RU2826979C1 - Method of reducing shoulder dislocation - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely traumatology and orthopaedics, and can be used for treating acute and habitual shoulder dislocation regardless of the position of the humeral head in relation to the articular process of the scapula. Traumatologist stands with his back to the couch, the height of which corresponds to the level of his/her hip joints, on the side of the injured arm of the patient. Then he takes the patient’s injured hand by the forearm with both hands, draws it in the frontal plane to a position perpendicular to the body, creates a support with the area of the iliac crest, similar to the injured arm, into the patient’s axillary cavity on the side of the dislocation. Then performs gradual, smooth, gradual traction along the axis of the abducted arm and its adduction towards the patient's body in the frontal plane, simultaneously turns its pelvis counterclockwise, if the injured arm is right, and clockwise, if the injured arm is left, to the moment of displacement of the head of the humerus into the joint cavity with a characteristic click.

EFFECT: method provides reducing injuries of shoulder joint structures, reducing pain.

1 cl, 1 tbl, 5 ex

Description

Field of technology

The invention relates to the field of medicine, namely traumatology and orthopedics, and can be used to treat both fresh and habitual shoulder dislocations, regardless of the position of the head of the humerus in relation to the articular process of the scapula.

State of the art

Most of the known methods of reducing shoulder dislocations have some disadvantages: reduction is carried out with the use of significant physical force on the part of the traumatologist, the need for assistance from medical personnel or special devices.

There is a physiological method according to Dzhanelidze (Kornilov N.V. Traumatology and Orthopedics. A Manual for Physicians in 4 Volumes. Volume 2. Injuries and Diseases of the Shoulder Girdle and Upper Limb. St. Petersburg. Hippocrates Publishing House, 2005, pp. 63-66), which is used for lower axillary shoulder dislocations. The patient is placed on his side on the edge of the table so that the injured arm hangs down and the shoulder blade rests on the edge of the table. The patient's head is placed on a second table. After 10-15 minutes, the muscles of the shoulder girdle relax. Then the traumatologist bends the limb at the elbow joint to 90 degrees and tractions the shoulder downwards, pressing on the bent forearm, while rotating the shoulder alternately outward and inward. In most cases, the dislocation is reduced almost unnoticeably.

The disadvantages of the method include: it takes a long time to perform, it is used only for lower dislocations, the weight of the limb is not always sufficient, sometimes additional weight is required. As a result, the table must be quite high.

The functional method of Mukhin-Mota is known (Kornilov N.V. Traumatology and orthopedics. Manual for doctors in 4 volumes. Volume 2. Injuries and diseases of the shoulder girdle and upper limb. St. Petersburg. Publishing house "Gipppokrat" 2005, page 66). The method can be used for any type of dislocation. The patient lies on a table or sits on a chair. The assistant fixes the scapula with a towel thrown over the armpit of the injured arm. The traumatologist grasps the patient's forearm and shoulder and gradually abducts the arm, bent at the elbow, to a horizontal position, performing moderate traction along the shoulder axis and making light shaking, rotational and adduction-abduction movements until the dislocation is reduced.

The disadvantages of this method include: the impossibility of performing it alone, a high risk of injury to the soft tissues of the shoulder due to the large number of different movements of the injured arm.

The closest analogue is the push method of reducing a shoulder dislocation, described by Hippocrates-Cooper in the 4-volume manual for doctors. Volume 2. Injuries and diseases of the shoulder girdle and upper limb. Traumatology and orthopedics. Kornilov N.V. St. Petersburg. Hippocrates Publishing House, 2005, p. 66.

The method consists of the patient being placed on his back, the heel (without shoes) being pressed into the patient's armpit, the hand and wrist being grasped on the side of the dislocation, and traction being applied along the axis of the limb, while the dislocated head of the humerus is pushed with the heel. To ease the physical strain on the traumatologist, traction can be applied using a sheet loop placed on the lower third of the forearm, with the arm bent at the elbow at an angle of 90 degrees.

The disadvantages of the analogue are: the need to apply significant force during traction along the axis of the limb, which may result in an increased risk of injury to both bone and soft tissue structures of the joint, as well as severe pain in the patient.

Disclosure of the essence of the invention

The objective of the invention is to create a method for treating fresh and habitual shoulder dislocation.

The technical result of the method is a reduction in the risk of complications during manipulation by eliminating the use of significant force by the traumatologist, as well as a reduction in the patient's pain.

The specified technical result provides a method for reducing a fresh and habitual shoulder dislocation, including support in the patient's armpit in a prone position, traction along the arm axis, characterized in that the traumatologist stands with his back to the couch, the height of which corresponds to the level of his hip joints, on the side of the patient's injured arm, then takes the patient's injured arm by the forearm with both hands, abducts it in the frontal plane to a position perpendicular to the body, creates support with the area of the crest of his ilium, the same name as the injured arm, in the patient's armpit on the side of the dislocation, and performs gradual, smooth, dosed traction along the axis of the abducted arm and its adduction towards the patient's body in the frontal plane, simultaneously turning his pelvis counterclockwise, if the injured arm is right, and clockwise if the injured arm is left, until the moment of displacement of the head of the humerus into the joint cavity with with a characteristic click.

In this application, the term fresh shoulder dislocation means a dislocation that has occurred within 24-36 hours.

The term habitual shoulder dislocation refers to a condition in which the humerus moves forward or backward from the glenoid cavity of the scapula without injury - during movements associated with abduction and external rotation of the arm.

The frontal plane refers to the plane that separates the front of the human body from the back.

The method is carried out as follows

The patient is placed on the couch on his back. The height of the couch should be at the level of the traumatologist's hip joints. The traumatologist stands with his back to the couch on the side of the patient's injured arm. Then he takes the patient's injured arm by the forearm with both hands, abducts it in the frontal plane to a position perpendicular to the body and creates a support with the area of the crest of his ilium, the same name as the injured arm, in the patient's armpit on the side of the dislocation. The traumatologist, using a little effort, performs the following sequential actions: he performs gradual, smooth, dosed traction along the axis of the abducted arm and brings it towards the patient's body in the frontal plane, simultaneously turning his pelvis, thereby continuing to create pressure on the area of the armpit until the moment of displacement of the head of the humerus into the joint cavity with a characteristic click. The traumatologist turns his pelvis counterclockwise if the injured arm is the right one, and clockwise if the injured arm is the left one, that is, always towards the patient’s legs.

By manipulating the patient's hand as a lever, and his ilium as a support, the traumatologist achieves effective elimination of the dislocation with a characteristic click, using little force and minimal trauma of reduction.

The method is illustrated by the following examples.

Example 1. Patient: F., born in 1962.

Household injury on 25.10.23, fell on the right shoulder in the street due to carelessness. He independently went to the Otradnenskaya Central District Hospital, where he was clinically and radiologically diagnosed with a closed anteroinferior dislocation of the right shoulder. After preparation under local anesthesia, with the patient in the supine position, the following was done: the patient's injured arm was abducted in the frontal plane to a position perpendicular to the body, the crest of the traumatologist's right iliac bone was rested on the patient's armpit, dosed and gradual traction by the forearm along the axis of the abducted arm, simultaneous adduction of the patient's arm and rotation of the traumatologist's pelvis counterclockwise until the moment of displacement of the head of the humerus into the joint cavity with a characteristic click.

During the reduction of the dislocation, the patient's pain syndrome according to the visual analogue pain scale (VAS) was 3 points. No pain was noted after the procedure. No complications were noted during the reduction. Clinically and radiographically, the shoulder dislocation was reduced. After restorative treatment, the range of motion in the right shoulder joint is full. No recurrence of the dislocation was noted.

Example 2. Patient: G., born in 1951.

Household injury on 13.07.23. Accidentally fell at home, in the yard on the right shoulder. She independently sought help at the "Otradnenskaya Central District Hospital", where the following diagnosis was made clinically and radiographically: closed anterior subcoracoid dislocation of the right shoulder. After preparation under local anesthesia, with the patient in the supine position, the following was done: the patient's injured arm was abducted in the frontal plane to a position perpendicular to the body, the crest of the traumatologist's right iliac bone was rested on the patient's armpit, dosed and gradual traction by the forearm along the axis of the abducted arm, simultaneous adduction of the patient's arm and rotation of the traumatologist's pelvis counterclockwise until the moment of displacement of the head of the humerus into the joint cavity with a characteristic click.

During the reduction of the dislocation, the patient's pain syndrome was 2 points according to the VAS. No pain was noted after the procedure. No complications were noted during the reduction. Clinically and radiographically, the shoulder dislocation was reduced. After restorative treatment, the range of motion in the right shoulder joint is full. No recurrence of the dislocation was noted.

Example 3. Patient: M., born in 1968.

Household injury from 22.08.23, due to carelessness, fell on the street on the outstretched left arm. She independently sought help at the "Otradnenskaya Central District Hospital", where the clinical and radiographic diagnosis was: closed posterior dislocation of the left shoulder. After preparation under local anesthesia, with the patient in the supine position, the following was done: the patient's injured arm was abducted in the frontal plane to a position perpendicular to the body, resting the crest of the traumatologist's left iliac bone on the patient's armpit, dosed and gradual traction by the forearm along the axis of the abducted arm, simultaneous adduction of the patient's arm and rotation of the traumatologist's pelvis clockwise until the moment of displacement of the head of the humerus into the joint cavity with a characteristic click.

During the reduction of the dislocation, the patient's pain syndrome according to VAS was 2-3 points. After the procedure, no pain was noted. No complications were noted during the reduction. Clinically and radiographically, the shoulder dislocation was reduced. After restorative treatment, the range of motion in the right shoulder joint is full. No recurrence of the dislocation was noted.

Example 4. Patient: T., born in 2006.

Household injury from 04.02.23 at home, reached for the upper shelf to get a tool and felt pain in the area of the right shoulder. According to his words, he has already dislocated his right shoulder for the fourth time in 12 months. After the first, he was treated conservatively, followed all recommendations. The last two dislocations occurred within 3 months. He independently went to the Otradnenskaya Central Regional Hospital, where he was clinically and radiologically diagnosed with closed habitual anterior dislocation of the right shoulder. After preparation under local anesthesia, with the patient in the supine position, the following was performed: the patient's injured arm was abducted in the frontal plane to a position perpendicular to the body, the crest of the traumatologist's right iliac bone was rested on the patient's armpit, dosed and gradual traction was applied to the forearm along the axis of the abducted arm, the patient's arm was simultaneously adducted and the traumatologist's pelvis was rotated counterclockwise until the head of the humerus was displaced into the joint cavity with a characteristic click.

During the reduction of the dislocation, the patient's pain syndrome according to VAS was 2 points. No pain was noted after the procedure. No complications were noted during the reduction. Clinically and radiographically, the shoulder dislocation was reduced. After restorative treatment, the range of motion in the right shoulder joint is full. Surgical treatment is recommended on a planned basis for habitual dislocation of the right shoulder.

Example 5. Patient: M., born in 1960.

Household injury from 04.02.23, fell at home on her left arm through carelessness. She independently sought help at the Otradnenskaya Central Regional Hospital, where she was clinically and radiologically diagnosed with a closed lower dislocation of the left shoulder. After preparation under local anesthesia, with the patient in the supine position, the following was done: the patient's injured arm was abducted in the frontal plane to a position perpendicular to the body, the crest of the traumatologist's left iliac bone was rested on the patient's armpit, dosed and gradual traction by the forearm along the axis of the abducted arm, simultaneous adduction of the patient's arm and rotation of the traumatologist's pelvis clockwise until the moment of displacement of the head of the humerus into the joint cavity with a characteristic click.

During the reduction of the dislocation, the patient's pain syndrome according to VAS was 2-3 points. After the procedure, no pain was noted. No complications were noted during the reduction. Clinically and radiographically, the shoulder dislocation was reduced. After restorative treatment, the range of motion in the right shoulder joint is full. No recurrence of the dislocation was noted.

In 2023, 31 reductions of fresh and habitual dislocations were performed using the proposed method. In all cases, there was no pain or complications after reduction. After restorative treatment, the range of motion in the shoulder joint was completely restored. No relapses were observed in any of the patients.

Claims (1)

A method for reducing a shoulder dislocation, including support in the patient's armpit in a prone position, traction along the arm axis, characterized in that the traumatologist stands with his back to the couch, the height of which corresponds to the level of his hip joints, on the side of the patient's injured arm, then takes the patient's injured arm by the forearm with both hands, abducts it in the frontal plane to a position perpendicular to the body, creates support with the area of the crest of his ilium, the same name as the injured arm, in the patient's armpit on the side of the dislocation and performs gradual, smooth, dosed traction along the axis of the abducted arm and its bringing towards the patient's body in the frontal plane, simultaneously turning his pelvis counterclockwise, if the injured arm is right, and clockwise, if the injured arm is left, until the moment of displacement of the head of the humerus into the joint cavity with a characteristic click.