Shoulder dislocation

The shoulder joint is a ball-and-socket joint formed by the head of the humerus and the glenoid cavity of the scapula. Like all ball and socket joints, the ligaments of the shoulder joint are sensitive to stress. According to statistics, acute shoulder injury accounts for 60% of cases in weightlifters.

Young people damage the joint when falling, overexerting themselves during sports (volleyball, basketball, strength sports), or dislocate their shoulder at work: when loading heavy objects or during repair work.

Middle-aged people (50 years and older) most often damage the joint in a fall or as a result of a bruise. The injury is aggravated by arthrosis associated with the “wear and tear” of the cartilage tissue of the joint, and the slow tissue restoration characteristic of middle age.

An elastic shoulder bandage will help prevent damage to the joint and alleviate the condition after an injury . Medical compression bandage "Intex" is a woven elastic tape made of latex, cotton and polyester fiber. When applied correctly, the bandage creates distributed pressure on the body, secures the bandages and stabilizes the joints.

Mechanism of injury

The shoulder is a complex structure that belongs to the ball and socket joints. It provides a significant range of movements of the upper limb in various planes. Features of the functions of the joint and its anatomical structure are factors that provoke the formation of dislocation.

It is an injury in which the head of the humerus comes out of the glenoid cavity. The main mechanism for the development of injury is excessive mechanical impact with stretching or rupture of reinforcing ligaments.

Diagnostics.

Diagnosis of a dislocation includes a detailed examination of the patient, palpation of the damaged joint and the appointment of x-rays in two projections of the damaged joint. Using the obtained x-ray, the doctor identifies the type of dislocation, whether there is a fracture, and determines the method of reduction. In more serious cases, the doctor may prescribe computed tomography and magnetic resonance imaging to clarify the diagnosis. If there are serious injuries, consultation with a surgeon is necessary.

Shoulder dislocation. Kinds

Shoulder dislocation.
Types Dislocation of the shoulder joint is a polyetiological injury. This means that its development is provoked by a significant number of different causative (etiological) factors, which, for ease of diagnosis, were divided into several main groups:

Excessive mechanical impact - pronounced extension or abduction of the arm, exceeding the stabilization capabilities of the ligaments, leads to damage (usually in the form of sprain) of the ligamentous apparatus and the exit of the humeral head. Typically, factors leading to excessive stretching occur in individuals with fairly high mobility and loads on the upper limbs (athletes, representatives of professions requiring physical effort).
Weakening of the ligamentous apparatus of the shoulder, which may be congenital (the result of changes in the functional state of certain genes) or acquired (a consequence of chronic inflammation or degenerative processes) of origin. In this case, dislocation of the humerus can develop even against the background of normal loads.
A combination of increased load on the shoulder with weakening of its ligamentous apparatus, which leads to habitual popping in the future.

Determining the cause that led to the prolapse of the humeral head is a priority measure for determining further treatment and diagnostic tactics, as well as preventing injury in the future.

University

According to the calendar, it has long been spring, but due to frequent changes in thaws and frosts, pedestrians do not have time to adapt to changes in travel conditions and lose caution. Typical “ice” injuries are fractures of the radius, ankles, and shoulder dislocation.

Classic type fracture

The radius is usually damaged in the distal metaphyseal regions at a distance of 1.5–3 cm from the wrist joint gap.
Most often, the extensor mechanism of injury is observed: when the palm comes into contact with the plane of support, a sudden fixation of the hand and the closely associated articular apparatus of the distal epiphysis of the radius occurs. At the same moment, the very strong (and, as a rule, not susceptible to rupture) palmar ligament is greatly strained. The result is that the thinned compact substance of the bone is injured in this section, and the fracture line begins on the palmar surface of the ray in close proximity to the joint and goes from bottom to top - to the dorsal-ulnar surface. A so-called fork-shaped deformity of the hand and forearm occurs. This injury was described by Colles in 1814 and is called type I. When falling on a hand bent at the wrist joint, a flexion fracture of the radius occurs in the classic place, or a type II fracture (the so-called Smith fracture; described by an Irish surgeon in 1847), characterized by a bayonet-like deformity.

In almost 80% of cases with radial fractures, the styloid process of the ulna is simultaneously separated in a typical location. If there is no displacement of the fragments, immobilization of the limb with a plaster splint, tape cast bandage or orthosis from the proximal third of the forearm to the metacarpophalangeal joints for a month is indicated. A doctor of any specialty must remember that subcutaneous ruptures of the extensor pollicis longus tendon occur from 1 week to 1.5 years after injury. This occurs in 1 case out of 300 radial fractures in a typical location without displacement of the fragments due to chronic trauma in the groove behind the Lister tubercle on the dorsal surface of the bone.

For displaced fractures of the radius, closed reduction of the fragments is performed after adequate anesthesia (local, intravenous, conduction). A fixing bandage is applied on the side of the displaced distal fragment from the upper third of the forearm to the metacarpophalangeal joints.

For type I (Colles) fractures, the hand is given palmar flexion and ulnar deviation - the splint immobilizes the dorsum of the forearm. For type II (Smith) fractures, the hand and forearm are fixed with a splint along the palmar surface, giving the position of dorsiflexion and ulnar abduction.

Control radiography is performed after the plaster cast has hardened and after 6–8 days. After approximately three weeks, it is possible to change the fixing bandage with careful moving of the hand to a functionally advantageous position. And after 5–6 weeks from the moment of fracture, immobilization is stopped and restorative treatment begins.

The most complex category of injuries is represented by intra-articular comminuted fractures of the distal metaepiphysis of the radius. With them, two types of deformation are also observed - on the dorsal and palmar sides.

Simultaneous manual reduction of such fractures is performed according to general rules, but immobilization is carried out to keep the fragments in the reduced state: from the middle third of the shoulder with a supinated forearm to the metacarpophalangeal joints. After four weeks, the elbow joint is released from fixation and, having brought the hand into a functionally advantageous position, additional immobilization is carried out for 2–3 weeks with an orthosis or a plaster (scotch cast) splint.

In some cases, closed reposition of fragments does not provide accurate comparison of multiple fragments. Then, for intra-articular comminuted fractures of the distal metaepiphysis of the radius, the method of choice is open reduction and functional stable osteosynthesis.

"Deza" for Dezo dressing

Shoulder dislocations most often occur when falling on an abducted, extended arm. Depending on the direction of displacement of the humeral head, there are anterior (75%), axillary (23%) and posterior (2%). Dislocations are always accompanied by ruptures of the joint capsule, sometimes with tears of the greater tubercle of the shoulder or damage to the rotator cuff.

The patient's injured arm is in a forced abduction position and supported by the healthy forearm. The head is tilted towards the dislocation. On examination, protrusion of the acromion process of the scapula and loss of the normal rounded contour of the shoulder are revealed. Retraction of the deltoid muscle is formed. It is always accompanied by a symptom of springing resistance: during forced adduction, the shoulder takes this position, but as soon as the doctor removes the hand, it returns to its previous forced position. This symptom is the most characteristic, therefore it is important in differentiating the diagnosis from fractures of the shoulder in its proximal part.

Reduction is carried out under full anesthesia using one of the traction techniques (Mukhina-Mota, Dzhanelidze). X-ray examination of the joint before and after reposition is mandatory. After repair of the shoulder dislocation, it is necessary to check the clinical symptoms of possible concomitant damage to the elements of the rotator cuff. If this is not available, the arm is fixed with a Deso bandage for three weeks. The rotator cuff consists of: m. supraspinatus, m. infraspinatus, m. teres minor, m. subscapularis. A rotator cuff tear can occur at any point, but most often occurs at the insertion of the supraspinatus muscle on the greater tuberosity or 1.5 to 2 cm proximally. The most typical symptom for such patients is the “falling arm” symptom: it is impossible to actively move it to a horizontal level and/or hold it in this position. Checked in all cases after reduction of a dislocated shoulder before immobilization. If a rotator cuff tear is suspected or its type and extent is clarified, either an MRI examination or arthroscopy of the shoulder joint is indicated. In case of partial damage (up to 30% of the width), conservative treatment is carried out; in case of extensive ruptures, early surgical treatment is performed.

Healing "boot"

Ankle fractures occur more often after indirect trauma (more than 90%). Usually one of two types occurs: pronation (abduction-eversion), when a traumatic force turns the foot outward, abducts it and pronates, or supination (abduction-inversion) - when the foot turns inward, adducts and supination. If at the time of injury the foot is in a plantar flexion position, a fracture of the posterior edge of the tibia may occur, and in the case of the dorsum, a fracture of the anterior edge of the tibia. Often a subluxation or dislocation of the ankle joint occurs simultaneously.

Treatment is aimed at restoring the disturbed relationships of the elements of the ankle joint. Without precise reduction of fragments, complete elimination of displacement and restoration of contacting surfaces, normal functioning of the joint is impossible. Uncorrected displacement leads to constant pain, severe swelling and rapid progression of deforming arthrosis of the ankle joint.

For isolated fractures of one of the ankles without displacement or subcutaneous damage to the ligaments, treatment is carried out in a deep posterior plaster splint from the upper third of the leg to the tips of the fingers. If the fractures are displaced, then a one-stage closed reduction is performed under local or general anesthesia, and a plaster cast “boot” is applied for up to 10 weeks. The patient is hospitalized in the hospital for further observation due to the threat of compression of the limb by a circular plaster cast. Control radiographs are taken immediately after reduction and after 7–10 days (when the swelling of the limb subsides).

Surgical treatment is indicated for open ankle fractures, in cases of failed closed reduction, as well as in cases of secondary displacement of fragments in a plaster cast. The ankles are fixed using appropriate metal structures. After immobilization, therapeutic exercises, massage, physiotherapeutic procedures are prescribed, and orthopedic insoles or shoes are recommended. Patients' ability to work is restored in approximately four months.

“Clinical signs of an ankle fracture are pain, swelling, changes in joint contours, and dysfunction. As a rule, the patient is not able to lean on the injured leg, but in some cases the limb’s ability to support is preserved, although the load is painful. To clarify the diagnosis, an x-ray of the ankle joint is performed in standard projections. » Alexander Martinovich , Associate Professor of the Department of Traumatology and Orthopedics of the Belarusian State Medical University, Candidate of Medical Sciences. Sciences Medical Bulletin , April 18, 2013

Kinds

Depending on the impact of the main causative factor, traumatic and pathological dislocation are distinguished. Traumatic exit of the humeral head is divided into 2 types according to the age of development:

Acute (first) shoulder release, which usually has a traumatic origin.
Habitual shoulder release, developing as a result of pathology with weakening of the ligaments or improper treatment of the primary injury.

Separately, congenital miscarriage is distinguished, which can also be the result of a complicated course of labor and improper extraction (forced removal from the birth canal) of the fetus.

Shoulder dislocation
The main clinical symptom of humeral head dislocation is pain. At the first dislocation it has significant intensity. Immediately after the injury, the shape of the shoulder joint changes (deformation) with the formation of a bulge in the area where the head emerges.

Inflammatory signs develop, the skin becomes red (hyperemia) and swollen. With a complicated injury, if blood vessels and nerve trunks have been damaged, bruising often appears and numbness develops, which spreads to the skin of the upper limb.

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.

First aid

Correct provision of care at the prehospital stage determines the effectiveness of treatment and recovery in the future, as well as the prevention of complications. It involves immobilizing the arm bent at the elbow (it is better to use a scarf for this), as well as reducing the inflammatory reaction by applying cold to the skin of the injury area.

After completing such measures, you should definitely seek qualified medical help as soon as possible. It is not recommended to perform self-reduction of a dislocation at home, as this can cause serious complications.

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.