What Is Involved in Dislocated Shoulder Surgery?

Dislocation of the shoulder joint is the most common, accounting for about 50% of systemic joint dislocations. This is related to the anatomical and physiological characteristics of the shoulder joint, such as large humeral head, shallow and small glenoid, loose joint capsule, weak anterior and inferior tissue, and range of joint motion. Large, many opportunities to suffer external forces. Dislocation of the shoulder joint occurs mostly in young adults and males.

Dislocation of shoulder dislocation

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Dislocation of the shoulder joint is the most common, accounting for about 50% of systemic joint dislocations. This is related to the anatomical and physiological characteristics of the shoulder joint, such as large humeral head, shallow and small glenoid, loose joint capsule, weak anterior and inferior tissue, and range of joint motion. Large, many opportunities to suffer external forces. Dislocation of the shoulder joint occurs mostly in young adults and males.

Chinese name

Dislocation of shoulder dislocation

Department

Shoulder joint

People group

Young adults and more men

the reason

The glenoid is shallow and small, and the joint capsule is loose

The shoulder joint is the joint with the widest range of motion and the most unstable structure in large joints throughout the body. It is easy to cause dislocation during trauma. The shoulder joint is second in the incidence of systemic joint dislocations. It can be divided into anterior dislocation. In contrast to posterior dislocations, an anterior dislocation is common.

Dislocation of shoulder dislocation

Shoulder joint dislocation with humeral neck, stem fracture, or glenoid fracture block embedded in the joint, or biceps long head embedded between the joints, or combined with blood vessel, nerve injury, open reduction should be performed. For old dislocations in children and young people, incision and reduction should also be performed. For old dislocations in middle age and above, if joint cartilage degeneration already exists, joint fusion should be selected at the same time as incision and reduction according to occupation and age. Or artificial joint replacement. On the other hand, old dislocations of middle age and above, if asymptomatic, and have a certain degree of activity, can be performed without any surgery.

1. When sterilizing the body, the patient takes the lateral position with the injured shoulders facing upwards. After disinfection and sterilization, the patient is placed on the supine position with the injured shoulders raised 30 °.

2. Incision and exposure According to the anterior medial approach of the shoulder joint (see the anterior medial approach of the shoulder joint), after cutting the skin and subcutaneous tissue, separate the deltoid muscle and pectoralis major muscle space, and cut off the triangle at 0.5cm below the clavicle and below the acromion. Muscles, valgus muscle flaps, pull open the pectoralis major muscles, you can reveal the humeral head wrapped in a layer of fibrous tissue, the fingers can touch the humeral head and its activities when gently turning the upper limbs. Part of the pectoralis major muscle attachment was cut off, and the tendons of the short head of the coracus brachii and biceps were cut off 0.5 cm below the coracoid process, and turned downward. When cutting off, care should be taken not to damage the axillary arteries, veins and brachial plexus nerves passing under the coracoid process. Then, clear the small humerus nodules and rotate the humerus externally to find the attachment of the subscapularis muscle and cut it to reveal the front of the shoulder joint.

3. If the shoulder glenoid is freshly dislocated, the fractures of the joint capsule are mostly in front of and below the shoulder glenoid. Cutting the switch capsule along the fracture can clear the blood clots and bone fragments. If it is old dislocation, trace back to the joint capsule along the long head of the biceps, cut the switch capsule on the inside of the shoulder glenoid, remove the scar tissue in the joint, and check the cartilage and labrum damage, modify the surgical design . When removing scar tissue, try to keep the joint capsule.

4. Loosen the humeral head and clear the humeral head. Then close the humeral head and cut the adhesion. Remove the fibrous tissue covering the humeral head and the scar tissue that affects the reduction of the humeral head. Gently rotate the humerus repeatedly to fully release the upper end of the humerus. Fractures of the greater humerus tuberosity are often located on the outside of the humeral head, or stuck near the scapula. They can be pried with a periosteal peeler, clamped with towel forceps, and turned outward with the external rotation muscle attached to it.

5. After the scar tissue is removed and fixed, the long head tendon of the biceps brachii is pulled apart. Pull the arm and make abduction, adduction and internal rotation, while pushing the humerus head towards the scapula by hand to reset it. After the reduction, the shoulder joint should be gently moved in all directions until it reaches the normal range, and at the same time, observe whether the reset humerus head is prone to prolapse.

If the large humeral nodule has a large fracture block, it can be fixed with a screw after reduction. Conversely, if the fracture block is small, fixing with the screw may cause splitting, you can use a Kirschner wire to fix it, or use a silk suture around the fracture block. The soft tissue is fixed.

If the humeral head is prone to dislocation when the shoulder joint is passively moved after reduction, internal fixation should be performed. At this time, an assistant could maintain the abduction of the injured shoulder at 45 ° and forward flexion of 20 °. The surgeon used two Kirschner wires to fix the acromion and large humerus nodules. The stump was bent into a hook shape, which remained under the skin, and was pulled out 2 weeks after the operation.

6. The sutured joint capsule should be sutured as much as possible, and the severed scapular tendon should be sutured again to strengthen the anterior wall and prevent recurrence. Then close the brachio brachii and biceps brachii, deltoid muscle and skin.

1. Old joint dislocation due to adhesions and scar tissue formation, changes in anatomical relations, the level is unclear. Removal of scars may damage blood vessels and nerves. Therefore, when cutting the coracoid brachialis muscle, it should be within 1cm below the coracoid process; when peeling off the joint to make up the bone, it should be pressed against the bone surface.

2. After the dislocation of the joint, due to disuse, the joint bone has a certain degree of loose decalcification. Violence should not be used during intraoperative reduction to prevent pathological fractures.

3. When sutured, the joint capsule and subscapularis tendon should be repaired as much as possible to restore the original anatomical relationship to prevent recurrent shoulder dislocation.

4. Shoulder joint dislocation complicated with humerus surgical neck folding incision and reduction, the switch should be cut, resetting under direct vision is easier, and it is not easy to cause blood vessel and nerve damage.

1. Postoperative fixation with abduction brace, so that the injured shoulder is abducted 45 °, forward flexed 20 °, and external rotation 25 °.

2. When the patient is in a semi-recumbent position, the abduction brace should be put on while sleeping to prevent dislocation after rotation.

3. After 2 weeks, remove the suture and pull out the Kirschner wire. Continue to use the abduction bracket to fix, but the bandage can be removed during the day to exercise joint function; still use bandages at night. This lasts from February to March.