Bruise of the shoulder joint: code according to ICD-10, treatment at home

The advisory service “Special Medical Assistance” was created in 2011, and since then it has been successfully providing its services, including for multiple and combined injuries, in all regions of Russia, the CIS and countries of the world. Currently, the service has 1 manager and 5 consultants, and the service has 3 commercial ambulances at its disposal at any time.

The main services provided by the advisory service include:

visit of a consultant resuscitator or surgeon;
assistance in carrying out emergency operations, organizing the transportation of patients and preparing for it;
organizing hospitalization of patients in specialized departments of medical centers;
organizing the use of air ambulance services around the world;
rehabilitation after multiple and combined injuries and strokes;
organizing the return of patients home.

Clinical picture of a shoulder injury

With a severe bruise, swelling and hematoma appear.
A shoulder bruise occurs as a result of a fall, collision, or blow. This can lead to aggravation of existing problems - tendon tears or ruptures, rotator cuff or biceps defects.

A shoulder injury causes severe pain almost immediately. This is a consequence of rupture of blood vessels, hemorrhages, and then the formation of intra-articular hematomas. It is important to immediately exclude fractures of nearby bones, as this can cause death of the nerve fibers of the brachial plexus. It is impossible to restore them, and the functionality of the hand will be incomplete.

The secondary reaction after a shoulder injury is inflammation due to sprained ligaments. Swelling of the joint usually occurs.

Typical symptoms for a shoulder injury:

Pain. Appears immediately after mechanical impact.
Swelling due to bleeding under the skin.
Swelling, disappearance of the joint contour due to edema.
Impaired fluid outflow from the joint cavity. It can only be detected using hardware examination methods.
Bruise at the site of the impact due to rupture of the arteries. The more blood spilled subcutaneously, the darker the hematoma.
With a strong blow, muscle fibers may rupture and soft tissues may sink into the joint itself.

A shoulder contusion is a soft tissue injury and not a fracture of the scapula or collarbone. In the event of a fracture, the mobility of the joint will be completely limited. The treatment method will also be chosen differently.

Danger of injury

Soft tissue injuries can have serious negative consequences if not responded to properly. First of all, this is a limitation of the functionality and mobility of the hand soon after an injury.

A strong impact may damage the cartilage layer, which protects parts of the joint from friction. The appearance of a crack is the first step towards arthrosis - a degenerative disease of the joint. Most often it begins after a fall on the arm or a side blow.

Joint instability is one of the consequences that requires suturing of ligaments and tendons. Occurs after primary dislocation during injury.

Degree of injury

Shoulder bruises can be divided according to severity:

No treatment needed. The person has no serious injuries - only minor bruises and abrasions.
There is a deep hematoma, the shoulder is very painful and has limited mobility. Local temperatures may rise.
Possible shoulder dislocation and tendon ruptures.
Surgical intervention is necessary, since the function of the joint is completely impaired.

Before making a diagnosis, it is recommended to immobilize the joint so as not to aggravate existing defects. Only after an x-ray or ultrasound can you do anything with the injured hand.

Multiple and combined injuries - features of first aid

Depending on the condition of a patient who has received multiple or combined injuries after a disaster, the service does not always send an ambulance to him. Quite often in such situations, it may be necessary to consult a neurosurgeon, traumatologist or resuscitator to more accurately determine the victim’s condition, stabilize his condition and prepare for transportation. Unlike the proposals of competitors, who propose to immediately carry out long-term transportation to the department of patients in an unstable condition, a victim who contacts our service can receive the necessary primary care for multiple and severe combined body injuries directly at the scene of the incident.

Causes of shoulder pain due to injury

During a bruise, you can receive the following injuries:

Shoulder dislocation. It can be front, bottom, rear - it depends on how exactly the person fell, where the main force of the impact fell. There is a primary dislocation, the cause of which is an injury, and a secondary one, if the ligaments and tendons were not correctly fixed during the treatment - the joint “walks”. A sign is that the arm sags and does not obey, and also hurts.
A rotator cuff tear occurs during a sudden injury or during prolonged, exhausting activities. The sign is pain throbbing down the entire arm. A cuff tear can get worse over time.
Violation of the capsule of the shoulder joint. Occurs in 98% of shoulder injuries. In this case, the articular labrum is torn off - a cartilaginous roller that holds the head in the articular cavity. If displaced, the head may end up in the subcoracoid or subclavian space.
A sprain is an unpleasant, painful occurrence that requires proper treatment and recovery. Without therapeutic measures, a person faces complications in the form of tendonitis, bursitis or periarthritis.
Bruising of the periosteum can cause chips and cracks in it. If soft tissues have separated from the periosteum, it is very difficult to restore their nutrition, especially if time has passed between the injury and treatment.

Any injury must be differentiated; for example, a dislocation sometimes occurs simultaneously with a fracture; its treatment is performed using a special technique.

Diagnosis of a shoulder injury

During the examination, the doctor clarifies the details of the fall or blow. Next, the patient is sent for x-rays in several projections. The image shows whether the bones are damaged, since an injury usually causes swelling, behind which their position is not visible. Sometimes the patient needs to be given anesthesia to make a diagnosis.

Ultrasound is used to assess the condition of soft tissues, but it is better to agree to an MRI - and the image shows the smallest tissue tears. This is important for professional athletes, who may experience worsening injuries during training.

The inner surface of the shoulder joint is examined using an arthroscope. In case of minor injuries, the surgeon can immediately correct them during the diagnostic process.

Classification

Combined body trauma is classified depending on the location of the leading injury and the greatest severity.

Combined cranial trauma is diagnosed in the presence of injuries to the skull, accompanied by hemorrhages, shock, coma, movement and breathing disorders, and intracranial hematomas.
Combined trauma to the musculoskeletal system is diagnosed in the presence of multiple injuries to the hip joints, severe spinal fractures with obvious damage to the spinal cord, and loss of limbs. The main danger of this type of combined injuries is the possible disruption of vital body functions caused by spinal injuries or injuries. Very often accompanied by traumatic shock.
Combined trauma to internal organs is accompanied by internal bleeding (often multiple) resulting from their rupture.
Combined chest trauma is accompanied by hemothoraxes and pneumothoraxes, ruptures of the diaphragm, lungs and their prolapse into adjacent cavities, and respiratory failure.
Combined injury of two or more areas without the possibility of identifying the leading injury is the most dangerous and has the most unfavorable prognosis.

The main task is to identify the leading injury, as well as the fastest possible assessment and identification of all possible life-threatening conditions, even before the victim is taken to the department of combined trauma:

Deep depression of consciousness, which is characterized by the loss of voluntary activity, while maintaining reflex activity (stupor, coma, stunned states).
The presence of internal and heavy external bleeding.
Trouble breathing and pathological nature of respiratory movements.

Treatment methods

To immobilize the shoulder, apply a Deso bandage.
If the damage is not significant, it can be eliminated using medications without resorting to surgery. There are many techniques to avoid the consequences of a bruise and prevent complications.

First aid

To stop the bleeding, cold must be applied to the site of the bruise. This will reduce the hematoma and the time it takes to resolve. It is necessary to make sure that the person does not have an open wound after the injury. If present, disinfect and bandage with a clean bandage.

The hand is tied with a scarf or special devices:

Deso bandage - looks like a bandage with which the arm is pressed to the body;
a square piece of fabric folded in half to tie the arm behind the neck in a bent state;
Kramer splint - its length from the hand on the affected arm to the scapula on the healthy arm, used when a fracture is suspected.

After applying the bandage, the person should be given pain relief and referred to a medical facility for further examination.

If a person's hand has been squeezed for some time in such a way that blood circulation is impaired, after release they should be rushed to the hospital. A person is at risk of acute renal failure due to compartment syndrome (softening and necrosis of muscle tissue). This condition occurs if blood has not circulated in the limb for 2 hours or more.

Drug treatment

Painkillers should be taken as prescribed by a doctor.
In order for tissues to recover faster, anti-inflammatory drugs are used in injections or tablets. They should be taken against the background of complete immobilization of the joint. For serious injuries, a novocaine blockade is sometimes performed. These medications can be taken 3 to 5 days after the injury. Nise, Movalis, Celebex, Paracetamol.

Painkillers will have to be taken longer, since acute pain usually lasts about 2 weeks: Spazmalgon, Sedalgin, Ketanov.

Local preparations - ointments with an analgesic effect - Diclofenac, Voltaren gel, Dolobene. Some ointments have a warming effect - they are best used later after inflammation has been relieved and pain has been relieved.

To strengthen the immune system during treatment, it is recommended to take calcium supplements, vitamin D, as well as vitamins C, A, and group B.

What not to do:

Treat yourself without making a diagnosis, without knowing the full picture of the condition of the shoulder joint.
Take corticosteroids for pain relief. The drugs in this group are very strong, but have many side effects and contraindications. Only a doctor should prescribe them.
Remove the immobilization bandage from your arm yourself.

On the recommendation of a doctor, it is necessary to undergo an intermediate examination to monitor the results of treatment.

When is surgery needed?

Arthroscopy is a minimally invasive diagnostic and therapeutic operation.
If the joint is severely damaged from the inside, ligament and tendon ruptures are found, fluid has accumulated in the joint, surgery will be required to restore the functionality of the arm.

If fluid accumulates in the joint capsule, it must be drained. Otherwise, the inflammatory process begins and tissue necrosis may occur. After this, the patient can only be saved by amputation of the limb.

Severe patients are advised to remain in bed so as not to disturb the shoulder joint. If this is not possible, it is fixed as much as possible and bandaged to the body to eliminate jolts and shaking.

Physiotherapy

During the recovery period after an injury, it is recommended to undergo several courses of physical therapy. This can be magnetic therapy, electrophoresis with painkillers, anti-inflammatory drugs, stimulation with electrical impulses. For warming up, paraffin applications, therapeutic mud, and herbal baths are used.

Physiotherapeutic procedures restore blood flow, stimulate the walls of blood vessels to contract, and new capillaries grow. A bruise on the shoulder can be eliminated with electrophoresis in 4 days.

ethnoscience

Cabbage leaf will help relieve swelling.
Traditional medicine recipes can be used for mild bruises to accelerate trophism in tissues and speedy resorption of hematomas. For moderate injuries, it is necessary to combine traditional medicine with medications and physiotherapy.

To relieve swelling:

A compress of unrefined sunflower oil and vinegar (can be natural apple). The components are mixed in equal proportions, gauze is moistened and applied to the inflamed area overnight.
Beat a cabbage leaf with a rolling pin to release juice. Apply to the shoulder and wrap it up, remove it in the morning and replace it with another one.
Oak bark decoction 15 g per glass of boiling water. Moisten the cloth and apply to relieve inflammation inside the joint.

Preparation of ointments:

Grind dry burdock root in an amount of 20 g. Add to vegetable oil (200 ml). Let it brew for 24 hours so that the beneficial components of burdock are extracted into the oil. After 24 hours, heat for 10 minutes and strain. Apply to the shoulder twice a day. Keep the ointment in the refrigerator.
Wormwood juice helps eliminate swelling and promotes the resorption of hematomas. To do this, the fresh plant needs to be crushed and the juice squeezed out. The course of treatment is 5 days.
Warming ointment made from black radish juice (2 parts) and mustard powder (1 part). Apply the paste to the skin of the shoulder for 5 minutes, then rinse. The ointment stimulates blood circulation.

After swelling and pain are eliminated, rehabilitation can begin.

Exercise therapy, massage

To restore lymph circulation,
exercise therapy massage is indicated; in case of severe injuries, it must be carried out in a medical institution under the supervision of a rehabilitation physician. Physical education is especially important for older people, since their regeneration processes are slowed down. If at a young age the shoulder stops bothering you after 2 weeks, in an elderly person it will take 1.5 – 2 months.

It is recommended to begin physical therapy while your arm is still in a cast or bandage. This makes it possible to control the load - in the first days you should not give too much to avoid exacerbation.

Massage is performed to speed up lymphatic drainage. During an injury, the lymphatic vessels are usually damaged, resulting in lymphedema - swelling of the arm. This prevents tissues from repairing.

Lymphatic massage is done from hand to shoulder with leisurely movements. The patient should not be in pain. You cannot massage if the wound on your shoulder has not healed and there is a danger of infection.

In case of lymph stagnation, the doctor may install a drainage tube to normalize fluid exchange.

What are multiple and combined injuries?

In traumatology, the most common cause of death, as well as disability of surviving patients, is multiple and combined injuries. With multiple injuries, damage occurs to two or more organs of one system (musculoskeletal system, digestive system, etc.). If a patient has numerous injuries localized in different organ systems, then such injuries are called combined. Injuries of this type aggravate the situation; they are more severe than isolated injuries. Foreign medicine uses the term “polytrauma” and evaluates severity using the ISS scale. Injuries from 17 points are classified as complex injuries. The Special Medical Assistance advisory service deals with the most severe multiple and combined injuries every day.