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Wednesday, 20.09.2017, 10:25
Main » Traumatology » Traumatic dislocations of the shoulder 
19:32
Traumatic dislocations of the shoulder


Traumatic dislocations of the shoulder are very common. They constitute more than half of all dislocations. Exposure to the shoulder joint dislocation due to its high mobility, high traffic volumes, which runs the joint.

The joint is formed on the one hand the spherical head of the humerus, on the other side of the plane, ellipsoid articular surface of the scapula. The contact between the articular surfaces is small, usually only a quarter of the articular surface of the humeral head is in contact with the blade. The stability of the joint to a large extent carried out joint capsule, ligaments and muscles - the so-called rotary cuff.

The mechanism of traumatic dislocation of the shoulder joint is more often indirect. If you fall on the outstretched arm raised or abstracted forms a lever that moves the head of the shoulder. Joint capsule in this case is terminated. The head of the humerus can move in different directions.

Distinguished:
  • front
  • lower
  • posterior shoulder dislocation.

Anterior dislocations occur most often (75%). If the capitellum has shifted slightly, so called dislocation podklyuvovidnym (head under the coracoid process scapula). With a significant displacement of the head, it is under the collarbone and a dislocated subclavian call. When the anterior dislocation of the shoulder can occur fractured acromion or coracoid process scapula, as well as the separation of a large tubercle of humerus.

At the lower dislocation of the humerus head is shifted to the axillary fossa and palpated there. Frequency of the lower shoulder dislocation about 20%. Posterior dislocation usually occurs by direct blow to the shoulder. The head of the humerus while shifting back to the shoulder blade. Posterior dislocation occurs rarely. Its frequency is about 1%. When the anterior dislocation of the shoulder holds the patient's shoulder with his good hand. Motion in the affected shoulder joint and arm sharply painful and almost impossible. The patient leans in the direction of a dislocated shoulder. The form of the shoulder changed: under the skin acts as acromion process of the scapula and shoulder joint in place there is retraction.

At the rear shoulder dislocation rotated forward, and at the bottom head shoulders palpable in the axilla. If the displaced capitellum compresses the neurovascular bundle, there hands and paralysis of muscles innervated by numbness in the affected areas of skin nerves. Diagnosis clarify when the X-ray study. As first aid is necessary to carry out joint immobilization with splints or bandages ladder desault and deliver a patient to a hospital.

Treatment of dislocation of the shoulder. Performed anesthesia by injection of local anesthetic into the shoulder joint. You may need narcotic analgesics, and administration. Most often used promedol. Straighten the joint should be as early as possible. There are many techniques reposition the shoulder joint. The most commonly used methods Janelidze, Mukhina, Mota, Kocher, Meshkov.

In field conditions can be applied method of Hippocrates, when the joint reduce a patient lying in using hands and heels doctor. After a successful reposition of dislocation imposed by the type cast desault for one month. Then, to develop joint appointed physiotherapy and physiotherapy. If you can not straighten the joint, surgery is carried out. Reduce a joint and fix the spokes or polyester suture. Up to half of patients after the first shoulder dislocation suffered habitual dislocation.

Habitual shoulder dislocation occurs frequently without much physical exertion, and during normal movements in the joint. The reason for habitual dislocation of soft tissue injury is the shoulder joint elements: the joint capsule, rotator cuff shoulder paresis of individual shoulder muscles. Some patients themselves familiar reduce a dislocation. Frequent repeated sprains further worsen the condition of the tissues surrounding the shoulder joint. The degree of joint damage clarify ultrasound, arthroscopy. Treatment of this condition promptly. There are about 150 procedures. Their use depends on the quality of trauma surgeons.



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