One of the most common types of domestic( and not only) injuries is a dislocation of the shoulder joint. Dislocation in the shoulder joint, as in any other, is characterized by the fact that the anatomical correspondence( congruence) of the articulating joint surfaces is completely broken. At the same time, the shoulder joint is a sort of leader in the frequency of dislocations.
The high frequency of dislocations of the shoulder joint is due to the features of its functions and anatomical structure. Our shoulder joint is spherical in shape, formed by the head of the humerus and the articular cavity of the scapula. Here, wide-amplitude motions are carried out in all three planes-elevation, reduction and retraction, rotation. It is thanks to this that our hand fully functions as a working body.
But, as you know, every medal has its own flip side. It is also at the shoulder joint. A wide range of movements caused the potential instability of this joint. The point is that the congruence of the shoulder joint here is initially low. The area of contact between the head of the humerus and the articular cavity of the shoulder is small. A cartilage cushion or cartilaginous lip, located along the circumference of the articular cavity of the scapula, increases this area, but only to a small extent. Bundles are practically absent. The role of the ligament apparatus is played by muscle tendons. The capsule of the joint is loose. The shoulder joint is largely fixed by the muscles of the shoulder girdle and upper limb. All this creates optimal conditions for the pathological displacement of the head of the humerus, ie, dislocation.
Most often, the dislocation of the shoulder occurs as a result of a fall on the outstretched arm of the
. However, the force vector does not coincide with the axis of the joint, and this force is quite large, which leads to dislocation. The dislocation is facilitated by the initial weakness of the muscles of the shoulder joint. This is why shoulder dislocations often occur when a child falls or an elderly person falls. And there are such situations when for dislocation quite enough small on force of influence or sharp movement by a hand is enough. Some of the dislocations of the shoulder joint may not be provoked at all and arise for no apparent reason.
These are spontaneous or habitual dislocations. There can be several reasons. First of all, these are congenital anatomical features - a weak ligamentous apparatus, a low cartilaginous lip, a small area of contact of articular surfaces. Articular disorders can be not only congenital, but also acquired. Basically, these are the consequences of injuries - clavicle fractures, shoulder blades, previous dislocations and sprains of the shoulder joints. Often, the habitual dislocation associated with systematic exercise, with physical exertion. Monotonous, stereotyped hand movements are the causes of microtraumas and capsular dilations, which also leads to habitual dislocation.
In the vast majority of cases, the dislocated head of the humerus is displaced anteriorly. Typical symptoms in this case: pain, changes in joint configuration and swelling of soft tissues. Movement in the shoulder joint is impossible, the arm hangs like a whip. When palpation of the shoulder joint, the displaced head of the humerus is determined. Palpation further exacerbates existing pain. However, due to local hemorrhage, subcutaneous hematoma is often determined. Blood is poured not only into soft tissues, but also into the articular cavity, hemarthrosis of the shoulder joint develops.
Thumb of the hand
Along with hemarthrosis, the dislocation of the shoulder joint is combined with other injuries. These are tears and complete ruptures of the tendons, joint capsule. Often when the shoulder is dislocated, damage to the vascular bundle is noted, fracture of the clavicle and scapula. In addition to severe pain and local edema, there are signs such as a decrease in sensitivity, numbness in the fingers of the hand.
The posterior dislocation of the shoulder is formed much less frequently than the anterior one. The symptoms here are the same as in the anterior dislocation, and the head is palpable on the back surface near the scapula. A typical mechanism of posterior dislocation is a fall forward on a horizontal surface and an elongated arm. The lower dislocation and displacement of the head of the shoulder joint develops extremely rarely. The distinctive symptoms of this condition in addition to pain, swelling and local deformation are a characteristic forced position. The victim throws up his hand and can not lower it. There is another subluxation of the shoulder joint. Unlike dislocation, in this condition, the head of the humerus is not completely displaced beyond the bounded articular cartilaginous lip.
Treatment of shoulder dislocation begins with first aid. The extent to which first aid is provided depends on how much further treatment will be effective. Therefore, in this case it is important to know what you need to do and what you should not do. The situation is further complicated by the fact that in most cases the shoulder dislocation, like all injuries, occurs far from the walls of medical institutions. And the medical workers are not around. But if suddenly lucky, and in the bushes was a grand piano, that is, a medical worker with everything you need, he must first anesthetize. And not pills, but injections. In addition to anesthetics, it is necessary to introduce blood-restoring drugs.
But even if there is no health worker with medicines, nothing fatal. In any case, the hand must be immobilized, that is, immobilized. Immobilization with dislocation of the shoulder joint is performed with the help of a conventional bandage bandage. There are for this purpose special devices, orthoses. But they are also at hand not always available. Do not lubricate the dislocated shoulder with anti-inflammatory ointments - at this time there is no need. But it's not only possible to apply cold to the joint, but it's also necessary. A superfluous touch will only exacerbate the pain. And in no case should you try to direct the dislocation yourself or trust this case to random people. Self-activity in this case can lead to painful shock, further displacement of the head with rupture of the joint capsule and damage to the neurovascular bundle.
Method of superficial scarf dressing
The correction of shoulder dislocation refers to small operations of .Therefore, like any operation, even a small one, it should be done by a doctor( in this case - by a traumatologist) in a medical institution. Moreover, special studies are needed to determine the type of displacement of the humerus. As a rule, this is enough ordinary radiography. In ultrasound, computed tomography is not necessary. Self dislocation is accompanied by pain and therefore it is produced under anesthesia. For this reason, after the injury before refresher, you can not drink or eat anything - anesthesia with a full stomach can provoke vomiting. And even a drunk sip of water can lead to undesirable consequences.
The direction of effort during the repositioning of the dislocation should be such that the head of the humerus returns to its original position. In this case, a characteristic click of the
should be heard. The inserted shoulder joint is fixed with a gypsum immobilizing dressing. In addition to the plaster bandage, the aforementioned orthoses can be used. Further treatment is performed on an outpatient basis. Immobilization lasts approximately the first 3 weeks.after injury. During this time, connective tissue scars should form on the site of the damaged cartilaginous lip and the ruptured capsule. The next stage is early rehabilitation, which lasts from the moment immobilization ceases to 3 months.after injury. At this stage, physiotherapeutic and massage procedures are carried out in combination with sparing physical exercises. The goal is to restore the functions of the shoulder joint.
Then a late rehabilitation is carried out. Here, the volume and duration of loads on the hand increases. Physiotherapy and massage continue. Properly carried out late rehabilitation, should lead to the complete restoration of the hand as a working organ no later than 6 months.from the moment of injury. With frequent habitual dislocations, surgical treatment is indicated. The operation involves different types of plasty of the articular cavity, lips, capsules and tendons.