Open dislocation of the left humerus. Shoulder dislocation: detailed description. Characteristic signs of dislocations

The shoulder joint is the most mobile in the human body. All types of movements are possible in it: flexion-extension, abduction-adduction, supination-pronation, rotation. The price for such freedom of movement is the significant “fragility” of this joint. This article will talk about the most common injury that awaits athletes who systematically overload their shoulder joints. This is a dislocated shoulder. In addition to the injury itself, we will touch upon issues of anatomy, biomechanics, first aid and, most importantly, preventive measures.

Anatomy of the shoulder joint

The shoulder joint is directly formed by the head of the humerus and the glenoid cavity of the scapula. The articular surfaces of the designated bones do not have absolute congruence. Simply put, they are not perfectly adjacent to each other. This moment is compensated by a large formation called the articular labrum. This is a cartilaginous body adjacent, on the one hand, to the articular cavity of the scapula, on the other, to the head of the humerus. The area of ​​the articular lip is much larger than that of the articular surface of the scapula, which ensures greater adherence of the articulating surfaces within the joint. The head of the humerus and the glenoid cavity of the scapula are covered with hyaline cartilage.

Joint capsule and clavicle

The described structure is covered on top by a thin articular capsule. It is a sheet of connective tissue that covers the anatomical neck of the humerus on one side and the entire circumference of the glenoid cavity of the scapula on the other. Fibers of the coracobrachial ligament, the tendons of the muscles that form the so-called rotator cuff, are also woven into the tissue of the capsule. These include the infraspinatus, supraspinatus, teres major and subscapularis muscles.

The listed elements strengthen the shoulder capsule. The muscles that form the rotator cuff provide a certain range of motion (read more about this below). Taken together, this formation limits the immediate joint cavity.

The clavicle also plays an important functional role in the structure of the shoulder joint. Its distal end is attached to the acromion or acromial process of the scapula. When the shoulder is abducted above an angle of 90 degrees, further movement occurs due to the mutual movement of the clavicle, the lower pole of the scapula and chest. Looking ahead, we will also say that the main muscle serving the shoulder joint - the deltoid - is attached to the described anatomical complex.




Rotator muscles

The condition of the muscles surrounding it is important for the health of the joint. (this statement applies to all joints of the human body, not just the shoulder ones). Let us repeat that the muscles serving the shoulder joint are located, so to speak, in two layers. The deep muscles include the already mentioned muscles - rotators:

• infraspinatus - located on the body of the scapula, as you might guess from the name, under its axis and is responsible for supination of the shoulder;
• supraspinatus - located above the axis, is involved in abducting the shoulder from the body. The first 45 degrees of abduction are performed primarily by the supraspinatus muscle;
• subscapular - located on the anterior surface of the body of the scapula (between the scapula and the chest) and is responsible for performing supination of the head of the humerus;
• large round - runs from the lower pole of the scapula to the head of the humerus, woven into the capsule by a tendon. Together with the infraspinatus muscle it performs pronation of the shoulder.

Moving muscles

The tendons of the biceps and triceps brachii muscles pass over the joint capsule. Since they extend over the head of the humerus, attaching to the acromion process of the scapula, these muscles also provide certain movements in the shoulder joint:

• the biceps flexes the shoulder, bringing the body of the humerus 90 degrees to the upper shoulder girdle;
• the triceps, together with the posterior head of the deltoid muscle, extends the shoulder, moving the body of the humerus back relative to the body of the scapula;

It should be mentioned that the pectoralis major and minor muscles and the latissimus dorsi muscles are also attached to the articular tubercles of the humerus, providing the corresponding movements:

• pectoralis major and minor muscles - responsible for bringing the humerus bones towards each other;
• The latissimus dorsi muscles provide downward movement of the bodies of the humeral bones in the frontal plane.

The deltoid muscle is directly responsible for movements in the shoulder joint. It has the following attachment points:

• the scapula axis is the point of origin of the posterior portion of the deltoid muscle;
• acromion - attachment point of the middle portion of the deltoid muscle;
• The acromial end of the clavicle is the attachment point of the anterior portion of the deltoid muscle.

Each portion, in fact, fulfills different function, however, balanced movements in the shoulder joint require coordinated work of all three “bundles”. This is emphasized by the fact that all three delta bundles converge into a single tendon, attached to the deltoid tuberosity of the humerus.

The large volume of the listed muscles provides an appropriate range of movements. However, practically they are the “base” of the joint. The shoulder does not have a reliable bone structure, which is why during sports activities, especially when performing amplitude movements, the shoulder joint is injured.




Mechanism of injury

A shoulder dislocation is a displacement of the head of the humerus relative to the glenoid cavity of the scapula. There are several types of shoulder dislocation based on the direction of displacement.

Anterior dislocation

This type of injury occurs most easily, since it is the posterior pole of the humeral capsule that is least strengthened by tendons and ligaments. In addition, the posterior portion of the head of the deltoid muscle must provide stability. However, it is not sufficiently developed in the vast majority of ordinary people, and athletes are no exception.

This injury can occur under the influence of a jerking effect on a limb - when practicing martial arts, performing elements on the rings, or on the uneven bars, the starting point for entering a handstand. An anterior dislocation is also possible due to a blow to the shoulder joint - when practicing striking martial arts (boxing, MMA, karate), or when landing after performing a jumping element (workout, parkour).

Posterior dislocation

Posterior shoulder dislocation and with does not occur as often as the front one, but, nevertheless, quite often in percentage. In this case, the head of the humerus moves to the back of the glenoid cavity of the scapula. As you might guess, such a displacement of the humeral head occurs when the anterior pole of the shoulder joint capsule is injured. Most often, the shoulder is in a flexed position, with the arms extended in front of the body. The impact occurs on the distal part of the arm. In other words, in the palm of your hand. Such an impact is possible when falling on outstretched arms, for example, with insufficient technical performance. Or when the weight of the barbell is incorrectly distributed when performing a bench press.




Lower dislocation

With an inferior dislocation, the head of the humerus is displaced under the glenoid cavity of the scapula. This type of injury is not common and occurs when the arm is raised up. Such an injury is possible when performing the “flag” exercise, when performing walking on hands, snatch and push. Snatch and push, in this case, are the most traumatic, since the shoulders are in an anatomically unfavorable position, and the load is vertical.

Habitual dislocation

There are other types of shoulder dislocations, but they are essentially combinations of the types of injury described above.

The most unpleasant consequence shoulder dislocation is its chronicity - the formation of a habitual dislocation. This condition is characterized by the fact that any minimal impact on a previously affected joint is enough to cause a full-fledged dislocation. Most often, this pathology develops due to improper treatment of a primary shoulder dislocation.

Signs and symptoms of a dislocation

The following unpleasant symptoms indicate an injury to the shoulder joint, namely a dislocation:

1. Sharp pain in the area of ​​the damaged joint, accompanied by a kind of “wet crunch”.
2. Inability to make active movement in any of the axes of mobility of the shoulder joint.
3. Characteristic displacement of the head of the humerus. In the deltoid region, the acromial process of the clavicle is determined, under it there is a “depression”. (With a lower dislocation, the arm remains raised upward, the head of the humerus can be felt in the chest area, under the armpit). The area itself, compared to a healthy one, looks “sunken”. In this case, the affected limb becomes relatively longer.
4. Swelling of the affected joint area. Develops due to traumatic damage to the vessels surrounding the joint area. The spilled blood permeates the soft tissues, sometimes forming a fairly large hematoma, which brings additional pain. Moreover, you will not see “blue discoloration” of the deltoid region immediately after injury; subcutaneous vessels are damaged extremely rarely, and a visible hematoma is characteristic only of direct injury to these vessels.

First aid for a dislocated shoulder

Don't try to straighten your shoulder yourself!!! In no case! Inept attempts at self-reduction of the shoulder lead to injuries to the neurovascular bundle and serious ruptures of the shoulder capsule!

First, you need to fix the limb, ensuring its maximum rest and limited mobility. If there is a painkiller (analgin, ibuprofen or diclofenac and the like), it is necessary to give the medicine to the victim to reduce the severity of the pain syndrome.

If there is ice, snow, frozen dumplings, or vegetables, it is necessary to apply an existing cold source to the damaged area. The entire deltoid region should be in the “cooling” zone. This way you will reduce post-traumatic swelling in the joint cavity.

Next, you need to immediately deliver the victim to a medical facility where there is a traumatologist and an X-ray machine. Before reducing the dislocation, it is necessary to take an X-ray of the shoulder joint to exclude a fracture of the body of the humerus and scapula.

Treatment of dislocation

As for how to treat a dislocated shoulder, we will give only a few general tips, since self-medication in this case can be very dangerous. The treatment process includes several stages:

• reduction of the dislocation by a qualified traumatologist. Better - under local anesthesia. Ideally, under anesthesia. Pain relief provides relaxation to muscles that spasm in response to injury. Thus, the reduction will be quick and painless.
• immobilization and ensuring complete immobility of the shoulder joint. The period of immobilization is 1-.5 months. During this period we try to achieve maximum healing of the shoulder capsule. For this purpose, during this period, a variety of physical therapy is prescribed to help improve blood circulation in the affected joint.
• rehabilitation.

We will talk about the rehabilitation stage for a shoulder dislocation in more detail below.

Rehabilitation

It is necessary to gradually expand the range of movements immediately after removing immobilization. Despite the fact that the connective tissues have grown together, during immobilization the muscles have weakened and cannot provide proper stability to the joint.

First stage of recovery

In the first three weeks after removing the fixing bandage, kinesio tape can be a reliable help, activating the deltoid muscle and thereby increasing the stability of the joint. During this same period, all possible presses and deadlifts should be eliminated. The remaining exercises available are:

1. Straight arm abduction to the side. The body is fixed in a standing position straight. The shoulder blades are brought together, the shoulders are separated. Very slowly and under control, we move our arm out to the side at an angle of no more than 90 degrees. We also slowly return it to its original position.
2. P ronation-supination of the shoulder. The elbow is pressed to the body, the arm is bent at the elbow joint at 90 degrees. The humerus stands still, only the forearm moves. We alternately bring and abduct it, with dumbbells clamped in the hands, left and right. The amplitude is minimal. The exercise is performed until a feeling of warmth, or even heat, appears in the inside of the shoulder joint.
3. WITH bending the arms in a machine that eliminates traction of the injured arm. Such, for example, is a block exercise machine with a built-in Scott bench.
4. R when bending the arms in a machine that simulates the French bench press, the humerus in relation to the body should not be placed at an angle of more than 90 degrees.

The weight of the weights is minimal; when performing them, you need to concentrate on the muscle sense. Barbells and dumbbells of moderate and heavy weight are completely prohibited at this moment.

Second phase

Three weeks after removing immobilization, you can include front raises and bent over flyes to engage the anterior and posterior portions of the deltoid muscle, respectively.

We begin to perform side flyes in two versions: with small dumbbells and extremely clean technique - to strengthen the supraspinatus muscle, and with slightly heavier dumbbells (preferably in a machine, but it may not be available in your gym) to target the middle portion of the deltoid muscle.

Thus, you need to train for another three weeks. And only after this period has passed, you can carefully return to your usual training regimen, gradually including pressing and pulling movements into the training program. Better - in simulators, with moderate or even light weights.

Third stage

After the four-week stage, you can move on to working with free weights. It’s better to start with a barbell, and only after that move on to working with kettlebells and dumbbells. Once you have mastered the movements with them, you can start working with your own weight again.

Prevention of shoulder dislocation involves systematically strengthening the rotator cuff muscles using the exercises described in the first stage of rehabilitation and working with each muscle bundle separately. Special attention attention should be paid to the posterior portion of the deltoid muscle, which is responsible for the stability of the posterior pole of the shoulder joint capsule.

You should never start training deltoids with heavy weights and bench press exercises. As a warm-up, it is very useful to pump up each bundle individually and perform exercises for the rotator cuff.

Injurious exercises

As is not difficult to understand from what was written above, the most traumatic exercises in CrossFit are gymnastic elements performed on rings and parallel bars, snatch, clean and jerk and exercises leading to them, walking and handstands.

However, not a single exercise will harm you if you approach your exercises wisely and in a balanced manner. Avoid one-sided loads, develop your body harmoniously and be healthy!

Shoulder dislocation is an injury that occurs when the head of the humerus extends beyond the boundaries of the glenoid cavity connecting to it.

Appears, as a rule, under the influence of unfavorable external influences in the form of strong blows and various kinds injuries Next, you are invited to familiarize yourself in more detail with basic information about shoulder dislocations, their types, causes, characteristic symptoms and treatment methods.

The dislocation in question can be of the anterior and posterior type, as well as lower - this is determined by the direction of displacement of the above-mentioned bone.

1. Front. Diagnosed in the vast majority of situations. The head of the bone moves anteriorly. If this type of damage occurs, the bone may go under the beak-shaped part of the shoulder blade and move further to the front, penetrating under the collarbone. In most cases, anterior dislocations are accompanied by a relatively minor disruption of the structure of the cartilaginous ridge.
2. Rear. Relatively rare injury. Accompanied by the departure of a cartilage roller in the area of ​​​​the posterior part of the cavity. It is formed mainly when a person falls on his arms outstretched in front of him.
3. Lower. Accompanied by downward movement of the head of the humerus. In the presence of such damage, it becomes impossible to lower the upper limb down - until a specialist sets the damaged joint, the injured person will only be able to keep his arm raised.

Classification of dislocations

The damage studied may be congenital or acquired. The latter are additionally classified into injuries of non-traumatic and traumatic groups.

The non-traumatic category includes chronic as well as voluntary dislocations. Regarding traumatic disorders, this category includes uncomplicated and complicated dislocations. The second group includes habitual and repeated dislocations, as well as chronic dislocations and fracture-dislocations. Additionally, this includes open dislocations, accompanied by a violation of the integrity of the tendons and neurovascular bundle.

In accordance with average statistical data, about 60% of all cases of damage to the shoulder girdle are caused by dislocations of traumatic origin. This frequency can be easily explained by the anatomical and physiological properties of the joint being studied: the dimensions of the socket and the head of the bone connecting to it do not coincide, the joint has a high density, the capsule is characterized by low strength - these and other associated factors contribute to an increased risk of dislocations.

The concept of habitual dislocation

The occurrence of this pathology is facilitated by fractures of the joint cavity, various types of violations of the integrity of the neurovascular bundle and other factors. Most often, the problem develops due to a dislocation of a traumatic nature if the rules for its treatment are not followed. As a result, damaged tissues are restored with scarring, which causes disruption of normal muscle balance. The joint becomes unstable, which is the main provoking factor in relation to habitual dislocation.

From the patient’s perspective, the situation looks like this: some time ago he suffered a severe shoulder injury. After some time, dislocations began to occur again even in the absence of significant loads. Moreover, the more often repeated dislocations appear, the less load is enough to cause the next injury and the faster it will pass.

Medicine knows cases when patients had over 500 dislocations in their history and they occurred every day, sometimes even several times. From medical care Such patients, as a rule, refused and adapted to self-reduction of the joint, which is incorrect, because this can cause all sorts of complications.

Causes of dislocations

The appearance of such injuries is facilitated, first of all, by blows to the corresponding area or, which according to statistics occurs even more often, by a fall on arms outstretched in front of oneself. Also among the provoking factors should be considered careless rotational movements of the upper limbs with the application of force.

What is noteworthy is that shoulder dislocations are diagnosed relatively rarely in people involved in powerlifting and bodybuilding, but receiving such injuries causes many problems and seriously threatens the possibility of further training as usual.

That is why athletes whose lifestyle involves serious stress on their shoulders and body as a whole need to be especially careful and attentive to their health.

Characteristic signs of dislocations

Symptoms of shoulder dislocations are described in the table.

Table. Signs of a shoulder dislocation

First aid

First, the victim must stop moving the affected part of the body.

Secondly, you need to call ambulance or promptly transport the patient to the emergency room if he can walk independently.

Thirdly, you need to apply an ice pack or any other cold object to the damaged area. After holding for 15 minutes, you need to take a break and then repeat the manipulation.

Fourthly, it is necessary to exclude independent attempts to reduce the damaged joint. If it is not possible to quickly seek help, the shoulder should be secured with a bandage.

The doctor will assess the victim’s condition and send him for an x-ray to determine the type of dislocation and exclude/confirm the presence of a fracture.

Treatment and rehabilitation

Treatment is carried out in several stages.

1. The doctor numbs the damaged area with an injection of an appropriate drug, for example, novocaine.

   
   

2. The specialist adjusts the shoulder.

   

   

   This process is accompanied by quite severe pain. That is why a painkiller injection is given first. If the dislocation cannot be adjusted manually, surgery may be required. During the operation, the specialist realigns the joint and ensures its fixation using needles and sutures.

3. The shoulder is immobilized, promoting faster recovery and minimizing the likelihood of relapses. The damaged area is immobilized using a Deso bandage, splint or other available means at the discretion of the doctor.

   
   

4. Rehabilitation measures are carried out, the main task of which is to strengthen the ligaments and muscles, thereby significantly reducing the risk of recurrence of dislocations. A variety of physiotherapeutic procedures, exercises, and massages help well.

   
   

In some cases, it is necessary to resort to surgical intervention. Most often, the need for this arises with very severe injuries or the development of a habitual dislocation.

The choice of a specific treatment option remains with the attending physician. Any vigorous activity and stress on the shoulders can be resumed only after complete restoration of the damaged areas. Specific recommendations for further life activities will be provided by the attending physician, taking into account the individual characteristics of the patient’s condition.

As for rehabilitation, the duration and severity of this process varies depending on the age of the patients and the characteristics of their life activities. For example, healthy adults recover in an average of 3-4 weeks. Athletes will have to wait at least 1.5-2 months before beginning a gradual return to sports.

You can begin to gradually develop the joint only after the complete disappearance of swelling and painful sensations. The selection of rehabilitation exercises is carried out by a doctor on an individual basis, focusing on the severity of the dislocation and its characteristics. You are invited to familiarize yourself with the list of exercises that are used in most cases. Before performing any of these, be sure to consult with your healthcare professional.

Useful exercises

The exercises are based on rotational-translational movements. The pace of execution is slow. Any sudden movements are excluded. The proposed complex makes it possible to restore the tone of damaged muscles and generally normalize the function of the shoulder joint. The optimal number of repetitions in each exercise is 5.

1. Lower your upper limbs down, press them towards your body. Your feet should be spaced shoulder width apart. Alternately raise your shoulders and lower them down.
2. Make circular movements with your shoulders. First work in one direction, then in the opposite direction.
3. Bend your elbows. Raise your hands to your shoulders. Make rotational movements with your arms.
4. Raise your hands up and clasp them together. Holding the “lock” above your head, make rotational circular movements to the left, then to the right. If performing this exercise is difficult, first work on one arm, first bending it at the elbow, then the other. Support your working hand with your free hand.
5. Clench your fists. Hold your arms in front of you and alternately bend and straighten them at the elbows.
6. Take turns placing your hands behind your back.
7. Place your palms together with your fingers pointing upward. Press your palms firmly against each other for a few seconds, then relax your hands.

You have now learned the basics about shoulder dislocation. Remember: the sooner you see a doctor if you are injured, the faster and easier the treatment and recovery process will be. Follow the recommendations of specialists, take care of yourself and be healthy!

Video - Shoulder dislocation symptoms

The shoulder joint is a ball-and-socket joint. This form of bone articulation allows for high-amplitude movements in all planes. The Achilles heel of such possibilities is the weakness of the ligamentous apparatus of the shoulder, which, under unreasonable loads, leads to dislocation of the shoulder joint.

A dislocation is a violation of the anatomical correspondence of the articular surfaces of the articulating bones.

Due to its mobility, the shoulder joint is more susceptible to dislocation than others.

In a specific case, the head of the humerus slips beyond the articular surface of the scapula.

There are three locations for the slipped humeral head:

• Anterior to the joint;
• Inferior to the joint;
• Posterior to the articulating surface of the scapula.

This topography of the lesion is due to the characteristics of the shoulder joint capsule.

In the upper sections, the capsule is significantly thickened due to the inclusion of a large number of muscles of the shoulder girdle and shoulder into its structure of tendon fibers. The lower pole, in addition to the absence of a tendon-ligamentous frame, also has free space in the form of a Riedel pocket, which allows you to freely make circular movements with your shoulder while throwing your arms behind your head, but does not at all contribute to strengthening the joint.

There are:

• Congenital dislocation of the shoulder. This pathology may be caused by insufficiency of the articular surface of the scapula or underdevelopment of the articular labrum, designed to increase the articular area of ​​the scapula;
• Acquired shoulder dislocation. In everyday life, this is usually an unsuccessful fall back or forward onto an outstretched arm.

According to the timing of the lesion, dislocations are divided into:

• Fresh, when the injury period does not exceed three days;
• Stale, if the injury occurred within a period of time from three days to three weeks;
• Old, in the absence of reduction of the dislocation for more than three weeks.

A first-time acute dislocation of the shoulder is accompanied by well-defined general symptoms in the form of severe pain, sometimes accompanied by nausea and single vomiting.

Local symptoms of a dislocated shoulder joint are characteristic enough to determine the diagnosis even for the victims themselves, these are:

• Flattening of the shoulder joint;
• Pathological fixation of the shoulder position in abduction;
• Absence of any active movements in the area of ​​the affected shoulder;
• Spring resistance when trying to perform a passive movement.

How to help before medical intervention

First aid for a dislocated shoulder joint is to create absolute rest for the injured limb, call an ambulance medical care, but not in an attempt to return the shoulder to its place, no matter how easy it may seem. Immobilization of the arm is carried out by bandaging the injured limb bent at the elbow to the body.
First, a roller twisted from available fabric should be installed in the armpit of the affected shoulder. You can cover the joint with ice wrapped in a cloth.
Watch the video on how to provide first aid for a sprain:

Pain is not an ally of treatment

Treatment of a dislocated shoulder joint means its reduction, which must be carried out under conditions of adequate pain relief. Anesthesia is carried out either by giving general anesthesia or by performing conduction anesthesia of the brachial plexus, sometimes with an additional single injection of narcotic analgesics.

Complete anesthesia leads to the relief of stressful tendon-muscular tension, which contributes to atraumatic reduction of the dislocation and, as a consequence, to the absence of post-therapeutic complications.

It is important to have an x-ray of the shoulder taken before starting treatment. Despite the obvious signs of dislocation of the shoulder joint, it is necessary to exclude the possibility of concomitant fracture of the articulating bones and compression of the neurovascular bundle. Infringement of nerves or blood vessels when juxtaposing articular surfaces will lead to serious consequences.

X-ray of the shoulder excludes a possible fracture

Why is immobilization necessary?

In second place in importance of therapeutic procedures, after proper analgesia, is immobilization for dislocation of the shoulder joint. For young people, it is carried out by applying a plaster splint extending from the healthy shoulder girdle through the elbow of the sore arm to the fingertips.

The arm plastered in this way is supported in a suspended state by a scarf bandage across the neck.

To restore full functional activity of the shoulder, it is important to comply with the full period of immobilization, which is 3 weeks.

If this requirement is ignored, complete anatomical and functional restoration of the muscles and tendons does not occur, gross scar changes occur, which ultimately leads to the formation of conditions for the occurrence of habitual shoulder dislocation.

For older people, avoid applying plaster splints and limit yourself to fixing the injured arm with a Deso bandage for up to 14 days.

The Deso bandage for a shoulder dislocation should be worn for two weeks.

The application of a scarf bandage for dislocation of the shoulder joint is a supportive measure in the first 10-14 days after removal of immobilization.

Read about how to choose a brace for the shoulder joint

Rehabilitation and what happens if you neglect it

Despite the fact that complete immobilization of the shoulder joint is an indispensable condition for recovery, rehabilitation measures cannot be neglected, which must be carried out in stages, based on the statute of limitations for the reduction of the dislocation.

Rehabilitation after a dislocation of the shoulder joint begins on the second day after applying an immobilization bandage and is aimed at improving the metabolism of damaged tissues, preventing atrophic changes in the muscles and ankylosis of the joint.

Recovery begins with isometric tension of the arm muscles and performing hand movements in the same mode as the healthy arm.

A set of exercises for restoring the shoulder joint after a dislocation begins with circular movements in the wrist joint, after which flexion-extension movements of the hand are performed, followed by clenching the fingers into a fist. By sending a mental working impulse to the shoulder muscles, resting your elbow on the fixing bandage, you can achieve rhythmic tension in the shoulder muscles.

During the same period, it is already possible to use medications aimed at pain relief, relieving swelling and resolving hematomas. These include amplympulse therapy, UHF, high-frequency magnetic therapy.

After removing the fixing bandage, a second rehabilitation period begins, which lasts up to 10-14 days and is accompanied by wearing a supporting bandage. Massage for a dislocated shoulder joint is performed precisely at this time and is in the nature of a warming procedure before performing a complex set of exercises.

The entire set of exercise therapy exercises for dislocation of the shoulder joint is performed in a scarf and all movements associated with the load on the shoulder are performed in a passive mode with the help of a healthy arm. During this period of time, swinging, swinging and circular movements of the shoulder, and hanging on the arms are prohibited. Only non-sharp movement of the shoulder girdle muscles up and down is permissible.
What exercises you can do - watch the video:

Complete development of the shoulder joint after a dislocation is possible only if the first two stages are successfully and painlessly completed.

At this time, the full load on the shoulder gradually returns, the exercises are performed with reasonable weighting.

In case of non-compliance with medical instructions, ignoring periods of rehabilitation, which is accompanied by early load on the damaged joint, the preconditions are created for the occurrence of habitual dislocation of the shoulder joint. Habitual dislocation is not accompanied by pain and the frequency of its occurrence encourages patients to treat shoulder dislocation at home, without resorting to specialized care.

Surgery

The ease of independent restoration of the conformity of articular surfaces should not lead to a rosy euphoria in the perception of the situation. Over time, pathological changes in the periarticular tissues worsen and the shoulder loses its functionality, and the frequency of dislocations reaches a tiresome number.

In this case, when seeking medical help, surgical intervention will be considered as a treatment option. In addition to the increasing risks of such treatment, the rehabilitation period increases and the question arises about the cost of such a solution to the problem.

After surgery, an even longer period of shoulder immobilization will be required.

If the price of surgery for habitual dislocation of the shoulder joint (which depends on the class of medical institution and the complexity of the reconstruction, and ranges from 13,000 to 80,000 rubles) greatly depletes the wallet, another opportunity is provided to treat habitual dislocation of the shoulder joint without surgery.

There is nothing new in this provided opportunity. The same immobilization after reduction of the dislocation (already extended to 1.5 months) and the same three-stage recovery period. Unfortunately, conservative therapy in this case rarely achieves a positive result.

Conclusion

The desire to be healthy must be supported by the conscious actions of the patient himself.

The cause of suffering is not always the lack of qualifications of the doctor. Often the patient himself becomes the source of countless troubles.

It should be remembered that correctly performed reduction of a dislocation is only the beginning of recovery and treatment of a dislocation of the shoulder joint after reduction has a significant role in preventing the development of complications and their correction.

Shoulder dislocations are a fairly common and, as a rule, reversible injury to the shoulder joint, as a result of which the patient loses the ability to perform the entire range of movements of the upper limb.

General

The shoulder joint is the most mobile joint in the human body. It allows you to raise your arms, put them behind your back, and reach the back of your head. It is generally accepted that only thanks to work and one’s own hands did a person become a person, but it would not be an exaggeration to say that all the variety of functions of the human hand comes precisely from the amazing mobility of the shoulder joint.

Movement in the shoulder joint occurs in three planes, but people have to pay for the increased range of motion in the joint with a decrease in its stability. The area of ​​contact between the bones of the head of the humerus and the glenoid cavity of the scapula is not so large, even taking into account the cartilaginous lip that surrounds it and expands the friction area of ​​the joint surfaces and its stability.

The joints themselves are formed by the glenoid socket, the head of the humerus, which is identical in shape to the socket, and the clavicle. The head of the humerus bone is fixed in the desired position thanks to the cartilaginous cushion located along the edge of the glenoid cavity and the connective tissue that forms the articular capsule. The strength and stability of the joint is provided by the muscles and tendons with which it is surrounded on all sides.

The tough tissue that forms the joint capsule is the ligament system of the shoulder joint, which helps the head stay in an anatomical position relative to the socket of the scapula. The veins are firmly fused with a thin capsule and they consist of the coracobrachial and articular-brachial ligaments, and have three bundles - upper, middle, lower. The shoulder joint is also surrounded by powerful muscles and tendons that provide stability through their efforts. These include the supraspinatus, infraspinatus, teres minor and subscapularis muscles. They form the rotator cuff.

Causes of damage

Shoulder dislocations have different causes, but the most common is trauma or force.

• Trauma is a fall on an outstretched arm or on the shoulder and entails a fracture of the glenoid cavity, head of the bone, coracoid and other processes of the scapula.
• Congenital anomalies in the shoulder joint - an anatomical feature of the development of the articular cavity in the scapula is characterized by small depth and inferior shape.
• Increased joint activity or generalized hypermobility is a pathology in which unusual movements appear in a joint. Excessive mobility of the shoulder joint occurs in 10–15% of the world's inhabitants.
• Stretching of the joint capsule is provoked by the implementation of identical repetitive movements. They cause constant stretching of the capsule and ligaments. Athletes most often suffer from this, namely swimmers and tennis players.
• Diseases of the shoulder joint such as arthritis, arthrosis.
• Systemic and other pathologies - tuberculosis, osteomyelitis, osteodystrophy, osteochondropathy.

Repeated injuries to the shoulder cause the ligaments to weaken, and as a result, the stability of the joint itself also weakens. A habitual shoulder dislocation is caused by the fact that the rotator cuff muscle was unable to fully recover after the patient dislocated the shoulder due to an injury.

The recurrence of a shoulder dislocation can be triggered by ordinary daily movements: cleaning the apartment, washing the floors, trying to put something on the top shelf. Moreover, each subsequent dislocation of the head of the humerus more and more disrupts the stability of the joint, as a result of which the intervals between relapses are reduced, and subluxations or dislocations occur more and more often.

Classification of dislocation

This injury to the shoulder joint is divided into several types. This can be either a dislocation of the shoulder or a subluxation of the shoulder joint. It can be habitual, as well as primary and others with the same, almost identical symptoms.

But in any case, first aid for a dislocated shoulder should be provided in a timely manner, and consist of applying a bandage and other actions. This will significantly reduce the risk of developing consequences. To make a diagnosis, it is necessary to take into account not only the causes, but also the types of injury.

By time of occurrence

1. Congenital dislocation - diagnosed in a child, can be detected even in a newborn or in the first year of his life.
2. Acquired dislocation or subluxation of the shoulder - typical for adults and children school age. Also seen in older people.

Classification of shoulder dislocations based on their causes

Acquired dislocations are divided into two types - habitual and traumatic.

Habitual shoulder dislocation is characterized by disruption of this area of ​​the bone, even under minor loads. This happens when there is an untreated injury, irritation of a bundle of blood vessels and nerves, and other violations of joint integrity.

Traumatic shoulder dislocation occurs much more often. It can lead to consequences, but it can pass without them. Complications include rupture of the capsule, tendons, soft tissues, blood vessels and nerves. There are several types of traumatic dislocation.

By location of humeral head displacement

• Anterior shoulder dislocation. The most common injuries in this area are anterior dislocations, which are the result of direct impact to the bone when the shoulder is struck from behind. Less commonly, such dislocation occurs due to convulsions.
• Posterior shoulder dislocation. Direct or indirect injury is necessary for a posterior dislocation to occur. Typically, this upper extremity injury occurs when the impact occurs on shoulders that are flexed or in a position of internal rotation.
• Inferior dislocation occurs infrequently and is due to impact on the shoulder, which is too far abducted, that is, the arm is above the horizontal level.
• Posteroinferior and anteroinferior dislocations are very rare and are a combination of the above forms.

There are also such concepts as primary shoulder dislocation and secondary or repeated dislocation.

Primary dislocations are the concept of when a dislocation occurs for the first time. The likelihood that after this injury the shoulder will dislocate again increases, especially if first aid for a dislocated shoulder was provided unskilled or when treatment for a dislocated shoulder did not give the desired effect, or the patient did not follow the doctor’s instructions.

In traumatological practice, in 75% of cases of the total number of all dislocations and subluxations of the shoulder, an anterior injury is diagnosed. In second place is the lower dislocation of the shoulder joint of the right or left arm—about 20% of cases.

Important! A shoulder dislocation is a serious injury that requires immediate action. The main symptoms and treatment of the injury can only be determined by a specialist. The diagnosis is made in accordance with ICD 10 in the clinic after examination. But, before this, it is necessary to recognize the characteristic symptoms of a dislocated shoulder and provide first aid to the victim, fix it with a bandage and take other first aid actions necessary for a dislocated shoulder based on the symptoms.

Symptoms

Signs of a dislocation of the shoulder joint, if the injury is primary, are pain, which is mostly caused by rupture of soft tissues. With repeated dislocations, there is much less pain or no pain at all. This is due to the fact that the structures that stabilize the joint have been damaged by a previous injury.

The symptoms of a shoulder dislocation are in many ways similar to those of other joints.

Symptoms of subluxation of the shoulder joint, like dislocation, are characterized by sharp pain in the corresponding place. One of the signs is shoulder deformity and drooping arm. Any movement is impossible due to increased pain and disruption of its functioning. During passive movement, springy resistance is felt.

The asymmetry of the shoulder joints is visually noticeable. The joint itself becomes angular, concave or sunken. Upon palpation, the doctor determines the protruding head of the bone emerging from the bed.

• Anterior dislocation is characterized by downward and forward movement of the head.
• For the anterior inferior - displacement to the anterior part of the axilla or down the coracoid process of the scapula. The victim is forced to keep his arm in a comfortable position: abducted and turned outward or bent.
• In the lower form of the pathology, the head moves into the armpit, the arm goes numb completely or in certain parts.
• With a posterior dislocation, the head moves towards the scapula.

A dislocated shoulder may have other symptoms.

• swelling of the shoulder joint;
• feeling of goosebumps on the arm;
• pain not only in the area of ​​injury, but also along the pinched nerve.

If a shoulder dislocation is severe, complications can develop. The greatest danger is represented by damage to the neurovascular bundle, open damage to the bone structure and soft tissues, and a closed fracture of the humerus.

Habitual shoulder dislocation can be complicated by other pathological situations. Among them is a Bankart injury, when the joint capsule ruptures and a section of the articular labrum is torn off. There are no external manifestations, but there is severe pain and the consequences are unpleasant.

How to identify a shoulder dislocation? Knowing the listed signs of damage, this will not be difficult to do.

First aid

What to do if you have a dislocated shoulder? When providing assistance, the main thing is not to try to straighten the joint yourself. The joint should only be adjusted by a specialist; a non-professional may cause damage to nerves or blood vessels.

1. Completely avoid any movement of the injured arm.
2. Use painkillers.
3. Apply a cold compress to the affected area.
4. Suspend your hand on a scarf.
5. Call a medical team.

Diagnostics

How to treat a dislocated shoulder? The attending physician will answer this question only after he receives the diagnostic results.

The diagnosis of humeral dislocation is made after examination and additional methods. During the examination, the specialist will ask about the circumstances of the injury and symptoms. The doctor will conduct a series of tests, examine the area of ​​the shoulder joint, prescribe x-rays in two projections, and then prescribe treatment.

To clarify the diagnosis and determine treatment tactics for a dislocation of the right or left shoulder, the doctor may prescribe a CT, MRI, or ultrasound examination. Based on the data obtained, one can understand the need to wear a bandage and undergo surgery.

In case of damage to blood vessels, before prescribing treatment, a consultation with a vascular surgeon is required; if a rupture or compression of the nerves is suspected, a consultation with a neurosurgeon is required.

After diagnosis, the doctor will talk about treatment; if there is a comminuted fracture, he will explain about repositioning the fragments. He will also answer how long the injury takes to heal, what consequences the injury may have, and how long the rehabilitation lasts.

Treatment

Treatment for a dislocated shoulder occurs in three stages.

The first stage is reduction

Reduction can be closed or open - respectively, non-surgical and with the help of surgery.

Closed reduction of a fresh shoulder dislocation is done under local anesthesia; for this, the affected area is injected with novocaine. To relax the muscles, a muscle relaxant is administered intramuscularly, and in case of severe pain, a narcotic analgesic is administered. Old habitual dislocation of the shoulder joint is eliminated under general anesthesia.

The most common options for reducing the joint are the Dzhanelidze, Mukhin-Mota, Hippocrates, and Kocher methods. Which one is used depends on the type of damage.

Reduction of habitual, repeated injuries or those that could not be eliminated by the closed method is performed using surgical intervention with fixation of the head of the humerus with special knitting needles and sutures in the glenoid cavity.

Treatment of habitual dislocation performed surgically at this stage consists of taking non-steroidal anti-inflammatory drugs and non-narcotic analgesics.

The second stage is immobilization

Treatment after shoulder reduction involves immobilization. This is necessary to secure the joint in the desired position, heal the capsule and prevent relapses. A special bandage or splint is applied to the arm for a period of one month. As soon as the joint is in the correct position, the signs of injury will disappear.

It is important to adhere to the recommended period of wearing the bandage, even if swelling, pain and other symptoms have disappeared. Joint capsules do not heal if shoulder immobilization is stopped prematurely. This provokes habitual dislocation, with subsequent damage to surrounding tissues.

The third stage – rehabilitation

A rehabilitation specialist is responsible for restoring the functions of a dislocated joint after immobilization. Physiotherapy helps to strengthen the ligaments and muscles of the shoulder - massage, electrical muscle stimulation and exercise therapy.

Rehabilitation is also divided into three periods:

The first 3 weeks are aimed at increasing muscle tone and activating their functions after immobilization.

A set of exercises after a dislocation of the shoulder joint begins with circular movements in the wrist joint, followed by flexion-extension movements of the hand, followed by clenching the fingers into a fist. By sending a mental impulse to the shoulder muscles, resting your elbow on the bandage, you can achieve rhythmic tension in the shoulder muscles.

At this stage, physiotherapeutic procedures can be carried out aimed at pain relief, swelling and resorption of hematomas.

The first 3 months are spent developing the joint and restoring mobility.

If the shoulder joint is dislocated, it is at this time that it is recommended to carry out a massage, which warms up the limb before a complicated set of exercises.

All exercise therapy for dislocation of the shoulder joint is performed in a scarf and all movements associated with the load on the shoulder are carried out in a passive mode with the help of a healthy arm. At this time, swinging, swinging and circular movements of the shoulder, and hanging on the arms are not allowed. Only non-sharp movement of the shoulder girdle muscles up and down is allowed.

Six months are allotted for complete recovery after a dislocation.

After treatment for a dislocated shoulder joint has stopped, they begin to gradually return the full load to the shoulder. It is recommended to perform exercises with reasonable weights and prescribe a special massage.

Important! If medical instructions are not followed or the rehabilitation period is ignored, the preconditions are created for the occurrence of a habitual shoulder dislocation. And due to the fact that habitual shoulder dislocation is not accompanied by pain, and the frequency of its occurrence pushes patients to treat shoulder dislocation at home, without resorting to specialized help. All this leads to negative consequences.

Surgical intervention

The ease of self-recovery after a dislocation should not make the victim want to refuse medical care in favor of home treatment. In the future, pathological changes in the periarticular tissues worsen, the shoulder loses its mobility, and the frequency of dislocations reaches a large number.

In this case, when you seek help from a doctor, the damage can only be cured through surgery, since neither immobilization and subsequent massage can give the desired results. Such treatment significantly increases the rehabilitation period and is much more expensive.

Complication

A shoulder dislocation is a fairly serious injury. Rehabilitation and therapy without accurate diagnosis can lead to the following complications:

• Joint instability.
• Damage to peripheral nerves.
• The range of motion in the joint is limited.
• Relapses after the slightest injury.
• Degenerative changes in the joint.

Important! Dislocation of the shoulder joint, treatment at home can be carried out only after a specialist has taken all the necessary actions. After a shoulder dislocation, you must follow all doctor’s prescriptions at home. Only in this case will treatment and rehabilitation give positive results. It should be remembered that you cannot immediately load the damaged joint - physical activity it should be given gradually.

Do not delay diagnosis and treatment of the disease!

Make an appointment with a doctor!