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Abstract: The shoulder joint is the joint with the largest range of motion and the most flexible joint in the body, and it is also prone to shoulder dislocation. This patient had a history of shoulder dislocation, and after a forceful throwing of an object, shoulder dislocation occurred again, and he intended to reset it by himself by manipulation, but the pain at the shoulder became more and more.
Basic information】Male, 24 years old
Disease Type】Shoulder dislocation
Hospital】The First Hospital of Harbin Medical University
Date of consultation】March 2022
Treatment plan】Medication for pain relief (parecoxib sodium for injection) + manipulation under anesthesia
Treatment period】1 day of outpatient treatment, 3 weeks of outpatient follow-up
Results】No discomfort in the shoulder joint, normal movement
I. Initial consultation
The patient was a 28-year-old male with a history of shoulder dislocation. The onset of the dislocation was after a forceful throwing of something, and at the time of the injury, he experienced pain and weakness in the shoulder and had difficulty moving around. The patient realized that the shoulder might be dislocated again. Due to the experience of resetting the shoulder after a previous dislocation, the patient wanted to reset it himself at home, but unfortunately, after half a day of research, the shoulder became more and more painful but did not recover. After listening to the patient’s description, I couldn’t help but sweat for the patient in my heart. The patient was in his young and strong age with well-developed muscles, even if I went to reset it, there was no guarantee that it would be successful. After repeated reset failures, it made the muscles around the shoulder more tense, and it was very difficult to reset.
II. Treatment process
After admission, the patient was first advised to take a film, and the imaging results showed that the patient had an anterior shoulder dislocation with no fractures in other locations. This simple anterior shoulder dislocation was the most common and the repositioning technique was relatively simple, and the patient strongly requested another manual repositioning. Therefore, after reassuring the patient and giving him parecoxib sodium injection for pain relief, the patient was repositioned again using traction. However, during the repositioning process, the patient’s muscles remained very tense and the repositioning was very difficult, and the patient finally had to undergo repositioning under anesthesia. Because the muscles could be completely relaxed during anesthesia, the repositioning was relatively easy.
III. Treatment results
After the repositioning, the deformity of the shoulder joint disappeared, and the pain disappeared immediately. The patient’s shoulder joint alignment was also restored on the same day, and the patient was able to go home on the same day. At the outpatient review 3 weeks later, the patient’s shoulder joint was free of discomfort and the mobility was back to normal.
IV. Precautions
The patient’s shoulder joint was dislocated and reset in time, so I was happy for the patient. Since the patient had dislocated the shoulder joint before, I asked the patient to use a deltoid sling to suspend the upper limb for 3 weeks after the repositioning in order to prevent the shoulder joint from dislocating again and forming a habitual dislocation, and then avoid excessive forceful activities of the shoulder joint to facilitate the repair of the ligaments and joint capsule around the shoulder joint and increase the stability of the shoulder joint. In the future, avoid sudden force or excessive activities of the shoulder joint. If there is any deformity of the shoulder joint, difficulty in movement or with elastic fixation, you should consult a doctor promptly instead of resetting the shoulder joint by yourself at home.
V. Personal insight
According to the relevant statistics, the majority of shoulder dislocations can be successfully repositioned manually. However, this success rate is relative to doctors, but it is not so easy for ordinary people to reset the shoulder by themselves after searching the internet. If the shoulder joint dislocation is difficult to reset, it can only be successfully reset after the muscle relaxation and even after the muscle relaxation drugs are given under anesthesia. This case reminds us that if a shoulder dislocation occurs, do not handle it on your own, but seek medical attention promptly. Self-solution may lead to occasional recovery, but the odds are that it will leave potential risks for yourself and even complicate other injuries.