Treatment of several types of joint dislocations
I. Dislocation of shoulder joint
Structural characteristics: The humeral head is large, the joint pelvis is small and shallow, the joint capsule is loose, and there are no ligaments and muscles covering the front and bottom of the joint capsule, so it is a weak link, so it is easy to be dislocated forward by external force, and posterior dislocation is rare.
Treatment.
1, hanging method – patient sitting, the operator stands on the affected side, with the upper arm through the axilla of the affected side, holding the lower end of the forearm of the injured limb with his hand, so that the affected limb flexes the elbow (palm down), the other hand holds the distal end of the upper arm of the affected limb so that it is close to the chest side of the doctor, first gently swing the affected limb back and forth: the lower part of the assistant’s chest against the patient’s back, holding the patient’s two shoulders with both hands (no force for the time being). Then, the operator moves the arm through the patient’s armpit outward with force and squeezes the elbow of the injured limb with the thoracic side, while the hand holding the elbow pulls downward with force. A downward traction force is formed. At this point, the patient is bound to protect the pain and jump up, and the assistant presses down hard. When the sound is felt, the head of the humerus comes out, and the force hangs towards the scapular glenoid, which can be reset. (Subglottic dislocation is mostly rectified by this method)
2, pull method – patient supine position, the operator stands on the injured side, one foot standing steady, the other foot (right foot for right shoulder dislocation, left foot for left shoulder dislocation) into the axillary fossa of the injured side, with the heel of the stirrup its axillary part; both hands hold the wrist of the injured limb, the injured limb abducted about 45 degrees, along the longitudinal axis of the injured limb pulling hard; in this case, the injured limb gradually inward, while the heel of the force slightly outward stirrup axillary part, so that the humeral head into the joint. This method is often used when the humeral head is dislodged to the sub rostral or sub clavicular process.
If this method is not successful, the humeral head may be obstructed by the biceps tendon. In this case, the upper arm can be rotated outward so that the humeral head bypasses the biceps tendon and then repositioned as above. When the sliding sound of the reset is heard, it means the reset is successful. After successful reset, the “square shoulder” deformity disappears immediately; the injured side of the upper arm can be close to the chest, and the injured side of the hand can feel the opposite shoulder.
Shoulder lock joint dislocation
Structural characteristics: It consists of the articular surface of the acromion of the scapula and the acromion of the clavicle. The joint capsule is tense and is strengthened by the acromioclavicular ligament, rostral ligament, rostral shoulder ligament and transverse scapular ligament. The range of motion of the joint is small.
Treatment.
Rectification – The affected limb is flexed at 90 degrees at the elbow, and the operator holds the injured limb at the elbow with one hand and pushes upward; the other hand presses the distal clavicle to reset it. However, if you let go immediately and stop pressing and pushing, the dislocation will appear again, and you need to let go only after fixation.
Dislocation of sternoclavicular joint
Structural characteristics: The sternoclavicular joint is the only joint between the upper limb belt and the trunk bone. It is composed of the clavicular notch of the sternum and the inner end of the clavicle. There is an articular disc in the joint cavity. The joint is surrounded by sternoclavicular ligament, costoclavicular ligament and interclavicular ligament to strengthen the role of the joint capsule.
Treatment.
Reconstruction – It is relatively easy to reset within 5-7 days after the injury. In anterior dislocation, the moving and pressing methods are commonly used: the patient is seated, the assistant is located behind the patient, holding both shoulders with both hands and moving and pulling them backward and upward, while using one knee between the patient’s two scapulae and pushing forward. The operator pushes and presses the sternal end of the clavicle with his hands: if it is anterior superior dislocation, push and press downward; if it is anterior inferior dislocation, push and press backward superiorly. It is not difficult to reposition, but after releasing the hand, it is easy to dislocate again and must be fixed under pushing and pressing.
Elbow dislocation
Structural characteristics: Elbow joint is the general name of humeral bypass joint, humeral ulnar joint and ulnar bypass joint. These three joints are jointly enclosed in a joint capsule. The anterior and posterior walls of this capsule are thin and loose, and the sides are thickened to form the lateral collateral ligament and the ulnar collateral ligament, respectively. The flexion and extension of the elbow joint are performed by the ulnar and humeral bypass joints, and therefore dislocation mainly occurs in these two joints.
Treatment.
1. Elbow joint backward dislocation rectification method.
(1) One person rectification method – the operator’s left hand (right elbow dislocation as an example) holds the distal ulnar radius of the injured limb, and makes the injured limb in a rotated posterior position, and then pulls hard with the posture of the injured arm (according to the degree of overlapping force). At the same time, the second and third fingers of the operator’s right hand clasp the distal end of the eagle’s mouth and pull hard; in addition, use the thumb or “tiger’s mouth” to hold the anterior side of the lower end of the humerus and push hard to push backward and upward to reset. Then, squeeze the elbow joint with one hand and hold the forearm with the other hand to carry the method, that is, it is passively extended and flexed two or three times, if the extension and flexion are not obstructed, the fingers can feel the injured side of the shoulder, indicating that the reset is completely successful.
(2) Two-person method – the assistant stands on the dorsal side of the patient and uses both hands to hold the upper arm of the injured limb and the operator to pull it with reverse force.
In addition, for posterior external dislocation of the elbow joint, first correct the outward dislocation so that it becomes a posterior superior dislocation, and then rehabilitate it according to the posterior superior dislocation. When correcting an outward dislocation, three people are required to perform the procedure, with two assistants holding the upper arm and wrist, respectively, and pulling gently against each other in a homeopathic manner, while the operator’s hand is placed at the medial epicondyle and the other hand is at the proximal end of the radius on the outside of the elbow, pushing hard against each other. If the dislocation is simple outward, this method can also be used to rectify.
V. Pediatric radial head dislocation
Diagnosis of symptoms: typical history of trauma. Elbow pain, unable to flex the elbow and raise the arm. The injured elbow is kept in a straight position, with a slight prerotation deformity of the forearm and limited postrotation activity. Most of the injured elbow is not swollen, there is pressure pain on its lateral side, and the dislocated radial head can be felt in its anterior side.
Treatment.
The parents hold the child in a sitting position. The operator sits opposite the child, holds the injured elbow with one hand, and pinches the prolapsed radial head with the thumb; at the same time, holds the wrist of the injured limb with the other hand, first pulls, gradually transforms the forearm into a rotated posterior position, slightly inwardly tucks the injured elbow, and then flexes the elbow joint. At this time, the doctor’s hand can have the radial head reset feeling or can hear the reset sound, reset that is successful, the pain immediately disappeared, the child will be able to lift the upper limb.
Sixth, hip dislocation
Structural features: the hip joint is composed of a semicircular femoral head and acetabulum. The acetabular fossa is deep, the joint capsule is thick, and there are several strong ligaments and thick muscles outside to protect it, so the hip joint is the most stable joint in the human body, and its dislocation is less common than that of the shoulder and elbow.
Causes and classification: hip dislocation is mostly caused by indirect external forces, and is divided into posterior and anterior dislocations.
When the hip joint is flexed at 90°, the thighs are inward, and only half of the femoral head is in the acetabulum, while the other half is only protected by the posterior joint capsule and ligaments. At this time, if there is a strong external force to make the femur ram backward, the posterior part of the joint capsule may rupture, tearing the internal femoral artery and the circular ligament (there are blood vessels inside the ligament to nourish the femoral head), and the external rotation muscles of the hip joint, such as the internal muscles of the closed hole, the upper and lower I muscles, the external muscles of the closed hole, and the pear-shaped muscles, are also bruised or even partially torn, resulting in backward dislocation.
In addition, if a strong external force suddenly acts on the sacroiliac region when bending over, causing the pelvis to impact forward, it may also cause backward dislocation, sometimes even combined with sciatic nerve strain injury and acetabular edge fracture.
When the hip and knee are flexed and the thigh is excessively abducted or externally rotated, a strong external force acts on the distal femur and is transmitted to the hip along its longitudinal axis, and the femoral head can break through and dislocate in front of the joint capsule. If the femoral head is dislodged to the closed hole, it is called closed hole dislocation. If the femoral head dislocates to the pubic bone, it is called pubic bone dislocation.
Sometimes, external impact on the hip with the thigh in abduction may also cause anterior dislocation of the hip joint.
Diagnosis.
In posterior dislocation, the injured limb cannot bear weight for walking and supination, and the affected limb is shortened and deformed significantly.
In anterior dislocation, there is significant swelling under the groin or perineum and a deformed appearance. The patients all had a typical history of injury. Localized pain.
On palpation, local tenderness is present. In anterior dislocation, the greater trochanter may be palpated to the medial or inferior aspect of the acetabulum, while the lateral aspect of the hip flattens. In the pubic type of anterior dislocation, the femoral head can be felt under the groin. In the sciatic type, the femoral head can be palpated at the perineum.
Treatment.
1. Use the “?” type method: (take left hip posterior dislocation as an example) – the patient lies on his back on a wooden board and fixes the pelvis on the board with a wide cloth belt (or an assistant presses the iliac crest on both sides); the operator holds the lower end of the calf of the injured limb with his left hand and the posterior side of the upper end of the injured limb with his right hand.
(1) The hip and knee joints of the injured limb are flexed to 90°, and the thighs are internally rotated.
(2) Traction along the longitudinal axis of the thigh of the injured limb while forcefully flexing the hip and knee joints.
(3) change the position of the right hand to hold the injured limb on the medial side of the knee joint, so that the thigh is abducted and externally rotated.
(4) Gradually straighten the entire injured limb. When you hear the “kata” sound of the femoral head sliding into the acetabulum, the reset is successful.
2.Pulling and hanging method: The patient is sitting with knee flexed at 90°, the pelvis is fixed with a wide cloth belt, and the assistant holds the patient’s waist. The operator sits opposite to the patient, crosses his feet and clamps the lower part of the lower leg of the patient; at the same time, holds the N fossa with both hands and pulls it forward, gradually pulling the thigh to the outer booth in the case of posterior dislocation, and gradually pulling the thigh to the inner position in the case of anterior dislocation; when feeling the sound of bone sliding, immediately rotate the thigh to make the femur rotate inwardly or outwardly, and immediately release the force to make the femoral head back into the acetabulum. If the deformity disappears immediately and various passive activities of the hip joint can be performed, it indicates that the rehabilitation is successful. This method is easy to work for patients who are not full of muscles.
3.Pulling and pushing method: (for anterior hip dislocation) Patients in sitting position, use cloth belt to fix the patient’s waist, abdomen and pelvis to the chair (when lying down, fix on the bed). The assistant hand holds the knee of the injured leg and pulls along the direction of thigh abduction. The medical practitioner pushes the femoral head from inward to outward with overlapping hands to bring it back to its socket; at the same time, the assistant slightly inducts the thigh and applies a rotational rocking. When a repositioning sound is heard, it means that the correction is successful. Patients with less developed muscles are more likely to succeed.