Habitual dislocation – an outcome of primary traumatic dislocation at which the articulate surfaces of an affected joint are repeatedly displaced from each other. Unlike primary dislocation which is result of considerable traumatic influence habitual dislocation occurs at the minimum trauma or usual daily actions (a raising of heavy objects, the sharp movements, washing, a combing etc.). Habitual dislocation of a shoulder and habitual dislocation of a patella is most often observed. The diagnosis is based on anamnestichesky yielded, results of survey, a X-ray analysis, MRT and ultrasonography of the injured joint. Treatment is quick: strengthening of the capsule, bone plasticity, plasticity of muscles and sinews, application of transplants.
Habitual dislocation – an outcome of primary traumatic dislocation at which the articulate surfaces of an affected joint are repeatedly displaced from each other. Unlike primary dislocation which is result of considerable traumatic influence habitual dislocation occurs at the minimum trauma or usual daily actions (a raising of heavy objects, the sharp movements, washing, a combing etc.). Most often habitual dislocation of a shoulder develops. Habitual dislocations of other localizations (habitual dislocation of a patella, elbow joint, lower jaw etc.) arise much less often. Young people have this pathology more often than patients of advanced age.
Habitual dislocation can develop owing to:
- the heavy primary traumatic dislocation which is followed by considerable damage of the capsule of a joint, the sinews surrounding a joint, ligaments and muscles;
- the defect of an articulate surface which arose during primary dislocation (for example, at a sdavleniye of a head of a humeral bone edge of an articulate hollow);
- late request for medical care;
- lack of an immobilization, insufficient immobilization or its premature termination;
- excessive physical activities in the period of recovering from a trauma.
Habitual dislocation of a shoulder
Arises at 16% of the patients, in the past who had traumatic dislocation of a shoulder. The risk of developing of habitual dislocation of a shoulder joint increases at:
- to large spherical head of a humeral bone;
- to the stretched joint capsule;
- to small flat articulate hollow of a shovel;
- paralyzes, paresis and weakness of a rotary cuff of a shoulder (the muscles fixing a shoulder joint) of other etiology.
As a rule, the disease develops within half a year from the moment of reposition of traumatic dislocation. Frequency of repetition of habitual dislocations of a shoulder can differ considerably. At one patients habitual dislocation of a shoulder joint arises 1-2 times a year, at others – several times a day. With each recurrence pathological changes in a joint become more and more expressed, and time intervals between dislocations are gradually reduced. Unlike primary traumatic dislocation, habitual dislocation of a shoulder is not followed by the expressed pain syndrome. Pain usually weak or is absent. Patients set dislocation independently, seldom address the traumatologist.
In some cases patients have an incomplete habitual dislocation of a shoulder which is followed by feeling of instability of a joint. Earlier this pathology was called a joint incomplete dislocation. Now the given state carries the name "instability of a joint" and is considered as a kind of habitual dislocation of a shoulder. Over time the movements in a joint become limited, develops deforming . Patients complain of a crunch during movements and the aching pains in a joint amplifying at physical activity. The muscles surrounding a joint gradually atrophy, weakness in an extremity appears.
The diagnosis of habitual dislocation of a shoulder is established on the basis of a typical story of a disease and data of external survey. Changes at a X-ray analysis after reposition of dislocation can not be defined. In some cases symptoms of the deforming arthrosis come to light. In certain cases for specification of the changes happening in a joint carry out ultrasonography of a shoulder joint.
Treatment of habitual dislocations only quick. At habitual dislocation of a shoulder the indication to expeditious treatment are 2 and more recurrence of dislocation within a year. There is a set of techniques surgical treatment of habitual dislocation of a shoulder joint. The choice of an operational technique is defined by features of a structure and the nature of pathological changes in a joint, level of a travmatization and other factors. All operations at habitual dislocation of a shoulder which are performed in traumatology can be divided on:
- bone plastic surgeries;
- surgeries for strengthening of the capsule of a joint;
- plastic surgeries on sinews and muscles;
- surgeries with use of transplants;
- the combined techniques (for example, a combination of plasticity of sinews to strengthening of the capsule, etc.).
In the postoperative period the hand of the patient is fixed a special bandage. The term of an immobilization depends on a type of surgical intervention and can fluctuate from 1 week to 1 month. To the patient appoint LFK for strengthening of muscles of a humeral belt. Duration of the rehabilitation period – 2-4 months. Full load of a joint is resolved in half a year after operation.
Habitual dislocation of a patella
The third on the frequency of requests for the specialized help pathology of a knee joint. Arises after traumatic dislocation of a patella. The probability of development of habitual dislocation of a patella increases at the increased elasticity of ligaments of knee joint, highly located patella, not union of the supporting ligament of a patella injured at traumatic dislocation.
Habitual dislocation of a patella is followed by weak pain or proceeds without serious consequences and is often set independently. At each recurrence of dislocation the patella and an external condyle of a hip hit the friend against the friend. At the same time their articulate surfaces are damaged. Pathological changes in a joint are aggravated with existence of "articulate mice" (the splinters of a cartilage which broke away at the time of primary dislocation and freely floating in a joint) which are diagnosed on ultrasonography or MRT of a knee joint. For fuller diagnostics of changes in a joint the arthroscopy of a knee joint is carried out.
Operation of the choice at habitual dislocation of a patella is arthroscopic intervention for removal of articulate mice and restoration of the supporting patella ligament now.