Dislocation of the shoulder in athletes are 34-46%, and in most cases occur in acrobats, gymnasts, wrestlers, rowers, (MG Zedgenidze, 1973) according to M. Sverdlov (1970) — the skaters, volleyball players, wrestlers and, finally, the skiers and football players. Analysis of our research reveals that the highest in frequency of primary traumatic shoulder dislocation occupy fighters of all styles, then gymnasts, skiers and boxers.
Symptoms. The diagnosis of primary traumatic shoulder dislocation in fresh cases is easy. Patients usually complain of sharp pain, and the impossibility of movement in the shoulder joint. Usually the patient good arm support for a sprained arm and abduction from the trunk limb. On examination, the shoulder joint is determined by the deformation in the form of depressions in the deltoid region. On palpation there is a lack head in the glenoid cavity (head shoulder more palpable under the coracoid process or in the armpit), sharp pain of the shoulder girdle. When there is a symptom of passive motion resistance springy limbs. Critical and are required for the diagnosis of X-ray data of the survey. Radiographs revealed anteroposterior displacement of the humeral head inwards and downwards, in Maximum projection — shift in the anteroposterior direction. In addition, these data also reveal and related damage, if any (impacted fracture surgical neck or greater tubercle humeral bone fracture of the back of the glenoid cavity, and so on).
Treatment. Reduction should be performed under anesthesia for pain relief and relaxation to achieve the required
muscles. Desirable general anesthesia. Most often, when using reduction methods Kocher, Mott Janelidze, as detailed in the manuals and handbooks. Do not forget the reduction by the method of Cooper (Hippocrates).
Fig. 8. Way to reposition dislocated by Yu Dzhanelidze
Yu Dzhanelidze way. After anesthesia the patient lies on its side, the corresponding dislocated limbs, with hand hanging over the edge of the table (Fig. 8). Assistant head support, but you can substitute a head and a high table. In this position, the patient should remain for 15-20 minutes. Under the weight of the affected limb shoulder girdle muscles gradually relax. Surgeon before becoming a patient flexes his arm hanging at the elbow at a right angle. To fixed in this position the patient's arm with his hand the doctor produces downward pressure on the forearm at the elbow, at the same time with the other hand, covering the patient's arm at the wrist, it produces a rotational movement of the shoulder joint outward and then inward. Thus there is a reduction of dislocation.
Method Cooper (Hippocrates). Athlete with the dislocation of the shoulder joint is placed on the floor on a blanket (mat). The surgeon removes the shoes from his feet, the same name with a dislocated shoulder joint patient, tape up her gauze bandage, and then sits down to face him. Then he makes a strong traction for a sprained hand, seized with both hands on the wrist, and at the same time pushes the heel to have shifted in the armpit head.
Usually head easily moves into the joint cavity.
It should be remembered that the reduction in the gross manipulation of dislocation can occur complications secondary shoulder fracture or damage to blood vessels and nerves.
When reposition head with a clicking sound is set into the joint cavity, elastic deformation of the joint, the patient is immediately relieved.