The shoulder joint provides movement of the upper limb in all directions. It is formed by the head of the humerus and the surface of the scapula, surrounded by ligaments and an articular capsule. There is a powerful muscular corset around the joint that holds it and is responsible for various types of movements. Unfortunately, traumatologists quite often have to treat people who have suffered a shoulder joint injury - ligament rupture. The peculiarity of this injury is that a person loses the ability to act with the injured hand for quite a long period of time. As a result, temporary disability occurs and the quality of life decreases.
Causes of shoulder ligament rupture
This type of injury is common among athletes.
- High physical activity or sudden unsuccessful movement. This cause usually causes injuries in people who play sports (basketball, volleyball, swimming, baseball, weightlifting).
- Insufficient nutrition of the tissue of the upper shoulder girdle. It usually develops with age or can occur in people after fractures (clavicle, shoulder), when blood vessels and/or nerves were damaged.
- Osteoarthritis of the shoulder joint.
- Regular lifting of weights (loaders, weightlifters).
- Unfortunate falls (for example, on an outstretched arm).
Causes of shoulder ligament ruptures
The cause of the pathology is almost always severe trauma. Tear of the ligaments of the shoulder joint can occur due to trophic or age-related degenerative changes in them. However, in practice this happens quite rarely.
Injuries that can cause damage to the ligamentous apparatus of the PS:
- a sharp blow to the front surface of the shoulder;
- strong jerking movement;
- external rotation of the upper limb;
- falling on an outstretched arm;
- sudden upward pull of a limb.
Rupture of the ligaments of the shoulder joint always accompanies dislocations of the shoulder and collarbone . In this case, a violation of the integrity of the ligamentous apparatus occurs due to displacement of the bones. They pull on the ligaments attached to them, causing them to tear easily. When a shoulder dislocates, the muscle tendons are also often affected.
In some sources you may come across the abbreviation ACJ - this is the acromioclavicular joint. It is the rupture of the AC joint of the shoulder joint that usually leads to dislocation of the clavicle. If other ligaments are damaged, the integrity of the connection may be maintained.
Diagnosis of shoulder ligament rupture
- Examination of the patient by a traumatologist-orthopedist. Based on palpation, the volume of passive and active movements, and the nature of the injury, the doctor makes a diagnosis. Sometimes additional studies are carried out to clarify the severity.
- X-ray images in two projections. CT scan.
- An ultrasound of the shoulder joint can reveal the presence of hemarthrosis (accumulation of blood in the joint cavity).
Damage to joints in the articular humeral structure: actions of a diagnostician
Even a small sprain can trigger serious inflammation and lead to long-term treatment. It is not necessary to go on sick leave - after diagnostic manipulations with the ligaments and the application of a shoulder brace, you can be treated independently. But the doctor must monitor the process, and before that, clearly determine how much the ligaments are injured.
To do this, if a sprain is suspected, the following is carried out:
- arthroscopy of the shoulder joint;
- x-ray of the shoulder;
- Ultrasound of the ligaments in the shoulder;
- in some cases, an MRI may be recommended to assess the progress of inflammation in the joint;
- An objective examination of the ligaments with palpation is required.
Treatment and rehabilitation after ruptured shoulder ligaments
Immediately after injury, you need to apply an ice pack to the shoulder, immobilize the arm and take the patient to the emergency room or trauma department.
- In a hospital setting, the patient is given a fixing bandage, with which he will have to constantly walk for some time, but not longer than 2-3 days.
- If the ligaments are completely torn, surgery is performed.
- Cryotherapy. Cold compresses 3-4 times a day for 10-15 minutes will help relieve swelling faster and reduce pain.
- Anesthesia. First, for greater effectiveness, analgesics (Ketorolac) are prescribed intramuscularly. Then the patient is given tablets (Ketanov). Throughout the entire treatment period, you can use local products (gels, creams) such as Voltaren.
- Medication support. To improve the nutrition of joint tissues and their rapid recovery, special medications (Chondroitin and Glucosamine) are prescribed.
Physiotherapy
- Ultrasound.
- UHF therapy.
- Magnetotherapy.
General principles of treatment
Therapeutic tactics for ligamentous injuries depend on their severity. If the ligaments of the shoulder joint are partially torn, doctors prescribe conservative treatment. Usually it helps restore a person to full working capacity. In case of complete rupture, the patient requires surgical intervention.
Conservative treatment
Includes temporary lifestyle correction, the use of medications and physiotherapeutic procedures. Treatment can only be prescribed by a doctor after examination. Before arriving at the hospital, experts advise patients to apply ice to the sore shoulder and immobilize the affected limb with a bandage or improvised means.
How long do you think it takes for a torn shoulder ligament to heal? In the absence of complications, a person recovers completely in 2-3 weeks.
Table 2. Main treatment methods
| Method | Features of application | Action |
| Dry cold | Before applying ice to your shoulder, wrap it in a clean, dry cloth. Cold compresses are recommended to be applied 4 times a day for 2-3 days. | Cold has an analgesic effect and helps reduce swelling of soft tissues |
| Immobilization of the affected limb | In the first few days after the injury, it is necessary to limit movement of the affected arm. At this time, a Deso bandage or a fixing support is often applied to the shoulder. | Shoulder immobilization allows torn connective tissue fibers to heal |
| Taking painkillers and anti-inflammatory drugs | To combat severe shoulder pain, drugs from the NSAID group (Diclofenac, Ketoprofen, Ibuprofen, Meloxicam) are used. They are prescribed in the form of tablets or intramuscular injections | NSAIDs relieve pain and prevent the development of tendinitis and other inflammatory diseases of the shoulder |
| Physiotherapeutic procedures | They are used for ruptured shoulder ligaments along with other methods. The most commonly used physiotherapeutic procedures are UHF and magnetic therapy. Their implementation does not require removal of the bandage and does not disrupt the immobilization of the joint. | Accelerate the regeneration of damaged tissues, promoting rapid recovery of injured ligaments |
| Physiotherapy | Prescribed during the rehabilitation period, 1-2 weeks after injury. A set of exercises is selected by a rehabilitologist or orthopedist-traumatologist | Helps restore full function and normal mobility of the shoulder |
Dislocations accompanied by damage to the ligamentous apparatus are also treated conservatively. Under general anesthesia, the displaced bone is reset into place. After this, the joint is immobilized for several weeks. For dislocations that cannot be corrected using a closed method, the person requires surgery.
Surgical intervention
Previously, torn ligaments were sutured openly: doctors had to cut through the soft tissue, which is why the postoperative wound took quite a long time to heal.
Today,
arthroscopic operations . They are low-traumatic, since to perform them it is enough to make 2-3 incisions 1-2 centimeters long. Thus, doctors suture the ligaments, causing minimal damage to the soft tissues of the shoulder. Now such operations are not performed in all hospitals and clinics.
If the tendons of the shoulder joint are completely ruptured, the patient requires surgical treatment. The operation should be done without delay.
Shoulder dislocation
Shoulder dislocation is common. Traumatic shoulder dislocations account for half of all recorded dislocations. This can be explained by the intensity of the movements performed by the joint. It is extremely important to identify at the very early stage what exactly happened to the patient: a dislocation or rupture of the shoulder ligaments. If a partial rupture of the shoulder ligaments , when part of the fibers are damaged, then this condition can be diagnosed as a sprain. A dislocated shoulder is usually accompanied by pain and therefore requires medical attention. In the most difficult cases, surgical intervention is used.
The surfaces that form the shoulder joint are the spherical head of the humerus, as well as the articular surface of the scapula. These surfaces have a small contact area. Stability and stability of the joint position is provided by the joint capsule, its ligaments and muscles.
When a mechanical force is applied to the arm (during a fall or blow), the head of the humerus can displace, tearing the joint capsule. Depending on the degree of displacement of the humerus, we can distinguish:
- anterior shoulder dislocation;
- posterior shoulder dislocation;
- inferior shoulder dislocation.
Treatment or surgery on the shoulder joint?
Treatment of the shoulder joint is directly dependent on the nature of the injury. If dislocation or the ligaments in the shoulder are torn, it may be necessary to undergo shoulder surgery. Anterior shoulder dislocation is very common. It is almost always accompanied by fractures of the processes of the scapula, as well as a separation of the tubercle of the humerus.
This type of dislocation is extremely painful, and the patient's arm is practically immobilized. The shape of the shoulder changes, and the shoulder joint , in turn, sinks. Posterior dislocation occurs much less frequently, but if the head of the humerus gets into the area of the neurovascular bundle, even temporary paralysis of the limb may occur. In case of inferior dislocation, the head can be felt in the armpit.
, treatment of the shoulder joint is mandatory . First, the arm is numbed with local anesthetics to realign the joint. If the patient’s sensations are too painful, then the use of promedol or other potent analgesics is allowed.
After this, a plaster cast is applied for a period of one month. In order for the patient to quickly return to his normal physical shape, it is important to prescribe physical therapy procedures and therapeutic exercises.
When the joint cannot be straightened using mechanical action, surgery is performed on it. The normal position of the joint is fixed using medical needles, as well as lavsan sutures.
In case of any - fresh or old - traumatic injuries to the shoulder , ruptured ligaments , chronic pain and other symptoms, you should definitely consult a doctor. Failure to carry out qualified treatment sometimes leads to an absolute loss of functional activity of a given joint, which will always lead to disability.
Arthroscopy of the shoulder joint
The first case of shoulder joint dislocation , as a rule, provokes repeated dislocations, which in science are usually referred to as “ habitual dislocation .” Habitual dislocations can occur not only as a result of injury, but also in the process of performing normal movements of the limb. To treat such dislocations, it may be necessary to undergo surgery on the shoulder joint. The cause of habitual dislocations can be: damage to the joint capsule, rotator cuff, paresis of the shoulder muscles. Whatever the reason, if the patient is diagnosed with a recurrent shoulder dislocation, surgery is simply necessary.
In order to determine the degree of injury as accurately as possible, arthroscopy of the shoulder joint (that is, ultrasound examination) is prescribed. Habitual dislocation, as a rule, each time worsens the general condition of the joint and injures all adjacent tissues. Depending on the results of arthroscopy of the shoulder joint , surgical intervention is prescribed, as well as subsequent treatment determined by the attending physician.