Motor mode athletes with recurrent dislocation of the shoulder in the postoperative period

Complex treatment of patients after surgery, is divided into three segments: medical rehabilitation, sports rehabilitation phase and stage of sports training.
Stage of medical rehabilitation divided into three periods of immobilization; restore limb function (postimmobilizatsionny period) Recovery overall disability.
First period. In the early postoperative period are the tasks to prevent various complications associated with anesthesia and surgery, and rapid normalization of the general condition of the patient, taking into account its specific features (allergic background, tolerance of drugs, etc.). Appointed by breathing exercises and light General tonic exercises in bed. After removing the sutures and the general state of the normalization main task is to maintain and preserve the body fitness with continued immobilization shoulder. Gradually expanded the scope and intensity of exercises tonic (allowed dosed walking, and by the end of the period dimensional light running), the nature of the power to exercise the muscles of the lower limbs, torso and abdomen. For healthy extremity muscle exercise shows forceful nature, isometric muscle contractions operated limb, strength exercises for the brush, etc.
Second period begins after the removal of the cast, that is, from 29-30th day after the operation. Its main task is the restoration of function of the operated joint, and the restoration and strengthening of muscles of the shoulder girdle and the entire limb. In this period, shows dose active flexor and extensor movements in the wrist, elbow and shoulder joints of the upper limb, significantly increasing the volume and intensity of restorative exercises (dosed walking, running, exercising on a bicycle ergometer, diving board, running on a treadmill, etc.). Patients received massage and physiotherapy. In order to prevent over-voltage capsule and ligaments of the operated joint should be excluded shirokoamplitudnye motion in the shoulder joint, great attention should be paid to weight training muscles of the shoulder girdle.
In cases of slow recovery of mobility in the joint recommended hydrotherapy (sea and pine baths, underwater massage shoulder muscles), electrotherapy (diadinamoelektroforez potassium iodide and novocaine), special packing operated limb, massage, shoulder girdle and upper limb, ultrasound therapy.
Range of motion in the operated joint, usually recovers in time from 2 to 3.5 months after surgery. By this time quite well restored power rates and muscle mass shoulder girdle, professional activities, not related to hard physical activity. The transition to the training period in these terms is premature as yet not fully matured muscles of the shoulder girdle.
Stage Sports Rehabilitation. Patients are encouraged to continue the general developmental exercise: walking and jogging dose, the exercises for the muscles of the nature of the power of the upper and lower extremities, spine. Widely used on the cycle ergometer exercise, running on a treadmill, and various training devices, etc. At this stage also apply simulation, sports and assistance exercises.
Stage sports training. Allowed to proceed to training no earlier than 6 months after surgery. It is divided into two stages: the preparatory and basic. In the preparatory period, the main objectives are: the restoration of the functional state of the cardio-respiratory system, muscle force production and athletic performance, and rehabilitation of complex coordination of the operated limb.
At this stage, the total amount of physical activity athletes involved in non-contact sports, close to the level of training. Representatives of team sports and arts groups begin to main training period, not earlier than 6-7 months after surgery.
The final recovery of the patient after surgical treatment of habitual shoulder dislocation depends on the conduct of complex fully fiziofunktsional treat-ment in the postoperative period and strictly differentiated approach to the continuation of sports.
Errors and complications of dislocation Shoulder summarized as follows:
      operational equipment,
      management of the postoperative period.
To diagnostic errors are those cases in which the diagnosis skipped damage, combined with habitual dislocation of the shoulder. According to the literature, a dislocated shoulder, complicated fractures, prevent relapses. However, this practice is not confirmed. There are habitual shoulder dislocation, complicated fracture of large tubercles humerus. Therefore, to confirm the diagnosis is recommended before surgical intervention subject to careful patient x-rays. Unidentified and timely untreated fractures of the proximal humerus reduce the effectiveness of surgical treatment.
To tactical errors include cases where the surgeon surgery prolongs the time of diagnosis of habitual shoulder dislocation, accumulating an excessive rate of recurrence of dislocation. According to our research, the vast majority of patients are referred for surgery later, and only after 10-15 relapse. This tactic is wrong, because a large number of relapses leading to a secondary weakness of the muscles surrounding the shoulder joint, deforming osteoarthritis, limited mobility, prolonged pain. This not only prolongs the post-operative treatment, but a negative effect on the final outcome of treatment.
Errors operative technique: 1. In operations for habitual dislocation of the shoulder, much depends on the correct choice of online access, which should be physiological, not to violate the neurovascular elements and muscle function. When anterior deltoid, pectoral access to the shoulder joint, without damaging the muscles and allows you to freely approach the department perednevnutrennemu shoulder joint, as well as to a small hillock shoulder, this problem is solved optimally.
2. Cutting out a thin stalk of aponeurosis-beakedhumeral muscle, which subsequently can not perform the function of ligaments.
3. To weak end vykroennoy strengthening ligaments in periosteal bone canal humeral bone.
4. The lack of shortening stretched and weakened tendon of the long head of biceps, and strong enough to lock in the interosseous groove.
5. Disadvantages hemostasis during surgery, leading to the formation of post-operative hematoma.
Errors in the conduct of the postoperative period. Immobilization of the joint must be constant and consistent terms of regeneration of fibrous tissue and tendon. Early termination of its violating the regeneration of tissues, which are subsequently subjected to tears. And that leads to the return of recurrence of dislocation. Restorative treatment should be up to the complete recovery of the patient. Essential to get a good result in patients with recurrent dislocation of the shoulder have terms of issue. Based on our experience is recommended to allow lessons in hard physical work not earlier than 3 months after the operation (with the complete disappearance of atrophy and recovery of muscle strength of the upper limb).
Among the complications of habitual dislocation of the shoulder dislocations emit with a margin of greater tubercle of humerus; dislocation complicated by peripheral nerve injury, dislocation with fracture of surgical neck of the humerus and dislocations complicated by damage to blood vessels (M. Sverdlov, 1978).
Reduction of shoulder dislocation without anesthesia and preliminary X-ray examination, and should be considered the most serious mistake, leading to the threat of occult fracture shoulder. Manipulation is aimed at the reduction of dislocation may lead to displacement of bone fragments.
Inadmissible as dislocation reduction coach. It is usually performed without anesthesia, leading to additional trauma elements shoulder. The absence of proper joint immobilization or early removal of the dressing lead to a sharp weakening perednevnutrennego department shoulder joint capsule and the formation of habitual dislocation of the shoulder.

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