Shoulder dislocation is a complete displacement of the head of the humerus relative to the articular cavity of the scapula. It can occur together with a fracture of the neck or head of the humerus, a fracture of the articular cavity, etc. damage. It is characterized by pain, swelling, deformity and lack of movement in the shoulder joint. Clarification of the diagnosis is carried out using radiography, in some cases, CT or MRI is additionally prescribed. Treatment includes its closed or open reduction, wearing a Dezo bandage, rehabilitation with the help of physical therapy and massage.
S43.0 Dislocation of the shoulder joint
Shoulder dislocation is a common injury and account for more than 50% of the total number of dislocations and 3% of all traumatic injuries. Such a high frequency of pathology is due to the peculiarities of the anatomical structure and a large volume of movements in the shoulder joint. The shoulder joint is formed by a flat-concave articular surface of the shoulder blade, into which the spherical head of the humerus enters by a quarter. The head is held in place by the so–called rotator cuff of the shoulder – ligaments, muscles and joint capsule.
As a rule, traumatic shoulder dislocation occurs as a result of an indirect injury – a fall on the withdrawn or raised arm. The capsule of the shoulder joint is torn, the head of the shoulder is displaced in the direction of the rupture. In some cases, the cause of the anterior form is a direct blow from behind, and the cause of the posterior dislocation is a direct blow from the front to the shoulder joint area.
Depending on the etiology, primary (traumatic), arbitrary, congenital, habitual and pathological dislocations of the shoulder are distinguished in traumatology and orthopedics.
- Habitual shoulder dislocation develops as a result of insufficient recovery of the rotator cuff of the shoulder after a traumatic dislocation.
- Pathological dislocation can occur due to damage to the tissues of the shoulder joint with tumors, osteomyelitis, tuberculosis, osteochondropathy, osteodystrophy, etc.
Pathology can be combined with a fracture of the head, anatomical or surgical neck of the shoulder, detachment of a small or large humerus, fracture of the articular cavity, acromial or cranial processes of the scapula, damage to nearby tendons, vessels and nerves. When a dislocation is combined with another injury, they talk about a complicated shoulder dislocation. Depending on the direction of displacement of the head of the humerus, anterior, posterior and lower dislocations of the shoulder are distinguished. Most often (3/4 of cases) there is an anterior shoulder dislocation. The second place in frequency is occupied by the lower shoulder dislocation (about 20%).
Shoulder dislocation symptoms
Traumatic dislocations of the humerus are accompanied by sharp soreness at the site of injury, deformation of the shoulder joint area (the joint becomes angular, sunken, concave). Movements in the joint are impossible. When attempting passive movements, a characteristic spring resistance is determined.
With anterior shoulder dislocation, the head shifts forward and down. The arm is in a forced position (withdrawn to the side or bent, withdrawn and turned outward). During palpation, the head of the humerus is not found in the usual place, it can be felt in the anterior parts of the armpit (with anterior dislocations) or below the cranial process of the scapula. Anterior and anterior dislocations of the shoulder are sometimes accompanied by the detachment of a large humerus tubercle, fracture of the cranial or acromial processes of the scapula.
With a lower shoulder dislocation, the head shifts into the armpit. Vessels and nerves pass through the armpit. If the head squeezes the neurovascular bundle, there is numbness of the skin and muscle paralysis in the area that the compressed nerve innervates. The posterior shoulder dislocation is characterized by a displacement of the head towards the shoulder blade.
To clarify the diagnosis of shoulder dislocation, to determine possible concomitant injuries of the humerus and scapula, an X-ray examination is performed in two projections. In some cases of long-standing shoulder dislocation, an shoulder MRI is required.
Shoulder dislocation treatment
First aid consists in immobilizing the damaged joint with a Dezo bandage or a ladder splint. Traumatic shoulder dislocationis accompanied by sharp pain, to reduce which the patient is injected with non-narcotic (analgin) or narcotic (promedol) analgesics. It should be borne in mind that the more time has passed since the injury, the more difficult it will be to set the shoulder, so the patient should be taken to an orthopedic traumatologist in the emergency room or trauma department as soon as possible.
Upon admission to the shoulder joint area, a local anesthetic is administered. Under local anesthesia, a closed removal of the shoulder dislocation is carried out. The method of Janelidze, Kocher, Hippocrates, Mukhin-Cat is used. Sometimes, under local anesthesia, dislocation cannot be corrected. The impossibility of reduction may be due to the infringement of soft tissues or a relatively long period of dislocation. In such cases, the dislocation is set under anesthesia. If the joint cannot be set without surgery, an open reduction is performed, followed by fixation with a spoke or dacron sutures.
After the shoulder dislocation is corrected, a Dezo bandage is applied for a period of 3-4 weeks. As soon as the shoulder head takes its proper place, the pain decreases sharply and may disappear after a few days, but the bandage is retained to ensure the fusion of damaged soft tissues. After the healing of the shoulder capsule, the bandage is removed, physiotherapy procedures and therapeutic gymnastics are prescribed to develop the joint.
Prognosis and prevention
With timely reduction of dislocation and compliance with the doctor’s recommendations, the prognosis is usually favorable. With premature unauthorized removal of the bandage in the long term, the usual shoulder dislocation is often observed. Primary prevention consists in the prevention of injuries, secondary – in strict adherence to medical recommendations, ensuring the immobility of the joint for the period necessary for the complete healing of damaged structures.