Joint arthroscopy > Shoulder joint > Diseases and injuries > Instability of the shoulder joint
Shoulder dislocation is a persistent separation of the articulating surfaces, namely, the head of the humerus and the glenoid cavity of the scapula. This may be the result of physical violence or some pathological process. In case of instability of the shoulder joint, the head of the humerus is weakly fixed in the glenoid cavity of the scapula, due to which it can move to greater distances than in a normal joint.
Dislocations of the shoulder (in relation to the scapula) can be anterior, inferior and posterior. The most common are anterior dislocations.
shoulder dislocation
shoulder dislocation
The shoulder is a complex anatomical structure. The joint has a spherical shape. The cavity is formed by the articular surfaces of the clavicle and scapula, and houses the head of the humerus. Stability is ensured by strong connective tissue ligaments.
If their anatomical integrity is violated, the strength of the fibers decreases due to injury or a pathological process, the head of the humerus comes out of the glenoid cavity and this pathological condition occurs.
Symptoms
As you know, in the middle of the shoulder there is an intra-articular capsule. During a dislocation, it can rupture and lead to a violation of the integrity of muscle fibers and tendons.
In such a situation, the following manifestations are observed:
- different arm lengths;
- deformed shoulder position;
- sinking of the skin;
- limited mobility;
- overstrain of muscle fibers;
- gradual appearance of cyanosis;
- partial loss of sensitivity;
- tingling in the fingers and their subsequent numbness.
Causes
Chronic shoulder dislocation is a polyetiological disease, the development of which can be caused by the influence of several provoking factors. These include:
- Traumatic or pathological damage to the soft structures of the shoulder that increases the depth of the glenoid cavity.
- Sprain of ligaments with a congenital decrease in their strength.
- Incorrect treatment of acute dislocation, accompanied by insufficient duration of immobilization (immobilization) of the joint or incorrect, insufficient reduction.
Acute shoulder dislocation, often leading to instability of the joint, occurs when the upper limb is sharply abducted posteriorly or is excessively rotated outward. As a result, habitual shoulder dislocation may develop. Rehabilitation and therapy necessarily take into account the causes of the pathology.
Kinds
In modern medicine, there are several types of this pathological condition. These include:
- Primary recurrent dislocation, often resulting from congenital ligament weakness. It usually occurs when exposed to minor functional loads.
- Secondary release of the humeral head is the result of significant traumatic damage to the joint structures, leading to its instability, as well as improper treatment of the dislocation.
Based on the frequency of development of the pathology and the strength of the mechanical impact required to remove the head of the humerus, compensated, subcompensated and decompensated habitual dislocation of the shoulder is distinguished. Surgery or conservative therapy is prescribed by a doctor after an objective diagnosis with determination of the type of pathological condition.
Symptoms
At the moment when the head of the humerus emerges from the socket, it is determined:
- joint deformity;
- deterioration of mobility in it in the form of spring resistance;
- the appearance of pain (their severity depends on the duration and frequency of development of the pathological condition);
- atypical position of the upper limb in relation to the body - a person usually holds it with his healthy hand.
Without treatment, these manifestations become more frequent. They appear when a minimal functional load is applied to the joint.
The long course of the pathological condition is characterized by the development in a person of motor stereotypes aimed at reducing movements in the area of the upper limbs.
The frequency of dislocations can reach several times a day. In this case, a person can adjust them independently or with the help of others. Painful sensations after each independent reduction are less intense and last longer.
Methods for self-reduction of the shoulder joint
Before you start realigning the joint, you need to numb it well and cool it down, otherwise you risk losing consciousness before completing the procedure.
Circular rotation
Do it while sitting or standing.
- Raise your arm bent at the elbow joint to chest level;
- Without straightening, move it to the side as far as possible;
- From this position, lift up so that your palm is above your head.
Movements should be smooth and non-stop.
Using your knee
- Sit on a horizontal platform;
- Bend your knees and press them to your body;
- Interlace your fingers and place them behind your knees;
- Slowly leaning back and straightening your knees, try to pull the head of the joint into place.
Either an epic hero or a person placed in a hopeless situation can perform such a manipulation. Much more often there are other people around the incident and the opportunity to receive or provide all possible assistance.
The main thing is that this help is competent enough and does not cause even more harm.
Diagnostics
Diagnostics
- examines the joint;
- pays attention to its configuration, the presence of an inflammatory reaction (redness of the skin, swelling of soft tissues);
- determines the possibility of performing active and passive movements, as well as their volume.
- if necessary, prescribe an additional objective study, which makes it possible to determine the nature and severity of possible damage to the joint structures.
For objective diagnosis, visualization methods are used, which include radiography (the study is carried out in frontal and lateral projection), computed or magnetic resonance imaging, which is a layer-by-layer scanning of tissues with high separation power, as well as ultrasound.
In modern medical clinics, diagnostic arthroscopy is performed to examine internal structures, which is their visualization using a small tube inserted with a camera and lighting. It can be used as a curative operation (habitual shoulder dislocation). Diagnostic prices depend on its volume and the methods used.
How the surgical procedure occurs: modern arthroscopy methods
Whenever possible, joint surgery is performed through arthroscopy. Arthroscopy refers to the surgeon's method of accessing the surgical field. It eliminates the need to make large incisions and, accordingly, significant tissue trauma. In addition, it takes into account the features of the complex structure of the articular apparatus more than classical open surgery.
The operating process looks like this: the patient is secured on a couch or in a special chair. It should take the most comfortable position, and to ensure complete immobility it is additionally secured with bolsters and belts.
After administering anesthesia, the surgeon treats the surgical field in accordance with aseptic requirements. When the anesthesia takes effect, the doctor makes a small incision and through it inserts an arthroscope into the shoulder - a flexible hollow tube with sensitive optics.
In order for the surgeon to have a better view of the field of activity, a sterile fluid is pumped through a tube into the joint, causing it to swell somewhat and make it easier to see. Several small incisions are made to allow instruments and cannulas to be inserted.
Having completed the necessary manipulations, the doctor removes the arthroscope and all his instruments, processes the incisions, and applies sutures or special patches to them.
Treatment
Treatment of this pathological condition, which involves repeated emergence of the head of the humerus from the socket, is complex. It includes conservative measures and surgical intervention followed by rehabilitation.
All events are carried out in stages and follow each other. Usually, conservative therapy is first prescribed at the stage of preoperative preparation. Then surgery is performed. It is aimed at restoring the stability of the joint, which was disrupted by habitual shoulder dislocation. After the operation, rehabilitation measures are carried out.
Conservative therapy
Treatment with medications is usually prescribed as preoperative preparation. In case of an inflammatory reaction, non-steroidal anti-inflammatory drugs are used. Also, if necessary, drugs are used to improve blood clotting and antibiotics to prevent secondary bacterial infection.
To improve the condition of the ligamentous apparatus and increase the strength of connective tissue fibers, physiotherapeutic procedures are performed, including electrophoresis with anti-inflammatory drugs, magnetic therapy, mud baths, and ozokerite. The scope of conservative measures is usually greater when planning open access surgery.
operations
operations
These types of surgical intervention can be performed using arthroscopy or open access. The choice of technique is determined by the doctor based on objective research data, as well as the technical capabilities of the medical clinic.
Arthroscopic operations
In modern medical clinics, whenever possible, arthroscopy is used, which makes it possible to correct habitual shoulder dislocations using small incisions. The cost of the operation and the overall course of treatment is lower, since the duration of the postoperative and rehabilitation period is noticeably reduced.
Arthroscopy is the method of choice, with which it is possible to effectively treat habitual shoulder dislocation. Video on the monitor allows the doctor to visually monitor the manipulations performed using special micro-instruments.
Open access operations
In case of significant violation of the anatomical integrity, leading to instability of the joint, plastic surgical interventions are performed using an open approach. To do this, wide incisions are made in the skin, subcutaneous tissue and capsule, allowing wide access to the structures being restored.
This type of surgical intervention can be used if it is necessary to perform osteoplastic surgery with implantation.
When surgical intervention is performed using an open approach to restore stability in such a pathological condition as a habitual dislocation of the shoulder, the prices are higher. This is due to the peculiarities of the operation, the need for a longer preoperative and rehabilitation period, and the frequent use of a significant number of drugs of various pharmacological groups.
Rating scales
Oxford Shoulder Instability Test (OISS)
The OISS is a 12-item questionnaire with five correct Likert responses for each question and has a range from 0 to 48 (with a score of 48 indicating better shoulder function). The OISS was developed and validated to assess shoulder instability and has also been tested to assess sensation in patients with shoulder instability.
Western Ontario Shoulder Instability Index (WOSI)
The WOSI is a 21-item questionnaire with a 100 mm horizontal visual analogue scale below each patient response question and ranges from 0 to 2100 as a percentage, with 100% representing the best possible shoulder-related quality of life. The WOSI is a carefully developed and evaluated instrument for patients with shoulder instability that has been demonstrated to have excellent sensitivity for posterior instability.
treatment without surgery
treatment without surgery
Treatment without surgery is possible with a compensated course of the pathological process. It includes physiotherapeutic procedures and physical therapy with the limitation of certain movements in the shoulder joint. Such therapeutic results are rather low in effectiveness.
Habitual shoulder dislocation – recovery after surgery
Rehabilitation after a habitual shoulder dislocation involves applying a plaster cast for a long period of time (several months). Then physical therapy is prescribed with a gradual increase in the load and range of motion in the joint.
conclusions
- Never try to correct a dislocated shoulder yourself unless it is due to emergency circumstances;
- If the situation forces you to make such a decision, perform the procedure as quickly as possible in the first 5-15 minutes after the injury;
- When you are afraid of the consequences, think about what will happen if the dislocation is not corrected. By comparing the risks, it is easier to choose a less dangerous option.
The worst case scenario is when alcohol as a painkiller was taken not by the victim, but by the person providing assistance, and after the procedure no one went to the doctors.