Dislocation of the shoulder (shoulder joint)
- Description and statistics
- Shoulder dislocation symptoms
- Causes of dislocation of the shoulder joint
- Types of shoulder dislocation
- Diagnostics of the joint dislocation
- Treatment methods
- Rehabilitation stages
Description and statistics
Shoulder dislocation is the most common traumatic dislocation. It accounts for about 55% of all injuries. The shoulder joint performs many different movements, but it is very vulnerable to injury, because the area of contact of its articular surfaces is quite small. For example, most often the dislocation of the shoulder is indirect: a person falls on an arm extended forward or to the side, its movement exceeds the physiological norm, the capsule is torn by the head of the humerus and falls out of the glenoid cavity.
Posterior dislocations are much less common. Statistics testified about 2% of the case. These injuries are formed due to quite frequent situations when, for example, a fall occurred, but the arms were extended forward. Then the gap occurs in the posterior section. There are practically no lower dislocations. This variety differs in that the head of the shoulder bone moves downward. With such injuries, motor function is noticeably reduced downward. Accordingly, in front of the victims there is a need to keep the injured limb in such a position that the hand is raised and directed upwards.
There is a risk of re-dislocation. It can occur within six months after the first is corrected. Repetitions can happen more than once - up to ten times a year. Each time the changes will increase. This will provoke more frequent diagnosis of recurrent dislocations. Statistics show that such injuries usually occur in people under the age of 20.
Shoulder (shoulder joint) dislocation symptoms
Symptoms of a shoulder dislocation are severe and severe pain and joint dysfunction. The shoulder or arm is moved to the side. Also, the shoulder may harden or deform (bend). As a result, the shoulder joints become asymmetrical. When palpating, the head of the shoulder joint is not in its usual place, but below the coracoid process. Joint mobility becomes impossible.
Another symptom is a weakening of the pulse in the radial artery, because the head of the humerus compresses the vascular trunk. Often, dislocation of the shoulder is also accompanied by impaired sensitivity and motor function of the hand and fingers.
You can find out about the development of the disease by the characteristic symptoms:
- Swelling, bouts of pain in the appropriate places.
- Mobility is markedly reduced, due to the position of the head described above, the patient can perform only a minimum of movements.
- The shoulder joint loses its characteristic smoothness.
- You can observe pain, which is described as stitching, the upper limb becomes numb, and bruising can reveal the sites of lesions, since the blood vessel is damaged, the nerve is in a pinched position.
- The sensitivity of such parts of the skeleton as the forearms and other components of the hands disappears.
The condition of the joint capsule deteriorates markedly - it loses its density, elasticity, if the disease is not cured immediately. Changes occur, due to which the volume of fibrous tissue increases. It begins to fill in the articular enclosing, that is, those areas that are around are no longer hollow. The stage begins at which the muscle mass ceases to function, that is, it atrophies. Dystrophic correction takes place.
There are often cases when the first dislocation of the shoulder leads to rupture of soft tissues. Then it is accompanied by bouts of noticeable pain. If the dislocation is repeated, the pain is not so strong, or does not appear at all.
Dislocation of the shoulder can be diagnosed with x-rays (CT or MRI) to differentiate the dislocation from a fracture of the proximal humerus or fracture of the scapula.
As soon as you have identified any of the first symptoms, self-treatment is contraindicated. Usually people try to straighten the joint, but this is very dangerous. Do not take risks, the consequences may be irreparable.
Causes of dislocation of the shoulder joint
We have already mentioned that the shoulder joint is highly mobile. A person most often "wields" this part of the skeleton. He is very vulnerable, and most often he is affected by such a disease as dislocation. Its common cause is the provision of a general force effect, the movement itself is eversion or twisting in nature. To lead to injury, it must be performed with a simultaneous violation of the volume of all possible joint movements.
There are other reasons and factors:
- Excessive movement directed at this part of the skeleton is diagnosed in 12% of cases, and this type of health disorder is called "joint hypermobility."
- The posterior or anterior varieties appear for various reasons, but most often due to the fact that the glenoid cavity is strongly tilted.
- If the scapular glenoid cavity has a small capacity, the cause changes markedly, and the risk factor for dislocation increases.
- A common cause is hypoplasia of the glenoid, that is, it changes, for the most part, its lower region, and many other changes of a physiological nature also occur.
- Often people are forced to repeat the same type of movement, and because of this, the ligaments and the joint capsule are repeatedly stretched. Among the patients, in this case, most often there are athletes (swimmers, handball players, etc.)
An especially high risk is associated with excessive range of motion. In medicine, this method of movement is called "generalized hypermobility". There are a number of reasons associated with the anatomical features of the joint structure. Then research should be carried out in advance and traumatic situations should be avoided.
Types of shoulder dislocation
Dislocations of the shoulder are classified into congenital and acquired. Acquired dislocations, in turn, are subdivided into traumatic and non-traumatic. Non-traumatic shoulder dislocations are arbitrary and pathological (chronic). Traumatic dislocations can be uncomplicated and complicated. Dislocation of the shoulder can be complicated by a violation of the integrity of the skin, tendon rupture, fracture, damage to nerves and blood vessels. Also, shoulder dislocations are chronic and pathologically repetitive.
Depending on the location of the surfaces of the joints of the humerus and scapula, dislocations of the shoulder are divided into anterior, posterior and lower. The anterior shoulder dislocation can be subclavicular and subclavian, the lower one - axillary, and the posterior one - subacromial and infraspinatal. Anterior dislocations account for the vast majority of shoulder dislocations (about 75%), followed by axillary dislocations (24%). The remaining dislocations account for only 1% of cases.
Shoulder dislocations are also classified according to the time elapsed since the injury. They are old (the injury was inflicted more than three weeks ago), stale (the time of injury is from three days to three weeks) and fresh (no more than three days).
In addition, dislocation occurs:
- traumatic (primary);
- pathologically chronic.
Any movement, even such as cleaning or combing, often becomes the cause of the disease. If the primary dislocation has undergone improper treatment, or it was not treated at all, complex pathologies of repeated dislocation of a traumatic nature develop.
Diagnostics of the joint dislocation
Dislocation of the joint is diagnosed according to certain indicators. We have already listed many of them among the symptoms. But all the same, the traumatologist makes a professional examination, drawing a conclusion based on the complaints that he lists.
Other medical examinations are also important. X-ray examination is very effective, for which the direct projection method or, if necessary, axial technology is used. The quality of the X-ray image is sufficient to view the location of the bone head, to reveal the features of its displacement, which also leads to damage to the integrity of the skeleton. The most important task remains to identify whether this dislocation is anterior or posterior. It is important to identify if there are any fractures.
Before repositioning the shoulder joint, the patient needs pain relief. Anesthesia can be both general and local. There are many methods for repositioning a shoulder dislocation. They are divided into lever, physiological and pushing (pushing the humerus into the articular cavity). But these methods are often combined with each other.
After the reduction and immobilization of the diseased joint with a plaster cast, its movements should be limited for three weeks. When the splint is removed, it is recommended to undergo a rehabilitation course that restores joint mobility and prevents repeated dislocations. The complex of procedures includes massage, remedial gymnastics, electrical muscle stimulation, water exercises, etc.
Reduction is the basic treatment for shoulder dislocation. It is not self-made. The only thing that a patient can do to cure the disease is to see a doctor as soon as possible. The first dislocations require special attention. They are more complex, given that it is the first dislocations that are harder to correct.
There is a wide range of treatments for dislocation of the shoulder joint.
All methods can be roughly divided into two broad categories:
The non-surgical or closed method consists in the action in relation to the head of the humerus. For this, anesthesia is done. In this case, it is customary to use a solution of novocaine.
You can not delay with medical intervention. If it is received out of time, one should expect such consequences as muscle contraction, and this factor greatly complicates reduction. Then anesthesia is not enough, in addition a number of special drugs will be required, the task of which is to relax the muscles. They are called "muscle relaxants". If such a measure does not work, then the patient will have to prepare for the operation. It is usually an open joint repositioning technique.
This is followed by treatment based on the immobilization of the damaged part of the skeleton. This leads to the fusion of the torn ligaments and the restoration of the articular lip. This process can occur due to the fact that the articular capsule, going in front, stretches in a peculiar way, which allows the severed articular lip to be pressed against the surface of the desired bone. As a rule, plaster casts are applied at this stage. They should be used for about three weeks.
Dislocation of the shoulder is treated in different ways, not excluding:
- painkillers in the form of tablets or injections, necessary to normalize the general condition of the victim, eliminate pain and more;
- anti-inflammatory drugs;
- exposing the injured area to cold, as this can reduce pain and swelling.
One of the simplest methods of physiotherapy is associated precisely with the application of cold to the affected area. The intensity of pain is markedly reduced, and inflammation is relieved. In the near future after the injury, it is necessary to apply a compress with ice. This reduces the risk of dangerous defects and speeds up recovery.
There is a special complex. Its task is to help create a muscular frame, to protect the patient from the development of this disease in the future. If a habitual dislocation of the shoulder joint of a permanent nature is diagnosed, then exercise therapy does not bring positive results. Such a pathology prevents the creation of conditions for further protection of the joint. Good results are obtained by a course of paraffin therapy, electrophoresis, SMT on the area of the affected joint. Not all physiotherapy methods are relevant in one case or another. For example, patients who have crossed the 70-year mark require caution. Elderly patients cannot be treated with physiotherapy.
After dislocation of the pleural joint, some rehabilitation is required. It consists of several parts:
- includes the activation of the functionality of the area of damaged muscles, when the period of immobilization begins, the duration of the course is about three weeks;
- the function of the shoulder joint is restored, the duration is approximately three months;
- final steps of rehabilitation of joint functions, duration - six months.
The bone joint must be immobilized. This requires immobilization. It is the best remedy and is applied after the plaster has been removed. Then comes the time of the rehabilitation process, when it is necessary to perform special exercises. They are aimed at making circular movements with the shoulder using circular motions. Exercises in water give good results.
A disease such as a habitual dislocation of the shoulder requires treatment under certain conditions of a specialized trauma hospital. It will take such a measure as surgery. Here, conservative procedures will not give a positive result. Surgery offers a whole section on the treatment of this pathology. Treatment should be consistent with the cause of the dislocation of the shoulder joint. Recall that due to this displacement, the head of the humerus can be of different nature.
After the operation, they undergo special rehabilitation. Electrical muscle stimulation, massage and exercise therapy are performed.
When three months pass after the operation, light loads are allowed (for example, six months later, hard physical labor). A fixing bandage must be used, it is not removed for 1-4 weeks. The time depends on the type of operation performed.
Rehabilitation helps to strengthen the muscles of the shoulder girdle. They are starting to get stronger in terms of a stabilizing effect on the joint. In the first stages, physiotherapy exercises are required, when the supervision of an instructor is necessary. After some time, the patient gets the opportunity to study at home. This stage can last 2-4 months.
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.