Traumatic posterior shoulder joint dislocation

　　First, etiology

　　Both indirect violence and direct violence can cause posterior dislocation.

　　Second, pathogenesis

　　1. Direct violence: Refers to external force coming from the front of the joint capsule that directly acts on the humeral head, causing posterior dislocation. It is common in house collapses and often accompanied by fractures of the humeral neck. One of the authors encountered several cases during the Tangshan earthquake, which may be related to the fact that most local houses are built with wooden beams and flat roofs.

　　2. Indirect violence: When the shoulder joint is in an internal rotation position and the hand lands on the ground after falling, the humeral head may suddenly protrude posteriorly and break through the posterior wall of the joint capsule and dislocate.

　　Since this disease is caused by joint dislocation due to trauma, it is easy to be complicated with median nerve and brachial artery injuries in clinical practice. In cases with vascular injury, osteofascial compartment syndrome may occur. Active surgical treatment is needed to avoid local tissue necrosis caused by hematoma compression.

　　The clinical symptoms are not as obvious as those of anterior dislocation. The vast majority of posterior shoulder joint dislocations are subacromial dislocations, without obvious shoulder deformity and elastic fixation. The range of shoulder movement is also not as obvious as that of anterior dislocation. The anteroposterior view of X-ray is often missed and reported as normal. The key to preventing misdiagnosis is to consider the possibility of posterior dislocation when the shoulder is injured, and to be strict, serious, and meticulous during physical examination.

　　When the shoulder joint is posteriorly dislocated, the anterior shoulder flattens, the acromion is prominent and easy to touch; the acromion is more obvious than normal, the posterior shoulder is丰满, and the humeral head can be felt; the upper arm is in a neutral position or internal rotation, adduction position, the upper arm is externally rotated, and the shoulder pain is exacerbated.

　　This disease is caused by direct trauma to the palm, wrist, and elbow, such as falls, falls, or sudden braking while driving. Therefore, attention should be paid to living habits, high-risk workers such as construction workers, miners, and drivers are prone to injury, and protection should be paid attention to during the working process. Stay calm when dealing with things to avoid emotional excitement and conflict leading to the disease. In addition, early detection, early diagnosis, and early treatment are also of great significance for the prevention of the disease.

　　Before X-ray, the anteroposterior view shows the disappearance of the humeral neck, the anterior inclination of the scapula, the disappearance of the normal elliptical shadow of the head and socket overlap, and the asymmetry of the head socket in height. If it is still uncertain and there is a suspicion of posterior dislocation, the axillary position or the scapular tangent position can be added to confirm it. CT is helpful to determine the glenohumeral relationship.

　　1. What foods are good for the body in the case of traumatic shoulder joint posterior dislocation

　　It is advisable to increase nutrition, eat more protein-rich foods such as fish, eggs, soy products, and appropriately increase calcium. Drink more water, eat more vegetables and fruits such as green vegetables, celery, bananas, etc.

　　2. What foods should not be eaten for traumatic shoulder joint posterior dislocation

　　Avoid spicy foods: such as chili, mustard, etc. Smoking and drinking should be戒除.

　　1. Treatment

　　The reduction of fresh shoulder joint posterior dislocation is relatively easy. Under the anesthetic painless condition, the injured person adopts a sitting position or supine position, the assistant uses one hand to grasp the scapula as a fixed point, and the other hand uses the thumb to push the humeral head downward; the operator holds the wrist of the injured limb with both hands, slightly flexes the humeral axis along the axis of the humerus, and externally rotates the upper arm to reduce the dislocation, makes small movements in all directions after reducing the dislocation, keeps the upper arm in a lateral abduction position, that is, 30°-35° lateral abduction, 30° extension and slight external rotation position, fixed for 3 weeks with an abduction brace, and strengthens the exercise of shoulder joint functional activities.

　　Older shoulder joint posterior dislocation is generally treated with open reduction. The surgical incision starts from the acromion, extends backward along the lower edge of the acromion and scapular spine for 10-12 cm, exposing the deltoid muscle, and cutting the insertion point of the deltoid muscle along the acromion, then cutting the combined tendons of the supraspinatus, infraspinatus, and teres minor 2 cm from the plane of insertion, exposing the humeral head dislocation, and under the operation of traction and external rotation of the upper arm, sending the humeral head back into the joint cavity to match the acetabulum, and checking the reduction after activity. Suture the combined tendons and deltoid muscles, and suture the skin. Starting from 3 weeks after the operation, joint function exercises are begun.

　　2. Prognosis

　　The general prognosis is good. Patients who are not fixed or fixed for less than 2 weeks after reduction are prone to recurrent dislocation. In cases with local fractures and rotator cuff injuries, some patients may have residual symptoms such as pain and limited activity. The efficacy of elderly and advanced cases is also greatly affected.