A spica bandage on the shoulder joint protects the wound surface from the effects of external negative factors. It immobilizes the injured limb, prevents bleeding and infection. This method of bandaging the shoulder joint reliably immobilizes the arm, ensuring tissue regeneration in case of dislocations, bruises, and progressive destructive and degenerative changes in the joints. Its application requires certain skills and is therefore carried out only by qualified medical personnel. Excessively tight or weak bandaging can cause complications and slow regeneration of damaged tissue.
Indications for use
A spica bandage for the shoulder joint is a device made of dressing material that protects the wound from the penetration of pathogenic microorganisms, mechanical stress, and temperature changes. Also, the purpose of bandaging is to retain pharmacological drugs on the damaged areas of the shoulder. In what cases is its application recommended:
- the formation of inflammatory foci in the joint structures or in the armpits, including those accompanied by the release of pus;
- wounds on the surface of the shoulder and (or) in the armpit;
- open and closed fractures, dislocations and subluxations;
- immobilization of the hand during exacerbations of arthritis and arthrosis.
A dislocated collarbone is a direct indication for wearing a bandage.
The spica bandage simultaneously prevents bacterial infection of the wound, ensures long-term retention of medications, immobilizes the limb and prevents relapse of the pathology.
An ascending spica bandage is used for damage to the surface of the shoulder near the joint, and when the wound is located on the shoulder girdle, a descending bandage is used. You can close the armpit using a special modifying bandage.
What types of shoulder braces are there?
A large load is regularly placed on the shoulders and this leads to negative consequences. The shoulder joint is surrounded on all sides by tendons, ligaments, and muscles, but remains vulnerable to injury. Dislocations or other injuries may occur, which are accompanied by pain, swelling of the entire upper limb, and limited mobility.
The benefits of using a bandage
Repeated injuries cause irreversible damage to the shoulder joint. Even the simplest manipulations with the hand will be difficult to perform in the future. But all these problems can be easily avoided. Injuries should be treated promptly and everything should be done to prevent them. For this purpose, special bandages have been developed that immobilize the clamps. This will keep the shoulder joint in the correct position, minimizing stress, which speeds up the healing process.
The brace intended for the shoulder joint is a universal orthopedic device. With its help, joint mobility is limited after injuries, surgical interventions, and some inflammatory or degenerative diseases. The emphasis is mainly placed not only on partial, but also complete immobilization of the shoulder. Reliable fixation in the correct position allows for faster treatment of joints
, minimize the risk of injury or complication.
When is a shoulder brace needed?
The list of cases when you can use such an orthopedic product is varied. It is effective in the following situations:
- injury;
- stretching;
- tendon rupture;
- injury to the collarbone or scapula;
- fracture;
- the rotator cuff is damaged;
- instability of the shoulder joint.
The bandage can be considered as an alternative to a plaster or bandage bandage, because it is convenient and practical. It is used for the following diseases:
- bursitis;
- arthrosis;
- gout;
- glenohumeral periarthritis;
- adhesive capsulitis.
Type of bandages
They come in the following types:
- For one joint - reinforcing with an elastic sleeve, pressing the limb to the body. Relieves and stabilizes the joint, protects ligaments.
- For two joints - an elastic cape-sleeve, with the help of which two shoulder joints are fixed simultaneously. Often used by athletes to reduce stress and relieve inflammation symptoms.
- Deso bandage – allows you to fix the limb in a suspended position. Suitable for fractures, rehabilitation of bruises, dislocations.
- Shoulder bandage – does not secure the arm in relation to the body. With its help, heat exchange and blood circulation improve.
- Shoulder orthosis - helps fix the limb to the body, with the elbow bent or in a free position. Suitable for cases of fractures and injuries.
Types of shoulder joint fixator
Products differ in purpose, degree of rigidity, and method of fixation. This must be taken into account during selection.
The protective retainer is a short sleeve that connects under the opposite arm. This product is an excellent preventative against sports, household or professional injuries. These types of bandages are characterized by easy fixation. In the future, less stress is placed on the tendons and muscles, which eliminates stretching. An elastic bandage is recommended to be worn for chronic inflammatory diseases and in the postoperative period. Due to moderate compression, blood circulation improves, so swelling goes away faster. Treatment of arthrosis with it
, like other diseases, goes away faster.
A gusset bandage is used to support the arm. It includes a support bag designed for the forearm, an adjustable strap. This model is easily adjustable, which allows you to choose the product to suit your individual body characteristics. It can be used for bruises, fractures, dislocations or other injuries of the upper limb. After fixing the shoulder girdle, the amplitude of movement is limited, and the load is removed from the injured area.
The bandage that limits mobility is in the form of a short sleeve. Due to the flexible straps, the amplitude of shoulder abduction can be adjusted. This model of the product limits movement, creates the effect of dosed compression, which allows you to relieve muscle tension, reduce swelling, and get rid of pain. Suitable for dislocations, fractures, endoprosthetics.
The shoulder girdle orthosis or Deso bandage has a more complex design, which provides fixation of the upper limb. It includes:
- clutch for placing the hand in the desired position;
- belts;
- removable wide belt.
This bandage is widely used for fractures. With its help, the load on the injured limb is reduced, displacement is eliminated, pain is reduced, and recovery occurs faster.
The abductor splint is used to secure the arm in the abducted position. A special pillow is placed between the arm and the body to create the desired abduction angle. This splint is easily secured using waist belts. This product is more suitable for the postoperative period, after endoprosthetics and other types of interventions.
To achieve maximum benefit from the bandage, you should follow the instructions for use.
Some models can be worn around the clock, but the patient’s condition must be taken into account. The cost of orthopedic products depends on the type, quality of the material, and manufacturers. After purchasing, you should consult with a specialist on how to properly put on and use the bandage. Author: K.M.N., Academician of the Russian Academy of Medical Sciences M.A. Bobyr
How to properly bandage the shoulder joint
The psychological state of the patient is important for the correct procedure. The person needs to be seated, calmed down, and told about the basic principles of the upcoming bandaging. This will help him relax, and the doctor will quickly fix the injured shoulder. Before bandaging, a roller supporting the arm is placed in the armpit, and a sterile dressing material is applied to the wound. Immobilization of the shoulder joint is carried out according to the following algorithm:
- during the first rotation, the bandage is applied loosely, and during subsequent rotations its tension should be tighter, with a tight fit to the body;
- The bandage will be tight and secure if you move the bandage by a third of its width with each turn. The basic principle of spica bandaging is based on the uniform weave of the dressing material covering the wound surface;
- During the application process, the surface of the bandage is constantly leveled by hand to ensure a tight fit and to avoid the formation of folds and bends. The area of the shoulder joint is uneven, so when fixing it, cutting the dressing material is allowed. After application is completed, the remaining part of the bandage is located under the last layers. It is secured with a safety pin or straps obtained by cutting the bandage.
The main requirements for a spica bandage are comfort, tight fit of the bandage layers and the absence of excessive compression. It should not reduce the range of motion of healthy joints and cause discomfort even when worn for a long time. It should only be applied by a qualified physician. Bandaging too tightly will compress blood vessels, nerves and muscles. This will cause the development of necrosis. And weak fixation will significantly slow down tissue regeneration or provoke a relapse of the pathology, for example, with dislocation of the abdominal end of the clavicle.
Signs of improper application include decreased sensitivity of the upper limb, swelling of the free part of the arm, and pain in the shoulder joint.
Fracture of the proximal humerus
Indications for surgical intervention for these fractures are determined by general and local concomitant injuries, the type and stability of the fracture, the quality of the bone tissue, and the age of the patient.
Conservative treatment is preferable in elderly patients with concomitant pathology and for fractures without displacement of the fragments.
Achieving the best results is possible with good reposition of the fragments and fixing them in the correct position until fusion occurs. For these purposes, methods of external osteosynthesis with plates and screws, intraosseous osteosynthesis with locking rods or endoprosthetics are used.
Clinical case:
Fracture of the greater tuberosity of the humerus
Operation: Open reduction, anchor fixation of the greater tubercle of the humerus.
Clinical case:
Incorrectly healing comminuted fracture of the greater tubercle of the humerus.
Operation: Open reduction of the greater tubercle of the humerus with fixation with an anchor suture
Clinical case
Closed comminuted intra-articular displaced fracture of the proximal humerus.
Surgery: open reduction of fragments of the proximal humerus, external osteosynthesis with a plate and screws
Humeral shaft fracture
Humeral shaft fractures account for approximately 1% of all fractures. They usually result from direct trauma, but can also occur in sports where rotational forces are high, such as baseball and arm wrestling. Fractures of the third humerus can cause damage to the axillary nerve. Fractures of the middle and distal third may compromise the radial nerve.
Osteosynthesis with a plate allows the surgeon to perform a good reduction and create stable fixation of components with interfragmentary compression of bone fragments. The plate in such cases is the best means of correcting the deformity and remains the method of choice in the treatment of false joints of the humerus.
Another treatment option for shaft fractures is intramedullary osteosynthesis.
Clinical case
Closed fracture of the middle/3-n/3 humerus with displacement.
Surgery: open reduction of fragments of the middle/3-n/3 humerus, osteosynthesis with a plate and screws
Fracture of the distal humerus
Fractures of the distal humerus account for 2-6% of all elbow fractures in adults. There is a distribution of fractures relative to age and gender, with peak rates in young men and older women. Most fractures in the elderly are intra-articular injuries involving both columns.
Intra-articular injuries have a relatively favorable prognosis with open reduction and stable fixation.
Modern methods of plate and screw fixation provide the possibility of reliable reconstruction, so that the native elbow joint can be preserved in the vast majority of patients.
In patients with severe osteoporosis, achieving stable internal fixation of the distal articular end of the humerus may not be easy, so total elbow arthroplasty may be considered.
Clinical case
Closed intra-articular fracture of the head, trochlear condyle and lateral epicondyle of the humerus with displacement.
Operation: open reduction of fragments of the distal condyle of the humerus, external epicondyle, osteosynthesis with a plate and screws.
Clinical case
Closed intra-articular fracture of the head and part of the trochlea of the humerus with displacement.
Operation: open reduction of fragments of the head and part of the humerus trochlea, osteosynthesis with screws.
Fedotov Evgeniy Yuryevich, Traumatologist - Orthopedist, Candidate of Medical Sciences Conducts outpatient appointments at the CDC (consultative and diagnostic department) for adults
Rising bandage
The interlacing of such a spica bandage on the shoulder joint is located on the outer surface. The bandage is secured with two turns around the shoulder joint on its upper section on the side of the wound surface. After placing it on the shoulder girdle, the dressing is carried along the shoulder blades to the other armpit, wrapped around the torso on the chest and brought out in front of the shoulder. Now it is applied by gradually wrapping the shoulder with the bandage coming out to its outer surface. The dressing material is positioned in such a way that the next turn secures the previous one. The bandage is applied according to the following algorithm:
- carried out along the chest;
- wrapped around the shoulder and shoulder girdle;
- falls behind his back.
Bandaging continues until the shoulder joint, the entire surface of the shoulder and armpit are completely covered. Once the fixation is complete, the end of the bandage is attached to several layers of material on the back with a safety pin.
What is a Deso bandage?
The Deso bandage is used to immobilize the arm. It fixes the shoulder and the forearm bent at the elbow to the body. Thus, the Deso bandage helps relieve stress, thereby preventing displacement, reducing the risk of complications and speeding up recovery from injuries.
The advantage of the Deso bandage is the ability to completely immobilize the entire arm, fixing it to the body, eliminating movement in all joints. At the same time, the bandage does not compress the tissues of the arm and does not interfere with blood circulation if it is applied correctly.
This type of shoulder brace is named after its inventor, Pierre Dezo, a French surgeon of the 18th century. The classic Deso bandage is a bandage. If you are going to wear it for a long time, the bandage is stitched so that it does not fall off. Sometimes the Deso bandage is made of plaster.
Currently, the Deso bandage is more often used in an improved form - the application technique and the materials used have changed, thereby increasing the effectiveness of treatment.
Ready-made Deso dressings are easy to use. They provide quick, reliable and adjustable fixation using hooks, Velcro, and locks. Modern braces for the shoulder joint are made of hypoallergenic materials that allow air to pass through.
An additional convenience of ready-made Deso dressings is that they do not require precise selection to size. They are presented in universal sizes and are individually adjustable.
Descending bandage
A descending spica bandage is obtained by applying the dressing in the opposite direction. First, the bandage is placed in several turns around the body at the level of the armpits. Next, it is carried out from the armpit of the healthy arm along the front part of the torso to the other shoulder joint as follows:
- starts behind the front area of the shoulder girdle;
- carried out along its back side;
- is brought to the front of the joint through the armpit.
Now the bandage near the neck is placed behind the back and lowered into the opposite armpit. In this way, the application continues, crossing the layers of the bandage by a third or half of its width. At the end of the procedure, the dressing material is wrapped around the forearm on the injured side a couple of times for reliability. The bandage is secured with a pin or a bandage cut into 2 parts. The result of this bandaging method is a “spike” located on the shoulder girdle.
During the procedure, it is not advisable to use a large amount of dressing material to ensure reliable immobilization of the limb and shoulder joint. Excessive turns of the bandage will increase the thickness of the spica bandage and cause discomfort when wearing it.
Bandage covering the axillary area
Reliable closure of the armpit area is carried out with a modified ascending spica bandage. When applying it, additional turns of the bandage are used through the healthy shoulder girdle. Reliable fixation is ensured by a wide cotton roll, which is placed not only in the armpit, but also outside it so that part of the chest is covered.
At the beginning of the procedure, the lower third of the shoulder is wrapped 2-3 times with a bandage to securely fix it. The dressing is carried along the back around the healthy shoulder girdle and passes along the chest towards the damaged muscle cavity. After completing a circular turn covering the back and chest area, the material is fixed with a layer of sterile cotton wool. Several additional circles passing along the shoulder girdle and around the torso help ensure the necessary tightness of the bandage and secure the roller in the armpit. At the end of the procedure, the bandage is wrapped twice around the sternum. The dressing material is secured with a pin.
Basic rules for caring for a bandage
A spica bandage on the shoulder can be used for different times depending on the degree of injury or the stage of chronic articular pathology. The duration of wearing is influenced by the patient’s age and the rate of restoration of damaged tissue. The presence of a person’s history of cardiovascular diseases, in which any excessive load is harmful, is also important. The wearing period is limited in case of pathologies accompanied by metabolic disorders. For example, with diabetes mellitus, tight bandaging can cause skin damage.
The material is replaced a week after its application. Before the procedure, the doctor assesses the condition of the wound surface, treats it with antiseptics and anti-inflammatory drugs. In some cases, the bandages are removed without waiting for 7 days to pass. What could be the reason for this:
- unbearable skin itching;
- the appearance of a putrid odor;
- constant or periodic painful sensations at rest or during movement;
- redness and (or) swelling of the skin below or above the bandages.
To immobilize the shoulder joint after a fracture, a spica bandage is applied for a period of several weeks to 2.5-3 months. Bandaging is carried out not only for the gradual restoration of damaged tissues. This is part of first aid for victims and is used to safely transport a person to a hospital facility for further treatment.
A spica bandage is as important in the treatment of fractures or dislocations as the timely administration of pharmacological drugs. It prevents displacement of articular structures relative to each other, which can cause inflammation. The duration and effectiveness of treatment depends on its correct application.
Consequences of a shoulder dislocation
Some of the main injuries resulting from shoulder dislocation are:
- fracture or Hill-Sachs defect, i.e. a change in the shape of the outer part of the head of the humerus (described by American doctors in 1940: Harold Arthur Hill (1901-1973) and Maurice David Sachs (1909-1987)).
- Bankart injury, i.e. a fracture of the anterior edge of the articular process of the scapula along with damage to the articular labrum.