Persistent and severe shoulder pain, often due to dislocation of the shoulder joint. There is a clear history of trauma. Traumatic anterior shoulder dislocation is associated with a history of trauma, shoulder pain, swelling and dysfunction. The injured limb is flexibly fixed in a mildly abducted internal rotation position with the elbow flexed and the affected forearm supported by the healthy hand. How to effectively prevent persistent and severe shoulder pain? 1.Manipulation reset The dislocation should be reset as soon as possible, and appropriate anesthesia (brachial plexus anesthesia or general anesthesia) should be chosen to relax the muscles and make the reset painless. Older people or those with weak muscles can also be performed under painkillers (such as 75-100 mg of dulcolax). Habitual dislocation can be performed without anesthesia. The repositioning technique should be gentle and violent techniques are prohibited to avoid additional injuries such as fracture or injury to nerves. There are three commonly used repositioning techniques. (1) Foot stirrup method (Hippocrate’s method): the patient lies on his back, the operator is located on the affected side, both hands hold the wrist of the affected limb, the heel is placed in the axilla of the affected side, both hands traction with a steady and continuous force, traction in the heel outward pushing the humeral head, while rotating, inward upper arm can be reset. A loud sound can be heard during the reset. (2) Kocher’s method (Kocher’s method): This method is easy to succeed when the muscles are relaxed, do not use excessive force to prevent the humeral neck from being subjected to excessive twisting force and fracture. Manual steps: hold the wrist with one hand, flex the elbow to 90 degrees, make the biceps muscle relax, hold the elbow with the other hand, keep traction, lightly abduct, gradually rotate the upper arm outward, then inwardly make the elbow along the chest wall near the midline, and then inwardly rotate the upper arm, at which point it can be reset. And a ringing sound can be heard. (3) traction and pushing method: the casualty lying on his back, an assistant with a cloth sheet over the thorax to the healthy side of the pull, the second assistant with a cloth sheet through the axilla over the affected limb to pull outward above, the third assistant holding the affected limb wrist downward traction and external rotation and internal rotation, three sides at the same time Xu Xu continuous traction. The operator pushes the humeral head outward with the hand in the axilla to return it to reset. The second person can also do traction repositioning. After the reset, the shoulder is restored to the normal shape of blunt garden plump, axillary, sub rostral or sub clavicular and then the dislocated humeral head cannot be felt, the shoulder hitch test becomes negative, and the humeral head is in normal position on X-ray. If the humerus is combined with an avulsion fracture of the greater tuberosity, because there is mostly periosteum between the fracture fragment and the humeral stem, in most cases, the avulsed greater tuberosity fragment is also reset after the shoulder dislocation is reset. After resetting the anterior shoulder dislocation, the affected limb should be kept in the internal rotation position, with a cotton pad in the axilla, and then fixed in front of the chest with a tricot, bandage or cast. After the posterior dislocation is reset, it is fixed in the opposite position (i.e. abduction, external rotation and posterior extension and pulling). The indications are: anterior dislocation of shoulder joint with backward slippage of biceps long head tendon, which prevents the repositioning of the shoulder joint by manipulation; avulsion fracture of humeral tuberosity with the fracture fragment stuck between the humeral head and joint pelvis, which affects the repositioning; combined with fracture of surgical neck of humerus, which cannot be repaired by manipulation; combined with fracture of rostral eminence, acromion or shoulder joint pelvis, which is obviously displaced; combined with axillary large Vascular injury. 3.Treatment of old shoulder dislocation If the shoulder joint has not been repositioned for more than three weeks after dislocation, it is considered old dislocation. The joint cavity is filled with scar tissue, there are adhesions with the surrounding tissues, contracture of the surrounding muscles, formation of bone scabs or deformed healing in the case of combined fractures, all these pathological changes prevent the humeral head from being reset. Treatment of old shoulder dislocation: If the dislocation is within three months, the patient is young and strong, the dislocated joint still has a certain range of motion, and there is no osteoporosis and intra- or extra-articular ossification on the X-ray, a trial of manual repositioning can be performed. Before resetting, the affected ulnar hawkbone can be traction for 1 to 2 weeks; if the dislocation time is short and the joint activity is light, no traction can be made. The resetting should be performed under general anesthesia, followed by shoulder massage and gentle rocking activities to release the adhesions and relieve muscle spasm to facilitate resetting. The operation of resetting is done by traction and massage or foot stirrups, and the treatment after resetting is the same as that of fresh dislocation. It must be noted that the operation must not be rough to avoid fracture and axillary neurovascular injury. If the manual repositioning fails, or if the dislocation has exceeded three months, surgical repositioning can be considered for young and strong-aged casualties. If the joint surface of the humeral head is found to be severely damaged, then shoulder fusion or artificial joint replacement should be considered. After shoulder joint repositioning surgery, the activity function is often unsatisfactory. For elderly patients, surgical treatment is not advisable and patients are encouraged to strengthen shoulder activities. 4.Treatment of habitual anterior shoulder dislocation Habitual anterior shoulder dislocation is mostly seen in young adults. The reason for this is that it is generally believed that the injury was caused after the first traumatic dislocation, and although it was reset, it did not receive proper and effective fixation and rest. The joint becomes lax because the joint capsule is torn or avulsed and the cartilage glenoid lip and glenoid rim are not well repaired, and the posterior lateral humeral head depression fracture becomes equal to the pathological changes. Subsequently, dislocation may occur repeatedly under slight external forces or during certain movements, such as abduction and external rotation and posterior extension of the upper extremity. The diagnosis of habitual shoulder dislocation is relatively easy. During X-ray examination, in addition to taking anteroposterior plain films of the shoulder, anteroposterior X-rays of the upper arm in the 60-70° internal rotation position should be taken, which can clearly show the posterior humeral head defect. For habitual shoulder dislocation, if the dislocation is frequent, surgical treatment is recommended. The aim is to strengthen the anterior wall of the joint capsule, prevent excessive external rotation and abduction, and stabilize the joint to avoid further dislocation. There are many surgical methods, the more commonly used ones are the subscapularis joint capsule overlap suture (Putti-Platt’s method) and the subscapularis muscle stop outward displacement (Magnuson’s method), and care should be taken to check for any comorbidities. Poor healing may cause habitual dislocation. The long head of the biceps tendon may slip posteriorly, resulting in impaired joint repositioning. The axillary nerve or the medial bundle of the brachial plexus nerve can be compressed or pulled by the humeral head, causing nerve dysfunction, and the axillary artery can also be injured.