Shoulder joint subluxation

　　Patients with habitual shoulder joint dislocation of the first type do not have a history of obvious trauma, and multiple joints on the body may also have excessive extension and relaxation. For example, the thumb can be easily bent backward and touch the forearm; the elbow joint or knee joint is excessively extended, and the main reason is that the body tissue is congenitally loose, causing joint instability, and it is multidirectional.

　　The second type, due to the habitual dislocation caused by injury, is often due to obvious trauma, such as sports injuries, such as excessive force during throwing, or sudden resistance during the throwing process, judo, wrestling, and other contact fighting sports; or falling with hands supporting the ground, or shoulders landing unexpectedly, causing shoulder joint dislocation. Most of the dislocations are anterior, and after conservative treatment (joint reduction), there is a recurrence of dislocation or subluxation. In the early stage of stroke, due to the low muscle tone of the affected limb, especially the relaxation of the fixed muscles around the shoulder joint (mainly the posterior fibers of the deltoid muscle, the supraspinatus muscle, the infraspinatus muscle, etc.), the fixing effect is lost; the humeral head is only 1/3 in the glenoid cavity, and is fixed by the soft tissues around the joint (fixed muscles), thereby ensuring the shoulder joint has the maximum range of motion. Therefore, the shoulder joint is a highly unstable joint structure. In the early stage of stroke, if attention is not paid, it is easy to occur subluxation; in the case of muscle relaxation, medical staff or family members drag the affected upper limb without protection; the gravitational force of the affected limb.

　　The complications of shoulder joint subluxation include:

　　The detachment of the long head of the biceps brachii often hinders the reduction of dislocation.

　　2. In the case of anterior dislocation of the great trochanteric fracture, about 30% to 40% are complicated with avulsion fractures of the greater结节.

　　3. Rotator cuff injury, such as a tear of the supraspinatus tendon.

　　4. Vascular and nerve injuries are prone to pull and damage the axillary nerve, resulting in deltoid paralysis and loss of skin sensation in the anterior and posterior sides of the shoulder. Vascular injuries are rare and can damage the brachial artery.

　　5. The pain and swelling of the fracture of the surgical neck of the humerus are more serious, and it is different from the simple shoulder joint subluxation that the upper arm has no fixed abduction deformity and has a certain degree of mobility.

　　The symptoms of shoulder joint subluxation include sinking of the shoulder girdle with decreased tension of the upward pull muscle of the scapula, loss of voluntary movement, and downward tilt of the glenoid. The scapula is close to the spine, but the scapular inferior angle is obviously retracted and lower than the other side. The inner margin of the scapula is pulled away from the chest and arm to form a 'wingshaped scapula'. There is significant resistance during passive correction. The posterior part of the supraspinatus, deltoid, and infraspinatus muscles are obviously atrophied.

　　Anatomy of the shoulder joint, the subscapular muscle, supraspinatus muscle, infraspinatus muscle, and teres minor muscle pass through the front, bottom, and back of the shoulder joint respectively, adhere closely to the joint capsule, forming a tendon sheath. The contraction of these muscles can maintain contact between the humeral head and the glenoid articular surface of the scapula. The function of the supraspinatus muscle is particularly important in preventing subluxation. Early prevention is very difficult for the recovery of shoulder joint subluxation, so early prevention and protection are very necessary. Firstly, the good posture of the body should be arranged, and when lying on the back, the patient's shoulder should be elevated to prevent the shoulder from retracting. When lying on the side, the scapula of the patient should be extended forward. When the patient is in a sitting position, the affected upper limb should be placed on the table in front of the patient or the support platform of the wheelchair. When taking a sitting position, the Bobath support posture should be adopted. During the process of treatment and care, attention should be paid to protect the shoulder joint, prevent surrounding soft tissue injury and destruction, and extend relaxation. The upper limb should be in an antispastic position; more side turning to the affected side should be done; when sitting up, the affected upper limb should bear the weight in an antispastic mode and extend the upper limb forward, extend the elbow, adduct the hand, cross the fingers, and place them on a table at an appropriate height.

　　Shoulder joint subluxation examination methods

　　① Palpation method: The patient takes a sitting position, with both upper limbs naturally hanging down on the sides. The examiner palpates the distance between the acromial prominence and the humeral head of the affected side, and expresses the degree of dislocation with the transverse finger width that can be accommodated between them. The gap between the acromion and the humeral head can accommodate 1/2 finger width as the diagnostic standard for shoulder joint subluxation.

　　② Anthropometric method: Measure the distance between the acromial prominence and the outer epicondyle of the humerus with a caliper with a scale.

　　③ Radiographic method: The patient takes a sitting position, with both upper limbs naturally hanging down on the sides, and a 45-degree angle oblique projection angle is used to take X-ray films of both shoulder joints. Measure the vertical distance between the horizontal extension line of the humeral head center and the horizontal extension line of the glenoid center, or the distance between the acromion and the humeral head gap is more than 14mm, or the difference between the two sides is greater than 10mm.

　　1. Avoid eating spicy and刺激性 and warm and dry foods, such as chili, curry, lamb, and so on.

　　2. Avoid foods that are too cold, such as cold drinks and raw pears.

　　3. Avoid acidic foods such as plum tea and white vinegar, as acidity is not conducive to the dispersion of blood stasis.

　　4. Avoid excessive consumption of sugar, as excessive sugar metabolism can easily cause acidosis in the body, excessively consume calcium, magnesium, sodium, and other ions, which is not conducive to the repair of shoulder joint dislocation. In addition, the metabolism of sugar consumes a large amount of vitamin B1, which then affects the recovery of nerve and muscle function.

　　5. Avoid greasy and difficult-to-digest foods such as fried foods, sweet potatoes, glutinous rice, etc.

　　6. Avoid stimulants such as coffee, strong tea, and strong alcohol.

　　7. Avoid insufficient water intake, as insufficient water intake can easily lead to constipation, urinary retention, urinary tract infection, and other conditions.

　　Conventional methods of Western medicine for the treatment of shoulder joint subluxation

　　1. By correcting the position of the scapula, the position of the glenoid is corrected, thereby restoring the natural绞索mechanism of the shoulder.

　　2. Stimulate the activity of muscles around the shoulder joint that play a stabilizing role or increase their tension. Use techniques such as hand massage, ice packs, and quickly massage the relevant muscles; use techniques such as joint reaction, functional electrical stimulation, and electromyographic biofeedback, etc.

　　3. Maintain a painless passive range of motion without damaging the shoulder joint and surrounding tissues.

　　Specific methods;

　　4. Avoid forceful dragging of the patient's affected upper limb during the acute stage;

　　5. One hand fixes the proximal end of the humerus, and the other hand fixes the inferior angle of the scapula, passively completes the movement of the scapulothoracic joint in all directions.

　　6. In the supine position, the upper limb is pronated and extended, and the upper limb and scapula are supported by a thin pillow to protrude the shoulder joint forward; the therapist holds the affected upper limb to maintain the elbow extended position and the shoulder joint externally rotated position, and then performs the movement of the scapula forward, upward, and downward.

　　7. Triangle bandage method: At the Brunnstrom I level, whether there is subluxation or not, a triangle bandage is used. At the Brunnstrom II to III levels, the muscle tone around the shoulder joint is sufficient, considering that subluxation will not worsen progressively, but if there is a concern that the use of a triangle bandage may worsen contracture, it may not be used. Otherwise, a triangle bandage is used if there is subluxation. At the Brunnstrom IV to VI levels, a triangle bandage is generally not used.