Dislocation and strain of shoulder and ligaments:
Shoulder Joints differ from the body’s other major part of it that it allows extremely large range of motion. This is a prerequisite for using the arm as the man using it. Flexibility is achieved at the expense of stability, and the shoulder is therefore that of the body’s major joints often go out of joint (dislocated). Annual incidence is approximately 23 new cases per 100,000 inhabitants. For about. 85% of cases go shoulder dislocated forward, but it also happens that the shoulder goes dislocated backwards or in both directions.
In connection with the damage rips fastening ligaments against bone and provides a weakness with the risk of new dislocations. Other patients experience pain from the damaged ligaments without dislocations. Often orthopedic shoulder surgeons standing out of joint and must be helped in place. In other cases, slip the shoulder in place by itself or does not go out of joint, despite ligament damage. The risk of new dislocations depends primarily on the patient’s age. Patients under 30 years has a high risk of new dislocations, up to 70% develop new dislocation after first-dislocation. Elderly patients achieving a greater degree a stable shoulder without treatment, but often have additional damage, broken bones and torn tendons. In complicated cases occur damage to the nerves out of the arm which may cause chronic reduced power and sensation in the arm.
Dislocation and strain of ligaments:
The collarbone, whose mission is to keep the shoulder from the chest and giving muscles a better torque using arm. To enable movement between the rib cage and scapula, which represents approximately half of the shoulder range of motion is collarbone associated to breast bone and shoulder blade joints and associated stabilizing ligaments. In a case against the shoulder risk that ligaments around one of these joints are overloaded and crevices, while wrist goes out of alignment (displaced) to a greater or lesser degree. Untreated the clause will usually standing out of position and can then cause pain and reduced function, especially during activity above shoulder height.
By dislocation, sprain and strain of joints and ligaments of the shoulder, must be carried out an investigation to ensure proper diagnosis and it must be a treatment plan. Investigation includes clinical examination and imaging. One distinguishes the acute treatment of shoulder which is left out of paragraph (dislocated) and chronic conditions with repeated dislocations. Depending on the type of injury, additional injuries to soft tissue / bone structure and age of the patient / activity level, treatment must be individualized.
Referral and Assessment
In acute injury to the shoulder with dislocation that remain out of alignment or causing pronounced reduced mobility, must shoulder examined acute in care professional. Often acute radiography and in some cases, magnetic X-ray imaging (MRI) of the shoulder applicable.
When chronic pain resulting from injury or repeated dislocations in the shoulder, starting assessment by a GP. He / she evaluates the need for X-ray and / or magnetic X-ray imaging (MRI) and referred to a specialist in orthopedic surgery or physical therapist if needed.
Choice of treatment depends on the symptoms and how pronounced changes detected in soft tissue and bone structure. Patient age, the softness in the joints and activity level also affects the result of the different treatment options. Legislation in the form of conversation, clinical examination and assessment of imaging is therefore essential to give good treatment recommendations.
X-ray of the shoulder
In acute shoulder dislocation which remains out of position:
If the joint does not return to the correct position must position corrected by a physician. The treatment is performed on emergency or hospital depending on local organizing. In most patients this can implement without anesthesia but local anesthesia in the joints and / or painkillers. In some cases, the patient must be anesthetized to undertake processing. X-ray should be taken to ensure correct positioning of the wrist and the absence of fractures that may arise in connection with the damage. After the shoulder is put in place is given a simple sling and pain relief in 1-2 weeks. Gradual rehabilitation should then be carried out in collaboration with the physiotherapist to the normal mobility, strength and coordination. Extreme range of motion and sports activities with the risk of new injuries should be avoided for at least six weeks. At pronounced reduced mobility after the shoulder is put in place should preclude tearing of tendons in the shoulder with magnetic x-ray imaging (MRI).
With repeated dislocation of the shoulder joint:
For people with congenital of mobile joints that dislocated without prior damage is physical therapy first treatment choice. If damage triggered shoulder has physiotherapy less opportunity to provide a stable shoulder, but can in case of minor symptoms considered. Operation indication is determined by how much shoulder function is affected by the instability and the effects of treatment from a physiotherapist. Often this is related to how often and how easily shoulder goes out of joint. Patient and doctor must assess the benefits of surgery against the disadvantages associated with recovery and risk of complications.
Traditional surgical treatment consisted of open-stabilizing operation when the ligaments and joints lip (labrum) to its anatomical location. The treatment has been reasonably effective in preventing new dislocations, with good improvement in function but with risk of new dislocation of approximately 10%.
Since the late 1990s, arthroscopic (keyhole surgery) stabilization of the shoulder joint become much more common, dominating since the mid-2000s the treatment in Norway. The advantage is a more anatomical repair of the damage, smaller scars, shorter operating time and faster recovery. The treatment can often be performed as day surgery. The functional outcome and the risk of new dislocations in the short term, in line with the results of open surgery. Long term results are however more uncertain, where the risk of new dislocations have been reported to be up to 30% after 10 years.
Due to the uncertainty regarding the long-term result keyhole surgery recommended alternative surgical approaches in patients with increased risk of relapse. These methods have, however, somewhat higher risk of complications. They are therefore suitable only for a subset of patients, keyhole surgery has either failed or are considered to have conditions to provide a stable shoulder.
Dislocation and strain of clavicle joints:
After acute injury degree of error position in the joint decisive for further processing. At small error position ligaments only partially torn and usually heal without specific operative treatment. Pain in the affected joint is however common and can often persist in the first year after the injury. When chronic pain can soft tissue of the joint (meniscus) is removed by arthroscopy (keyhole surgery) to increase symptoms.
For larger deformities clavicle and scapula can be considered acutely fix the wrist in the proper position to allow adjacent ligaments to heal with the correct length. Fixation is normally done by arthroscopy (keyhole surgery), but in some centers used open surgery with plate and screws. Acute fixation should be conducted within 2 weeks after the injury to give a good result.
In chronic wrong position in the collar bone joints and injuries in the joint between the sternum and collarbone normally used open surgery, where ligaments reinforced with tendon from another part of the body (normally tendon from the thigh) or the use of artificial materials.
Depending on the type of treatment and local organization implemented treatment either indwelling or as outpatient surgery. Usually one can be discharged the day after surgery by indwelling surgery. Often used a sling for 2-6 weeks. Rehabilitation time after surgery is minimum 4-6 months before declining to sports and other activities with a risk of incurring new shoulder injury. During this period can be expected during intensive training under the supervision of a physiotherapist.
After discharge from the hospital, there must be a plan for further rehabilitation with physiotherapist, possibly. Restrictions on the use of the arm and prescription of adequate analgesic medication. Sick leave must be weighed against any intervention that is performed, the patient’s work and the possibility of organization of work tasks.
It is expected that the surgical wound is dry without secretion ca. 7 days after surgery. Local redness around wound edges, drainage from the incision or fever are warning signs of infection and must be evaluated by a physician.
Follow-up Procedures vary between hospitals and surgery types. One must expect a normalization of shoulder function 4-6 months after most operational types.