Old shoulder dislocation: causes, symptoms, diagnosis, treatment
Last reviewed: 18.10.2021
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Older dislocation - dislocation, not eliminated within 3 weeks or more.
ICD-10 code
S43.0. Dislocation of the shoulder joint.
What causes chronic dislocation of the shoulder?
With old dislocations, the joint capsule thickens, becomes thicker, loses its elasticity. In the joint cavity proliferation of fibrous tissue, covering the articular surface and filling the free space. Atrophic and dystrophic changes occur in the muscles surrounding the shoulder joint. With the increase in the duration of unremoved dislocation, fibrosis, fatty degeneration, synovial sclerosis, cartilaginous degeneration and even ossification of the joint develop even more in the tissues, which leads to the formation of an extensive conglomerate, which in most cases does not allow us to restore the congruence in a closed way.
Where does it hurt?
What do need to examine?
How to examine?
Treatment of chronic shoulder dislocation
If the diagnosis of chronic shoulder dislocations does not pose a problem, the choice of a method of treating a chronic dislocation of the shoulder, which guarantees the full restoration of the functions of the arm, is not always possible. The tactics of the surgeon depends on the type of dislocation, its prescription, the presence of concomitant diseases and the age of the patient. In young people, the surgeon must try to eliminate the closed shoulder dislocation regardless of his prescription. We managed to eliminate sprains 4 and even 6 months ago.
Shoulder rests are performed under general anesthesia and only in the operating room for the following reasons.
- First, when the axillary artery is involved in the adhesions surrounding the shoulder joint, it may burst at the time of the repressions - urgent surgical intervention will be required.
- Secondly, the repositioning of the shoulder sometimes occurs relatively easily, but with weakening of the fixation of the limb, the head of the shoulder slides off the articular cavity. In such cases, two Kirschner spokes are transarticularly performed in order to keep the head from relaxation. Spokes removed after 3 weeks. It seems to us that this method should be resorted to more often, since in half of the patients, whose old dislocation was eliminated in later terms, there was a relaxation on the 3rd-10th day, it was necessary to repeat the correction.
- Thirdly, if the closed direction failed, use the open, which the patient should be warned in advance.
It must be remembered that the longer the duration of the dislocation, the more complex, traumatic the intervention and the worse the functional result. Because of the often occurring stiffness in the shoulder joint, some surgeons refuse radical interventions and perform palliative: shoulder head resection, arthrodesis of the shoulder joint. In elderly people, the stiffness of soft tissues develops much faster, and therefore eliminating long-lasting dislocations, even with short periods, presents considerable difficulties and danger. At the slightest risk, this group of patients should abandon manipulation and prescribe electrophoresis or phonophoresis of analgesic agents, beginning active development of movements with gradually increasing volume. The goal is the creation of neoarthrosis. With sufficient physiofunctional treatment, the results are often better than after surgical treatment. The patient can fully serve himself and do homework.