Fracture of the shoulder joint is a severe injury that can be presented in various forms. Symptoms and manifestations of trauma can vary depending on the type of damage and its location. For successful treatment, it is important to recognize the presence of a fracture of the shoulder joint in time and take appropriate measures. Therapy is carried out in an inpatient setting, and in some situations, surgical intervention may be required. The period of rehabilitation depends on the type of damage and the measures taken to treat the fracture.
Symptoms
Symptoms associated with a fracture of the shoulder joint may vary depending on the location of the injury. In any case, at the site of damage to the bone structures, a high-intensity pain syndrome appears. Against the background of a soft tissue rupture, swelling and bruising occur. When palpating in the injured area, a crunch may be felt due to the presence of bone fragments. The motor function of a damaged limb becomes limited.
Shortening the shoulder
If we are talking about a fracture of the neck of the shoulder joint, then we can observe a shortening of the shoulder. An injury with displacement can lead to deformation changes in the arm. There are also cases where the fracture is open, which can lead to damage to nerve endings and loss of sensitivity.
If the tubercle is damaged
If a fracture of the shoulder joint in the tubercle occurs, pain occurs over the shoulder. When the arm is moved to the side, the pain increases significantly or a sensation of the presence of an obstacle arises, indicating a violation of the tendon in the supraspinatus muscle. In the latter case, puffiness is not expressed, and besides, such a fracture is not characterized by deformation. With a fracture of the tubercle, damage to blood vessels and nerve endings rarely occurs.
If the body of the shoulder bones is damaged, the patient experiences severe pain, swelling and bruising are pronounced and can reach the carpal areas of the limb. Motor function in the joints of the shoulder and elbow is limited. When bone fragments are displaced, shortening of the damaged arm occurs. In this case, there is a violation of the nerve endings and blood vessels, which leads to a loss of sensitivity and mobility of the fingers.
Trans-alkaline fracture
Transdermal fracture of the joint of the humerus is characterized by intense pain, radiating to the forearm and elbow joint. Swelling occurs in the joint of the elbow, in addition, deformation changes occur against the background of bone displacement. Mobility is impaired, while movements in the shoulder are limited slightly. Fracture of the supracondylar bones is dangerous for the brachial arteries, the damage of which can cause gangrene of the limb. The absence of a pulse on the forearm is the main sign of damage to the vascular system.
Conservative treatment
After a patient with a fracture of the shoulder joint is delivered to a medical facility, drugs with anesthetic effect are administered to him. When the pain syndrome loses intensity. Radiography is performed, and based on the results obtained, an appropriate therapeutic regimen is selected, which may include:
- Conservative methods involving the application of gypsum or a tight dressing, as well as tires.
- Surgical treatment, when special corrective plates, structures, etc. are installed on a broken joint.
- Bone traction.
If there is a fracture of the shoulder joint without displacement, or it is insignificant, the method of reposition of bone fragments is used. After a quick reposition, gypsum is applied to the injured limb or it is fixed with a tight bandage or a special tire.
As a rule, a plaster cast is used in cases where damage to the tubercle of the humerus occurs. Along with gypsum, a deflecting splint can be used, which can ensure the immobility of a broken joint and contributes to the effective fusion of muscle above the bone, which is often damaged during a tubercle fracture.
When a fracture of a large tubercle and a surgical neck without bias is diagnosed, conservative treatment methods are used. A damaged limb is fixed with a retractable splint or kerchief. The recovery period in this case is one month.
Surgery
There are fractures of the joint of the humerus, in which it is impossible to avoid surgical intervention. In particular, surgery may be required in the following cases:
- The impossibility of conducting open type reposition, that is, bone reduction.
- After the reduction, the bones depart.
- Installed damage to the roots of nerves.
- Muscle tissue is affected by bone fragments.
- The integrity of the blood vessels of the circulatory system is broken.
In order to restore the natural position of the damaged bone and fragments, an operation is performed to install a plate that fixes parts of the tissues before they are fused. When using devices for proper bone fusion, gypsum does not overlap.
If a fracture with displacement is diagnosed, an operation is performed. Surgical intervention involves fixing fragments with a screw or knitting needles, which are removed after a few months. In this case, gypsum immobilization is carried out for 4-6 weeks, and the total rehabilitation period can reach three months.
Bone traction
Skeleton bone traction is used when a fracture of the shoulder joint occurs with displacement. The essence of the procedure is to install the knitting needle in the area behind the process of the elbow, due to which the shoulder is extended. The tire is installed for four weeks and significantly limits the motor function of the limb. After removal of the knitting need rehabilitation up to six weeks. The total duration of treatment is up to four months.
When the shoulder fracture is open, an Ilizarov apparatus is installed on the limb, which is a complex structure of rings and knitting needles. Such treatment can last up to six months, but at the same time movements in the joints are available from the first days of therapy.
When damage to nerve endings and blood vessels occurs, additional surgical treatment is performed. Special stitches are applied to them. The recovery period in this case can be prolonged.
Summarizing the treatment methods depending on the location of the fracture, we can draw the following conclusions:
- Fracture of the shoulder body without displacement - the application of a plaster cast for a period of 6-8 weeks.
- Fracture of the shoulder body with displacement - installation of plates, screws and rods. Gypsum application for 4-6 weeks.
- Surgical neck without displacement - a bandage with gypsum for four weeks, then the development of mobility.
- Surgical cervix with displacement - if successfully repaired, restoration takes place within a month and a half.
- Fracture of the lower end of the shoulder bone with displacement - a plaster cast for 6-8 weeks. If the bone cannot be corrected, surgical treatment is used.
Rehabilitation
In case of fractures of the shoulder joint after immobilization of the arm for the required period, further treatment is carried out on an outpatient basis. After the bandage is removed, treatment with physiotherapeutic methods is prescribed, and a course of restorative gymnastics aimed at developing the joint is also prescribed. Thus, it is possible to return mobility to the damaged arm. Rehabilitation for a fracture of the shoulder joint can last up to three months.
Regardless of the type and location of the fracture, the patient is prescribed painkillers and anti-inflammatory drugs for the rehabilitation period. In addition, for the bones to grow together quickly and correctly, calcium supplements are prescribed. Also, the patient is prescribed to follow a special diet and include in the diet products enriched with this microelement.
After the dressing with gypsum is removed, the patient is X-rayed. Based on the obtained image, a conclusion is drawn on the degree of bone fusion and on subsequent treatment. If plates were installed, a decision may be made to leave them. This is especially true for elderly patients, for whom reoperation can be dangerous.
What else is used in the treatment of a fracture of the shoulder joint?
Massage
Massage helps improve blood circulation in the damaged arm. You can start the massage immediately after removing the plaster cast. When conducting a massage, it is recommended to follow the following rules:
- Massage should be started with light strokes.
- Gradual warming up of muscles, warm-up.
- Movement during massage should begin with the fingers, gradually rising to the shoulder. You can not strongly massage the broken area and put pressure on the damaged joint.
The patient can independently massage. To get the best effect, you need to conduct at least ten sessions. Physiotherapeutic methods should be used to relieve inflammation and improve blood flow.
The correct development of the shoulder joint after the fracture is important.
Physical Education
Physiotherapy exercises are necessary to normalize muscle tone and accelerate the process of bone fusion. The following exercises are considered the most effective:
- Limb movements like a pendulum. In this exercise is performed by both limbs.
- Circular movements of the joints of the shoulder to increase their flexibility. If pain occurs, stop the exercise.
- Lead limbs to the sides. If you cannot perform the exercise with an injured hand, you can help healthy. Thus, it will be possible to remove the load from the shoulder joint.
- Mahi with straight arms in front of the chest.
- The reduction of hands in the castle in front of the chest. Gradually try to straighten the brushes.
- Establishment of a damaged arm behind the head.
These exercises after a fracture of the shoulder joint are performed in order to prevent possible complications that can lead to loss of mobility of the affected limb.
Consequences of a fracture
Damage to the neck, body, joint, nerve or muscle tissue can lead to the following unpleasant consequences:
- Paralysis of the deltoid muscle.
- Arthrogenic type contractures.
- Habitual dislocations.
- The occurrence of false joints.
- Volkman Contractures.
- Violation of muscle mobility in the forearm.
Damage to nerve endings
In addition, complex damage to the joint of the shoulder can lead to damage to the nerve endings, which will subsequently cause paresis or complete paralysis of the arm. Changes in the structure of the joint can cause the destruction of cartilage, the growth of scar tissue, as well as the compaction of ligaments, neck and capsules. Prolonged wearing of a plaster cast leads to squeezing of blood vessels, as well as damage to bone fragments. In addition, the flow of oxygen into damaged tissues is disrupted, motor function is impaired, and sensory loss is observed. Atrophy of muscle tissue while wearing plaster is also possible.