What to do if the shoulder is dislocated and the nerve is injured

Shoulder dislocation is relatively common in our daily life, accounting for more than half of all joint dislocations. This is closely related to the anatomical and physiological characteristics of the shoulder joint. If dislocation occurs, it will have a great impact on health, especially some habitual dislocations, which often lead to dislocation with a little force, which also has a great impact on the nerves in the shoulder joint.

Shoulder dislocation is divided into anterior dislocation and posterior dislocation according to the position of the humeral head. Anterior dislocation of the shoulder is very common and is often caused by indirect violence, such as falling with the upper limb abducted and externally rotated, and the palm or elbow landing on the ground. The external force impacts upward along the longitudinal axis of the humerus, and the humeral head tears off the joint capsule from the weak part between the subscapularis and the teres major muscle and dislocates forward and downward, forming an anterior dislocation.

The humeral head is pushed under the coracoid process of the scapula, forming a subcoracoid dislocation. If the force is greater, the humeral head will move forward to under the clavicle, forming a subclavian dislocation. Posterior dislocation is rare and is usually caused by a violent force from front to back on the shoulder joint or by the hand landing on the ground when falling in the adducted and internally rotated position of the shoulder joint. Posterior dislocation can be divided into subscapular dislocation and subacromial dislocation. If shoulder dislocation is not treated properly in the early stage, habitual dislocation may occur.

Treatment

1. After manual reduction , the dislocation should be reduced as soon as possible, and appropriate anesthesia (brachial plexus anesthesia or general anesthesia) should be selected to relax the muscles and allow the reduction to be performed painlessly. Elderly people or those with weak muscles can also undergo the procedure under the influence of analgesics. Habitual dislocation does not require anesthesia. The reduction technique should be gentle, and rough techniques are prohibited to avoid additional injuries such as fractures or nerve damage. There are three commonly used resetting techniques.

2. Surgical reduction A small number of shoulder dislocations require surgical reduction. The indications are: anterior shoulder dislocation complicated by posterior slippage of the long head of the biceps tendon that hinders manual reduction; avulsion fracture of the greater tuberosity of the humerus, with the fracture fragment stuck between the humeral head and the glenoid fossa affecting reduction; combined with a fracture of the surgical neck of the humerus that cannot be reduced by manipulation; combined with fractures of the coracoid process, acromion or glenoid fossa with obvious displacement; combined with injury to the great blood vessels in the axilla.

3. Treatment of chronic shoulder dislocation: If the shoulder dislocation has not been reduced for more than three weeks, it is considered a chronic dislocation. The joint cavity is filled with scar tissue, there is adhesion with surrounding tissues, the surrounding muscles are contracted, and callus or malformation healed in patients with fractures. These pathological changes hinder the reduction of the humeral head.

4. Treatment of habitual anterior shoulder dislocation Habitual anterior shoulder dislocation is more common in young and middle-aged people. The reason is generally believed that the first traumatic dislocation caused injury. Although it was reduced, it did not get proper and effective fixation and rest. Due to the failure of good repair of joint capsule tear or avulsion and cartilage labrum and glenoid rim damage, the posterolateral depressed fracture of the humeral head becomes an equal pathological change and the joint becomes loose. Dislocation may occur repeatedly later under slight external force or during certain movements, such as abduction, external rotation and extension of the upper limbs. The diagnosis of habitual dislocation of the shoulder joint is relatively easy. During the X-ray examination, in addition to taking the anteroposterior plain film of the shoulder, an anteroposterior X-ray film of the upper arm with 60° to 70° internal rotation should be taken. If there is a defect on the posterior side of the humeral head, it can be clearly shown.