Pathology of shoulder joint dislocation

2021-01-30 12:00 AM

The side view is not clear chest delta groove. The arm bone is raised in the front, making the diameter for the front and back of the shoulder thicken.

Outline

Shoulder dislocations are the most common types of dislocations and are common in healthy young adults accounting for about 50-60% of the total dislocations.

The most common causes and mechanisms of dislocations are due to falls on the hand or elbows in a squat, backward, and outward rotation.

Direct injury to the shoulder joint from behind the shoulder is uncommon (usually caused by a Honda or a rolling car accident).

In labour, there is a dislocated shoulder in a porter, who is carrying one shoulder, one hand is put up on the shoulder to embrace the loader. Stumbled and stumbled on the arm, dislocated.

Clinical symptoms

In the shoulder dislocation, based on the position of the arm bone cap compared to the pan, the shoulder joint is divided into 4 types: front, back, up and down.

In the measurement, the first deviation is 95% of the cases.

In the anterior shoulder dislocation, depending on the degree of displacement of the arm bone, one can distinguish four forms:

Dislocations under the crow's beak, this is the most common type in about 90% of cases.

Dislocations outside the crow's beak or dislocated shoulder on the socket account for about 7% of cases.

Dislocated under collarbone.

Dislocations in the chest.

Clinical symptoms of a typical forward dislocation of the shoulder

Look

Immediately see typical distortions.

Looking forward and back there are signs of hunchback, because the den-tae muscle collapses the shoulder dropped like perpendicular. The upper arm bone does not support the delta muscle anymore, the tip and shoulders are raised. The outer edge of the upper arm is not straight and soft but is broken to an angle extending outward due to the shape of the arm (ax stance sign). Arm shapes about 30 - 400 and rotates outwards.

The side view is not clear chest delta groove. The arm bone is raised in the front, making the diameter for the front and back of the shoulder thicken.

Touching

The hollow joint can be palpable, the arm bone tip moving anterior and protruding towards the thoracic fissure is different from the healthy side.

Examination

Loss of muscle movement in the shoulder joint. The most noticeable sign is the Berger sign: The arm is about 300, the elbow cannot close in the body, when trying to press the elbow closed on the body and then release, there will be a sign of elastic resistance (spring sign). Need X-ray to see the lesions accompanying such as large fracture, fracture of the arm bone surgery.

Symptoms

Nerve damage

Meet about 15% of cases. Especially cap nerve paralysis. This is manifested by loss of sensation in the den-ta muscle area, and after the manipulation is completed, the arm cannot be formed. So after manipulation of the joints must check the ability to contract delta muscle and sense of the shoulder area.

There are cases where the arm plexus is completely paralyzed. Nerve paralysis usually recovers after 1-8 weeks.

Damage to blood vessels

Approximately 1% of the axillary artery is blocked due to damage to the mantle and inner lining. Sometimes a side wall is torn due to a cut at the base of a lateral branch or sometimes just a spasm. After manipulation of the joint, it is necessary to check by angioplasty. It is necessary to have an angiogram to handle depending on the injury.

Associated fracture

Fracture of the large cotyledon occurs in about 30% of cases. Usually after manipulation of the joint, the fracture will return to a good anatomical position.

Broken bank of pans.

Hill-Sachs type arm cap deformation.

Neck fracture arm bone: Can fracture neck surgery.

Shoulder belt injury

Accounting for 55% of patients with anterior dislocations of the shoulder and up to 80% of patients over 60 years of age cause prolonged shoulder pain, weak shape and rotation of the outer shoulder.

Treatment

Need to manipulate early and should be anesthetized to soften muscles to ease. To avoid cartilage and joint damage caused by soft cartilage cap being pressed on hard bones in the neck and shoulder, causing elongation deformation (Hill-Sachs deformation), muscle contraction and gentle manipulation should not be used. If you try to fix it, it will cause additional damage. There are many different methods divided into two groups: force manipulation (Hypocrates method, Milch, Eskimo, Stimson, Pick and Lippert) and lift with raised arm (Kocher's outer rotation method).

Method of Hippocrates

Also known as the heel method.

Have the patient lie on their back on the ground. The curler grabbed the patient's hand, let it out slightly and pulled it along the axis. Place heel in the patient's armpit and push against the pull of the arm. Pull for about 5 minutes, remove heel and bring patient's arm inward. If you hear a lump, the cusp has entered the joint. This is the simplest and earliest method but the highest rate of complications and failures of all methods.

The Kocher method

Have the patient sit 900 elbows. He squeezed the arm elbow into the chest, and then extended the arm as far back as possible. Then rotate the forearm outward until the horizontal-vertical plane will enter. If not in, bring the folded arm first, the elbow will gradually come out first, eventually turning the arm inward.

Motionless after dislocation

DESAULT Arm cast of type 200, forearms are crossed in front of chest, so that the arm is rotated inward, causing the front joint to tear loose and easily heal. Time to keep dough 3 - 4 weeks.