Dislocation of the shoulder joint treatment rehabilitation

Shoulder dislocation: treatment at home. Dislocation of the shoulder joint: causes of

Dislocation of the shoulder joint is the most common problem related to the musculoskeletal system. The reason is a peculiar design that provides the greatest range of movements among all the joints of our body. In this article, we will look at how to recognize shoulder dislocations, the symptoms of the disease. Prevention and treatment as important measures to prevent and eliminate the consequences of such injuries will also be described in the material presented.

What is a dislocation?

Dislocation we call the loss of contact of the articular surfaces with each other. Injuries occur most often during sports or traffic accidents. Particularly exposed to this are people involved in volleyball, hockey, handball and winter sports. In case of shoulder injuries, correct diagnosis is necessary.

One of the most difficult types of shoulder injuries is a dislocation of the shoulder joint. Causes and treatment are established by the doctor at close examination of the victim. The further therapy consists in restoration of joint work and prevention of complications.

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Why does this problem happen?

The most common causes of dislocation of the shoulder joint are injuries during physical activity, falling on the outer( side) part of the arm. The cause of the problem can be a strong blow. Sometimes an injury is caused by falling from a height, for example, while working on a construction site. When the impact occurs, the head of the shoulder bone is displaced. Depending on the direction in which it has moved, shoulder dislocations can be divided into:

  1. Anterior shoulder dislocation of the joint. This is the most common type of displacement, which usually occurs as a result of falling on an elongated arm or shoulder.
  2. Rear shoulder dislocation of the joint. Such displacements can be caused by direct impact or sharp turns of the shoulder.

Symptoms of

The dislocation of the shoulder joint can damage other structures in the shoulder area. How to identify the problem and what to do after diagnosing a "dislocated shoulder"?Symptoms and treatment( first aid) depend on the severity of the injury.

Signs of dislocation of the shoulder joint:

  1. Sudden, very severe pain in the shoulder area.
  2. Large swelling or bruising.
  3. Limited mobility of the joint.
  4. Distortion of the outline of the joint, there is an absence of the head of the humerus, which moves to the area of ​​the armpit.
  5. Pain increases when trying to move the joint( so the patient holds his hand closer to the body).
  6. Fainting and fever.

Treatment measures and diagnostics

A very serious injury is a dislocation of the shoulder joint. First aid and medical intervention are prerequisites for the rapid rehabilitation and recovery of the patient to a normal lifestyle. It is necessary to anesthetize the shoulder joint, which is performed under general anesthesia to prevent other injuries while the doctor is working. Treatment is carried out on the basis of factors determined by manual method, and radiography.

After that, on the shoulder( where the shoulder joints), impose gypsum with a bandage. Such immobilization of the limb, as a rule, lasts about 4 weeks. After removing the bandage from gypsum and examining the radiograph, if there is no repeated dislocation of the shoulder joint, rehabilitation becomes a prerequisite for restoring the operation of the affected shoulder. It is also recommended to refrain from physical activity for two to three months.

Sometimes, in order to treat a doctor's diagnosis of "habitual dislocation of the shoulder joint", the operation is a necessary part of the recovery process, since other problems can also be identified, such as:

  • fracture of the bones of the shoulder;
  • muscle or joint bag injury;
  • damage to blood vessels or nerves.

As a rule, arthroscopy is performed. The surgeon makes very small incisions of the tissues, through which he introduces the camera and instruments. If the patient experiences numerous hand injuries and a habitual dislocation of the shoulder joint, the operation becomes a rather difficult task for the surgeon, after which the patient must avoid the movement of the upper limb for a long time( 6 weeks).

Rehabilitation

Rehabilitation is necessary for further treatment. The following nuances should also be considered:

  1. Avoid sharp movements of the shoulder joint for a short time after removal of the gypsum.
  2. Apply cold compresses to reduce swelling.
  3. Pharmacological treatment, which consists in taking anti-inflammatory drugs. If the pain is intense, you can ask the doctor to prescribe analgesics. The drug "Nurofen Plus" should be taken every 6 hours for 15 ml.
  4. Perform therapeutic procedures. They promote analgesic and anti-inflammatory action( cryotherapy), restoration of damaged soft tissues( magnetotherapy, laser therapy, ultrasound), increase muscle mass and strength( electrostimulation), improve blood supply and nutrition of tissues( whirlpool bath for upper limb).
  5. Massage of tissues adjacent to the joint, relieves stress, and also improves blood supply and nutrition.
  6. Mobilization of the shoulder joint.

It is best to perform medical exercises in the initial stage of rehabilitation with a psychotherapist. It is necessary to pick up easy manipulations without loading on the diseased joint, for example: isometric exercises and stretching tasks stimulating neuromuscular tissue. Step-by-step introductions to the emphasis, strengthening the strength of muscles and improving the stability, elasticity of soft tissues. At the last stage of treatment, exercises are used for the entire upper limb, increasing strength, controlling movement and work, improving the dynamics of movements of the shoulder joint.

Kinesiotherapy consists in wrapping the joint with special elastic patches. They have sensory action, improve the functioning of the joints. The patches applied to the scapular articulations provide stability, improve healing processes and reduce the risk of injury during exercise.

Complications of

Unfortunately, the diagnosis of "dislocation of the shoulder joint" is quite serious. Rehabilitation and treatment without accurate diagnosis can lead to numerous complications. These include:

  • instability of the joint;
  • peripheral nerve damage( tingling sensation, sensitivity disorders of the entire upper limb);
  • limitation of the range of movements in the joint;
  • relapses even after a trivial injury;
  • degenerative changes in the shoulder joint.

Ways to treat shoulder injuries at home

A little relief comes from applying a cold compress to the damaged area if a shoulder dislocation occurs. Treatment at home with severe injuries is impossible without the provision of qualified medical care. The injured person should be taken to a doctor who will take the necessary measures after performing X-rays. For the time of transportation, the hand must be fixed: it can be slightly bent at the elbow, pressed to the chest and wrapped with bandage to the body.

To relieve pain, an analgesic or non-steroidal anti-inflammatory drug( Nurofen Plus or Ibuprofen 15 ml every 6 hours) should be given. Recovery usually takes 3-6 weeks.

Then it is recommended to perform stretching exercises for the muscles of the arm and shoulder. After a series of such activities, when the limb will be fully functional, you can return to the sport, but only in special clothing, so that in case of a fall it prevents the dislocation of the shoulder joint. Home treatment and rehabilitation after trauma are possible with the systematic performance of stretching exercises, so that the muscles are elastic and less prone to damage. In the case of muscle strain, for example, after intensive training, you can apply ice to the shoulder.

Shoulder dislocation

This is a serious injury due to the inability to move the hand due to the dislocation of the shoulder joint. Treatment at home( first aid): drink pain medications in the dosage indicated in the instructions, tie your arm to your body, and then urgently visit an orthopedic or traumatologist. Such damage is a very serious injury that can lead to the death of nerves and blood vessels.

Tension of the tendons

What if I have sprained ligaments and a shoulder dislocation? Treatment at home involves the use of a cold compress( it is superimposed for half an hour), drugs with analgesic and anti-inflammatory action( gels, ointments).They are applied a thin layer on the damaged area several times a day. It is also necessary to rest your arm, that is, to limit movement.

Shoulder joint bruise

As a rule, it results from a sharp fall, which leads to damage to soft tissues. Signs of a bruise: gradually increasing pain, bruising, swelling. It is necessary to quickly apply ice to the site of injury. This will limit the hematoma and swelling of the soft tissues, unless, of course, there has been a dislocation of the joint.

And treatment with folk remedies in this case will not be superfluous: several times a day for 20 minutes, apply cooling compresses or ice cubes wrapped in foil or wrapped in cloth. Relief brings also ointments with analgesic and anti-inflammatory effect. They are applied several times a day. However, if the pain does not recede, you need to consult an orthopedist, since the injury can be much more serious than you think.

Folk remedies

A lot of home methods for eliminating the consequences associated with the diagnosis of "dislocation of the joint."Treatment with folk remedies is aimed at relieving pain. It is recommended to use compresses from hot milk: it must be heated, moistened with bandages and applied to the affected joint. Well helps finely chopped onions or "dough" from a glass of flour and a spoonful of vinegar. They need to be put on the damaged place and keep for half an hour.

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Dislocation of the shoulder - treatment - SportWiki encyclopedia

Help measures and treatment procedures that are performed on their own:

  • Stop any movements with the
  • shoulder. Call your doctor( immediately call an ambulance).
  • Apply ice immediately after the injury for 15 minutes.
  • try to fix the shoulder yourself
  • If the shoulder is fixed in the near future is not possible, then a fixing garter is made to eliminate the load and movements in the joint.

Medical care

Shoulder dislocation is regulated only by a qualified specialist under anesthesia or anesthesia, sometimes with the use of muscle relaxants. Never try to do this yourself, as this can lead to serious damage to the joint! Consult a doctor even if there has been a spontaneous redirection, it is necessary to inspect and exclude a fracture.

Diagnostics

Habitual dislocation of the shoulder with joint hyperactivity

Ideally, immediately after entering the trauma station, an X-ray is taken to exclude a fracture and also determine the type of shoulder dislocation. If this is not possible, then after returning the shoulder to the joint, it is necessary to take such a picture as early as possible.

After repositioning

After repositioning it is recommended:

  • Rest and lack of movements in the shoulder joint for 5-7 days, this is achieved by applying a fixative bandage or longi.
  • If there are complications: fractures or soft tissue disorders - it may require immobilization for a longer period.
  • Non-steroidal anti-inflammatory drugs such as ibuprofen or ketones may be required to relieve pain and eliminate inflammation.
  • After a period of complete immobilization, it is necessary to gradually include the shoulder in the work.
  • It is necessary to strengthen the ligaments that support the shoulder joint to prevent repeated dislocation.
  • Exercise using a light dumbbell and expander is perfect for early stages of rehabilitative treatment of shoulder dislocation.

Operation

Surgical intervention is sometimes required in order to prevent subsequent dislocation of the shoulder, or if there has been serious damage to the muscle, tendon, nerve endings, blood vessels or joint. The operation is usually performed as soon as possible after the injury.

In case of the development of the habitual dislocation of the shoulder, the operation can be proposed as an attempt to stabilize the joint by strengthening the ligamentous apparatus of the joint. There are a number of operational techniques that can be proposed for these purposes. The decision about which of them will be performed depends largely on the patient's lifestyle and the type of his activity. Some procedures lead to reduced mobility of the shoulder, therefore, are not suitable for athletes participating in those sports where it is necessary to throw a projectile or play a racket, since such a procedure will affect the sports results.

After the operation, sports activities will have to be postponed until full recovery and in the future does not overload the damaged joint.

Rehabilitation after dislocation of the shoulder

Warm-up of the shoulder before performing strength exercises

Stage 1: After reassembling the , the Dezo type dressing.

Purpose: Immobilization( immobilization) to prevent further damage and reduce pain and inflammation, creating conditions for scarring.

  • Duration: After initial dislocation, it takes 4-5 weeks.
  • Perform wrist and hand movements: finger rotation and hand tightening to the fist - to prevent stiffness and maintain normal blood flow in the fixed area, isometric exercises for the shoulder muscles, with an emphasis on the deltoid muscle.
  • Continue applying ice regularly to reduce pain and swelling.
  • If prescribed by a doctor, take anti-inflammatory or pain medications.

Stage 2

Purpose: After the immobilization has ceased. First shoulder movements.

  • Duration: 2-3 weeks
  • It is necessary to begin exercises to strengthen the muscles of the shoulder and shoulder straps. The amplitude of the movements is small, painless. The weight of the weights should not cause pain.
  • The starting points for the exercises should include support for the shoulder. Avoid combined movements, for example, pulling the arm to the sides or turning the shoulder outwards, as they can lead to repeated damage.
  • Only act if there is no pain.
  • Continue to wear a soft supporting bandage for the upper limb, 2 more weeks after immobilization ceases.
  • Apply ice after training if there is swelling

Stage 3

Purpose: Further strengthening of shoulder and foreleg muscles.

  • Duration: up to 3 months.
  • Active exercises are shown to restore the function of the flexor muscles of the shoulder, shoulder and rotator levies.
  • Providing support for the shoulder and protecting the capsule joint from stretching.
  • Do not rush to restore the full range of motion.
  • The amplitude of movement in full is restored to the year from the moment of injury.
  • Begin to refuse wearing a bandage.
  • Perform exercises with weights and resistance.

Stage 4

Goal: Return to sports loads.

  • Duration: from 6 months.up to 1 year.
  • Increasing the weight of dumbbells and other weights used to strengthen the periarticular muscles of the shoulder joint.
  • Begin to carry out the "lead-up" exercises specific to your sport: throws, shocks, imitations of shots, etc.
  • Increase the load gradually, controlling the technique of the exercise. Introduce difficultly coordinated exercises. Avoid stretching the capsule joint, jerking, loss of coordination of motion.

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The decision on the method of treatment is taken by a specialist, a trauma doctor, to which the victim must be delivered.

Treatment of shoulder dislocation includes a number of stages of

1. Dislocation of dislocation

Is carried out both conservatively, and with the help of an operation intervention.

Conservative treatment consists in the manual insertion of a dislocation.

In the procedure, fixing the joint in the physiological position is performed instrumentally( using special spokes).

Indications for surgical treatment are:

  • repeated repeated dislocations;
  • complex dislocations, accompanied by fractures of the head of the humerus and scapula;
  • chronic dislocation( when manual treatment was not within 2-3 weeks after injury).

2. Immobilization

Produced after the dislocation of the dislocation by additional fixation of the joint with special bandage or gypsum bandages.

The average duration of immobilization will be 3-6 weeks.

3. Drug Therapy

It is used in the administration of anti-inflammatory and analgesic agents( otrofen, ibuprofen, pentalgin, etc.), as well as agents that improve local circulation and relieve edema.

Drug administration is limited to three to four days after the dislocation is corrected.

4. Recovery and rehabilitation of damaged shoulder joint

This is carried out by methods of physiotherapy, physiotherapy and massage in combination with the individual characteristics of the injury.

To rehabilitation begin already in the first days of immobilization by activating the muscles of the injured hand in order that they retain their functionality until the bandage is removed.

  1. The first exercises assign fingers and wrist joints to the fingers.
  2. The next stage is the impact on the joint itself, the joint bag and the muscles covering it. The purpose of these actions is to relax the spasms at the first time after removing the muscle bandage and improve mobility in the joint with the help of gentle loading and massage under a special program.

The exercises use additional items - a ball, a stick, dumbbells. This period lasts up to three months from the time of injury.

Full recovery of joint work with the possibility of obtaining the previous loads is quite feasible in six months after the adjustment of the dislocation.

How to fix the shoulder joint?

Independent( or with the help of outsiders) correction of the shoulder joint dislocation is possible only in cases when such a dislocation was previously encountered in the patient, and it is impossible to apply for help of a professional at the moment.

Most often these( habitual) dislocations occur even with a slight load on the joint. Their frequency, which occurs six months after the previous one has been adjusted, increases to a dozen per year, reaching in some situations( washing, scratching) several times a day.

This condition requires mandatory surgical correction of the defect for the prevention of dislocations in the future.

Self-regulation is practicable in various ways, and each patient chooses his own

  • Clutching the hand of the injured hand between the knees, folds the trunk back.
  • With a healthy hand, he stretches a dislocated arm.
  • Self-rotates and retracts the hand in the desired direction( opposite to the dislocation of the dislocated head of the humerus).

With the help of others, you can correct the dislocation if you follow a certain procedure( Hipokrat's method).

  1. The patient lies on his back, preferably on a hill( bench, table).
  2. The assisting person is suitable from the side of the injury and tightly covers the victim's hand with his own hands, pulling on the injured limb.
  3. Simultaneously, he sets the heel of his foot in the armpit of the patient and presses the humerus head that has moved downward.

This is sufficient for the correction, which is characterized by a sense of "click".

Movement should be smooth, and in no case should you allow unexpected jerks, which only exacerbate the dislocation.

LFK or therapeutic exercises

In the period of immobilization, the set of exercises includes:

  1. passive( with the help of a healthy hand) and active finger movements of the brush with subsequent transfer of the load to the wrist joint4
  2. successive successive muscle tension of the brush in the first days after the injury, supplemented by the muscle tension of the forearm at the end of the first week after the injury andmuscles of the shoulder in the next two to three weeks.

The transition to a load on the next joint of a dislocated arm or a group of muscles does not at all abolish the set of exercises that were started earlier, but only supplements them.

In the postimmobilization period, after the removal of gypsum, certain exercises are included in the rehabilitation of the joint.

  1. Along with the increase in the volume of movements in the wrist, flexion-extension at the elbow joint is developed.
  2. Develop a shoulder joint by dosing the load on different planes of motion:
  • Light swinging movements of the limb back and forth.
  • Drawing of the arm bent at the elbow to the side.
  • Raise first with the help of a healthy, and then without it, the injured arm in advance.
  • Dosed pressure on the horizontal( table) and lateral( wall) surfaces by the pads of the fingers of the straightened arm.
  • The rotation of the palm of a free-hanging hand.
  • Mixing together and diluting both blades.
  • Raising the arm top( or putting an arm behind the back).

General principles of physical therapy with dislocation of the shoulder

  • Simultaneous and simultaneous exercise with a healthy arm.
  • Gradual increase in the pace and quantity of exercises and approaches to them.
  • The presence of visual control of the joint and movements with the help of a large mirror.
  • After 4 weeks after injury, it is necessary to include additional sports equipment: gymnastic stick, mace, ball, dumbbells, expander.

In addition to physical exercises, self-service skills are developed at each stage.

As the recovery occurs, the patient must be included in the household work.

Massages and physiotherapeutic procedures( hydrotherapy, UHF, magnetotherapy) are also important components of rehabilitation. They are appointed already in the first days after conservative or surgical treatment. Their goal is to relieve pain and improve blood supply in the area of ​​dislocation.

Basic principles of massaging the injured limb

  • Massage movements should not be painful.
  • In the presence of a fixative bandage, massage the open sections of the hand( fingers, hand, forearm) with the inclusion of the rest of the limb when removing the immobilization.
  • Massage movements should have a direction from the periphery of the limb to the joint.
  • Gradual increase in the intensity of pressure on soft tissues.

Features of the habitual dislocation of the shoulder joint and its surgical treatment

The main feature of the habitual dislocation of the shoulder joint, which develops due to incorrect manual correction of the previous or inferiority of the articular surfaces, is an increasing increase in its instability after each episode of a repeated loss of the head of the humerus.

In cases where a dislocation has already occurred repeatedly, only surgical intervention can stop this chain of injuries. Physical exercises, which the patient begins to perform to strengthen the joint after repeated dislocations, will not increase the stability of the operation and may, on the contrary, cause subsequent dislocations with further destruction of the joint.

There are numerous options for surgical interventions. However, with the widespread introduction of endoscopic, minimally invasive technologies into practice, the most common manipulation was the Bankart's operation.

  1. Under the control of optical( arthroscope) devices, surgical instruments are inserted through the holes pierced in the joint wall.
  2. With its help, plastic methods create a new joint lip along the periphery of the articular surface of the scapula instead of the lost one after numerous injuries or completely absent.
  3. For the reconstruction of the lips use special twisting small spokes( latches), which can be metal, remaining forever, or from a material that eventually dissolves.

For each type of fixation, there are indications, and their choice is made by a trauma surgeon.

In addition to using the arthroscope, operations can be performed by the open method when the joint bag is opened and all manipulations are performed under direct visual control of the physician.

The final stage of both types of operations on the joint are actions to directly strengthen the tendons and muscles that cover it.

Positive results of surgical treatment with complete absence after it of repeated dislocation can be achieved in 85-92% of cases.

Life after surgery: rehabilitation and rehabilitation

According to the methods and terms of rehabilitation after surgical correction of the habitual dislocation of the shoulder, the management of the patient after the operation completely coincides with the periods described above after manual repositioning of the shoulder.

Special feature, perhaps, is only special care for postoperative sutures and intra-articular drainage, which can be left for some time after the operation for additional control and administration of drugs that accelerate reparative processes.

Sutures are removed on the 7-9th day after the operation.

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Dislocation of the shoulder( shoulder joint of the hand) - Causes, symptoms and treatment. MF

In the "people" it is customary to call any dislocation of ligaments dislocated due to the twisting of the limb. However, dislocation of is considered the displacement of the articular surface of one bone relative to the other, the displaced articular part of the bone( in this case the head of the shoulder) is outside the joint and can simultaneously damage the nerves and vessels passing next to it.

Symptoms of dislocation of the shoulder

Of all the joints of the human body, it is the shoulder joint that is most often dislocated. The dislocation of the shoulder is one of severe injuries and is fraught with the development of complications. The most common complications after dislocation are: contracture( restriction of movements) of the shoulder joint, nerve damage and hand paralysis.

The main symptoms of shoulder dislocation are:

• Pain in the shoulder joint, which is strong enough and accompanied by a feeling of severe discomfort in the joint. • Visible deformation. Due to the displacement of the head of the shoulder, the shoulder joint is flattened, the head of the shoulder is probed in an uncharacteristic place, it can be checked by probing the healthy joint and comparing it with the dislocated one. • Restriction of movements in the shoulder joint. Active movements are severely limited, when you try to take your hand with help, there is a "symptom of springing resistance." • Edema in the dislocation of the shoulder can spread to the hand. • If the nerves are damaged, there may be paralysis of the hand or hand as a whole, as well as a violation of skin sensitivity.

With repeated( habitual) dislocations of the shoulder, all symptoms can be expressed to a lesser extent. The habitual dislocation of the shoulder can spontaneously recur and repeat at a frequency of several times a month or more, delivering a lot of indignation.

First aid for dislocation of the shoulder

The shoulder joint must be immobilized, this is achieved by hanging a hand on the kerchief. You can not try to independently adjust the dislocation, as well as engage in diagnosis and ask the patient to move his hand. With a pronounced pain syndrome, you can give anesthetizing, but remember that swallowing the tablets with liquid, you will delay the time of giving anesthesia to correct the dislocation.

Diagnosis of shoulder dislocation

For diagnosis, radiography is used, which is prescribed before and after the adjustment of the dislocation, to control the standing of bones in the joint. To determine the presence of ruptures in the capsule and muscles of the shoulder joint, ultrasound or MRI is performed. In case of nerve damage, electromyography is used.

Snapshot of shoulder dislocation

Treatment of shoulder dislocation

Treatment begins with a dislocation adjustment under general anesthesia. It is possible to direct the dislocation under local anesthesia with the usual dislocations of the shoulder and in the elderly. After repositioning, a gypsum or its replacement bandage is applied, immobilizing the shoulder joint for a period of 3-4 weeks. With old and stale dislocations, the direction can be associated with difficulties, in this case, the dislocation is eliminated by the operative method, simultaneously sewing the capsular-ligament apparatus of the shoulder.

Gypsum with a dislocation of the shoulder

With the usual dislocations, the operation on the plastic of the capsule and ligaments of the shoulder joint is done in a planned order, after the operation the joint is immobilized with a plaster bandage or a special discharge line.

The dislocation of the shoulder joint can be accompanied by damage and rupture of the rotator cuff of the shoulder joint, which also often requires surgical treatment and stitching and plasticity of the muscles surrounding the shoulder joint.

Rehabilitation after dislocation of the shoulder joint

From the first days after the adjustment of the dislocation proceed to active movements in the healthy arm and fingers of the sore arm.

From 7-10 days, it is possible to perform isometric contractions of the muscles under the plaster bandage. Also, physiotherapy can be prescribed in these terms: magnetotherapy( for the purpose of relieving pain and inflammation), UFO for a healthy shoulder joint( in this case, there is a reflex action), the procedures are prescribed by a course of 8-10 sessions.

After the removal of gypsum, the spectrum of physiotherapy procedures expands, ultrasound is prescribed, including hydrocortisone, magnetotherapy, laser therapy, electrophoresis, etc. All physiotherapy procedures are aimed at reducing pain and inflammation, and improving tissue nutrition, which accelerates the fastest development of movements and promotesrecovery.

To develop the movements in the shoulder joint proceed after the removal of gypsum, the exercises are done for 10-15 repetitions, 3-4 times a day. Exercises can be duplicated in the pool or sea water.

Exemplary exercises for the development of movements in the shoulder joint:

• Position - standing, with hands down along the trunk. Both shoulders are lifted and lowered with arms extended in the elbow joints. • Position - too. Circular movements in the shoulder joints • Position - too. We reduce and divide the shoulder blades on the back • Position - the brushes are placed on the shoulder joints. We make rotational movements in the shoulder joints • We try to close the brush in the lock on the back, changing them in turn, • We connect the brushes to the "lock", palms forward. We try to raise our hands as high as possible. • The position is the same. We spread our hands to the sides.

If you have significant difficulties, you need to use the help of the second hand. And to develop the outgoing movements in the shoulder joint, you can by moving your fingers along the wall. With the increase of the pain syndrome, take a break and( or) apply anti-inflammatory ointments( fastum gel, ultafastin, etc.) and salt baths.

After a month or more after the injury, you can start the massage. In the massage zone, except for the shoulder joint, you can include the entire cervical-collar zone.

General terms of treatment of a dislocation from 1.5 to 3 months.

Prognosis after dislocation of the shoulder

The prognosis is quite favorable, but can be quite serious if the nerves and muscles of the rotator cuff of the shoulder are damaged. Among the unpleasant consequences is the habitual dislocation of the shoulder, which occurs some time after the first dislocation and in the future, in the absence of the necessary treatment, can be repeated more and more often.

Doctor-Traumatologist Voronovich NA

# 2 TATYANA 06.18.2015 07:40LIKE TO THE DOCTOR YOU SHOW WHERE THIS DOCTOR ME TREAT FROM ONE DOCTOR TO ANOTHER DOCTOR I-LATER FROM MEDICINE I UNDERSTAND THAT THEY DO NOT KNOW THEM THEY # 1tatyana02.03.2015 08:26 after the dislocation of the shoulder dislocated her husband's swollen wrist-not possible to touch, very painful. We were guided in traumatology, the district surgeon can not achieve anything and he does not even look at the pictures. Thanks for the description of the rehabilitation, now at least we will know what to share further. But the brush is very troublesome

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Dislocation of the shoulder joint symptoms, treatment, rehabilitation How to treat a habitual dislocation of the shoulder joint

Dislocation is a painful displacement of the end of the joint, causing its dysfunction. In this case, there is no contact between the surfaces articulated with each other. Due to the structure of the shoulder joint, when dislocated, it is able to perform all available movements. Any instability of the shoulder joint releases the head of the humerus from the place of attachment, thus causing a dislocation.

Depending on the type of purchase, the dislocations of the shoulder joint are classified into two types:

  • congenital;
  • purchased.

The acquired shoulder dislocations are subdivided into the following subspecies:

  1. The habitual dislocation is a non-traumatic dislocation that occurs due to instability of the shoulder joint and occurs even under small loads.
  2. Traumatic dislocation is the most common type of dislocation, which can occur with complications or without complications.

In the area of ​​location, dislocations of the shoulder joint are divided into:

  • anterior dislocation, in which the head of the humerus is displaced forward and comes under the corpuscle process( sublocutaneous dislocation).And if the displacement of the head of the humerus occurs further, up to the clavicle, then such a dislocation is called subclavian;
  • posterior dislocation is the least common type of dislocation, in which a cartilage rupture occurs in the posterior part of the articular cavity. Such an injury is received mainly after falling forward with an outstretched hand;
  • lower dislocation is a rare type of dislocation, in which the head of the humerus is displaced downwards. With such trauma, the victim can not lower his hand down and is forced to hold it over his head.

Symptoms and causes of dislocation of the shoulder

Often the cause of dislocation of the shoulder joint is an external force action on it, which violates the complete freedom of movement of the joint. To such influences it is possible to include a twisting and an eversion. Let's consider more in detail other factors leading to dislocation of the shoulder:

  1. Hypermobility of the joints - contributes to the appearance of a shoulder dislocation in 10-15% of cases. This factor is a condition characterized by an overabundance of motor activity in the shoulder joints.
  2. Repetitive monotonous movements, which are characterized by multiple stretches of ligaments and capsules of the joint. This feature is mainly found in professional athletes engaged in those sports where movements are carried out with an excessive span and as a result lead to sprain of the shoulder ligaments.
  3. Dysplasia of the articular cavity of the scapula - this factor is very common due to the fact that some people due to their anatomical features are provided with a shallow articular cavity, which contributes to the dislocation of the shoulder joint.

The main symptoms of shoulder dislocation are:

  • acute attack of pain;
  • restriction of joint motion;
  • external changes of the shoulder joint;
  • , with damage to the blood vessels or pinching of the nerve, stitching pains, bruising in the affected area and numbness of the hands may appear;
  • violation of the sensitivity of the shoulder, forearm, hand.

For chronic dislocations, joint joint capsule and loss of elasticity are characteristic.

The first dislocation of the shoulder is often accompanied by pain, which indicates a rupture in the soft tissues. The subsequent dislocation causes much less pain, or it is completely absent.

Treatment of dislocation of the shoulder joint

Diagnosis of shoulder dislocation includes the following complex of measures:

  1. Medical examination of the victim;
  2. Collect information on the circumstances in which the injury was sustained;
  3. Appointment of additional research methods( computed tomography, X-ray, magnetic resonance imaging) if necessary.

It should be borne in mind that in no case should you attempt to independently fix your shoulder! You should immediately contact a specialist for help. After conducting the diagnosis and clarifying the circumstances of the injury, the doctor will anesthetize the joint and correct it. The next step will be radiography, after which it will be possible to assess the quality of the repositioning of the joint and exclude the presence of fractures.

  1. small tubercle of humerus;
  2. shoulder joint( capsule).

The structure of the shoulder joint has a number of characteristics, among which one can distinguish the processes of the scapula, especially the acromion. It begins with awn, that is, with a wide horizontal plate perpendicular to the posterior surface of the scapula, and divides it into the subacute and supragastric region.

Further the plate becomes much narrower already, it is directed outwards and upwards, where it bends in the form of a hook over the shoulder joint. With the collarbone, the acromion is connected by the anterior end with the acromioclavicular joint.

The tendon of the supraspinatus passes through the subacromial space located between the acromion and the head of the humerus.

The shape of the shoulder joint refers to the globular joints and is triaxial. Due to the fact that the shoulder joint is the most mobile in the human body, the hand has practically unlimited freedom of movement.

Reasons for

The main causes of dislocation of the shoulder joint are direct or indirect impacts to the joint area.

Also the dislocation of the shoulder occurs due to falling on elongated arms, or intense rotational motion with the application of force.

For athletes during weight training, especially for beginners who are not used to high loads, the dislocation of the shoulder occurs during the bench press laying, pulling up with weighting, as well as other types of exercises, which involve the use of the shoulder joint.

Symptoms of

The first thing that the victim feels immediately after a dislocation of the shoulder is acute joint pain , and a feeling of unnatural shoulder position.

Outwardly this is manifested by a violation of symmetry with respect to the healthy shoulder, the former rounded contour is lost, the joint becomes sharp, somewhat lowered.

The victim tries to press the injured hand to the body with a healthy hand to avoid inaccurate movements and do no harm even more.

If the dislocation caused damage to the nerves and / or blood vessels, the sufferer feels the stitching pain of , the hand may become numb, bruises appear in the area of ​​injury.

Classification of shoulder dislocation

Among the dislocations of the shoulder, the fore, subclavian, lower and posterior are distinguished.

Separately it is necessary to note habitual dislocations. When the shoulder is dislocated, the ovality of the contour of the shoulder joint is lost. It acquires swiftness, resembles the contour of the epaulet.

Front

With anterior dislocations of the shoulder, the subclavian fossa is smoothed.

Subclavian

With subcutaneous dislocations, the fossa becomes oval-convex. The shoulder, visually, appears shorter, it is slightly retracted, its axis shifts in the frontal plane inwards.

In the palpation examination of the shoulder region from the outside, the finger easily immerses under the shoulder strap, and below the collarbone, the head of the humerus is palpated.

Bottom

For lower shoulder dislocations, a noticeable shoulder deflection is characteristic, which often reaches a right angle, the head of the humerus is palpable in the armpit.

Rear

With posterior dislocations, the upper limb is shown and rotated inward. The shoulder also becomes a little shorter, and its axis is often shifted back in the sagittal plane. On the anterior-lateral surface, the portion of the shoulder joint is significantly flattened, and under the skin is the contour of the anterior margin of the shoulder shoulder of the shoulder blade, and the apex of the beak-shaped process and the anterior margin of the shoulder blade of the shoulder. On the posterior surface of the shoulder joint, in the place of the subacute fossa, an oval bulge appears.

When it is palpated, the head of the humerus is determined.

In case of displacement, the head of the humerus can injure the brachial plexus, which is manifested by paresthesia, paresis and paralysis of the injured limb.

Traumatic dislocations can be complicated not only by the trauma of the brachial plexus. Together with them, they diagnose and detachments of muscles attached to the large tubercle, as well as fractures of the latter.

Common shoulder dislocation

A habitual or repeated dislocation of the shoulder is an unstable condition of the shoulder joint, in which dislocation occurs even under low load. For example, when swinging for a throw, laying hands on the head, putting on clothes and even in a dream. Improper treatment of primary dislocation and rehabilitation leads to the development of habitual dislocation.

Correction of

Dislocations of the shoulder are corrected according to the method of Kocher , Hippocrates , Janelidze , Mota , etc.

Method of Kocher

The anterior dislocations are better to be guided by the method of Kocher.

Depending on the method of anesthesia, the dislocation is adjusted in the supine position on the back or sitting.

The assistant fixes the scapula to the table, and if the victim is sitting, then to the back of the chair.

The left hand surgeon grasps the injured hand of the injured person above the elbow, and the right hand over the forearm, bends it at the elbow joint to the right angle and gradually, without jerking or violent, performs the following actions( stages):

  • Stage I of the - smoothly,the surgeon exercises the traction( traction) of the shoulder down the axis, overcoming the contraction( contraction) of the muscles.
  • II stage - rotates the shoulder outward. In this position, the head has the smallest diameter, the angle between the head and the diaphysis is leveled. Due to this, it is prevented from clinging to it and further injury to nearby muscles when the head is displaced to the joint fossa.
  • Stage III of the - the surgeon, without reducing the thrust along the axis of the shoulder, leads the shoulder in the direction of the midline to the trunk so that it at the level of the lower and middle third rests against the thorax and the shoulder becomes a two-arm lever. The long arm of the lever is the upper and middle third, and the short one is the lower third of the shoulder. Next, the surgeon, keeping traction along the axis, presses the outer surface of the elbow joint( short arm) from the top down. At this time, at the end of the long arm develops a force that introduces the head of the humerus to the level of the articular fovea of ​​the scapula.
  • IV stage - after sensing the displacement of the head of the humerus and seeing the execution of the contour of the shoulder joint, the surgeon makes an energetic inner rotation of the shoulder and puts the forearm brush on the thorax at an acute angle in the position of pronation. At this time, the head of the humerus moves with a characteristic sound. As soon as the head is repositioned, "elastic mobility" immediately disappears, the ovality of the contour of the shoulder joint is restored. Immobilization is carried out with a Dezo bandage, which is additionally strengthened with gypsum bandages, for at least 3 weeks( the time necessary for the joint capsule to be jointed).Treatment without immobilization or early removal of it leads to a serious complication - a habitual dislocation of the shoulder.

Direction of a dislocation for Hippocrates

This method is also called military field. The victim lies on his back on the table or floor. The surgeon sits sideways facing him and takes the injured hand with both hands over the forearm above the wrist joint. After that, he inserts the middle section of the foot( and not the heel) of his leg into the armpit so that the arch of the foot covers it. In this case, the outer edge of the middle part of the foot rests against the lateral surface of the chest, and the inner edge - in the medial surface of the upper third of the shoulder. A two-arm lever is formed, the short head of which is the head and the upper third of the shoulder, and the lower is the middle and lower third of the shoulder. Having fulfilled the conditions described above, the surgeon starts gradually, without jerks, to increase traction along the axis of the hand with bringing it to the body. At this time, according to the principle of the action of the lever, the head is gradually withdrawn to the level of the articular fovea of ​​the scapula and its repositioning takes place. The contour of the shoulder joint takes the usual form, the symptom of elastic movement disappears, passive movements become free, unlimited. All these signs indicate that the dislocation is corrected. Immobilization is carried out with the Dezo bandage.

Method Dzhanelidze

An effective way to adjust the lower shoulder dislocations is the Janelidze method. The victim is put on the table on the injured side so that the spatula is fixed to the table and does not go beyond its edge, and the arm hangs freely. The head of the victim is held by an assistant or placed on an additional table. A prerequisite is to fix the blade to the table. Only with this condition in 10-15 minutes you can achieve relaxation of the muscles of the upper extremity belt. Having made sure that the muscles are relaxed, the surgeon flexes the forearm in the elbow joint to a 90 ° angle and gradually, with increasing force, presses the upper third of the forearm down. Perform small rotational movements, due to which the head is repositioned.

Treatment and rehabilitation after repositioning of

shoulder dislocation After shoulder adjustment, the patient is recommended:

  • Complete absence of movements in the shoulder joint for a week. For this, the doctor applies a fixative bandage or longi.
  • In the case of complications such as fractures or soft tissue damage, immobilization is required for a longer period.
  • For the removal or alleviation of pain and pain relief, non-steroidal anti-inflammatory drugs, for example ibuprofen or ketans, may be required.
  • It is necessary to switch on the shoulder gradually, and only after a period of complete immobilization.
  • To prevent repeated dislocations, it is necessary to strengthen the ligaments that support the shoulder joint.
  • At the initial stages of rehabilitation of shoulder dislocations it is recommended to use exercises with light dumbbells and expander.

Operation

Surgical intervention is required in cases when a dislocation of the humerus caused serious damage to the joint, muscles, tendons, nerve endings. The operation should be carried out as soon as possible after the injury.

The habitual dislocation of is subject to prompt treatment, since conservative methods are ineffective in this case. The operation is aimed at stabilizing the joint by strengthening the ligament apparatus. For these purposes, a number of different techniques can be proposed. To select the appropriate technique, the surgeon must take into account the patient's lifestyle and the nature of his activities. Some methods have disadvantages, which manifest themselves in the limitation of the function of the shoulder joint. Such operations are not suitable for athletes who participate in competitions such as projectile throwing, or tennis, where to kick the ball, the athlete is forced to make a strong swing.

Rehabilitation

After repositioning the shoulder dislocation, recovery rehabilitation includes four steps:

First stage. The use of a dezo dressing for immobilization, prevents further damage, reduces pain, inflammation, creates the necessary conditions for scarring. The duration of immobilization is about four to five weeks after the primary dislocation. The patient should perform not difficult exercises: squeezing the hand into a fist, spinning the fingers, in order to keep the blood flow in the area fixed by the bandage. Use cold compresses, and ice to reduce pain and relieve swelling. The doctor prescribes anti-inflammatory and pain medications.

The second stage. This stage begins immediately after discontinuation of immobilization and lasts for two to three weeks, at which time the patient continues to wear a soft supporting bandage. Begins to perform exercises to strengthen the muscles of the shoulder and shoulder. Amplitude and weight of weights should be selected in such a way that does not cause pain. The starting position provides support for the shoulder. To avoid repeated damage, it is necessary to avoid combined movements - hand-sideways movement, turning the shoulder outward. If there is a swelling after training, you can apply ice.

The third stage. The duration of the third stage is about three months. The patient's actions are aimed at further strengthening the muscles of the shoulder. It is recommended to perform exercises restoring the flexor muscles of the shoulder, the rotators and the leverage of the shoulder. It is important for the not to rush to restore the full amplitude of the movement, which will fully recover only a year after the injury. At the third stage, you can begin to take off the bandage and gradually give up wearing it altogether. It is also possible to increase the weight of weights when performing exercises, including resistance.

Fourth stage. This stage is focused on returning the patient to the usual activities and sports loads. It is allowed to increase the weight of the weights that the patient uses during exercises to strengthen the muscles of the shoulder joint. At this final stage of rehabilitation, it is possible to perform basic exercises specific to a particular sport, if the patient is an athlete. The load must be increased gradually, concentrating on the technique of execution. It is important for to follow the coordination of movements to avoid stretching the joint capsule.

A habitual dislocation of the shoulder is a pathology associated with chronic joint instability.

Because of the malfunctioning of the joint fixator, permanent dislocation occurs during physical activity or even sleep.

In 95% of cases, the anterior form of dislocation occurs. Dislocation can also be posterior, inferior, superior or intrathoracic, although they are very rare.

Treatment of dislocation of the shoulder joint involves an analgesic therapy after injury - this is the use of special medicinal preparations inside in the form of capsules. These drugs include orthophene, paracetamol, ibuprofen and others. In addition, during the next three days, a cold compress should be applied to the shoulder.

If there is a habitual dislocation, then the only way out of this situation may be a surgical intervention. There are many different options for surgical methods, but with the usual dislocation, the most common operation is Bankart.

In the treatment of dislocation of the shoulder joint, three stages play an important role:

  • repositioning;
  • restoration of the function of the shoulder joint.

Rehabilitation of the shoulder joint after a dislocation

Rehabilitation for a shoulder joint dislocation should include elements of health-improving physical culture. To the exercises you need to start from the first days after the procedure of correction.

As a rule, the rehabilitation period should consist of several stages.

  1. After the doctor puts the head of the humerus, the first stage of rehabilitation begins. Its duration is 7 days. The goal of this stage is to completely immobilize the hand in order to avoid repeated dislocation, as well as to prevent inflammation and reduce pain. The shoulder joint is immobilized with a special dressing. After the bandage is applied, it is necessary to perform exercises to compress the hand into a fist, and also to make rotational movements with your fingers, so that the normal flow of blood is carried out.
  2. The second stage usually lasts from 2 to 4 weeks. During this period, the patient works out the first movements with the shoulder after the dislocation.
  3. The third stage covers the next 4-6 weeks. During this period, the joint is strengthened by the full mobility of the shoulder. If the patient does not feel pain, then you can perform static exercises. When developing the joint, the hand should be withdrawn to the side and then it should be rotated. It is allowed to perform any movements, if this does not cause pain. During the third stage you need to gradually give up and bandages.
  4. The fourth stage can last from 6 to 10 weeks. It is designed to fully restore the functioning of the injured shoulder. If there is no pain, then it is necessary to continue to perform strengthening and rotational movements, as well as exercises that increase the mobility of the joint. In the case of a successful course, joint repair can begin to perform exercises with a small load. The fifth stage is the final stage. It lasts from 10 to 16 weeks. During this time, there is a return to the normal training regime. You should gradually increase the load so that the damaged shoulder can be fully used.

With proper performance of all exercises, the dislocation of the shoulder joint will never happen again. Rehabilitation measures are designed to minimize the possibility of re-injury.

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