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SHAFT LUXATION - PULLED THE SHAFT FROM LED

What is shoulder dislocation?

 

The shoulder joint has fantastic mobility. As a result, it also becomes a little more unstable than joints with less range of motion and there may be a risk that the shaft goes out of joint.

The articular ball of the upper arm is significantly larger than the articular surface of the shoulder blade to which it leads. The fact that the joint is not so enveloping around the joint ball of the upper arm enables the fine mobility that exists in the joint. But that is also why there is a risk of shoulder dislocation. Around the edge of the shoulder blade's joint surface is a cartilage ring, Labrum glenoidale, which increases the contact surface between the joint surfaces and improves stability. In addition, there are a number of ligaments that passively contribute to stabilization in the area. Outside of this, there is a set of muscles around the joint, the Rotator Cuff, whose main task is to actively control the upper arm so that the joint ball is centered in the shoulder joint.

Rehabilitation of shoulder from joint 

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If the shaft goes out of joint, it almost always does so forward in the joint. It usually occurs in a sudden movement when the arm is turned outwards / backwards under load. It can happen, for example, in a fall, or if you get caught in an throw in an opponent (think handball, basketball). If this happens, the cartilage, Labrum, is usually damaged and partially detached from the joint edge. The fact that Labrum is injured is one reason why it can be easy to suffer the same injury again after a dislocation. This is called a Bankart injury (after an orthopedist who noticed this in the 1920s). Approximately 50% of those who have an accident with the shoulder dislocating also get a joint surface injury on the back of the upper arm joint ball. This happens when the joint ball strikes back with force against the joint edge just after the dislocation when the muscles in the shoulder / shoulder cramp.

At the back of the shoulder there are more protective structures that make it unusual for the shoulder to dislocate that way (only 5% of the shoulder joint dislocations). It takes more force in the accident for it to happen, for example an accident in a car or when skating at high speed.

In terms of the shoulder, this is one of the most common injuries. Of those injured, 85% are men and a majority of them are aged 20-30. This usually happens in connection with sports.

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Symptoms of shoulder dislocation

 

In the acute situation, these patients are usually significantly affected by pain and cold sweats with pain in the shoulder. If the person has had several dislocations before, the pain may be clearly milder. In the more painful cases, it is common for him to keep his arm slightly out of the body and relieve / protect the injured arm with the healthy amen. Visually, the shaft has a different shape than the other side. Looks like there is a small step from the shoulder blade edge on the outside shoulder down to the upper arm. We check that there is a pulse at the wrist so that the vessels in the shoulder do not stop the blood flow out into the arm / hand. In most cases, mobility is markedly inhibited. The patient is not interested in trying to move the arm at all. There are a few different ways to gently try to get the upper arm back in the right position (this is called repositioning the shoulder) However, many patients are so affected by pain that it is not possible to even try. Then just make sure that he goes to medical care as soon as possible where painkillers can be given before repositioning can be performed.

Something to be vigilant about here is that in a fall or if you hit the shoulder, the ligaments in the collarbone joint up on the shoulder can drop and the collarbone stands up under the skin. It can then look a bit like a shoulder dislocation. However, these patients are seldom as affected by pain and it is possible to move more on the arm. Rotator cuff rupture, fracture of the upper arm can also cause similar symptoms.

Treatment when the shoulder has been pulled out of joint

 

After repositioning, the arm is placed in a shoulder lock or mitella for a few days. After that, careful rehabilitation of the shoulder can be started. We then start by conducting an examination of the shaft to find out the current starting position. Passive movement training for the shoulder begins. Exercises for forearm / elbow are also instructed.  Rehabilitation training  then gradually increases depending on how the shoulder responds to the exercise. The rehabilitation period is around 3 months, but can vary from case to case. The goal of the rehabilitation is equal mobility and strength in the shoulder and that the patient does not experience the shoulder as unstable. If the shoulder "just" almost went out of joint, subluxated, as it is called, the rehabilitation looks almost the same, but you can usually start training at a higher level. If we suspect damage to the rotator cuff, we will carry it out  ultrasound diagnostics  on the shoulder.

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Forecast

The forecast can be considered relatively good. Especially if you undergo a guided rehabilitation. If you have luxated the shoulder and this is the first time this has happened, the risk of it happening again is 30%. The risk increases if you are young when it happens. If the shaft repeatedly dislocates and the shaft is perceived as unstable, surgery may be necessary. During the operation, damage to the labrum and ligaments is repaired. Of those who have undergone surgery, about 90% manage new dislocations.

Physiotherapy at Alta Vita Physiotherapy

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