Habitual dislocation of the shoulder joint: treatment, operation

Habitual dislocation of the shoulder

Habitual dislocation of the shoulder- a pathological condition in which after a primary traumatic dislocation of the shoulder, the patient experiences repeated dislocations as a result of a small physical effort. Develops with normal movements, in the absence of violence.

It is manifested by pain, deformity and impossibility of movements in the shoulder joint. As a rule, it is easy to reset, often spontaneous reentry is observed. The diagnosis is made on the basis of anamnesis, clinical data and radiographic findings.

Conservative treatment is usually ineffective, surgery is required.

The habitual dislocation of the shoulder is the repeated persistent separation of the articular surfaces of the head of the shoulder and the articular cavity of the scapula, which arises after the usual traumatic dislocation of the shoulder.

According to various data, the outcome is 12-17% of traumatic dislocations. Usually detected in people of working age (20-40 years), men suffer 4-5 times more often than women.

Right-sided habitual dislocations are observed more often left-sided, possibly two-sided lesion. Poorly succumb to conservative therapy, usually requires surgical intervention.

The treatment of this pathological condition is performed by traumatologists.

Causes of habitual dislocation of the shoulder

It has been established that the development of this pathology is facilitated by damage to the joint lip (Bankart injury).

Articular lip is a fibrous-cartilaginous formation, which is attached to the articular cavity of the scapula, making a concave the surface of the shoulder joint is deeper and prevents the separation of the head of the shoulder and the cavity of the shoulder blade with intense movements.

In addition, patients with habitual dislocations often have posterolateral defects of the head of the humeral bones, caused by a compression fracture, not detected during the primary traumatic dislocation.

In such cases, the soft-tissue joint structures damaged during the traumatic dislocation do not have time to fully recover. Are formed areas of non-affection and rough persistent scars.

There is a muscle imbalance, the joint becomes unstable.

The likelihood of developing habitual dislocations also increases with certain individual features of the structure of the shoulder joint, for example, a slightly concave, flat articular cavity.

The immediate cause of repeated dislocations are usually abduction movements, external rotation and shoulder-back movement.

A combination of two or three listed movements is often observed, sprains that arise as a result of unidirectional movement are less common (for example, only abduction or only rotation).

Among the typical actions that cause habitual dislocations - dressing, raising hands, pulling on the crossbar, lifting weights, etc. Sometimes a dislocation occurs in a dream.

Usually the more repeated the dislocation, the easier it arises. In this case, the number of dislocations can vary considerably - from 2-3 to several dozen times.

In most cases, patients adjust the habitual dislocation themselves or with the help of relatives. The reason for going to the emergency room is usually a failure when trying to self-reinstatement.

If the patient arrives in the state of another dislocation, there is a characteristic deformation of the shoulder joint (in the place of the head a depression is defined). The patient holds the sick arm healthy.

Movement in the shoulder joint is impossible, when trying to passive movements, a springing resistance is determined.

Seeking medical help in a state of remission, as a rule, occurs after several (sometimes several dozen) repeated dislocations. When examined in such cases, no pathology is often detected.

The diagnosis is made on the basis of anamnesis, old X-rays and extracts from the medical history. In some cases, blurred muscle atrophy, as well as reduced pain and skin sensitivity in the joint area.

Often there is a restriction of movements, caused by both indistinctly expressed cicatricial contracture, and fear of repeated dislocation - a motor stereotype is developed, in which patients are accustomed to avoid movements that can provoke relapse.

To more accurately assess the condition of dense structures, x-ray of the shoulder joint is prescribed.

At the same time, a defect can be defined on the posterolateral surface of the head of the humerus (only found when special stowage with the rotation of the shoulder, sometimes to identify pathological changes, several pictures). It is possible to increase the distance between the upper part of the head of the shoulder and the acromion, as well as damage to the edge of the articular cavity.

If the radiography data for some reason is not enough to determine the tactics of further treatment, patients are referred to the CT of the shoulder joint.

In order to get an idea of ​​the state of soft tissue structures, perform an MRI of the shoulder joint. If necessary, perform contrast arthrography.

Conservative therapy of habitual dislocations is in most cases ineffective.

However, with a small number of dislocations (no more than 2-3), you can try to designate a special complex of exercise therapy and massage to strengthen the muscles of the shoulder girdle.

At the same time during the treatment it is necessary to limit the external rotation and abduction in the shoulder joint. With ineffectiveness of conservative treatment and a large number of dislocations, the only reliable means is surgery.

There are about 200 surgical techniques for treating this pathology.

All surgical methods can be divided into 4 groups: operations aimed at strengthening the capsule of the joint; plastic surgery on the muscles and tendons; osteoplastic operations and operations using transplants; combined methods, combining the elements of several listed methods. In this case, the most common is Bankart's operation, in which the surgeon fixes the cartilaginous lip and creates from the capsule of the joint a connective tissue roller that limits excessive mobility of the head shoulder.

Operation Bankarta can be carried out both in a classical way (through a normal cut), and with the use of arthroscopic equipment.

In the latter case, two small incisions of 1-2 cm are made in the joint region.

, an arthroscope and manipulators are inserted through the incisions, after which all necessary elements of surgical intervention are performed under the control of vision.

The use of arthroscopic technique can significantly reduce the traumatic nature of the operation, minimize the risk of complications and shorten the period of rehabilitation of the patient. Currently, this technique becomes the gold standard in the treatment of habitual dislocations of the shoulder.

Along with this, there are other methods, shown with certain pathological changes in the joint, or used in the absence of arthroscopic equipment.

All interventions are performed in a planned manner, in a hospital setting, after a necessary examination.

In the postoperative period, massage, exercise therapy and physiotherapy are prescribed, including amplipulse therapy, ozocerite, magnetotherapy and UHF. For pain use phonophoresis with analgin.

Immobilization is usually retained for a month. Then the gradual development of the joint with the use of exercise therapy (including exercises in the pool) and physiotherapy methods begin.

2-3 months after surgery, emphasis is placed on restoring the amplitude movements in the joint and training the muscles of the shoulder girdle, using special exercises and classes on simulators.

Full recovery, as a rule, occurs within 3-8 months from the moment of operation.

A source: http://www.krasotaimedicina.ru/diseases/traumatology/recurrent-shoulder-dislocation

Habitual dislocation of the shoulder: treatment without surgery and surgery of the shoulder joint, rehabilitation

The shoulder joint is the most mobile compound in the human body. The head of the shoulder is adjacent to the joint deepening of the scapula. Thanks to the ball joint, the range of movements of the hand is wide enough.

This is the main advantage and the lack of unstable shoulder joint, which is often traumatized. When dislocated, the head of the shoulder emerges from the joint cavity.

After the first injury, the probability of repeated damage increases.

A habitual dislocation is a condition for which a free displacement of articular surfaces is characteristic without trauma.

If the head of the shoulder does not completely exit from the joint cavity, and then becomes in place, then the subluxation appears. Frequent recurring injuries threaten loss of bone tissue and degeneration of cartilage. As a consequence, the likelihood of severe arthrosis increases.

In the article you will learn everything about the habitual dislocation of the shoulder, as well as about treatment without surgery and with surgery on the shoulder joint.

Types of habitual dislocation

The brachial junction consists of the clavicle, scapula and humerus. The head of the shoulder is adjacent to a small depression of the shoulder blade.

At the edges of the cavity envelops the woven lip, due to which the depth of the articular cavity increases.

During the dislocation, the lip is detached, which is then most often fixed only with the help of special implants.

Frequent dislocations of the shoulder cause tension and rupture of ligaments and tendons. As a consequence, the number of injuries increases in the future. Thus, habitual dislocation is a condition for which a persistent inability to hold the head of the shoulder in the articular cavity is characteristic.

Types of dislocation, depending on the direction of displacement of the head of the humerus:

• Anterior dislocation occurs most often, with the humeral head moving forward to the coracoid process or collarbone;
• Rear - arises from falling on an elongated forward limb. This is a rare type of injury, in which the joint lip breaks away from the cavity of the scapula;
• Bottom - the head of the shoulder goes down, and therefore the injured person's hand is over his head.

In case of traumatic dislocation, the capsule is broken and the humeral head is displaced. The main reason is a stroke or other physical effect on the brachial junction.

Types of dislocations, depending on the period from the first injury:

1. Fresh - after a primary dislocation has passed 3 days;
2. Stale - after the first trauma has passed from 4 days to 3 weeks;
3. Elderly - from 3 weeks or more.

In the absence of treatment, the dislocation of the shoulder joint can become chronic, which greatly worsens the quality of life.

Causes of habitual shoulder dislocation

There are several causes of dislocation:

• Syndrome of hypermobility generalized is a congenital increased flexibility of joints, which is accompanied by a crunch and aching pains;
• Glenoid dysplasia (articular cavity of the scapula) is a pathology in which a flattened articular cavity can not hold the head of the shoulder;
• Hypoplasia of the articular cavity - the lower part of the articular cavity is not completely formed, as a result the humeral head is displaced;
• Frequent overload of the shoulder joint. This problem is typical for athletes (swimmers, tennis players, volleyball players) who repeat the movement over their heads many times in a row. Because of stressful loads, ligaments and tendons are weakened, stretched, provoking the instability of the articulation.

Instability of the brachial junction is a condition characterized by predisposition to dislocation with a slight load on the joint.

Trauma is manifested by dull pain and discomfort in the shoulder area. The hand moves with effort, and you hear a click.

Characteristic symptoms - the tension of the shoulder girdle, involuntary contraction of the shoulder to the chest due to painful sensations.

Chronic instability of the humeral joint is a dangerous condition. It is important to conduct surgical treatment in time to restore the structure of the joint. In addition, it is necessary to constantly check with a doctor and follow his recommendations.

Single dislocation increases the likelihood of relapse. This is due to the fact that the ligaments overstretch and the joint lip does not withstand tension.

At risk, patients who first traumatized before age 30. People of this age group suffer from complications and fractures more often than others.

Symptoms of dislocation

A habitual dislocation is diagnosed if after the first trauma has passed from 3 months to 2 years. Each repeated case is characterized by a reduction in the intervals between dislocations.

In this case, the traumatic force that causes the displacement of the head of the shoulder becomes more and more insignificant.

For example, 4 to 5 times a dislocation may occur due to the fact that the victim will start the limb by the head.

With each subsequent episode, it is easier to set the bone, and painful sensations are almost not felt. In addition, the victim begins to independently adjust the bone, which is displaced.

The clinical picture with the usual dislocation is as follows:

1. Under the influence of a minor traumatic force, the area of ​​the shoulder is deformed, with the articular cavity the shoulder head slips, it moves to the chest and its contours can be considered as skin;
2. Painful sensations with each repeated dislocation become less intense;
3. Over time, there is an increase in the volume of the muscles of the shoulder and shoulder girdle on the damaged side;
4. The range of movements of the injured hand is reduced, especially in the lead position;
5. If the nerves or blood vessels are damaged during a trauma, there is a sensation of numbness, tingling, bruising, a pulse on the aching limb is not felt.

Doctors categorically forbid to direct the joint independently without the necessary qualifications and experience. In this way, nerves and blood vessels can be damaged, which increases the likelihood of loss of motor function of the hand.

If you experience symptoms typical of a habitual dislocation, you must immobilize the injured limb, fix it with a soft bandage.If necessary, a cold compress is applied to the joint to reduce puffiness. Then the patient is transported to the emergency station.

Diagnosis of injury

Identify the habitual dislocation of the shoulder joint is quite simple. First of all, the doctor collects an anamnesis, conducts a visual examination, palpates the humeral joint.

Then tests are conducted, which allow you to assess the strength, the volume of movements of the limb, to identify the degree of instability. For example, the victim is asked to perform a circular motion with the injured hand and palpate the shoulder.

If a spring resistance is felt during the test, then there is a dislocation.

The neurologist asks the patient about the preservation of the sensitivity of the skin. If the victim feels numbness in some areas, then this indicates a disruption of the operation of the shoulder joint.

Specify the diagnosis will help radiography, computer and magnetic resonance imaging. These studies can determine the type of dislocation and exclude or confirm fracture.

Conservative treatment

Doctors say that treatment of the habitual dislocation of the shoulder joint with the help of medications is meaningless. In this case, surgical treatment will be most effective.

There are more than 300 methods of restoring the shoulder joint with the help of surgery. However, even a surgical procedure can not guarantee recovery without qualitative rehabilitation.

After all, it is important to gradually include the muscles-rotators, ligaments and tendons.

Power kinesitherapy stabilizes the musculature with the help of step-by-step metered power loads.First, the victim is engaged in preventive training, and then performs a program of general physical training.

In addition, physical exercises improve the blood flow in the capsule, stabilize the joint, restore and gradually increase the range of movements of the injured arm.

At stages 2 and 3, the patient gradually increases strength and muscular tone, strengthens ligaments, tendons that support the capsule of the shoulder.

The amplitude of the movements of the injured limb reaches the norm, the regeneration is accelerated. In addition, special exercises allow you to avoid repeated dislocations.

This is an effective treatment technique that not only restores the shoulder joint, but also strengthens the immune system. The main thing is to follow the recommendations of the doctor.

Surgery

If the patient leads an active lifestyle, from which he does not want to give up, but because of which the shoulder joint becomes unstable, the only way out is an operation.

Do not do without surgical intervention in those cases when the habitual dislocation occurs during sleep, dressing, work, etc.

To treat the trauma use open and minimally invasive methods.

Arthroscopy is a minimally invasive surgical procedure that allows you to examine and treat the shoulder joint.

Manipulation is carried out using an arthroscope (an instrument that is placed in the space of the shoulder joint through a puncture in the skin).

A small tool practically does not damage the tissues that surround the articulation, after which they heal faster and its functionality is renewed. Arthroscopy allows you to explore soft woven and stabilize the shoulder joint.

During the operation, the doctor removes damaged tissue, bony growths, fixes the torn lip, restores the structure of the joint deepening. For fastening use special anchors or anchors.

An anchor anchor is placed in the bone through a small incision in the skin under the care of an arthroscope. Threads that leave the anchor are guided through the joint of the joint and are attached to the bone with the help of knots.

Special implants are made of metal, which eventually dissolves. Depending on the degree of damage, you need 2 to 4 anchors or anchors. If the arthroscope is used during the procedure, the patient can go home the same day.

If the joint is highly unstable or there are a lot of dislocations, an open surgery is needed. This refers to patients with bone defects of articular deepening of the scapula.

Surgery is performed with loss of the bone mass of the anterior part of the articular recess of the scapula.

This procedure compensates for the missing bone in this area.

After surgery, the area of ​​the articular cavity of the scapula increases, and the muscle and tendon stabilize the shoulder joint during the removal of the arm.

Rehabilitation after surgery

For the treatment to be successful, it is necessary to follow the doctor's recommendations after the operation. The recovery rate depends on the type of operation. In most cases, the lower arm is allowed to move on the second day after surgery.

Perform movements limb in the shoulder joint after 7 to 20 days (the final term also depends on the type of operation).

A full range of movements can be made in 40 - 56 days. Full recovery of the shoulder joint is expected in 3 months.

After the treatment of the habitual dislocation, you can return to work and exercise after 3 months.

If it is a question of hard physical labor or professional sport, then the recovery period can take 12 months.

In any case, this decision is made by the attending physician on the basis of research.

After surgical intervention, the probability of repeated dislocation is reduced by 5 - 8%, depending on the type of operation.

Thus, postoperative rehabilitation with a dislocation of the humeral joint consists of the following items:

• Immobilization of the joint for a week;
• Light exercises with the lower part of the injured limb for normalization of blood circulation;
• Use of cold compresses and analgesics.

Physiotherapy exercises under the supervision of a specialist will help gradually strengthen the muscles, ligaments and tendons.

More information about rehabilitation after dislocation of the shoulder can be found here.

Complications of habitual dislocation

Often, the injury is complicated by damage to the peripheral nerves. This is because the brachial plexus is placed close to the joint and compresses it with the displaced head of the shoulder.

A traumatologist should determine whether the patient was delivered with this injury or whether it occurred during medical manipulations. After all, the treatment scheme depends on this.

Restoration of the motor function of the humeral joint depends on the nature and severity of nerve damage.

For habitual dislocation, the damage is not only of soft structures, but also of bone tissue, because of which the trauma appears even with insignificant physical activity. Short shoulder rotators are damaged, their tonus decreases, and scars appear.

Subsequently, habitual dislocation can develop during normal activities (washing, dressing, combing, etc.).

Decreased work capacity, often the patient has to change the type of activity (if it is associated with the load on the humeral joint).

A person can not fully serve himself, and in the absence of treatment he becomes disabled.

A source: https://1travmpunkt.com/vyvihi/ruk/plecha/privychnyj-vyvih-plecha.html

Habitual dislocation of the shoulder

Unstable condition of the shoulder joint, which leads to a permanent disruption of its functions in any, even small loads on it, is called a habitual dislocation of the joint.

There are several types of this disease:

1. Congenital dislocation.
2. Acquired dislocated nontraumatic nature. It can be pathological, chronic and arbitrary.
3. Acquired traumatic dislocation. Has a complicated, open, pathologically repetitive, chronic form, or is defined as fracture.

According to statistics, the majority of patients (60%) have a traumatic illness.It is observed most often among athletes, whose constant exit of the head of the shoulder joint makes it necessary to give up training for a while.

Causes

the reason for such a shoulder injury is to get a direct blow in his area or fall on an elongated arm. In this case, the joint capsule breaks and stretches, causing the bone head of the shoulder to pop out of the scapula.

Damage to the shoulder is also possible with a rupture, tearing of the tendon of the muscle, which strengthens the joint of the shoulder and passes through its cavity.

Other reasons for the formation of habitual dislocations include:

1. Presence of primary dislocation in severe form. It is fixed in the sixth part of patients who have suffered a shoulder injury earlier and is considered the result of an inadequate, insufficient treatment of the primary trauma of this area of ​​the body.
2. Late appeal to doctors about the injury.
3. Removal of immobilization before the due date.
4. Insufficient fixation of the shoulder joint after the dislocation was corrected, which leads to disruption of the healing of the tendons, which ensure the stable operation of the humerus.
5. The presence of genetic diseases associated with increased elasticity of connective tissue, which cause excessive stretching of ligaments, tendons, joint laxity.
6. Excessive excess of movements of the upper extremities in some categories of people, especially athletes (swimmers, volleyball players, basketball players), leading to a permanent stretching of the shoulder joint.

There are factors that increase the likelihood of habitual dislocation associated with the characteristics of the components of the shoulder:

• The head of the large-sized shoulder bones is ball-shaped;
• The presence of a small cavity of the scapula with insufficient concavity;
• Muscles performing the functions of the rotation of the shoulder, perform insufficient fixation of this joint (paralysis, natural muscle weakness, paresis);
• Too elongated joint capsule.

Symptoms

Determining the condition of the patient who suffered a dislocation of the shoulder joint, a sign is a sharp attack of pain at the time of injury and a restriction of his motor abilities. The person at the same time feels that the shoulder has changed its usual position.

In the future, the pain with this type of injury is not expressed and is of little concern to the patient.

Externally, the dislocation is manifested in the characteristic deformation of the shoulder joint, in which the roundness and smoothness of the outlines are lost. The hand of the injured person remains pressed to the body, it is unable to move normally.

Relapses of habitual dislocation can occur with varying frequency in each person - from weekly trauma to annual. And they all provoke abnormalities in the shoulder and pause between relapses less and less.

Sometimes the dislocation of the shoulder joint does not take place fully, the signs of this are its instability, aching pain, sounds of crunching when the hand moves. Especial strengthening of these symptoms causes physical activity.

If there is damage to the blood vessels, nerve endings, the patient experiences pains of the stitching property and numbness in the limb. There is a bruise in the shoulder region.

The sign of a dislocation in the presence of an old trauma will be a strong compaction of the joint capsule and a loss of its elasticity. In this case, the joint cavity is filled with the forming and growing fibrous tissue.

Changes in the muscles in the shoulder region are atrophic and dystrophic in nature.

To exclude complex injuries, radiographs of the humerus in two projections and MRI are performed to examine soft tissue injuries (tendons, ligaments, joint lip).

The diagnosis of this disease is simple. Most often, a dislocation is determined by a simple examination of the surgeon, which fixes the restriction of the arm movement. Further, observation of the patient reveals the development of deforming arthrosis with aching pain and a crunch in the shoulder joint, muscle atrophy.

Treatment

There are two options for getting rid of the habitual dislocation of the shoulder joint - conservative and operative. Conservative often does not give a positive effect, but when the first treatment in traumatology begin treatment with it.

Conservative treatment

For the removal of inflammation and painful sensations, the doctor prescribes anti-inflammatory drugs, for example, ketans, voltaren and others.

Strong pain syndrome is removed with the use of a therapeutic blockade, for which diprospan is used or Kenalog, who have the ability to remove inflammation and effectively anesthetize for a long time time. Edema and pain in this phase of the disease is reduced by the imposition of ice in the package on the area of ​​the injured shoulder.

Conservative treatment of acute dislocation consists in the patient wearing a special bandage for 3 weeks. After its removal, rehabilitation therapy is prescribed.

It consists in physiotherapeutic procedures, massage and physiotherapy exercises, which strengthens the muscles of the shoulder girdle.

This therapy lasts up to 2 months, after which the majority of patients return to full-fledged life.

Operative treatment

Modern surgery has a large number of treatments for this disease, which is chosen for each patient individually, depending on the features of the structure of the shoulder joint, its characteristic changes and degree traumatization.

The following types of operative actions are applied:

• An operation that strengthens the joint capsule;
• A bone-plastic operation, during which bone defects are restored, or additional abutments are installed that can make the shoulder head less mobile;
• Plastics of tendons and muscles, allowing to change their length in order to eliminate imbalance in them;
• Operative intervention with the installation of a transplant;
• Combined method.

The most used method, allowing to combine all the techniques.

The main cause of the disease, leading to unstable performance of the shoulder joint - this is Bankart's injury, consisting in detachment of the joint lip.

This structure is designed to prevent the displacement of the head of the shoulder from the articular cavity. Torn at the time of the first dislocation of the shoulder, the joint lip further makes the transition of the disease to a chronic form realistic, only the operation can help in this situation.

Periodically continuing dislocations erase the articular cartilage of the head, and neglected cases of the disease often cause a disease such as arthrosis.

To ensure the stable operation of the shoulder joint, doctors use an arthroscopic operation, which consists in the re-fusion of the joint lip to the scapula cavity.

For this, thin and strong anchor locks are used, capable of self-absorbing through a certain time, during which the tendons must coalesce.

All operative actions are aimed at strengthening damaged, overstretched ligaments of the capsule of the shoulder joint, located on its front or lower part.

Anterior dislocations of the shoulder joint are subject to recovery most often with the help of Bankart's operation, which is currently an effective and high-tech technique for orthopedic surgery.

The orthopedic doctor acts as follows:

1. All defective elements of the capsule and ligaments of the shoulder joint are removed.
2. Drilled holes to fix the ligaments.
3. Special seams or ligament retainers are attached in these holes.

The gradual germination of the connective tissue allows the ends of the ligaments to become attached to the vents of the scapula and to ensure the normal functioning of the shoulder joint in the future.

Sometimes the operation of the Bankart is performed by arthroscopic method (with the help of the thinnest punctures in the joint) significantly reducing the recovery period and providing less painful sensations after it carrying out. The patient may be discharged from the hospital even the next day.

Operative intervention ends with the fixation of the patient's arm bandage to immobilize the shoulder joint. The bandage is supposed to be worn for 7 days to a month, depending on the method of the operation performed and the nature of the shoulder injury.

Equally important for proper treatment is the recovery period. Rehabilitation includes a course of massage, electrostimulation of muscles.

It is also necessary to conduct therapeutic physical education of the patient, first with an instructor, and then self-study at home.

Recovery lasts from 2 to 3 months, after which it is allowed to partially load the shoulder joint and only after a year the load on it is fully allowed.

A source: http://www.knigamedika.ru/travmy-i-otravleniya/plecho/privychnyj-vyvix-plecha.html

Habitual dislocation of the shoulder joint

The habitual dislocation of the shoulder is a traumatic injury caused by the instability of the joint, which provokes a disruption in its functioning even under the minimum load. According to statistical data, in 60% of cases this disease is traumatic, developing against the background of previously suffered shoulder injuries.

In general, the dislocation occurs approximately 6 months after the primary trauma.

Further manifestations of secondary dislocation occur throughout the year.

This condition is quite dangerous and significantly reduces the quality of life of patients, and therefore requires competent professional treatment.

From what arises?

The most common causes are blows or falls.

Such injuries are accompanied by damage to the joint lip, stretching and rupturing of the joint capsule, resulting in, even with minor provoking factors, the joint head occasionally pops out of the scapula area cavities.

In addition, the rupture of muscle tendons localized in the region of the shoulder joint may provoke this traumatic injury. Traumatologists identify the following factors that can trigger the development of pathology:

1. Increased motor activity of the shoulder, a consequence of sprains of the joint (especially athletes who engage in professionally sports).
2. The presence in the patient's history of severe primary dislocation.
3. Incorrect treatment of a primary injury or untimely appeal to a specialist.
4. Weak fixation after the adjustment of the dislocation, leading to a disruption in the restoration of the tendons and ligaments responsible for the stability of the humerus tissue.
5. Premature removal of immobilization.
6. Genetic diseases, accompanied by excessively high elasticity of connective tissue, leading to joint laxity, ligamentous and tendon strains.

In addition, some patients, due to their anatomical features, fall into a group at increased risk.

To such provoking factors it is possible to carry the large sizes of the head of the humerus, the distension of the joint capsule and the insufficiently concave cavity of the shoulder blade.

Particularly susceptible to trauma people suffering from paresis, paralysis, due to the weakened muscle groups responsible for rotational movements of the shoulder and fixation of the joint.

In the future, to provoke the trauma is capable of simply retracting the shoulder, disguise, lifting weights, loads. A certain group of patients recorded such dislocations that occurred during sleep.

Experts note a sad pattern: the more often the trauma is repeated, the less effort is required for its subsequent occurrence.

That's why the affected joint needs to be treated - competently and comprehensively!

How is it manifested?

With such a shoulder injury, a person experiences pain, however, they are no less pronounced than in the case of primary traumatic injuries.

Sometimes the pain syndrome may not be present at all, the victims complain only of a feeling of discomfort localized in the region of the shoulder joint.

Pain disappears with frequent repeated traumas, which is due to degenerative processes occurring in the ligamentous apparatus and cartilaginous tissue.

When the dislocation of the bone head takes a pathologically wrong position, leading to a violation of motor activity. Possible temporary loss of sensitivity of the hand, shoulder and forearm, which is due to swelling and damage to the nerve endings.

Why is treatment needed?

Nerve compression in anterior dislocation

Quite common are cases where patients with habitual dislocations, especially with frequent repetition and absence of strong painful sensations, independently direct to itself the amazed joint, not addressing to specialist. However, such actions are very dangerous! Self-correction does not eliminate the causes of the disease, each subsequent relapse occurs in a more severe form, causing pathological, at times, irreversible articular changes.

In the absence of competent, timely therapy (the most radical way is surgery on the shoulder joint), the patients can develop the following dangerous complications:

1. Deforming osteoarthritis;
2. Strong pain syndrome in the shoulder joint;
3. Violation of the motor activity of the upper limb.

In addition, the independent correction of the dislocated joint can result in damage to the nerves, rupture of the vessels and ligaments. That is why, when manifesting clinical manifestations, it is recommended to go urgently to the emergency room to the doctor.

First Aid

Treatment of habitual dislocation of the shoulder should be carried out exclusively by a qualified specialist, under stationary conditions. But before addressing a doctor it is important to be able to provide the patient with first aid. To do this, trauma doctors are advised to listen to the following recommendations:

• Maximally limit the motor activity of the shoulder and upper limb as a whole.
• Hang the injured arm on a special bandage (it can easily be made by tying the ends of the tissue cut between them and putting it on the neck).
• 15-20 minutes after the injury, attach an ice compress to the area of ​​the damaged joint or at least just something cold.

With severe pain, the patient must take an anesthetic drug, after which it is mandatory to seek help from a trauma doctor.

About diagnostics

Anterior dislocation

Diagnosis of the habitual dislocation of the shoulder joint begins with an examination of the injured by a trauma doctor, a study of the symptoms and an analysis of the collected anamnesis. Also, patients can be recommended the following types of studies:

• Radiographic study;
• Magnetic resonance and computed tomography;
• Contrast arthrography;
• Diagnostic arthroscopy.

X-ray examination

Conservative therapy techniques

If the usual dislocation of the shoulder joint is diagnosed, the treatment without surgery is based on the methods of drug therapy, gymnastics, physiotherapy. Patients are prescribed the following medications:

1. Drugs with analgesic action, non-steroidal anti-inflammatory drugs (NSAIDs) - to eliminate painful symptoms and signs of inflammation.
2. Chondroprotectors (Chondroxide, Teraflex, etc.) - whose action is aimed at strengthening the joint ligaments and cartilage, as well as the activation of metabolic processes.
3. Vitamin-mineral complexes enriched with calcium.

To eliminate acute symptoms (pain, swelling, hemorrhages), external medicines can be used in the form of gels, ointments.

Note that appointing any drugs, determine their dosage and the duration of the therapeutic course, should only the attending physician individually!

With the purpose of activation of blood circulation, acceleration of regeneration processes and restoration of damaged tissues, elimination of painful symptoms, patients with a habitual dislocation of the shoulder are recommended the following physiotherapeutic procedures:

• Mud and paraffin applications;
• Magnetotherapy;
• Electrophoresis;
• UHF-therapy;
• Phonophoresis;
• Laser treatment;
• Massage.

These procedures promote the fastest recovery of damaged tissue and joint stability.

Gymnastics classes play an important role in the conservative treatment of this traumatic injury.

Correctly chosen exercises contribute to the elimination of spasms, the normalization of muscle tone, stabilization of the affected joint and the restoration of its functionality.

Operational techniques

As a rule, surgical intervention is considered to be the most effective and effective method of treatment in this case. Operation with a habitual dislocation of the shoulder is prescribed when:

1. Presence of a patient with traumatic injuries;
2. Frequent relapses (more than two cases of dislocation during the year);
3. Lack of effectiveness of conservative therapy.

Treatment is carried out in a hospital, provided that the patient is hospitalized. Methods of surgical intervention are selected depending on the severity of the lesion, the duration of the pathological process and the individual characteristics of the individual patient.

To combat the habitual dislocation of the shoulder, specialists apply the following surgical techniques:

• Surgery to strengthen the joint capsule.
• Plasticity of muscle tissues and tendons, with the purpose of changing their length and eliminating imbalance.
• Surgical formation of ligaments for optimal fixation of the head of the humerus.
• A bone-plastic surgery aimed at repairing bone tissue defects with the help of special bone abutments.

If the victim is diagnosed with a habitual dislocation of the shoulder, then the operation is often done using combined techniques. Surgeons give them preference, as the most effective.

Very popular are minor traumatic surgeries. For example, arthroscopy is used to attach the severed articular lip.

When performing this operation, the doctor makes only two punctures, without surgical incisions, which significantly shortens the duration of the recovery period.

Competent surgical intervention makes it possible to prevent the occurrence of repeated dislocations, damage to blood vessels, tendons, nerve endings. The goal of the specialists is to maximize the stabilization of the shoulder joint and restore its normal motor activity.

Rehabilitation period

After the operation on the shoulder joint is completed, the patient's hand is fixed with a special bandage, for the purpose of immobilization. This dressing is worn about 1 to 4 weeks (duration depends on the severity of the injury and the method of surgical intervention).

In general, the rehabilitation period after surgical treatment of shoulder injury lasts from 2 to 3 months.

In the recovery and rehabilitation period, the patient should be especially careful and avoid excessive loads on the shoulder joint area.

A comprehensive rehabilitation course aimed at consolidating the results achieved, preventing possible complications and accelerated restoration of the joint, includes the following procedures:

1. Massage;
2. Physiotherapy;
3. Electrical stimulation of muscle tissue;
4. Physiotherapy;
5. Magnetorapia;
6. Phonophoresis with Analgin;
7. Ozokerite.

Classes of medical gymnastics are recommended to begin in 1 weeks after the operation, when the patient does not suffer from a pain syndrome. Optimal physiotherapeutic procedures are selected by a specialist, taking into account the individual characteristics of a particular clinical case.

A habitual dislocation of the shoulder is a serious enough, recurrent trauma, threatening the development of a number of complications.

Timely appeal to a specialist and competent treatment in a conservative or surgical way will allow you to maximally protect yourself from possible risks of complications, prevent repeated dislocations, restore motor activity and return to normal, full life!

A source: https://lechimtravmy.ru/vyvihi/privychnyj-vyvih-plecha