How is shoulder dislocation treated?
The diagnosis of shoulder dislocation has important consequences with regard to the form of therapy that is chosen after the diagnosis has been made. Depending on the form and severity of the shoulder dislocation, a distinction is made between conservative therapy and surgery of the shoulder dislocation. At this point, however, it should be mentioned that in the case of a proven shoulder dislocation, the joint should be repositioned (= put back in place) as soon as possible.
Otherwise, serious damage to cartilage and soft tissues (especially the rotator cuff) can occur. Since repositioning causes severe pain, the doctor will first administer an analgesic to the patient. This will also achieve the necessary muscle relaxation, which generally only allows shoulder movements to be made again.
There are various ways to reduce a shoulder joint. A distinction is made: Reduction should only be performed by an experienced doctor. Improper handling can lead to serious damage.
The measures described above should only describe how a reduction is performed. Under no circumstances are they descriptions of the reduction performed by the patient himself. The Hippocratic reduction shows that shoulder joint dislocations have been present for quite some time.
In fact, Hippocrates, for example, performed reductions more than 2000 years ago. However, this does not mean that repositioning is always successful. If a repositioning of the shoulder dislocation cannot be performed manually, the repositioning is performed during surgery.
After repositioning, the shoulder joint should always be checked by means of a new X-ray image in two planes. In addition, the motor function, blood circulation and sensitivity should be checked. Depending on the extent of the injury, therapy is carried out by immobilization using shoulder bandages of varying duration.
When estimating the length of immobilization, the degree of severity but also the age of the patient is decisive. A simple dislocation of an older patient implies immobilization of about one week, while in other circumstances immobilization of up to 6 weeks may be conceivable.
- Reduction according to Arlt:The elbow is bent by 90°, the arm is placed hanging over the back of the chair while sitting.
The doctor applies a longitudinal traction.
- Kocher reduction: The reduction is performed lying down, with the patient’s upper body slightly raised. Here too, the elbow is angled at 90°. The doctor performs the reduction in three steps.
- Reduction according to Manes:This reduction option is used particularly in patients over 60 years of age.
The doctor pulls on the patient’s arm and at the same time moves the humeral head to its original position. Here too, the elbow is angled at 90°.
- Reduction according to Hippocrates:This reduction option is also used especially for patients over 60 years of age. The patient lies down, the doctor pulls on the stretched arm.
The doctor’s heel serves as the pivot (support) point of the lever.
Important questions that should be asked are The form of therapy for shoulder dislocation must always be decided individually and must therefore be based on the different circumstances and, of course, the requirements of the patient. A young patient with sporting ambitions places different demands on his shoulder joint than, for example, an older patient without sporting ambitions, who can also be happy without surgery. Differences in the area of therapy must of course also be made with regard to the classifications (see above).
A traumatic shoulder dislocation is treated differently than a habitual shoulder dislocation, in the effects of which the shoulder joint luxates even during normal movements, for example. The declared goal of therapy is primarily the repositioning (see above) and, in addition, the achievement of stabilization of the shoulder joint, so that stress is possible again. The form in which this goal can be achieved varies from individual to individual.
As already mentioned, the classification plays a major role in the treatment. The therapeutic measures are carried out in accordance with certain principles, the so-called treatment principles. Although in individual cases the physician may, under certain circumstances, deviate from these principles in his or her form of treatment, the principles listed below apply as a rule.
- Classification of shoulder dislocation
- Assessing the pain
- If a reduction has already been performed: How was it performed?
(spontaneous, automatic, external reduction)
- To what extent is there a functional limitation (effects on: mobility, strength (dead arm sign)
- Is there a feeling of instability?
- Can neurological failures, circulatory disorders be detected?
- What sports activities are practiced? (This question is particularly important with regard to therapeutic measures; see below)
- Right-left-handed?
- Age?
- Which shoulder-stressing activities are carried out (privately)?
- Are there any previous damages? Previous therapy?
