Shoulder dislocation (shoulder slip)
Shoulder dislocation (shoulder slip) rank first in frequency. Such frequency shoulder dislocation explains in 1's, a lot of work and its extensive volume and a wide variety of movements, in 2 relatively flat articular capsule saucer and weakness, especially in the lower front of her department. Just that's the place and there is a break it when the fall in the extended forward and the allotted double-arm lever arm is formed with a focus in the posterior cervical-upper edge of the glenoid cavity and acromion of the scapula. Under these conditions, excessive retraction of the long end of the arm from the body, continuing over the horizontal plane, with great force pushes the short end - head - on maloukreplennuyu anteroinferior part of the capsule. Tearing her head humerus continue in this direction to go further ahead and inwards (medially).
Rostral-shoulder ligaments tension and muscular twitching sometimes fix the humeral head in the armpit position strongly allotted raised hands. However, the severity of the hands usually overcomes this sharply allotted position, the arm falls down, the head of the humerus, scapula, tightens the chest muscles, slides upward on the chest and the front surface podlapatochnoy muscles (m. Subscapularis) and is set mostly under the coracoid - once near neurovascular bundle, giving the front a dislocated shoulder.
Depending on whether the head of the humerus near the pits, or it moved under the coracoid process, or gone on under the collarbone - distinguished:
- anterior shoulder (glenohumeral joint) dislocation to the blade glenoid cavity
- anterior shoulder (glenohumeral joint) dislocation under the scapula coracoid
- anterior shoulder (glenohumeral joint) dislocation under the collarbone
Less than a fall on an outstretched hand and elbow, shoulder dislocation obtained with a sharp active movement of the entire upper extremity upwards and backwards (eg., With stone-throwing disc) as well as by direct effort on his shoulder from behind perёd or, if allotted shoulder, top to bottom. Posterior dislocation of the shoulder (glenohumeral joint) - a very rare occurrence and obtained by direct effort. The head of the humerus, ectopic in the supraspinatus fossa (fossa infraspinata), visible to the eye, and the coracoid process will stand in front of the blade sharp. Since that practical importance only front shoulder (glenohumeral joint) dislocation, further description only applies to him.
Diagnostic symptoms of shoulder joint dislocation
Shoulder move aside, tensed and can remain without support. The area of the shoulder joint has lost roundness. Under the tip protruding outside and even in lean sharply outlines acromion blades lying outwards from the axis of the arm, clearly palpable recess. The axis is projected onto the shoulder coracoid process, or even in the middle of the clavicle. When attempting to move the shoulder exerts a spring resistance and rotational movement of the head is felt medially from the coracoid process.
Because of complications shoulder (glenohumeral joint) dislocation found damage blood vessels and nerves armpit, often in the form of compression of - a sensory and motor disorders, especially from the axillary nerve that surrounds the head of the shoulder, back, and supplies the deltoid muscle. Partial paralysis of the muscles, weakening the function of the shoulder are frequent and may contribute to the formation of the habitual shoulder (glenohumeral joint) dislocation.
When a dislocated shoulder (glenohumeral joint) are frequent bone fragments as lower-front edge of the glenoid cavity, as well as detachments mounds, most often greater tuberosity. The gap between the last clinically diagnosed morbidity in the appropriate location of the head and the presence of abundant hemorrhage, coming down from the head band over the front of the shoulder to the elbow, sometimes stepping on the forearm, even on the trunk. These complications, which give extensive gaps bags, can also contribute to the formation of the habitual shoulder (glenohumeral joint) dislocation, if the patient is too early to begin the hard work. Habitual shoulder (glenohumeral joint) dislocation are observed in the W-4% of all shoulder dislocations.
The prognosis for a dislocated shoulder (glenohumeral joint) is generally favorable, deteriorating detachments and breaks mounds of large vessels or nerves to form a tight or mobility or paralysis, or habitual dislocation.
Treatment of shoulder (glenohumeral joint) dislocation - reduction and operation
Fresh uncomplicated shoulder (glenohumeral joint) dislocation should be reduced during the first day. At the end of the month reduction of shoulder (glenohumeral joint) dislocation rarely succeed.
The procedure reposition the shoulder joint dislocation is performed under local anesthesia.
From numerous methods of reposition shoulder (glenohumeral joint) dislocation are used:
- More rough method of dislocated shoulder reposition, practiced since the time of Hippocrates, and referred to the method of Cooper, is to ensure that the doctor sits against the patient lying on the bed or on the floor, and, having rested the heel in the armpit, with the force of traction produces hand or body length or allotted hand
- Dislocated shoulder Shintsinger's rotary reposition method
- Akin to latter method of dislocated shoulder reposition, especially a favorite at the moment, method Kocher. It contains from 4 elements:
- laid along the length of the torso arm bent at the elbow and strongly rotate (rotating) outwards, thus releasing the head from adhesions and bringing it to the pit
- then, raising the elbow forward, shoulder abduction relax rostral-shoulder ligament (lig. coraco-humerale)
- followed by rotating the arm inward to bringing it to the chest wall head is rolled into place
- The most tender and of normal anatomic considerations receptions should be attributed Moth method consisting in a strong abduction, traction and direct pressure with your fingers on the head. This method is fit for dislocations with a margin of mounds where rotary methods may increase the gap
- Method Janelidze - reposition a dislocated shoulder, hanging off the table, with the patient on his side; bent at the elbow of the forearm is produced downward pressure to rotary motion
Whichever method of shoulder (glenohumeral joint) dislocation reposition nor use - reduction is easy if performed under general anesthesia.
With long-standing and not reduced dislocation (up to 3 months) and with a fractured neck sprains shoulder Hofmeister offers to attempt reposition after a long vertical hanging of the upper limb with traction through the block (in the healthy side). If irreducible shoulder (glenohumeral joint) dislocation on the front surface of the neck of the scapula form a sort of pits with fibrous razrascheniyami around the head. In cases where such neartroz later acquires motion, surgery is not necessary. It is only necessary to try to increase it mechanotherapy. In the absence of neoartroza, with bone ankylosis shoulder movement successfully takes on the blade.
The surgical intervention in chronic dislocation of the shoulder (glenohumeral joint) is not absolutely necessary. When attempting the surgery with a view to whether the of reposition, resection of the head, neck osteotomy, the release of nerve or stitching - beware damage to the neurovascular bundle, which ectopic head tightly soldered.
Habitual dislocation of the shoulder (glenohumeral joint) reduce a very easy - often even by the patient. Too frequent repetition of the minor reasons, they harass the patient and make him look for surgery. When the operation of habitual shoulder (glenohumeral joint) dislocation are mainly the following methods:
- simple suturing of the capsule of the shoulder joint - capsuloraffia
- transplanting muscles to strengthen and support the joint below: example of this method is the method Clermont-Enrlich - transplanting posterior third of the deltoid muscle, with its holding in the armpit through the square hole (foramen quadrilaterum) and suturing to the periosteum of the anterior shoulder surgical neck circumference
- Kirschner's fascioplasty
- suturing fascia (fasciosuspensio) to strengthen the capsules and suspension of the blade head to the acromion (acromion)