A dislocation, especially in the shoulder, is a painful injury that causes the immediate - but temporary - inability to use the limb. It is impossible to move the joint until it is returned to its natural location. The shoulder is particularly sensitive to this type of trauma because it is the most mobile joint and people tend to fall by hyperextending the arm, which causes the joint to assume an abnormal position. Shoulder dislocation reduction should always be performed by a licensed orthopedist, although in some special (emergency) circumstances it is necessary to do it yourself. If a dislocated shoulder is not replaced promptly, the problem may need to be surgically resolved.
Steps
Part 1 of 3: Managing a Dislocated Shoulder
Step 1. Recognize the symptoms
Shoulder dislocation is usually caused by a fall on the hyperextended arm or by an object coming from behind that hits the joint itself. The injury generates a sharp and immediate pain, preceded by a "snap" or the sensation that something moves inside the shoulder. The joint is visibly deformed, out of place, and swelling and bruising develop rapidly. The shoulder cannot be moved until the dislocation is reduced.
- Typically, the damaged joint "dangles" lower than the healthy one and you may notice a depression or an inversion of the deltoid muscle.
- The person experiencing a shoulder dislocation may also experience numbness, tingling, and / or weakness in the hand. If the blood vessels are damaged, then the arm and hand downstream of the injury are cold and turn bluish.
- About 25% of first-time dislocations are accompanied by a fracture of the humerus or shoulder girdle.
Step 2. Immobilize the arm
While waiting to be treated by a doctor, you should avoid any movement or attempt to move the joint, as this could make the situation worse. There could be a fracture, nerve damage, or a rupture of blood vessels, so any movement could lead to serious consequences. For these reasons, you have to bend your elbow and rest your forearm against your abdomen. Finally, lock the limb in this position with a sling bandage.
- If you don't have a ready-made shoulder strap available, you can make your own with a pillowcase or piece of clothing. Pull it under the elbow / forearm and tie it at the nape of the neck. This type of bandage blocks movement and protects the shoulder from further injury, while also helping to reduce pain.
- About 95% of shoulder dislocations are of the "anterior" type; it means that the humerus is pushed forward until the head comes out of the glenoid cavity.
Step 3. Apply ice
It is important to cool the dislocated shoulder immediately with ice or a cold pack to keep the inflammation under control and thus experience less pain. Cold therapy reduces the diameter of blood vessels by limiting the amount of blood and inflammatory substances that reach the joint and the surrounding area. Place a bag filled with crushed ice on your shoulder for about 15-20 minutes (or until you feel some numbness) every hour or so.
- Always wrap the ice in a thin cloth, towel, or plastic bag before placing it on your skin to avoid irritation and chilblains.
- If you don't have crushed or cubed ice at your disposal, you can use a pack of frozen vegetables or a cold gel pack.
Step 4. Take pain relievers
Once the dislocated shoulder has been immobilized and covered with an ice pack, you can take over-the-counter medications to further combat the pain and inflammation. Those who suffer from this injury typically describe the pain as "unbearable" due to straining or tearing of tendons, ligaments and muscles, as well as possible fracture of bone and cartilage. Ibuprofen (Moment, Brufen) and naproxen (Aleve, Momendol) are the best choice because they are powerful anti-inflammatories, although acetaminophen (Tachipirina) is useful against pain.
- In case the dislocation is accompanied by severe internal bleeding (you may notice a large hematoma), do not take ibuprofen and naproxen, as they have "anticoagulant" properties.
- You can also consider muscle relaxants if the muscles surrounding the joint twitch into spasms. In any case, remember not to mix the drugs; stick to one type of medicine.
Part 2 of 3: Reduce Dislocation in Emergency Situations
Step 1. Do this maneuver only in emergency situations
In most cases it is always better and safer to wait for the intervention of a doctor; however, on some occasions this attitude is not possible. If you are in an isolated place, away from hospital facilities (camping, during a mountain climb or on a trip abroad), then the risks that could arise from "self-reduction" or from the intervention of a relative or family member does not weigh as much as the benefits of immediate pain relief and increased joint mobility.
- As a general rule, if you can get medical help within 12 hours, then you should wait patiently and attempt to control the pain with ice, pain relievers, and a sling bandage. If, on the other hand, there is a high probability that the wait will be greater, especially if you need to regain arm mobility to reach the hospital, then you should consider intervening alone.
- The major complications of unprofessional reduction of dislocation are: worsening of muscle, ligament and tendon injury; damage to nerves and blood vessels; life-threatening bleeding; severe pain with loss of consciousness.
Step 2. Get help in an emergency
If you are forced to intervene to reposition your shoulder in an emergency situation, remember that doing it yourself is next to impossible. For this reason, you must ask someone to help you or offer to help the victim. Some individuals may be reluctant for fear of increasing pain or causing worse damage to your shoulder, so try to reassure them and relieve them of any responsibility.
- If your help is needed to reduce another person's shoulder dislocation, make sure you have the victim's consent, remind them clearly that you are not a doctor and that you have not received any professional training to intervene in these situations (if possible). You certainly don't want your attempt to be helpful to turn into a personal injury lawsuit in case something goes wrong.
- If you have a phone available and can make a call, contact 118 for advice and support. The operator can give you useful instructions even if the sending of emergency vehicles is not immediately possible.
Step 3. Lie on your back and move your arm outward
In general, the maneuver to reduce a dislocated shoulder by non-professional personnel consists in placing the victim supine with the affected arm extended at 90 ° with respect to the body. At this point, a friend or person present should grab your hand / wrist and slowly (but firmly) apply some traction. This person can also place their foot on your torso for added leverage. By pulling the arm in this way, the head of the humerus slides under the shoulder bone and re-enters its seat with relative ease.
- Remember that the pull should be slow and steady (without quick movements or jerks) in a direction perpendicular to the body until the dislocation is reduced.
- As soon as the head of the humerus is back in place, the pain associated with the injury should be significantly reduced. But remember that the joint is still very unstable, so try to immobilize your arm as much as possible.
Part 3 of 3: Finding Medical Help
Step 1. Go to the emergency room as soon as possible
You must quickly undergo the care of an orthopedist (or a qualified professional) because in cases of dislocation the muscles, tendons and ligaments surrounding the joint stiffen over time and make repositioning the head of the head very difficult. Homer. In this circumstance surgery must be resorted to. Most doctors will want to do an x-ray before proceeding with any reduction maneuvers to rule out any fractures.
- If there are no severe injuries or strains, then the traumatologist provides a closed reduction maneuver on the shoulder, giving you a sedative, a strong muscle relaxant or even an anesthetic before manipulating the joint, due to the intense pain.
- A very common procedure for relocating the dislocated shoulder is the Hennepin maneuver, which uses external rotation of the joint. You will need to lie on your back as the doctor bends your elbow 90 degrees and rotates your shoulder outward. A few gentle pushes in this position are all it takes for the humeral head to return to its seat.
- There are other techniques available to the doctor, the choice depends on the preferences of the orthopedist.
Step 2. Be prepared for possible surgery
If your shoulder dislocates frequently (due to a bone deformity or loose ligaments), you have a fracture or tears in the nerves or blood vessels, then you will need to have surgery to repair this damage and you will have to undergo an open reduction of the dislocation.. Sometimes surgery is the best solution, because it allows you to resolve any internal anomaly and stabilize the shoulder, greatly reducing the risk of recurrence.
- There are several operating procedures in this regard and the surgeon will choose the most suitable one based on the severity of the trauma, the patient's lifestyle and his level of physical activity.
- Some studies suggest that an "open" surgical reduction is the best solution for adult patients under 30 years of age, because it results in a lower relapse rate and leads to better quality of life outcomes.
Step 3. Run a rehabilitation program
Regardless of the type of reduction the dislocation has undergone (closed or surgical), you need to undergo physical therapy to strengthen the joint. Physiotherapists, chiropractors and / or sports therapists will be able to show you specific stretching exercises, to recover complete mobility of the shoulder, and others of strength, to stabilize the joint and avoid future trauma.
- It usually takes 2-4 weeks of recovery before following a physiotherapy program. During the recovery phase, you will need to wear a shoulder bandage, apply ice, and take over-the-counter medications.
- The total time required to fully recover shoulder function varies between 3 and 6 months, depending on the severity of the injury and the type of patient (an athlete or an ordinary person).
Advice
- When the inflammation and pain subside after a few days, you can apply moist heat to your shoulder to allow the tight, sore muscles to relax. Herbal wraps that can be heated in the microwave are perfect, but remember to limit application to 15-20 minutes per session.
- Put the shoulder back in place immediately after the accident, as soon as possible, as the reduction of a dislocation becomes more and more complicated over time.
- Remember that shoulder dislocation is different from acromioclavicular ligament injury, although these two injuries are sometimes confused. In the second case, there is a stretching or rupture of the ligament that joins the clavicle to the anterior part of the shoulder girdle and the glenohumeral joint is intact.
- When you suffer a shoulder dislocation, the risk of future similar trauma increases, especially if you play contact sports.
