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Shoulder dislocation


The shoulder joint is the most mobile joint in an organism which allows a hand to move diversely. This ability to move causes high percent of dislocations in a shoulder joint.
The head of a humeral bone "sits" in a socket which represents expansion of a shovel. As a socket small, other structures and the fabrics surrounding a shoulder joint are necessary for maintenance of its stability.
Dislocation of a shoulder arises when the head of a humeral bone leaves a socket. The shoulder can be deployed diversely. In more than 90% front dislocations are observed that means that the head of a humeral bone is moved on a position in a front part of a joint. Posterior dislocation is observed in case of the shift of a head of a humeral bone towards a shovel.  Other rare species of dislocation of a shoulder includes dislocations below a joint and chest option of dislocation at which the head of a humeral bone gets stuck between edges.

Вывих плечевого сустава

Dislocation of a shoulder joint

Shoulder dislocation reasons:

Shoulder dislocation, as a rule, arises because of the injuries which are often connected  with sport or falling. Elderly patients are inclined to dislocations of a humeral bone because of gradual weakening of sheaves and cartilages which support a shoulder joint. Even in these cases, however, developing of dislocation requires application of external force.

Front dislocation often occurs when the shoulder is in vulnerable situation. This situation can occur at a throw of a ball or blow at playing  volleyball. Front dislocation of a shoulder also occurs when falling arm-distance. Front dislocation includes external rotation of a shoulder, that is the shoulder turns from a body aside.

Posterior dislocation of a shoulder are a rarity and it is often connected with a specific injury, for example, lightning strokes, electric injuries and spasms. In certain cases, this type of dislocation of a shoulder can develop at the minimum injury at elderly people, and often the diagnosis is missed at primary survey.

Shoulder dislocation symptoms:

Dislocations are always painful. Often pain is so expressed that the patient cannot move with a hand. Muscles which surround a shoulder joint, as a rule, spazmirutsya. As a rule, at front dislocation the hand is slightly away from a body, and the patient tries to relieve pain, supporting the injured hand. Sometimes, the dislocated head of a humeral bone can be visible as camber in a front part of a shoulder joint.

As well as other bone damages, pain can provoke nausea and vomiting, perspiration, dizziness and weakness. It happens because of irritation of a vagus nerve which blocks adrenalinolinovy reactions in an organism. Sometimes, it can lead the patient to a faint (a vazovagalny syncope).

Diagnosis of dislocation of a shoulder:

It is possible to suspect shoulder dislocation on symptoms and the characteristic anamnesis (injury).
Pain and spasm of muscles accompanies dislocation of joints, and dislocation of a shoulder is not an exception. The muscles surrounding a shoulder joint stretch and spazmirutsya. The patient feels severe pain which arises even at the slightest movement  by any part of a hand.

At survey loss of physiological outlines of a shoulder joint attracts attention. More lean patients can have a head of a humeral bone a palpirovana in a front part of a joint.
The brachial plexus, axillary artery and axillary nerve are located in an axillary hollow and are rather unprotected. At shoulder dislocation the neurovascular bunch can be damaged.
That confirm the diagnosis of dislocation of a shoulder X-ray picture can be applied. The X-ray analysis is applied also to an exception of fractures of bones.
For exact diagnosis the X-ray analysis needs to be executed at least in 2kh projections.

Treatment of dislocation of a shoulder:

The purpose of treatment of dislocation of a shoulder is decrease in dislocation and return of a head of a humeral bone to anatomic situation in a socket. There are various methods which can be used for achievement of this purpose. The decision on what of them to use, depends on the patient, a situation and experience of the doctor. The term "open reposition" belongs to performance of operation on reposition of dislocation. Correction methods dislocation of a shoulder are described below.

1. The patient can is in a sitting position or lying. The doctor tries to turn shovels, displacing a head of a humeral bone, helping it to be set independently. The assistant can be necessary to help to stabilize a hand.

2. External rotation. Position of the patient – sitting and lying. The doctor gradually turns a shoulder outside (outside rotation). The muscular spasm can be overcome within 5 - 10 minutes then the shoulder joint is set. The equipment Milkh assumes also a hand raising above the head to achieve reduction.

3.  The patient lies, the towel is wrapped around an armpit. While the doctor pulls a hand down, the assistant, standing in a bed-head, pulls a towel on himself. As muscles relax, the head of a humeral bone can return to normal situation.

4. Open reposition. In rare instances, the shoulder cannot be set in the closed way because sinews, sheaves or a part of the broken bone return of a head of a humeral bone to a socket gets into a joint, prevention. At the closed reposition it is not possible to set dislocation, and in that case the best method of treatment is operation or open reposition of dislocation.

Drug treatment.
Intravenous administration  of narcotic analgetics and muscle relaxants is used for the purpose of reduction of pain and relaxation of muscles. Use the general anesthesia, applying morphine, hydromorphone and fentanyl. Versed, diazepam (Valium) or lorazepam (Ativan) can be used as a muscular relaxant.
Anesthesia using Ketaminum or a propofol is also widely used at reposition of dislocation of a shoulder. Intra joint lidocaine injections in a shoulder joint in itself can be used as local anesthesia.

Вправление вывиха плеча по Кокеру

Reposition of dislocation of a shoulder according to Cocker

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