the upper extremities is indicated in the case when the patient has a compression of the nerve node in the articular canal of the wrist. Untimely medical care, in this case, can lead to degeneration of the nerve and loss of mobility of the lower arm.
During surgery, the surgeon makes an arcuate incision on the skin of the injured hand, through which it will be possible to reach the wrist joint. If necessary (the specialist decides this during the operation), another incision is made, which cuts the capsule of the hand joint. After that, distraction is performed (along the axis of the forearm), in parallel with which the surgeon removes the damaged tissue and sets the dislocation.
Sometimes, during a surgical operation, there is a need for additional fixation of the wrist joint. For these purposes, surgeons use Kirschner wires, which must be present in the patient's joint for at least 4 weeks (in difficult cases, the wires can fix the joint for 4 months). Their removal occurs after examination of the damaged joint and control X-ray.
Author of the article: Kaplan Alexander Sergeevich | Orthopedist
Education: diploma in the specialty "General Medicine" received in 2009 at the Medical Academy. I. M. Sechenov. In 2012 completed postgraduate studies in Traumatology and Orthopedics at the City Clinical Hospital named after Botkin at the Department of Traumatology, Orthopedics and Disaster Surgery.