Definition
Shoulder dislocation occurs when the upper arm bone pops out of the shoulder socket, often from falls or contact. When it happens repeatedly, it becomes a recurrent shoulder dislocation, requiring strengthening, stabilization, or even surgery.
Common causes of shoulder dislocation
A shoulder dislocation occurs when the head of the humerus is out of the glenoid socket.
In most cases it leaves the shoulder by:
- External force (fall or impact against another player) or forced movement in abduction, or external rotation force of the joint leading to dislocation of shoulder (ahead or behind)
- Laxity of the tissues (young people under 20 years of age and population female due to its greater elasticity; adult greater than 30 years, the probability of reluxación is much lower, at around 50%).
- Regardless of the age, it may happen that they will play new episodes.
- Dislocations previous (the so-called dislocation recurrent shoulder).
- Diseases related to collagen
Are more likely to suffer this injury the athletes performing sports in those who perform repetitive movements above the head (such as taps, plugs , throws to the basket, etc…) own sports like ours or like volleyball or swimming.
From the internal point of view, that people with a predisposition have a higher risk of recidivism due to the bag of ligaments, after the break, and though to heal, not again have the same containment.
Diagnosis
Who do you turn to? How are the bones? and what about fabrics?
Diagnostic techniques:
- Physical examination
- Switching of abduction with external rotation (tested below the horizontal, 90°, and 140 ° – observe if the patient has the sensation that he quit the shoulder)
- Dislocation posterior Force back
- Hiperlaxitud pulling down the arm
- Hiperlaxitud with hyperextension of the elbow or if thumb touches the forearm is passively
- In the position of lying face-up, test placing bringing the arm bent and palm up back support with pressure back. It is likely that the patient feels a sense of relief because that is the return to the natural position of the head of the humerus to the glenoid.
- Nuclear Magnetic Resonance
- Scanner
Article on ‘the Effectiveness of the Test apprehension Test relocation and Arthros MRI for the diagnosis of anterior instability of the shoulder extracted from REVISTA ARGENTINA DE ARTHROSCOPY – VOL. 16 – No. 1 – PAG. No. 52. Click here to read the article online.
Below we offer information on what to do when it has already been produced dislocation of shoulder.
In the first part, the rehabilitation, and in the second, the exercises to perform, which also serve as a prevention.
Treatment
What should I do?
First recommendation: to Go to the hospital (there may be fracture). Not maneuver because it can get worse. For the transfer to make a sling.
Only reduce if it is seen by a specialist (doctor, orthopedic surgeon, physical therapist).
Management of the first episode:
Adolescents (below the age of 20, the chance is over 90%). To greater recidivism, more associated injuries and greater laxity. It is recommended that surgical intervention because of reproduced each time it will be more the complexity of the surgical intervention.
Requires reduction and usually require surgical treatment (to assess the intervention)
It is recommended that the surgical intervention when the patient is younger than 20 years or in the first episode because it is the most decisive and prevents re-play more episodes. The greater number number of episodes, more complexity and a lesser degree of success of the intervention.
- Surgical treatment of the dislocation is recurrent: is artrostópica to:
- give a retensioning all the soft parts that are given of himself.
- in case of bone injury, you must reinstate the bony fragment in order to avoid the instability. Not usually frequent.
Rehabilitation and prevention
Conservative treatment (patient or greater in the first episode)
- Rehabilitation, compensating for the instability of the shoulder by means of the strengthening of the muscles around the joint exercise:
- rotator cuff
- deltoid,
- muscles around the scapula,
- correct postural hygiene with the back shoulder.
Below is a exercise for the muscles of back of the arm and shoulder by means of a teraband:
The workout is toning and reprogramming of the muscle performs abduction, external rotation and extension.
It is advisable to use a rubber or a weight (t use the rubber because it provides a progressive resistance -the color of the band indicates the degree of elasticity of the rubber.)
Perform contractions of 1 second with a break of 4-5 seconds.
Exercises are easy to do and achievable in everyday life.https://www.youtube.com/embed/o_dItVej1uAhttps://www.youtube.com/embed/dq1i57Ib0G8
Back to the action after suffering a shoulder dislocation
In case you received surgery:
It keeps the patient immobilized a time (with sling) to heal all the structures that have been repaired.
Post-operative, requires an immobilization to 6 weeks (with sling) and then start recovery through rehabilitation and physical therapy exercises with strength progressive. Performing daily activities at 3 mesescon normal and sport activity between 6 and 9 months with complete recovery after 9 months.
The operation does not guarantee 100% that did not come out. Between the 10% and 15%, despite having been operated on are at risk of recidivism. It is important to accurate diagnosis, assess risk factors and to do the surgery that is customized for each patient (each subject is a particular case). There are also other solutions, using plastías or increments of the surface of the bone-glenoid to make it harder to exit the head of the shoulder. The ideal thing is that the first surgery to be the most decisive.
Cedric Arregui Guivarch
National Coach of Basketball (CES 2014)
