Dislocations of the shoulder, forearm, fingers

A dislocated shoulder. Symptoms: the area of the shoulder joint is flattened. Active movement impossible. Depending on the position of the head arm there are several kinds of dislocation of the shoulderdislocations of the shoulder: 1 - front podlubny; 2 - front vnutricletocny with a margin of large tubercles; 3 - front subclavian; 4 - bottom axillary; 5 - rear podgrebelniy; 6 - full shoulder turn up.(Fig). When you try to raise the arm of the patient, to lead or take it felt springy resistance. Offset cylinder shoulder can compress or damage to the brachial plexus, a particular nerve trunk. If squeezed the blood vessels, heart rate at the radial artery is missing or weak. The diagnosis to be confirmed by x-ray.
First aid: calm, transport immobilization; the patient should immediately be sent to the surgeon.
Treatment. Shoulder dislocation should be urgently put under General or local anaesthetic.
There are several ways to reset.
resetting of dislocation of the shoulder, the way Dzhanelidze4. Method of emergency medicine (Fig. 3). After anesthesia patient is placed on its side, the corresponding sprained limbs, with hanging from the dressing-table with his hand. In this situation the patient should remain 15-20 minutes. Under the weight of the hands of the shoulder muscles gradually relax and dislocation can sometimes spravitsya himself. Otherwise, the surgeon becomes ahead of the patient, flexes his dangling arm in the elbow joint. With one hand he presses down on the arm in the elbow bend the other hand, covering the forearm of the patient at the wrist, produces rotation of the shoulder joint to the outside and then the inside. Thus there is a reduction of dislocation.
the reduction of dislocation way Kocher2. The way Kocher (Fig. ). Patient is placed on the dressing table. First stage: the hand of the patient bend of the elbow at a right angle. Pulling the shoulder down and slowly overcoming resistance springing muscles, press elbow patient to its trunk. Second stage: the forearm slowly turn outwards until then, until the Palmar surface does not coincide with the front surface of the body. Third stage: slowly promote pressed to the body of the elbow of the patient to the middle line and up. The fourth stage: the forearm smash inside and put on the chest of the patient so that the brush affected limb Touched healthy shoulder joint.
The head of the shoulder in this position usually falls into place, we can often hear a clicking sound.
By way of emergency medicine (reduction of dislocation of the shoulder due to the relaxation of the muscles under the weight of the hand), you can use, if you are unable to urgently bring the victim to a surgeon. In this case, pain relief joint't produce, you must enter the subcutaneous morphine (1 ml of 1 % solution). To use manual methods of reduction can only physician. After reduction of dislocation required control radiograph and immobilization hands for 3 weeks plaster Longuet (see Immobilization).
Dislocations of the forearm. Often dislocations of the two bones of the forearm to the back. Hand and hanging slightly bent at the elbow joint, olecranon visibly, sags tendon triceps shoulder. Dislocation of one of the radial bone is often accompanied by a fractured elbow bone.
First aid: in the affected limb impose immobilizers armband type kerchiefs and the patient is referred to a surgeon.
Treatment. the reduction of dislocation of the forearmResetting of dislocation of the forearm is done usually under General anesthesia. The patient is put on the table; shoulder to divert right angle. The surgeon becomes behind allocated hands, patient and two hands covers over his shoulder elbow: Assistant surgeon covers one hand on the forearm in the bottom third, and the other brush (Fig.).
The surgeon and assistant gently but firmly pull the arm of the patient, bending of the elbow. At the same time the surgeon fingers shifts speaker posterior elbow, process and head of the radial bone. Before and after the reset is required radiography. Joint after reduction of dislocation fixed on 8-10 days plaster Longuet right angle, and the forearm - in position supination. Then allow careful movements.
Dislocations of bones of the wrist are extremely rare. More often happen dislocations Crescent or the scaphoid (see the Wrist joint).
Dislocations fingers; Often observed dislocations I finger in the back. With full dislocated major joint of the finger is at right angles to the first metacarpal bone (Fig. 2). In case of incomplete dislocation this angle is obtuse. Dislocation is often accompanied by infringement of tendons and sesamoides bones, making it difficult resetting.
Treatment. Taking your finger, make peremeshivanie and at the same time stretching it, and then the fingers bent in towards your palm (Fig. 2 - 4). Put a plaster bandage on the forearm, wrist and finger, which is fixed in position allows easy rolling. The bandage is removed after 10 days and permit movement."
Dislocations clavicle - see Collarbone.