The shoulder joint is considered the most mobile joint. It provides completely all the basic functions of a limb. In this case, the hand can bend and move normally in absolutely any planes. Sometimes, due to a decrease in stability, a subluxation of the shoulder occurs.
They lead to limited mobility and provoke quite severe soreness. Basically, their subacute course is observed. It is important to pay attention to the appearance of symptoms and conduct treatment to prevent the development of complications.
Classification
If a partial slipping of the head from the articular cavity is observed, then this is a subluxation of the shoulder. This condition indicates instability of the shoulder joint. There are such types of subluxations as:
With anterior lesion, the head of the bone moves slightly forward, falling under the scapula. Back subluxation occurs when falling on an outstretched arm. It is caused by the separation of cartilage. With a lower subluxation, the articular head moves beyond the border of the cavity.
By the time of occurrence of subluxation can be congenital and acquired. The first is diagnosed in a child, therefore, it can be detected in a newborn or in the first year of his life. Acquired subluxation is characteristic of school children and adults. It is also sometimes observed in older people. This form is divided into familiar and traumatic.
The usual shoulder subluxation is characterized by a malfunction in the damaged area, even with minor loads. This happens in the presence of an unhealed injury, irritation of the nerve endings, blood vessels, as well as in the case of other violations of the joint integrity.
Traumatic subluxation of the shoulder is much more common. It can occur with complications. These include the rupture of soft tissues, nerves, blood vessels and tendons.
If instability develops in only one direction, then it is called single-plane. It is often triggered by ruptures of the joint capsule or significant damage to the cartilage lip. Multiplane develops with sprain of the ligaments and tendons and synovial membrane. In this case, excessive mobility along several axes is characteristic at once. The symptoms of shoulder subluxation will largely depend on the type of instability that occurs in the shoulder joint.
Causes
Subluxation of the shoulder has various causes, but often this is due to injury or mechanical stress. Provoking factors include:
- congenital malformations;
- injuries
- increased activity;
- joint capsule distension;
- arthrosis, arthritis;
- systemic and other pathologies.
Injury is a fall on an outstretched arm or shoulder and entails a fracture of the articular cavity, processes of the scapula and head of the bone. Congenital anomalies are an anatomical feature of the development of the articular cavity in the scapula.
Increased joint activity is a pathology in which uncharacteristic movements appear. Excessive mobility of the brachial joint occurs in about 10-15% of the world's inhabitants.
Stretching of the joint capsule is provoked by the implementation of repeated movements. They cause a constant sprain, capsules. Athletes, namely tennis players and swimmers, often suffer from such a violation.
Multiple shoulder injuries provoke weakening of the ligaments and as a result, the stability of the joint weakens. Subluxation of the shoulder is provoked by the fact that the muscles of the shoulder joint cannot fully recover after the patient dislocated the shoulder due to the injury.
Repeated shoulder subluxation can provoke daily movements. Moreover, over time, the stability of the joint is increasingly violated. As a result of this, the intervals between relapses are reduced.
Symptoms
Symptoms of shoulder subluxation are quite characteristic, therefore, it is quite simple to recognize the course of the violation. To make the correct diagnosis, the doctor conducts a survey for the presence of certain complaints. Subluxation is accompanied by certain symptoms, which is determined not only by the injury itself, but also by its mechanism. With a sharp influence of external factors, rather intense pains in the shoulder arise, associated with rupture of ligaments, tissues and joints. However, with chronic instability, such sensations become much weaker or completely disappear. In addition to painful manifestations, the usual shoulder subluxation is characterized by such signs as:
- joint deformation;
- restriction of movements;
- forced limb position;
- tingling, numbness.
With multi-plane instability, patients feel excessive displacement of the shoulder head during movements, muscle tension and increased fatigue. Some people show signs of connective tissue dysplasia, which include:
- it is possible to touch the forearm with the thumb;
- excessive extension of the elbows;
- can be reached with the index finger of the back surface of the brush.
These signs do not indicate the presence of a dislocation, but indicate a high risk of its development. A chronic course of pathology is possible if a person had previously dislocated his shoulder and this led to negative consequences. The stretched muscle-ligamentous apparatus cannot fully perform its functions, so the joints become vulnerable and can undergo various injuries. A similar problem is quite often observed with subluxation of the shoulder in infants, as well as in athletes.
Diagnostics
To confirm a subluxation of the shoulder in a child or adult, you need to see a doctor for diagnosis. To do this, the doctor initially conducts an examination of the patient, as well as clinical tests. A person experiences severe pain, therefore, tries to limit movement. In injuries, instrumental techniques may be required to see damaged skeleton structures and assess the degree of pathology. This allows you to do such procedures as:
- Magnetic resonance imaging;
- radiography;
- CT scan.
The bones are clearly visible on the x-ray, but this method does not allow assessing the condition of the soft tissues. MRI allows a good look at the structure of the synovial membrane, tendons and muscles, ligaments, and cartilage. This greatly facilitates the diagnosis.
Quite often, a fracture of the shoulder with a subluxation occurs, which is why it is absolutely necessary to make a diagnosis. The nature of the damage will largely depend on the mechanism of injury, which determines the essence of therapeutic procedures.
Treatment feature
If the movement is accompanied by pain, then you need to fix the hand in a certain position to keep it stationary. Cold should be applied to the damaged area.
The duration of the recovery period after an injury is usually 1-1.5 months. During treatment of shoulder subluxation, painkillers should be taken. For a quick recovery, it is important to strictly follow all the doctor's recommendations. It is necessary to avoid unnecessary movements without loading the hand.
It is useful to engage in physiotherapy exercises, which will help strengthen muscles. This will protect against subluxations in different parts of the body. To restore the joint very quickly, you need regular massage.
When playing sports and other loads, it is important to adequately assess their capabilities and pay special attention to the muscles. It is important to take care of your health, preventing the development of diseases of the musculoskeletal system.
In some cases, there is a subluxation of the shoulder after a stroke, which manifests itself as quite severe soreness. It is very important to provide timely assistance to the patient and carry out rehabilitation measures, since the recovery period will largely depend on this.
A feature of this condition is that it is impossible to eliminate pain in the joint with the help of analgesics, as well as other drugs. In addition, severe muscle weakness is observed.
How to treat shoulder subluxation after a stroke can only be determined by the attending doctor after diagnosis. However, it is very important to ensure the immobility of the affected area to prevent complications. After eliminating the acute period, you need to gradually develop a hand. To do this, the doctor prescribes physiotherapy. Antidepressant and anticonvulsant medications are also indicated. The result can be seen only after a month of treatment.
First aid
How to treat a subluxation of the shoulder, only a doctor can decide after a diagnosis, but if you suspect a violation, it is important to provide first aid. Blood vessels may be squeezed or blood circulation may be disturbed, so you need to act very quickly. When providing first aid you need:
- provide complete rest of the limb;
- apply a cold compress;
- put the roller between the arm and armpit;
- apply a fixative bandage, wrapping the damaged limb to the body;
- give pain medication;
- deliver to the hospital.
It is very important to act quickly but carefully so as not to cause pain or aggravate the damage.
Reduction procedure
Treatment of the usual shoulder subluxation without surgery is carried out by means of reduction. It can be closed and open. The first option is performed under local anesthesia. For this, the affected area is chipped with novocaine. A muscle relaxant is injected intramuscularly to relax the muscles, and if the pain is very severe, a narcotic analgesic will be required. The old habitual subluxation is eliminated under general anesthesia.
The most common methods of joint reduction are considered to be such as Hippocrates, Janelidze, Kocher, Mukhin-Mota. Which one is used depends largely on the type of damage.
Treatment after repositioning involves immobilizing the shoulder. This is necessary to fix the joint in the required position, heal the capsule and prevent relapse. A special bandage or a longuet for a month is applied to the arm. Once the joint is in the correct position, all signs of injury will immediately pass.
It is important to strictly maintain the required period of wearing the bandage, even if swelling, pain and other symptoms have passed. Joint capsules do not heal if shoulder immobilization has been discontinued earlier. This provokes a habitual dislocation with subsequent damage to adjacent tissues.
Medications
To eliminate the painful symptoms of shoulder subluxation, treatment involves the use of medications. Doctors prescribe non-steroidal anti-inflammatory drugs in the form of gels and ointments for external use.
In the first 3 days, when swelling and pain in the limbs are significant, the injection of Diclofenac and its analogues is indicated. During the recovery period, you will need to take chondroprotectors and vitamin-mineral complexes.
Physiotherapeutic Techniques
Treatment of subluxation of the shoulder joint includes physiotherapeutic techniques, in particular, such as:
- laser therapy;
- inductothermy;
- thermal wraps with paraffin or ozokerite;
- electrophoresis;
- massage;
- magnetotherapy.
At home, you can apply dry compresses with heated salt or sand. The use of heat is allowed no earlier than 3 days after injury. The use of a blue lamp is also effective, as well as baths with decoctions of medicinal herbs or with sea salt. All these techniques have the following effect:
- normalize metabolism and blood circulation in tissues;
- restore joint mobility;
- accelerate the recovery process;
- eliminate the symptoms of inflammation.
You can also do a light massage, easily pinching or stroking the site of injury.
Physiotherapy
To restore the motor functions of the limb after subluxation, it is recommended to perform certain exercises, in particular, such as:
- shrug;
- rotational movements;
- hand swings;
- the establishment of hands clasped with a lock over his head;
- lessons with a stick or ball;
- movements of the arms bent at the elbow.
Exercises should be performed without the use of force against the shoulder joint, as otherwise, there may be a relapse of the injury.
Operation
If timely assistance is not provided to the victim, then pathological changes in the periarticular tissues will only be aggravated, the shoulder loses its mobility, and the frequency of dislocations will also increase.
In this case, damage can be eliminated only during the operation, since neither immobilization nor massage can give any results. Such treatment significantly increases the rehabilitation period.
The operation is performed with fixation of the head of the humerus with sutures and special knitting needles in the articular cavity. After the intervention, anti-inflammatory drugs and non-narcotic analgesics are required.
Possible complications
Subluxation of the shoulder joint is a fairly serious injury. Improper treatment can lead to complications such as:
- damage to nerve endings;
- joint instability;
- relapses even after the slightest injury;
- range of motion is limited;
- degenerative joint changes.
A complication is also considered a fracture of the neck of the shoulder with subluxation, which requires complex therapy. Treatment must be carried out only by a doctor, since improperly conducted therapy threatens with very serious consequences.
Prophylaxis
To avoid subluxation of the shoulder joint, it is recommended to strengthen the ligaments and muscles of the upper extremities daily through special exercises. You must also adjust your diet, exclude fried, fatty and salty foods, alcohol. It is advisable to include in your usual diet foods containing vitamin C and collagen.
It is important to lead an active lifestyle, move as much as possible. When sedentary work, you need to take breaks, stretch and warm up. All injuries and bruises of the shoulder should be treated in a timely manner.