For habitual shoulder dislocation, such as frequent trailing tail, surgical treatment is appropriate. The mother of all lies in strengthening the forearm of the joint capsule, preventing excessive external rotation and abduction activities, and stabilizing the joint to avoid further dislocation.
1、Manual reset
The dislocation should be reset as soon as possible after the dislocation, and appropriate anesthesia (brachial plexus anesthesia or general anesthesia) should be selected to relax the muscles and make the reset under painless. Elderly people or those with weak muscles can also be performed under analgesic (such as 75~100 mg of dulcolax). Habitual dislocation can be performed without anesthesia. The repositioning technique should be gentle, and rough techniques are prohibited to avoid additional injuries such as fractures or damage to nerves.
2、Surgical repositioning
There are a few shoulder dislocations that require surgical repositioning. The indications are: anterior shoulder dislocation with posterior slippage of the long head of the biceps tendon. The indications are: anterior shoulder dislocation with posterior slippage of the long head of the biceps tendon.
3、Treatment of old shoulder dislocation
If the shoulder joint has not been repositioned for more than three weeks after dislocation, it is considered old dislocation. The joint cavity is filled with scar tissue, there are adhesions with the surrounding tissues, the surrounding muscles are shrunken, and in cases of combined fractures, bone scabs are formed or deformed healing occurs, all these pathological changes hinder the repositioning of the humeral head.
Treatment of old shoulder dislocations: If the dislocation is within three months, the patient is young and strong, the dislocated joint still has a certain range of motion, and there is no osteoporosis and intra-articular or extra-articular ossification on the x-ray, manual repositioning can be tried. Before resetting, the affected ulnar hawkbone can be traction for 1~2 weeks if the dislocation time is short and the joint activity is light. The resetting should be performed under general anesthesia, followed by shoulder massage and gentle rocking activities to release the adhesions and relieve the muscle pain contracture, and then dry reset. The resetting operation is performed by traction and massage or foot stirrups, and the treatment after resetting is the same as that for fresh dislocation.
4、Treatment of habitual anterior dislocation of shoulder joint
Habitual anterior dislocation of the shoulder joint is mostly seen in young adults. It is generally believed that the injury is caused after the first traumatic dislocation, and although it is reset, it is not fixed and rested effectively. The joint becomes flaccid due to pathological changes such as tearing or avulsion of the joint capsule and damage to the cartilage glenoid labrum and the monsoon margin without good repair, and the posterior lateral humeral head depression fracture becomes equal. Subsequently, dislocation may occur repeatedly under slight external forces or during certain movements, such as abduction and external rotation and posterior extension of the upper limbs. The diagnosis of habitual shoulder dislocation is relatively easy. During X-ray examination, in addition to taking anterior-posterior plain films of the shoulder, anterior-posterior X-rays of the upper arm in the 60-70° internal rotation position should be taken, which can clearly show the posterior humeral head defect.
For habitual shoulder dislocations, surgical treatment is recommended if the dislocation is frequent. The aim is to enhance the anterior opening of the joint capsule, prevent excessive external rotation and abduction activities, and stabilize the joint to avoid further dislocation. There are many surgical methods, the more commonly used ones are Putti-Platt’s method and Magnuson’s method.
Post time: Feb-05-2023
