Dislocation of the scapula: symptoms and treatment of the clavicle joints. Dislocation of the scapula: causes, symptoms, treatment With subluxation of the scapula, is the xiphoid process displaced

The human body is inherently unique. Everything in it is thought out to the smallest detail. Each muscle, each cell does its own specific job. And only thanks to this a person can fully exist. Now I want to talk about what the subscapularis muscle is and what is its main function.

Definition of concepts

Initially, you need to understand the basic terminology. So what is the subscapularis muscle? According to the medical dictionary, in Latin the name of this part of the human body sounds like m. Subscapularis. It belongs to the belt group. It originates from the front surface of the scapula, which is also called costal. It is attached to the tubercle located on

Main function

Why you need a subscapularis is quite simple. However, without their fulfillment, a person will not be able to fully live and do his daily work. So she:

• leads the shoulder to the body of a person;
• helps the shoulder to turn inward.

However, its main task is to help stabilize its work during shoulder movements. It is indispensable for the correct operation of the entire shoulder girdle.

Appearance

The subscapularis muscle has a triangular shape, it is flat. Consists of multiple bundles. It is important to note that there are special layers between these bundles, which makes this muscle very unique and unlike others. It also has two layers:

1. Deep. It starts from the costal surface of the scapula. However, it does not coincide a little in shape with it, as it seems a little offset.
2. Surface. It is located from the fascia of the subscapularis type, where it is securely attached to the edges of the subscapular fossa.

Feeling (palpation)

In addition to the subscapularis muscle, the so-called rotating ring includes three more: the small round, abdominal and supraspinatus. It is because of this that the subscapularis muscle is very, very difficult to feel. Not only is it part of a larger complex, but it is also located on the front of the scapula. That is, it fits snugly against the chest. Only a specialist can palpate it. To do this, you will have to perform a number of actions:

• The patient should lie either on his stomach or on his back.
• The patient's hand is maximally retracted to the side.
• You need to "pass" with your fingers under the back wall, while feeling the edge of the scapula.
• Moving medially, you can feel the subscapularis muscle. In this case, it must be pressed against the front wall of the scapula.

Doctors say that the muscle is not always detectable. Much depends on the ability of the patient's scapula to move relative to the chest.

About pain

Damage to the subscapularis muscle is always associated with discomfort. So, a person can feel discomfort not only in the place where it is located. The pain can be concentrated in the area where the muscle is located, it can spread to the entire scapula. But it also happens that uncomfortable sensations appear even in the wrist area. It is in this place that they are encircling. Also, discomfort can be in the case of an attempt to move the shoulder to the side or move it out. Pain can result from the most common causes:

• heavy load on the shoulder when turning inward, especially if the load is regular. This problem, for example, often occurs with crawl swimmers;
• shoulder injuries of various origins can also be the cause.

About problems

What problems can arise when it comes to this part of the human body? The first problem is subscapularis tendopathy. These are some that arise as a result of insufficient blood supply to the muscles. The cause of tendopathies can also be hereditary pathologies of the connective tissue. It should be noted that, for example, with tendopathy of the subscapularis muscle, pain in a person intensifies at the moments of bringing the spoon to the mouth, combing the hair, and taking the hand behind the back. It should be noted that if a patient often has similar problems concerning the muscles of the shoulder girdle, then he may be diagnosed with "periarthritis of the shoulder scapula". Also, this problem can arise in the case of permanent injury to the tendons.

About gaps

Rupture of the subscapularis muscle is less frequent. However, the most common cause is tendopathies that arise as precursors of this problem. Symptoms of a subscapularis tendon rupture:

• a sharp increase in pain;
• inability to move the hand freely.

It is also important to note that tears can be either partial or complete when the tendon is completely detached from the attachment. Of course, the intensity of pain depends on this. With partial ruptures, hand movement may still be preserved (although it will be accompanied by pain), while with full ruptures, the hand is completely immobilized.

Diagnostics

Only a doctor can diagnose the problem. This will require an examination of the patient and taking an anamnesis. Also, the patient must be sent for x-ray. To clarify the extent of the damage, you will have to undergo an ultrasound scan or MRI.

Treatment

How is the subscapularis muscle treated? Most often it is conservative. The main thing with a partial tendon rupture is to relieve the pain. For this, pain relievers, anti-inflammatory drugs can be prescribed. Also, the sore spot is fixed with a tight bandage. A splint may be used if the tendons are torn. When the pain goes away and the shoulder is back to normal, doctors prescribe special exercises to work the joint.

Sometimes surgery is required. This is most often necessary in the event of a complete rupture of the tendons, or if conservative treatment has not yielded the desired results.

The structure of the upper limb girdle

The shoulder blades, collarbones and muscles that provide support and movement to the upper limbs together form the shoulder girdle. The scapula is a paired flat bone of a triangular shape. On its back surface there is a bony protrusion called the scapular spine. Its height from the inner to the outer edge gradually increases, and the scapular spine passes into the acromion - a large bony process. Together with the articular end of the clavicle, it participates in the formation of the acromioclavicular joint.

A little lower is the glenoid cavity. It is a depression that connects to the head of the humerus. Outside, the joint is covered with a capsule and strengthened by ligaments and muscles.

Dislocation of the acromioclavicular joint

This dislocation most often occurs when falling on the shoulder or when hitting the collarbone. The clavicle is connected to the scapula using the acromioclavicular and clavicular-coracoid ligaments. In those cases when only the first of them breaks, the dislocation is considered incomplete, and if the integrity of both is violated at the same time, it is complete.

If the clavicle is displaced above the acromial process, then such a dislocation is called supraacromial. With subacromial dislocation, the outer end of the clavicle is located below the acromion. The latter type of displacement of the articular surfaces of the bones is very rare.

There are a number of signs that are characteristic of complete dislocation of the acromial (scapular) end of the clavicle. A person, when moving in the shoulder joint, as well as when the doctor probes the acromioclavicular joint, experiences pain. The shoulder girdle on the side of the injury appears to be shortened. The outer end of the clavicle protrudes as a step and easily slides back and forth.

Keystroke symptom is an important sign of a dislocated clavicle ... When pressed on the acromial end, it easily returns to its place. But if you let go of the collarbone, then its outer part, like a key, quickly rises up.

In order to confirm the diagnosis, an X-ray examination is performed. When taking pictures, the patient must be standing. When it is necessary to distinguish complete from incomplete dislocation, symmetrical radiographs of both acromioclavicular joints are taken.

The dislocation can be adjusted easily, and after that it is very important to keep the collarbone in the desired position. A variety of bandages (usually plaster) are used, and a cotton-gauze retainer is applied to the acromioclavicular joint. The period of immobilization (creating immobility in the joint) is about six weeks.

For chronic dislocations and in cases where conservative treatment methods have been unsuccessful, surgery is performed. The surgeon forms new ligaments from synthetic materials (silk, lavsan, nylon), auto tissues (tissues that belong to the patient himself) or allot tissues (taken from the body of another person). After that, a plaster cast is applied for six weeks.

Shoulder dislocation

Traumatic shoulder dislocations usually occur when falling forward onto an outstretched or abducted arm. The displacement of the articular surfaces of the humerus and scapula relative to each other can also occur if a person falls backwards on the extended arm.

The head of the humerus can move in different directions relative to the glenoid cavity of the scapula. Depending on this, dislocations are divided into anterior, posterior and lower.

Symptoms of dislocation appear immediately after the injury that led to its occurrence. The shoulder girdle of the injured hand is lowered, while the patient tilts his head towards the injury. A person complains of pain and inability to move in the shoulder joint.

The injured arm appears to be longer, it is bent at the elbow joint and is in the abduction position. In order to create rest of the limb, the patient holds it with his good hand.

When probing the area of \u200b\u200bthe joint, the doctor discovers that the head of the humerus is in an unusual position. He should also determine if movement and skin sensitivity below the injury site are disturbed and check the pulse on the injured arm. This is necessary in order to find out if the nerves and blood vessels have been damaged.

X-ray is an important method of examining a patient, with the help of which a final diagnosis is made. The dislocation should not be corrected prior to this study, as it is necessary to clarify whether there are fractures of the scapula and humerus.

The dislocation must be corrected immediately after the final diagnosis is established. This manipulation is performed under local or general anesthesia. There are many methods that can be used to correct a dislocated shoulder. Dislocated shoulder - don't try to put everything in place

A sure sign of a bruise is the appearance of severe swelling, the formation of hematoma and bruising. When moving the arm, back, and also while walking, the victim will experience discomfort and pain.

Lying and sleeping on your back will also be unpleasant. Experts warn that soft tissues and muscles can ache for a week, then the symptoms will gradually subside.

Dislocation of the shoulder joint is a pathology that is accompanied by the appearance of a number of external symptoms that almost always make it possible to accurately determine this ailment. Basically, these are signs indicating a change in the structure and function of the joint, as well as a change in the shape of the shoulder and shoulder girdle.

Dislocation is usually accompanied by a number of unpleasant subjective experiences, among which there is an intense painful sensation.

Among the symptoms of shoulder dislocation, the following groups of signs are distinguished:

• signs of dislocation of the shoulder joint;
• signs of complicated shoulder dislocation.

Signs of a dislocated shoulder joint

Symptoms of a dislocated shoulder joint can be quite varied, but they usually present with pain, limited movement, and shoulder deformity.

In the case of a large displacement of the scapula, a complete dislocation occurs in the shoulder and clavicular joints. With such a violation, a severe pain syndrome develops, and the hand becomes inactive.

Symptoms of incomplete dislocation of the scapula may be blurry. Severe or not very severe pain indicates other injuries: fracture, sprain, ligament rupture.

The victim may experience pain even with a simple bruise if the nerve endings are involved.

Symptoms of a dislocated shoulder are severe and sharp pain and joint dysfunction. The shoulder or arm is moved to the side.

Also, the shoulder may harden or deform (bend). As a result, the shoulder joints become asymmetrical.

When palpating, the head of the shoulder joint is not in its usual place, but below the coracoid process. Joint mobility becomes impossible.

Another symptom is a weakening of the pulse in the radial artery, because the head of the humerus compresses the vascular trunk. Often, dislocation of the shoulder is also accompanied by impaired sensitivity and motor function of the hand and fingers.

You can find out about the development of the disease by the characteristic symptoms:

Swelling, bouts of pain in the appropriate places.

Mobility is markedly reduced, due to the position of the head described above, the patient can perform only a minimum of movements.

The shoulder joint loses its characteristic smoothness.

You can observe pain, which is described as stitching, the upper limb becomes numb, bruising can reveal the sites of lesions, since the blood vessel is damaged, the nerve is in a pinched position.

The sensitivity of such parts of the skeleton as the forearms and other components of the hands disappears.

The condition of the joint capsule deteriorates markedly - it loses its density, elasticity, if the disease is not cured immediately. Changes occur, due to which the volume of fibrous tissue increases.

It begins to fill the articular enclosing ones, that is, those areas that are around are no longer hollow. The stage begins at which the muscle mass ceases to function, that is, it atrophies.

Dystrophic correction takes place.

There are often cases when the first dislocation of the shoulder leads to rupture of soft tissues. Then it is accompanied by bouts of noticeable pain. If the dislocation is repeated, the pain is not so strong, or does not appear at all.

Dislocation of the shoulder can be diagnosed with x-rays (CT or MRI) to differentiate the dislocation from a fracture of the proximal humerus or fracture of the scapula.

As soon as you have identified any of the first symptoms, self-treatment is contraindicated. Usually people try to straighten the joint, but this is very dangerous. Do not take risks, the consequences may be irreparable.

The appearance of the victim is characteristic: the head is tilted towards the dislocation, the shoulder girdle is lowered, the hand is moderately abducted, bent at the elbow and supported by a healthy hand. The shape of the joint is changed, a depression is determined along its upper-anterior surface.

Active movements are absent, passive ones are sharply painful. Only adduction of the elbow joint is possible.

On palpation, it is possible, but not necessary, to determine the head of the humerus in the armpit.

The shoulder is abducted, tense and can be left unsupported. The area of \u200b\u200bthe shoulder joint has lost its roundness.

Under the apex of the externally protruding and thin even sharply outlined acromion of the scapula, lying outward from the axis of the shoulder, there is a clearly palpable notch. The axis of the shoulder is projected onto the coracoid process or even into the middle of the clavicle.

When trying to move, the shoulder provides spring resistance, and during rotational movements, the head is probed inward from the coracoid process.

Of the complications of dislocation of the shoulder (shoulder joint), there are damage to the vessels and nerves of the armpit, more often in the form of compression of them - with sensory and motor disorders, especially from the axillary nerve, which surrounds the head of the shoulder, behind and innervates the deltoid muscle.

Partial paralysis of this muscle, weakening the function of the shoulder, is not uncommon and can contribute to the formation of the habitual dislocation of the shoulder (shoulder joint).

With dislocation of the shoulder (shoulder joint), bone fragments at the lower anterior edge of the glenoid cavity are also common, as well as tears of the tubercles, especially often of the large tubercle. The separation of the latter is diagnosed clinically by soreness in the corresponding place of the head and the presence of profuse hemorrhage, descending in a strip from the head along the front surface of the shoulder to the elbow, sometimes extending onto the forearm, even on the trunk.

These complications, resulting in extensive bursal rupture, can also contribute to the habitual dislocation of the shoulder (shoulder joint) if the patient starts hard work too early.

Habitual dislocations of the shoulder (shoulder joint) are observed in 3–4% of all shoulder dislocations.

The prognosis for dislocation of the shoulder (shoulder joint) is generally favorable, worsening by the separation of the tubercles and ruptures of large vessels or nerves with the formation of either tight mobility, or paralysis, or habitual dislocation.

A fracture of the scapula is always pain and swelling. When a part of the body is palpated at the location of the bone, discomfort increases. In case of neck fractures, sometimes the doctor probes the sharp edges of the bone. With dislocations of the shoulder joint, the edges of the scapula remain semicircular and smooth.

This type brings with it complications and long-term rehabilitation. Such a fracture can be with or without displacement. The patient often holds the injured hand with his healthy hand and presses it to his chest. In the area of \u200b\u200bthe scapula, an oval-shaped swelling appears. With a fracture of the neck without displacement, the patient does not feel pain in the forearm. It responds to armpit palpation.

In the case when a displacement fracture of the scapula occurs, several other symptoms appear:

• the hand is brought forward, not laid back;
• the shoulder joint takes on a spherical shape;
• on palpation, the patient complains of pain precisely at the site of the impact;
• passive hand movements are not difficult.

A complicated fracture of this type may require surgery. It is used extremely rarely, but it is 100% necessary according to indications.

Any type of injury requires hospital investigation and immediate treatment. The patient feels acute pain when the scapula is fractured. The symptoms then gradually subside, and the person walks on with the injury until they face complications of the disease. Therefore, if you suspect a fracture, you should urgently consult a doctor.

The scapula is located from the II to VII ribs along the posterior surface of the chest, is a flat triangular bone with three edges: upper, medial and lateral, which converge and form three angles: upper, lateral and lower.

The lateral angle is thickened and forms the neck of the scapula passing into the glenoid cavity. Near the depression, the coracoid process departs from the upper edge.

The anterior surface of the scapula is filled with the subscapularis muscle. The posterior surface of the scapula is divided by the spine into two unequal fossa sizes: the smaller supraspinatus, filled with the muscle of the same name, and the large infraspinatus, filled with the infraspinatus, small and large circular muscles.

The spine of the scapula, continuing to the lateral side, ends in an acre ion hanging from behind and above the glenoid cavity. From the spine and acromion, the deltoid muscle begins, and from the coracoid process to the shoulder there are the coracohumeral muscle, the short head of the biceps brachii and the pectoralis minor.

To the tubercles of the glenoid cavity above and below the cartilaginous zone, the long head of the biceps and the long head of the triceps muscles of the shoulder, respectively, are attached.

Starting from the transverse processes of the G-Civ with four teeth, it goes obliquely downward and the muscle lifting the scapula is attached to the upper corner of the scapula. Two more muscles are attached to the medial edge of the scapula: the rhomboid, which starts from the spinous processes Cvi-Cvii and Di-Div, and the anterior dentate, which starts with nine teeth from the upper ribs (from I to VIII or IX).

Such an abundance of muscles makes the scapula very mobile. In addition, all of these muscles are involved in abduction, adduction, external and internal rotation of the shoulder, and the trapezius and serratus anterior muscle abduct the shoulder beyond 90 °.

What provokes Damage to the scapula

Symptoms depend on the site of the dislocation. The victim is in pain. which, depending on the severity of the damage, may or may not be very severe. The pain spreads in different directions from the site of the dislocation, it is felt on palpation and at rest.

In case of damage in the acromioclavicular region, the outer end of the clavicle protrudes outward and, when pressed, easily returns into place. However, upon termination of exposure, it bulges again. This symptom is called "key" because of its similarity to keyboard instruments. The shortening and swelling of the damaged shoulder girdle is also visually determined.

If the shoulder region is damaged in the scapular region, then, on the contrary, the shoulder girdle will seem elongated. The victim's head is slightly lowered and tilted towards the injured shoulder. It is impossible to make movements with the injured joint, the victim is forced to hold the bent injured arm with the healthy one in order to create peace.

All traumatic dislocations of the shoulder are accompanied by sharp pain at the site of injury, deformation of the shoulder joint area (the joint becomes angular, sunken, concave). Joint movements are impossible. When trying to passive movements, a characteristic spring resistance is determined.

With an anterior shoulder dislocation, the head moves forward and downward. The arm is in a forced position (laid to the side or bent, abducted and turned outward).

On palpation, the head of the humerus is not found in its usual place, it can be felt in the anterior sections of the armpit (with anteroposterior dislocations) or below the coracoid process of the scapula.

Anterior and antero-inferior dislocations of the shoulder are sometimes accompanied by a separation of the large tubercle of the humerus, a fracture of the coracoid or acromial processes of the scapula.

If the normal range of motion in the shoulder joint is exceeded, the articular surface of the humeral head can slip out of the glenoid cavity of the scapula, which, depending on the degree of slip, is called dislocation or subluxation of the shoulder. Most dislocations and subluxations occur in the antero-inferior direction.

Causes

A dislocation of the scapula can be earned only by direct mechanical action or with a sharp jerk of the arm forward or upward. Also, such an injury can be obtained when falling from a great height, the scapula will turn and shift slightly outward, and its lower part will be pinched between the ribs.

Such damage is almost always accompanied by severe stretching, but it can also lead to rupture of the muscles located between the spinal column and scapula. Motorcyclists and cyclists are more likely to suffer such injuries.

There are two main mechanisms of damage to the scapular joints. In the first case, a strong pull for the hand is meant, while the scapula is shifted to the side and muscle tissue suffers. In the second case, they talk about a blow to the shoulder. Common causes of dislocation are falling back onto an abducted limb. When struck from behind, the collarbone is knocked forward.

We have already mentioned that the shoulder joint is highly mobile. A person most often "wields" this particular part of the skeleton.

He is very vulnerable, and most often he is affected by such a disease as dislocation. Its common cause is the provision of a general force effect, the movement itself is eversion or twisting in nature.

To lead to injury, it must be performed with a simultaneous violation of the volume of all possible joint movements.

There are other reasons and factors:

Excessive movement directed at this part of the skeleton is diagnosed in 12% of cases, and this type of health disorder is called "joint hypermobility".

The posterior or anterior varieties appear for various reasons, but most often due to the fact that the glenoid cavity is strongly tilted.

If the scapular glenoid cavity has a small capacity, the cause changes markedly, and the risk factor for dislocation increases.

A common cause is hypoplasia of the glenoid cavity, that is, it changes, for the most part, its lower region, and many other changes of a physiological nature also occur.

Often people are forced to repeat the same type of movement, and because of this, the ligaments and the joint capsule are repeatedly stretched. Among the patients, in this case, most often there are athletes (swimmers, handball players, etc.)

A particularly high risk is associated with excessive range of motion. In medicine, this method of movement is called "generalized hypermobility". There are a number of reasons associated with the anatomical features of the joint structure. Then research should be carried out in advance and traumatic situations should be avoided.

Found a mistake in the text? Select it and a few more words, press Ctrl Enter

This part of the skeleton rarely breaks. No more than 1.5% of scapula fractures are recorded per year compared to other bones. But this does not mean that this component of the skeleton should be treated with disdain.

A fracture of the scapula entails long-term treatment and difficult rehabilitation. The most common cause of this injury is a fall on the back. It is also easy to get a fracture of this type with a direct blow to the scapula.

Sometimes there were cases when this bone broke when the muscles of the shoulder joint were stretched. In this case, tension is transmitted to the neck of the scapula, and it breaks under the weight of the bones of the arm. Often athletes who throw the ball face this problem. Moving your hand deeply backwards can cause this injury.

It has been established that the development of this pathology is facilitated by damage to the articular lip (Bankart damage). The glenoid lip is a fibrocartilaginous formation that attaches to the glenoid cavity of the scapula, making the concave surface of the shoulder joint deeper and preventing the dissociation of the shoulder head and the scapula cavity during intense movement.

In addition, in patients with habitual dislocations, posterolateral defects of the humerus head are often observed due to a compression fracture not detected during the primary traumatic dislocation.

Treatment of habitual shoulder dislocation

In most cases, conservative therapy for habitual dislocations is ineffective. However, with a small number of dislocations (no more than 2-3), you can try to prescribe a special exercise therapy complex and massage to strengthen the muscles of the shoulder girdle.

At the same time, during treatment, it is necessary to limit external rotation and abduction in the shoulder joint. With the ineffectiveness of conservative treatment and a large number of dislocations, the only reliable means is surgery.

There are about 200 surgical methods for treating this pathology. All surgical methods can be divided into 4 groups: operations aimed at strengthening the joint capsule; plastic interventions on muscles and tendons; osteoplastic and transplant surgeries; combined methods that combine elements of several of the listed methods.

In this case, the most common is the Bankart operation, in which the surgeon fixes the cartilaginous lip and creates a connective tissue roller from the joint capsule, limiting the excessive mobility of the shoulder head.

Diagnostics

Diagnosis of dislocation of the shoulder joint is based on the clinical picture, which in most cases is quite specific and allows the diagnosis to be made without additional research.

However, since in some cases this ailment can be accompanied by a number of severe complications, for the final diagnosis, it is necessary to undergo a series of examinations that will determine the type of dislocation and identify concomitant pathologies.

X-ray

Radiography is recommended for all patients with suspected dislocation of the shoulder joint, as it allows you to accurately determine the type of dislocation and suggest possible complications. Reduction of dislocation without a preliminary X-ray is unacceptable.

The essence of the method is to obtain an image of the anatomical structures of the shoulder on a special film using X-rays. X-rays, passing through the human body, are partially absorbed, and the degree of absorption depends on the type of tissue and organ.

Bone tissue absorbs X-ray radiation as much as possible, as a result of which a fairly clear image of bone structures can be obtained on an X-ray image.

If a dislocation is suspected, X-ray of the shoulder joint in two projections is recommended - straight and axial. X-ray images determine the degree of displacement of the head of the humerus and the direction of displacement, as well as bone fractures, if any.

Computed tomography (CT)

Computed tomography is a modern method with which it is possible to study the organs and tissues of the body layer by layer by obtaining appropriate high-resolution images.

Computed tomography is based on X-rays and modern computer technology. The essence of the method lies in the fact that a patient who lies on the table of a CT scanner for several minutes is "shone through" with a series of X-rays emanating from a device rotating around him, which takes many pictures.

The main advantage over conventional radiography is that after computer processing, a clearer and more detailed layer-by-layer image of the examined internal organs and anatomical structures is obtained.

With dislocation of the shoulder joint, CT can accurately determine the direction of the dislocation, the position of the head of the humerus in relation to the articular surface of the scapula. Determination of bone fractures and fractures, if any, is possible.

If necessary, intravenous administration of a special contrast can be used, which makes it possible to better visualize the soft tissues and blood vessels of the studied area. It is important to note that with CT, as with X-ray, the patient is exposed to radiation exposure, therefore, the appointment of CT should always be justified.

However, modern computed tomographs allow minimizing the radiation dose, so today CT is considered a relatively safe research method and the only contraindication for its conduct is.

If the shoulder joint is dislocated, the doctor may prescribe a CT scan in the following cases:

• if radiography does not allow you to accurately determine the extent of the joint lesion;
• if you suspect a fracture of the humerus or scapula, which are not displayed on a conventional radiograph;
• if you suspect damage to the vessels of the shoulder (CT with contrast);
• when planning shoulder surgery.

Magnetic resonance imaging (MRI)

Magnetic resonance imaging is a modern high-precision method for examining internal organs and tissues of the body, which is considered absolutely safe and harmless to humans.

The procedure itself is identical to computed tomography, but unlike CT, where X-rays are used to obtain an image, MRI uses the effect of nuclear magnetic resonance, which allows you to obtain more accurate images of soft tissues, ligaments, cartilaginous surfaces, capsules of joints, vessels.

The main advantage over CT is the complete absence of radiation, so the only contraindication for MRI is the presence of metal parts in the patient's body (.

implants, metal fragments after wounds Indications for MRI in case of dislocation of the shoulder joint:

• clarification of the results of conventional radiography in the presence of contraindications to CT;
• questionable data obtained with CT;
• determination of the extent of damage to periarticular tissues (ruptures of the capsule of the joint, ligaments, muscles);
• for the diagnosis of compression of the vessels of the shoulder (the introduction of contrast is not required).

Ultrasound examination (ultrasound) of the shoulder joint

Ultrasound examination is a modern safe examination method based on the use of ultrasonic waves. This study is usually prescribed when fluid accumulation is suspected (

) in the cavity of the shoulder joint. However, according to ultrasound data, the nature of the lesion of periarticular tissues can also be determined (

ruptures of the capsule, ligaments, muscles

), and when using

mode that allows you to judge the speed and quality of blood flow

) the presence and degree of compression of the vessels of the shoulder can be determined.

To determine if the scapula is dislocated, the doctor takes an x-ray of the right or left shoulder. The indication for X-ray examination is a suspicion of a fracture - a diagnosis can be made from one projection, in the case of complicated fractures, two images are sometimes taken.

To determine concomitant disorders, it is necessary to use other examination methods: MRI, CT, ultrasound. Instrumental methods determine the degree of dislocation, concomitant damage to soft tissues and vascular network.

Dislocation of the joint is diagnosed according to certain indicators. We have already listed many of them among the symptoms. But all the same, the traumatologist makes a professional examination, drawing a conclusion based on the complaints that he lists.

Other medical examinations are also important. X-ray examination is very effective, for which the direct projection method or, if necessary, axial technology is used.

The quality of the X-ray image is sufficient to view the location of the bone head, to reveal the features of its displacement, which also leads to damage to the integrity of the skeleton.

The most important task remains to identify whether this dislocation is anterior or posterior. It is important to identify if there are any fractures.

A scapula fracture is very rare, but any traumatologist or surgeon can determine it. The patient is palpated the impact site, and according to the reaction and description of the victim's sensations, a picture of the doctor's diagnosis is already formed.

To confirm the doctor's assumptions, an X-ray examination is performed in two projections. The results can confirm or deny the preliminary diagnosis 100%.

With such a dislocation, an X-ray examination is required to assess the severity of the damage and exclude or confirm the presence of fractures. Sometimes two pictures are taken - a healthy and a damaged scapula in the clavicular region.

This is necessary to determine the type of dislocation - complete or incomplete. If the extent of the joint lesion is not displayed on the x-ray or there is a possibility of damage to the blood vessels, then the patient may be prescribed a computed tomography scan.

If for some reason it is impossible to conduct an X-ray examination (for example, during pregnancy), then the patient is prescribed other methods of examination, such as magnetic resonance imaging or ultrasound examination (including Doppler mode to assess the state of blood flow).

Shoulder (shoulder joint) dislocation treatment - reduction and surgery

Fresh uncomplicated dislocations of the shoulder (shoulder joint) should be adjusted within the first day. After a month, the dislocation of the shoulder (shoulder joint) is rarely repaired.

The procedure for repositioning the dislocation of the shoulder joint is performed under local anesthesia.

Of the many ways to reposition a shoulder (shoulder joint) dislocation, the following are used:

1. A more crude method of repositioning the shoulder dislocation, which has been practiced since the time of Hippocrates and called the Cooper's method, boils down to the fact that the doctor sits down opposite the patient lying on the bed or on the floor, and, resting his heel against the armpit, with force produces an extension by the arm or along the body length or by the abducted hand
2. Schinzinger's rotational method of reducing dislocation of the shoulder
3. A related to the latter method of repositioning the dislocation of the shoulder, especially favored at the present time, is the Kocher method. It consists of 4 points:
   • the arm laid along the length of the body is bent at the elbow and strongly rotated (rotated) outward, thus freeing the head from adhesions and bringing it closer to the fossa
   • then, bringing the elbow forward, abducting the shoulder relax the coraco-humeral ligament (lig.coraco-humerale)
   • by subsequent rotation of the shoulder inward, bringing it to the chest wall, the head is rolled into place
4. The most gentle and from anatomical considerations normal techniques should be attributed to the Mote (Mothe) method, consisting in strong abduction, extension and direct pressure with the fingers on the head. This method is also suitable for dislocations with tearing of cusps, where rotational methods can increase the separation.
5. Dzhanelidze's method - reduction of a dislocated shoulder hanging from the table, with the patient on his side; for the forearm bent at the elbow, downward pressure is produced with rotational movements

Whatever, however, the method of reduction of dislocation of the shoulder (shoulder joint) is used, - the reduction is made easy if performed under anesthesia.

In case of chronic unreduced dislocations (up to 3 months) and dislocations with a fracture of the neck of the shoulder, Hofmeister suggests making an attempt to reposition after prolonged vertical suspension of the upper limb with traction through the block (on the healthy side).

With irreducible dislocations of the shoulder (shoulder joint), a semblance of a fossa with fibrous growths around the head is formed on the anterior surface of the scapula neck. In cases where such nearthrosis later acquires movement, surgery is not needed.

It is only necessary to try to increase it with mechanotherapy. In the absence of neoarthrosis, with bone ankylosis, the shoulder blade successfully takes over the movement of the shoulder.

There is no particular need for surgery for chronic dislocations of the shoulder (shoulder joint). When attempting an operative intervention for the purpose of reduction, head resection, cervical osteotomy, nerve release or stitching, one should beware of damage to the neurovascular bundle, with which the displaced head is closely soldered.

Habitual dislocations of the shoulder (shoulder joint) are adjusted very easily - often even by the patient himself. With too frequent repetition from minor reasons, they harass the patient and force him to seek surgery. In the operation of habitual dislocations of the shoulder (shoulder joint), the following methods are used mainly:

• simple suturing of the shoulder joint capsule - capsulorrhaphy
• muscle transplantation to strengthen and support the joint from below: an example of this method is the Clairmont-Enrlich method - transplantation of the posterior third of the deltoid muscle, with its passage in the armpit through a square hole (foramen quadrilaterum) and suturing to the periosteum of the anterior circumference of the surgical neck of the shoulder
• kirschner fascioplasty
• suturing the fascia (fasciosuspensio) to strengthen the capsule and suspend the head to the acromion of the scapula (acromion)

First aid

First aid for suspected dislocation of the shoulder should consist in limiting movements in the area of \u200b\u200bthe damaged joint, eliminating the traumatic factor, and also in timely seeking medical help.

If you suspect a shoulder dislocation, the following measures should be taken:

• ensure complete rest of the joint (stop all movements);
• apply ice or any other cold (allows you to reduce the inflammatory response and tissue swelling);
• call an ambulance.

It is highly not recommended to independently correct the dislocation of the shoulder, since, firstly, it is extremely difficult to do without proper qualifications, and secondly, this can lead to damage to nearby muscles, nerves and blood vessels.

Do I need to call an ambulance?

If you suspect a dislocation of the shoulder joint, it is recommended to call an ambulance, since, firstly, an ambulance doctor can alleviate the victim's pain syndrome, and secondly, he can exclude some serious complications.

However, if there are no signs of nerve or vascular damage, you can do without calling an ambulance. However, it should be understood that the treatment of dislocation can only be carried out in a medical institution and only by qualified personnel.

Thus, if, after an injury that caused a dislocated joint, the patient's condition is stable and an ambulance has not been called, you should contact the local trauma center as soon as possible.

It should be borne in mind that the earlier the dislocation is reduced, the higher the chances of a full restoration of joint function.

What position is better for the patient?

The victim should provide maximum rest for the damaged joint. This is achieved by positioning the free upper limb in the abduction position (

adduction for posterior dislocation

). At the same time, the forearm is bent at the level of the elbow and rests on a roller pressed against the side of the body. In this case, to ensure complete immobility, it is recommended to use a bandage that supports the arm (

a triangular headscarf that fits the forearm and ties around the neck

It is not recommended to lean on or lean on the injured shoulder or free upper limb, as this can provoke even greater displacement of the articular surfaces, rupture of the ligamentous apparatus and damage to the vascular bundle.

Is it necessary to give an anesthetic?

Self-administration of medications is not recommended, however, if it is impossible to get prompt medical assistance, the victim may take some

Thus, reducing the negative experiences of pain. In most cases, you should use

Which, due to their effect on the synthesis of some biologically active substances, can reduce the intensity of pain.

Applying ice to the affected joint can also reduce the intensity of the pain.

First aid in case of suspicion of this type of damage is urgent delivery to a hospital. This should be done in the position of the victim on his stomach on the shield. For severe pain, the use of analgesics is allowed.

After a person is taken to the department, a consultation with a traumatologist and a mandatory X-ray examination are required, which will help to accurately understand the picture of the disease. It is better to do x-rays on the right and left, to exclude even a minor violation.

Treatment of incomplete dislocation of the scapula consists in immobilization of the limb, adequate anesthesia, and after pain relief, it is imperative to carry out exercise therapy procedures, during which it is not recommended to abduct the shoulder more than 90 degrees.

Immobilization of the affected limb lasts for 3 weeks, and after removing the plaster cast or soft bandage, a rehabilitation period is required.

In full form, the joint is first reduced, which can be done both under local anesthesia and in the operating room. Also, the restoration of the affected ligaments is carried out in an operative way. In this case, the duration of treatment is already 6 to 8 weeks.

Sometimes it happens that surgical treatment may be contraindicated for one reason or another. In this case, a plaster cast is applied for a long period, which reliably fixes the affected joint and ligaments.

To control the progress of recovery, an X-ray examination is required, and after removing the plaster cast, gymnastics with dislocation of the scapula, which will allow the limbs to return to their former mobility.

Regardless of the nature of the injury, you must call a doctor. The apparent dislocation may hide a fracture of the head of the humerus. First aid for trauma involves immobilization and pain relief. Correctly provided first aid will save you from complicated treatment.

If you suspect a dislocation of the patient, you need to lay down or sit down, give a non-narcotic analgesic in a standard dosage, and cool the damaged area. First aid will prevent possible complications: sprain, inflammation, internal hemorrhage. Abrupt movements should be avoided - all manipulations are carried out without violence.

Limb immobilization involves the imposition of a belt-belt. If there is no experience in providing medical care, in case of a scapula injury, it is enough to place the injured limb on a scarf, and immobilize the clavicle joint with a bandage. You can fix the lower section of the scapula with a scarf in the form of an eight.

If there is a person nearby with symptoms indicating a fracture of the scapula, then he needs to be helped before the ambulance arrives or before transporting the patient to the hospital on his own:

• give any anesthetic in tablets ("Analgin", "Spazmalgon", "Ibuprofen", with intolerant sensations it is allowed to use "Ketanov");
• put a small pillow of cotton wool or a roller made of several twisted bandages in the armpit;
• apply any cold to the injury site (products from the freezer must be applied through a diaper or sheet so as not to freeze the skin);
• with the help of a piece of tissue, apply a fixing bandage of the hand pressed to the chest, so it will be possible to avoid further injury to the vessels and nerves by bone fragments;
• the patient should be taken to the hospital only in a sitting position.

These rules will help to avoid additional complications and severe pain to the affected person.

Treatment methods

Before repositioning the shoulder joint, the patient needs pain relief. Anesthesia can be both general and local. There are many methods for repositioning a shoulder dislocation. They are divided into lever, physiological and pushing (pushing the humerus into the articular cavity). But these methods are often combined with each other.

After the reduction and immobilization of the diseased joint with a plaster cast, its movements should be limited for three weeks. When the splint is removed, it is recommended to undergo a rehabilitation course that restores joint mobility and prevents recurrent dislocations.

The complex of procedures includes massage, remedial gymnastics, electrical muscle stimulation, water exercises, etc.

Reduction is the basic treatment for shoulder dislocation. It is not self-made. The only thing that a patient can do to cure the disease is to see a doctor as soon as possible. The first dislocations require special attention. They are more complex, given that it is the first dislocations that are harder to correct.

There is a wide range of treatments for dislocation of the shoulder joint.

All methods can be roughly divided into two broad categories:

Non-surgical.

Operating.

The non-surgical or closed method consists in the action in relation to the head of the humerus. For this, anesthesia is done. In this case, it is customary to use a solution of novocaine.

Do not delay with medical intervention. If it is received out of time, one should expect such consequences as muscle contraction, and this factor greatly complicates reduction.

Then anesthesia is not enough, in addition a number of special drugs will be required, the task of which is to relax the muscles. They are called "muscle relaxants".

If such a measure does not work, then the patient will have to prepare for the operation. It is usually an open joint repositioning technique.

This is followed by treatment based on the immobilization of the damaged part of the skeleton. This leads to the fusion of the torn ligaments and the restoration of the articular lip.

This process can occur due to the fact that the articular capsule, going in front, stretches in a peculiar way, which allows the severed articular lip to be pressed against the surface of the desired bone.

As a rule, plaster casts are applied at this stage. They should be used for about three weeks.

Dislocation of the shoulder is treated in different ways, not excluding:

painkillers in the form of tablets or injections, necessary to normalize the general condition of the victim, eliminate pain and more;

anti-inflammatory drugs;

exposing the injured area to cold, as this can reduce pain and swelling.

Physiotherapy

One of the simplest methods of physiotherapy is associated precisely with the application of cold to the affected area. The intensity of pain is markedly reduced, and inflammation is relieved. In the near future after the injury, it is necessary to apply a compress with ice. This reduces the risk of dangerous defects and speeds up recovery.

There is a special complex. Its task is to help create a muscular frame, to protect the patient from the development of this disease in the future.

If a habitual dislocation of the shoulder joint of a permanent nature is diagnosed, then exercise therapy does not bring positive results. Such a pathology interferes with the creation of conditions for further protection of the joint.

Good results are obtained by a course of paraffin therapy, electrophoresis, CMT on the area of \u200b\u200bthe affected joint. Not all physiotherapy methods are relevant in one case or another.

For example, patients who have crossed the 70-year mark require caution. Elderly patients cannot be treated with physiotherapy.

For any type of fracture, it is initially necessary to anesthetize the site of injury. At home, you need to take an anesthetic pill. The hospital can inject Novocaine into the fracture site.

Then a tight bandage is applied with a roller under the arm. Thus, the patient walks for 3-4 weeks. The restoration of working capacity occurs in no less than 5-6 weeks.

In severe cases with combined injuries, surgical intervention is performed. This method is used less often when a scapula fracture is diagnosed. Treatment and rehabilitation after it are more difficult and longer.

Recovery after removal of immobilization

Fixing the hand in a special position helps the scapula to heal in the correct way. What kind of immobilization is needed for a fracture of the scapula? Fixation with plaster is now used extremely rarely.

In this period, rehabilitation and physical activity of average intensity come to the fore. If rehabilitation is carried out on time and correctly, then the ability to work will be fully restored in a few weeks.

The intensity of the exercise is constantly increasing, and the use of sports equipment is encouraged:

• balls;
• wooden and plastic sticks;
• sports elastic bands;
• expander;
• small rubber balls for hand and finger exercises.

All rehabilitation is aimed at restoring the work of weakened muscles and joints. Activities in the water are encouraged. Thus, the patient experiences less stress, and rehabilitation can be extended up to 40 minutes.

First, it is better to exercise in the bathroom, in warm water. In this case, the muscles are steamed and easier to stretch and contract. After a few sessions, you can start swimming in the pool or pond in the summer.

You do not need to put a heavy load on the body first. The main goal is to gradually restore the work of all muscle groups and joints.

Effects

With illiterate or untimely treatment of the disease, there is a great chance of developing serious complications. Even if the patient received an incomplete dislocation, after a few months he can go into a complete one, in which the ligaments, blood capillaries and nerve endings will begin to be damaged.

This complication is dangerous in that it can reduce the sensitivity of the affected limb and provoke further joint problems. To protect himself from re-dislocation, the victim will need to regularly do specially designed exercises even after the end of the rehabilitation course.

A common injury does not entail complications and cannot negatively affect the patient's later life (with the exception of dislocations and fractures).

If treated incorrectly, incomplete dislocation can lead to complete dislocation, while not only tendons and ligaments can be affected, but also nerves, which in the future threatens with problems with movement in the joint, as well as with sensitivity in the hand itself.

Other complications include rupture of the capsule of the shoulder joint, damage to the head of the humerus, and regular spontaneous repetition of the injury.

A fractured scapula is not as harmless as it seems. During treatment, dislocation of the forearm bones may occur. This is due to the inability to hold the head of the forearm bone with the fragments of the scapula.

During such injuries, the cartilage in the shoulder joint suffers. Over time, the patient in this place may develop arthrosis. A displacement fracture threatens to deform the scapula. Then this bone cannot move freely along the ribs. This is accompanied by painful sensations and an unpleasant crunch.

Surgery can cause:

• chronic dislocations;
• muscle atrophy;
• intercostal neuralgia;
• stiffness in hand movement.

But if the operation is not carried out on time, then the person can completely lose his ability to work and remain disabled. It is very important to react in time to a fracture of the scapula. The consequences of a negative nature will then be minimized.

Improper treatment of a dislocated scapula can lead to serious complications. An incomplete incomplete dislocation can eventually turn into a complete one, in which not only tendons, ligaments, blood vessels are damaged, but also nerves, which is fraught with a decrease in sensitivity in the injured limb and problems with joint movements.

In addition, among the possible complications can be a rupture of the capsule of the joint, a fracture of the head of the humerus, damage to the periosteum, as well as a constant spontaneous repetition of dislocation.

Rehabilitation stages

After a dislocation of the scapula, physiotherapy and massage are recommended. Physical therapy is indicated to strengthen the muscles and develop the hand, however, they begin training after the joint is fully restored. Swimming will be a good help during the rehabilitation period.

Hardware physiotherapy offers treatment methods such as UHF, magnetotherapy, drug electrophoresis. Treatment with physical factors helps to improve regeneration processes, normalizes tissue blood supply, and enhances lymph outflow.

After a dislocation of the pleural joint, some rehabilitation is required. It consists of several parts:

includes the activation of the functionality of the area of \u200b\u200bdamaged muscles, when the period of immobilization begins, the duration of the course is about three weeks;

the function of the shoulder joint is restored, the duration is approximately three months;

final steps of rehabilitation of joint functions, duration - six months.

The bone joint must be immobilized. This requires immobilization.

It is the best remedy and is applied after the plaster has been removed. Then comes the time of the rehabilitation process, when it is necessary to perform special exercises.

They are aimed at making circular movements with the shoulder using circular motions. Exercises in water give good results.

A disease such as a habitual dislocation of the shoulder requires treatment under certain conditions of a specialized trauma hospital. It will take such a measure as surgery.

Here, conservative procedures will not give a positive result. Surgery offers a whole section on the treatment of this pathology.

Treatment should be consistent with the cause of the dislocation of the shoulder joint. Recall that due to this displacement, the head of the humerus can be of different nature.

After the operation, they undergo special rehabilitation. Electrical muscle stimulation, massage and exercise therapy are performed.

When three months pass after the operation, light loads are allowed (for example, six months later, hard physical labor). A fixing bandage must be used, it is not removed for 1-4 weeks. The time depends on the type of operation performed.

Rehabilitation helps to strengthen the muscles of the shoulder girdle. They are starting to get stronger in terms of a stabilizing effect on the joint. In the first stages, physiotherapy exercises are required, when the supervision of an instructor is necessary. After some time, the patient gets the opportunity to study at home. This stage can last 2-4 months.

There is no official diagnosis for scapular dislocation. In this part of the body, 2 dislocations are distinguished: in the shoulder and scapular. Doctors explain this by the fact that in any dislocated place there is a peripheral bone, and in our case it will be the humerus. The exception to the rule is the collarbone. There are dislocations of the sternal or scapular end of the clavicle, but not the scapula.

To understand the essence of the problem, one should understand the very structure of this bone. The scapula is a flat, triangular bone. It connects to the acromial or scapular process, forming the scapular-clavicular joint and the girdle of the upper limbs. On the other hand, the scapula is connected to the humerus and forms the shoulder joint.

Thanks to the scapula, 2 joints are formed at once, but it is in them that dislocations often occur. Dislocation should be understood as a persistent displacement of the articular bones that make up the joint.

Usually, a dislocation in the area of \u200b\u200bthe scapula occurs during a strong pull on the arm or a powerful blow to the scapula. At this time, the scapula is shifted to the side, and the angle that is below between the ribs is infringed. Sometimes muscle tissue attached to the scapula can be affected.

Often there are dislocations of the acromioclavicular joint or. They are caused by hitting or falling on the shoulder. The main condition of injury is that the lesion is always directed to the collarbone.

Its connection with the scapula is provided by the acromioclavicular or clavicular-coracoid ligament. Already, depending on the nature of the damage, the following types of dislocations are distinguished:

1. incomplete (only one ligament breaks with it);
2. full (both ligaments are torn);
3. supraacromial (there is a displacement of the clavicle over the acromial process);
4. subacromial (the outer end of the clavicle is located below the acromion).

A dislocated shoulder occurs when you fall on an outstretched or abducted arm. In this case, the surfaces of the humerus and scapula are displaced in relation to one another when the victim falls back on the abducted limb. The head of the humerus is sometimes displaced to the side in relation to the scapular cavity. In such cases, injuries can be: front, bottom, back.

In medicine, there is another concept of pathological dislocation. This is the name of the damage that arose after the transferred diseases. In the joints, such trauma is observed due to inflammatory changes caused by infectious processes. The site of inflammation can be in or near the joint.

The pathological change is often neurotrophic in nature. The surfaces of the joints change quite strongly, they lose their natural congruence (proportionality).

Pathological dislocation occurs due to abnormal bone growth in length, if the segment of the limb is two-boned. As a consequence, a small force is sufficient to produce a dislocation.

Dislocation signs

Trauma symptoms depend entirely on the specific area of \u200b\u200bthe injury. For example, for a complete dislocation of the clavicular scapular end, symptoms are characteristic:

• pain syndrome. When the patient tries to move the shoulder, he feels pain. Depending on the type of damage, it can be mild or severe enough. Due to the fact that such a dislocation may be accompanied by other injuries, the pain syndrome spreads on different sides. It also hurts when the doctor palpates the joint;
• shortening of the shoulder girdle. This symptom is visible without radiography and is observed from the damaged side.

When the scapula is dislocated, the outer end of the clavicle protrudes, moving forward and backward. Another important sign that helps identify trauma is called a "key".

When pressing on the acromial end, it immediately returns to its original position. When the collarbone is released, the outer half of the collar bone rises upward and resembles a piano key.

If the scapula is dislocated, the symptoms will appear immediately. The shoulder girdle on the affected side will be lowered and the patient's head pointed to the side. The person will feel severe pain, will not be able to make a single movement of the affected joint.

Outwardly, in such cases, the lengthening of the injured arm is noticeable; it is bent at the elbow joint and slightly abducted.

The victim is forced to hold the affected arm with a healthy limb, which will provide her with complete rest and temporarily relieve severe pain.

Treatment methods

If any of the relatives or passers-by gets a dislocation of the scapula, it is necessary to provide assistance to the victim as soon as possible. The patient's condition and the consequences of such an unpleasant trauma completely depend on the literacy of actions.

The main thing that everyone should know and remember is that it is strictly forbidden to correct dislocations on their own. Inappropriate actions can worsen the situation. Note that only a doctor conducts!

If there is no medical facility or emergency room nearby, you need to call an ambulance. With fractures of the shoulder joint, you will need to fix the hand in the position in which it is at the moment. This is done with a kerchief used to hang the arm.

A cold dry compress is additionally applied to the dislocated area. When the wound is open, it is necessary to apply a pressure, always sterile dressing. In the case when the patient complains of severe pain, it will be necessary to give him an anesthetic drug. The rest of the activities and medications are the responsibility of the ambulance team.

In the clinic, the patient will be immediately sent for x-ray. Based on the results of this study and visual examination, the doctor will make a final diagnosis. If there is a dislocation in the area of \u200b\u200bthe scapula, then it is provided for its reduction under general or local anesthesia. There are several methods used to reposition the dislocation. The most famous and popular methods should be called:

• Chaklin;
• Hippocrates.

It is impossible to eliminate only irreducible dislocation. This is what doctors call an injury in which soft tissue gets into the space between the articular surfaces. Such injuries require opening the cavity of the shoulder joint to remove the obstacle and the dislocation itself. The procedure is called arthrotomy, and the video in this article will tell you about the nature of the dislocation.

There is no official diagnosis of scapula dislocation. Most often, this term means a rupture or other damage to the acromioclavicular joint, or dislocation of the clavicle.

If the acromioclavicular joint is damaged, the scapula is completely detached from the clavicle and rests against the rib, thereby losing its connection with the joint. If the case is limited only to the rupture of the acromioclavicular joint, then here we can talk about incomplete dislocation or subluxation. But when there is a rupture of more powerful ligaments, which are called clavicular-coracoid, then we can talk about complete dislocation.

This injury has its reasons - a strong jerk for the right or left arm, a fall on a straight arm, an impact with force on the shoulder area. Most often, motorcyclists and cyclists are injured, although in some cases this can also happen when falling from a height of just one's own height.

Clinical picture

The main symptom of a dislocation of the scapula is difficulty in movement or their complete impossibility. As for passive movements, they are very difficult and very painful. When touched, the site of injury is characterized by painful sensations, which, again, increase when touched.

On examination, there is a violation of symmetry, protrusion of the lower or upper end of the scapula on the injured side, while the lower part of the vertebral edge is practically not palpable, which is associated with the unnatural position of the bone after injury. At the same time, it visually seems that one arm is somewhat longer than the other. If a bruise forms on a sore spot after a few days, then this indicates a serious case and a concomitant tear of the ligaments.

There are five degrees of severity of such damage. At the first, there is no displacement of the clavicle. In the second, clavicle subluxation and rupture of the acromioclavicular ligaments are diagnosed, but the clavicular-coracoid ligaments are not disturbed.

If the joint is not adjusted within a couple of weeks, then this leads to the appearance of degenerative-dystrophic changes in the area of \u200b\u200bthe shoulder girdle. This variety is called grade B. If the damage occurred less than 2 weeks ago, then they speak of grade A.

In the third degree, there is a violation of all ligaments and a shift of the clavicle. With the fourth, the clavicle at the time of injury not only leaves the joint, but also shifts backward. And finally, in the fifth degree, the clavicle shifts strongly upward.

First aid

First aid in case of suspicion of this type of damage is urgent delivery to a hospital. This should be done in the position of the victim on his stomach on the shield. For severe pain, use is allowed.

After a person is taken to the department, a consultation with a traumatologist and a mandatory X-ray examination are required, which will help to accurately understand the picture of the disease. It is better to do x-rays on the right and left, to exclude even a minor violation.

Treatment of incomplete dislocation of the scapula consists in immobilization of the limb, adequate anesthesia, and after pain relief, it is necessary to carry out procedures during which it is not recommended to abduct the shoulder by more than 90 degrees. Immobilization of the affected limb lasts for 3 weeks, and after removing the plaster cast or soft bandage, a rehabilitation period is required.

In full form, the joint is first reduced, which can be done both under local anesthesia and in the operating room. Also, the restoration of the affected ligaments is carried out in an operative way. In this case, the duration of treatment is already 6 to 8 weeks.

Sometimes it happens that surgical treatment may be contraindicated for one reason or another. In this case, a plaster cast is applied for a long period, which reliably fixes the affected joint and ligaments. To control the progress of recovery, an X-ray examination is required, and after removing the plaster cast, gymnastics with dislocation of the scapula, which will allow the limbs to return to their former mobility.

Complications

If treated improperly, incomplete dislocation can lead to complete dislocation, while not only tendons and ligaments, but also nerves can be affected, which in the future threatens with problems with movement in the joint, as well as with sensitivity in the hand itself.

Other complications include rupture of the capsule of the shoulder joint, damage to the head of the humerus, and regular spontaneous repetition of the injury.