Under the habitual dislocation of the shoulder understand its unstable state, which leads to disruption of its functions even with small loads exerted on it. The main part of the pathology develops as a result of injuries. But some people have a congenital disease, as well as an arbitrary, chronic or pathological condition.
Shoulder joint structure
It includes:
- humerus
- shoulder blade;
- collarbone.
The shoulder has a head, which is adjacent to the recess of the scapula, which is small in size. The cavity at the edges is covered with a lip, which contributes to an increase in the articular cavity. A capsule consisting of connective tissue surrounds the joint. The joint is also fixed with muscles, tendons and ligaments. They provide a snug fit of the shoulder head to the middle of the scapular cavity.
Causes
The main one is a fall on an elongated upper limb. Also, one of the main reasons for the habitual dislocation of the shoulder is to receive a direct blow to its area. In this case, the articular capsule ruptures and stretches, which leads to a jump out of the scapular cavity of the bone head.
In addition, a similar ailment can be noted with a rupture or tear of the tendon of the muscle, which passes through the cavity of the shoulder joint and strengthens it.
There are other reasons for the usual dislocation of the shoulder:
- excessive intensity of hand movements in individuals, such as athletes, which leads to a constant stretching of the described joint;
- genetic ailments that provoke increased elasticity of the connective tissues, which leads to increased extensibility of the ligaments, tendons, “laxity” of the joints;
- improper fixation of the shoulder joint after reduction of the dislocation, as a result of which the healing of the tendons, which ensure the functioning of the humerus, is disturbed;
- removal of immobilization of earlier established term;
- being late when contacting a doctor if injured;
- more than 15% of patients who have previously suffered an injury may experience a primary dislocation that occurs in severe form, which is noted due to the treatment of this organ, which is not fully completed.
The following factors contribute to the appearance of a primary dislocation:
- large extension of the joint capsule;
- muscle paralysis and paresis, their natural weakness;
- an existing small cavity of the scapula with insufficient concavity;
- the spherical shape of the head of the humerus is large.
Symptoms
This ailment is characterized by severe pain at the time of injury and limitation of a person's motor abilities. As time passes, the first becomes dull. The shoulder joint is deformed, it loses its smoothness and roundness. The hand ceases to perform the usual human movements and remains pressed to the body.
For a habitual dislocation, relapses are characteristic, which can have from daily to annual recurrence. As a result, pathologies are formed in the shoulder that shorten the time between subsequent ones. Because of this, dislocations can occur after 4-5 times from the institution of the hand behind the head.
Joint dislocation may not be fully observed. As a result, there is a crunch when moving the upper limb, aching pains, joint instability appears.
In case of damage to nerve endings or blood vessels, numbness of the limb may occur or the patient may experience stitching pains. In the area of the location of the shoulder, bruising is noted.
If there was an old injury, then there is a loss of elasticity of the joint capsule and its strong compaction. Its cavity begins to fill with fibrous tissue.
In the area of the shoulder in the muscles, dynamics of a dystrophic and atrophic nature is observed.
The older the dislocation, the faster the processes of bone integration of the parts of the condyles of the shoulder and fatty degeneration.
Classification of dislocations
Depending on the direction of displacement of the head, the following types of dislocations are distinguished:
- lower - while the head moves down, and the hand moves up and is above the head;
- hind - appears due to a fall on an elongated limb forward, is not common;
- front - the head goes forward to the clavicle or the coracoid process, the most common type of dislocation.
According to the term of the first injury, the following types are distinguished:
- fresh - if the time interval after the initial dislocation is 3 days;
- stale - 4-21 days;
- obsolete - from 3 weeks.
Diagnostics
It is performed by the surgeon during the examination and fixation of limiting the movement of the hands. After that, deforming arthrosis with the presence of a crunch in the shoulder is diagnosed, muscle atrophy is observed.
To exclude complex injuries, before treating the usual shoulder dislocation, perform an x-ray of the humerus in two projections. In addition, the study of the articular lip, tendons and ligaments is performed using MRI.
Treatment of habitual dislocation of the shoulder without surgery
As a rule, treatment is started with it, although its effectiveness is low. In order to relieve pain and inflammation, the doctor prescribes anti-inflammatory drugs.
With severe pain syndromes, therapeutic blockade is prescribed. The following drugs are recommended for her:
They contribute to pain relief and the removal of inflammatory processes for a long time period. Edema is relieved by the application of ice placed in the package on the shoulder area, in which the disease in question is noted. For 3 weeks, the patient should wear a special dressing, after removal of which rehabilitation is prescribed for the usual dislocation of the shoulder.
With it, exercise therapy is performed to strengthen the shoulder muscles, massage and physiotherapeutic procedures are prescribed.
If all the doctor's instructions are followed, after 2 months, a return to a full life is possible.
Treatment of a habitual dislocation of the shoulder with surgery
If the conservative therapy considered earlier did not bring the expected results, as well as in the presence of a chronic injury, surgery is prescribed. An indication for its implementation is the presence of more than two relapses during the year.
Surgery with the usual dislocation of the shoulder is assigned individually for each patient. It is selected depending on the degree of injury, the characteristic dynamics and structural features of the shoulder joint.
The following types of surgical procedures may be used:
- transplant mounting;
- plastic surgery of muscles and tendons, with the help of which their length is changed to eliminate imbalance in them;
- osteoplastic surgery, in which bone defects are restored or additional emphasis is placed under the shoulder head to ensure its less mobility;
- surgery to strengthen the joint capsule;
- combined intervention.
The instability of the shoulder joint can be obtained as a result of damage to Bankart. With it, a separation of the articular lip is noted, which prevents the displacement of the shoulder head from the articular cavity. With its implementation, the disease with a high degree of probability will go into the chronic stage. Therefore, in this case, an operation is prescribed.
Relapses contribute to the abrasion of the articular cartilage of the head, in advanced cases of this ailment arthrosis develops.
Also, surgery can be carried out according to the method of Latter. It is used for bone mass loss of the anterior part of the scapular cavity for the joint. In this case, the coracoid process with the muscle attached to it moves with attachment to the front-lower edge of the recess for the joint.
According to available reviews, the usual dislocation of the shoulder during surgery is rarely accompanied by any relapse. Patients note that after their implementation in many cases repeated dislocations are not noted.
New treatments
In order for the shoulder joint to work stably, an arthroscopic operation is used, in which the joint lip is fixed to the cavity of the scapula. Durable thin anchor retainers are used, which resolve on their own after a certain period of time, during which the tendons are fused.
The operation of the usual dislocation of the shoulder in the front part is carried out mainly according to the Bankart method. At the same time, their ligaments are fixed in the position that is necessary.
Surgical intervention is as follows:
- all defective elements of the ligaments of the shoulder joint and capsule are removed;
- holes are drilled to secure the first;
- clamps or laces they are fastened in these holes.
Connective tissue begins to germinate gradually, which allows the ends of the ligaments to acclimate to the scapular openings, which will ensure the normal functioning of the joint in the future.
When carrying out such an operation using the arthroscopic method, the recovery period is significantly reduced, the patient can be discharged from the hospital the next day after surgery.
To immobilize the shoulder joint, the patient's arm is fixed with a bandage. It is worn from one week to one month, which is determined by the nature of the shoulder damage and the method of the operation.
Rehabilitation
A complete recovery without quality rehabilitation measures is not guaranteed even by the operation. It is necessary to gradually include tendons, ligaments, and rotator muscles in the work. With the usual dislocation of the shoulder, exercises to strengthen the above elements begin to be performed with preventative simulators, gradually moving to general physical training.
At the first stage of power kinesitherapy, capsules are strengthened, muscle atrophy is eliminated and their spasm is eliminated. With the help of physical exercises, the movements of the damaged limb are restored, its amplitude is increased, the joint is stabilized and blood flow in the capsule is improved.
At subsequent stages, strength increases, muscular tone increases, tendons and ligaments strengthen. The range of motion reaches normal values, regeneration is accelerated.
The use of special exercises in the treatment of habitual dislocation of the shoulder without surgery or with it helps prevent relapses.
Possible complications
The resulting injury may be accompanied by damage to the peripheral nervous system, since the brachial plexus is located near the joint and compresses it when the head is displaced.
With a habitual dislocation, bone tissue is also damaged, which can lead to the development of this ailment during the commission of habitual actions. As a result of this, a person gradually loses the ability to self-service and, if untreated, can become a disabled person.
Finally
Habitual dislocation of the shoulder is a serious ailment that can develop as a result of injuries. Sometimes there is a development of pathology with a genetic predisposition, various ailments of tendons, muscles and joints. To prevent relapse, it is necessary to start treatment on time, follow the doctor's recommendations. Regardless of whether surgical or therapeutic treatment was carried out, during the rehabilitation period, special exercises should be performed that will restore the activity of the upper limb and prevent relapses in the future.