Habitual dislocation of a shoulder – a pathological state at which after primary traumatic dislocation of a shoulder the patient as a result of small physical effort has repeated dislocations. Develops at the usual movements, for lack of violence. It is shown by pain, deformation and impossibility of movements in a shoulder joint. As a rule, it is easily set, spontaneous repositions are quite often observed. The diagnosis is exposed on the basis of the anamnesis, clinical yielded and results of a X-ray analysis. Conservative treatment is usually inefficient, operation is required.
Habitual dislocation of a shoulder
Habitual dislocation of a shoulder – the repeated permanent dissociation of articulate surfaces of a head of a shoulder and an articulate hollow of a shovel arising after usual traumatic dislocation of a shoulder. According to various data becomes an outcome of 12-17% of traumatic dislocations. Usually comes to light at people of working-age (20-40 years), men suffer 4-5 times more often than women. Right-hand habitual dislocations are observed more often left-side, perhaps bilateral defeat. Badly give in to conservative therapy, surgical intervention usually is required. Traumatologists are engaged in treatment of this pathological state.
It is established that development of this pathology is promoted by injury of an articulate lip (Bankart's damage). The articulate lip is fibrous and cartilaginous education which is attached to an articulate hollow of a shovel, doing the concave surface of a shoulder joint of deeper and interfering with dissociation of a head of a shoulder and a hollow of a shovel at heavy traffics. Besides, at patients with habitual dislocations the zadnebokovy defects of a head of a humeral bone caused by the compression change which is not revealed during primary traumatic dislocation are often observed.
The contributing factors are lack of an immobilization, defective or too short-term immobilization, and also existence of early physical activities. In similar cases the myagkotkanny structures of a joint damaged during traumatic dislocation do not manage to be restored fully. Sites of not union and rough resistant hems are formed. There is a muscular imbalance, the joint becomes unstable. The probability of development of habitual dislocations also increases at certain specific features of a structure of a shoulder joint, for example, to a slabovognuty, flat articulate hollow.
The abduction movements, external rotation and assignment of a shoulder of a kzada become an immediate cause of repeated dislocations usually. The combination of two is often observed or three listed movements, the dislocations which arose owing to the unidirectional movement meet less often (for example, only abductions or only rotation). Among the typical actions which are the cause of habitual dislocations – clothing, a hand raising, pulling up on a crossbeam, a raising of weights etc. Sometimes dislocation occurs in a dream. Usually the more often dislocation repeats, the easier it arises. At the same time the quantity of dislocations can vary considerably – from 2-3 to several tens times.
In most cases patients set habitual dislocation independently or by means of relatives. Failure in attempt of independent reposition becomes the reason of the appeal to emergency station usually. If the patient arrives in a condition of the next dislocation, there is a characteristic deformation of a shoulder joint (on the place of a head the hollow is defined). The patient holds a sore hand healthy. The movements in a shoulder joint are impossible, in attempt of passive movements the springing resistance is defined. Intensity of a pain syndrome can vary considerably – from sharp pains to insignificant morbidity. Hypostasis of soft fabrics is absent.
The request for medical care in a condition of remission, as a rule, happens after several (sometimes – several tens) repeated dislocations. At survey in similar cases no pathology quite often comes to light. The diagnosis is exposed on the basis of the anamnesis, old x-ray pictures and extracts from the clinical record. In certain cases the unsharp atrophy of muscles, and also decrease in painful and skin sensitivity in a joint is defined. Often the restriction of movements caused comes to light as unsharply expressed cicatricial contracture, and fear of repeated dislocation – the motive stereotype at which patients get used to avoid the movements capable to provoke a recurrence is acquired.
For more exact assessment of a condition of dense structures appoint a X-ray analysis of a shoulder joint. At the same time defect can be determined by a zadnebokovy surface of a head of a humeral bone (it is found only at special laying with rotation of a shoulder, sometimes for identification of pathological changes it is necessary to make several pictures). Increase in distance between the top part of a head of a shoulder and akromiony, and also damage of edge of an articulate hollow is possible.
If given to a X-ray analysis for some reason it is not enough for definition of tactics of further treatment, patients are directed to KT of a shoulder joint. To gain an impression about a condition of myagkotkanny structures, carry out MRT of a shoulder joint. If necessary carry out a contrast artrografiya. If there are an opportunity and the corresponding indications, carry out the diagnostic arthroscopy allowing to study in detail a joint from within by means of the special camera.
treatment should be carried out only under the supervision of a doctor. Self-treatment is unacceptable!!!
Conservative therapy of habitual dislocations in most cases is inefficient. However at a small amount of dislocations (no more than 2-3) it is possible to try to appoint the LFK special complex and massage for strengthening of muscles of a humeral belt. At the same time for the period of treatment it is necessary to limit external rotation and abduction in a shoulder joint. At inefficiency of conservative treatment and a large number of dislocations the only well-tried remedy is operation.
There are about 200 operational techniques of treatment of this pathology. All surgical methods can be divided into 4 groups: the operations directed to strengthening of the capsule of a joint; plastic interventions on muscles and sinews; bone plastic surgeries and operations with use of transplants; the combined methods combining elements of several listed techniques. At the same time the most widespread is Bankart's operation at which the surgeon fixes a cartilaginous lip and creates the soyedinitelnotkanny roller limiting excessive mobility of a head of a shoulder from the joint capsule.
Bankart's operation can be performed as a classical way (through a usual section), and with use of the arthroscopic equipment. In the latter case in a joint do two small sections 1-2 cm long, through cuts enter and manipulators then under control of sight carry out all necessary elements of surgical intervention. Use of the arthroscopic equipment allows to reduce significantly injury of operation, to minimize risk of development of complications and to reduce the term of rehabilitation of the patient. Now this technique becomes the gold standard at treatment of habitual dislocations of a shoulder.
Along with it there are also other techniques shown at certain pathological changes in a joint, or applied in the absence of the arthroscopic equipment. Boychev's operation, Weinstein's operation, Putti-Plyatt's operation, Friedland's operation etc. is among such techniques. All interventions are made in a planned order, in the conditions of a hospital, after necessary inspection.
In the postoperative period appoint massage, LFK and physical therapy, including an amplipulsterapiya, ozokerite, magnetotherapy and UVCh. At pains use with analginum. The immobilization is usually kept within a month. Then begin gradual development of a joint with use of LFK (including exercises in the pool) and physiotherapeutic methods. In 2-3 months after surgical intervention place emphasis on restoration of amplitude of movements in a joint and a training of muscles of a humeral belt, using special exercises and occupations on exercise machines. The complete recovery, as a rule, occurs within 3-8 months from the moment of operation.