Dislocation of the clavicle - Causes, Symptoms and Treatment .MF .
dislocation of the clavicle - a fairly common injury.The percentage of the number of cases of dislocation of the clavicle is 5% of the total damage of this kind.It should strictly distinguish dislocated acromion (external) and sternal (internal) end.But first things first.
clavicle - a hollow bone steam S-shaped part of the upper extremity of the shoulder girdle.As the first bone in the body, which begins the process of ossification is still at the embryonic stage of human development and the only articulation of the upper extremity to the skeleton, it performs several important functions.In particular, the reference (to the collarbone by a series of muscles attached blade and limb), protective (collarbone covers the space between the neck and limbs, through which several vital anatomical structures) and transport (collarbone is the pulse of the conductor limbs to the spine).However, its main task is to ensure the free movement of the hands.This explains the structure of the bone: external, acromial en
Dislocation of the acromial end of the clavicle
Symptoms dislocated collarbone
Dislocated clavicle, usually occurs by indirect mechanical damage.It may be falling on the arm or shoulder, or as a blow to the upper body.However, in rare cases, may occur and samproizvolnye dislocation of the clavicle (those who are not preceded by a direct injury).
lion's share of these injuries account for external dislocation (acromial) end of the bone.By comparison, the internal dislocation (sternal) end of the clavicle is diagnosed much less frequently.And very rarely observed simultaneous dislocation of both ends.
Dislocation external (acromial) end of the clavicle
Exterior, acromial end of the clavicle is connected to the acromion process of the blade with two bundles.Depending on how damaged one of them or both, diagnosed a subluxation or complete dislocation of the clavicle, respectively.
main symptoms of dislocation of the outer end of the clavicle are pain in the joint area of the clavicle to the scapula and pain when trying to move my arm or shoulder.
is worth noting that last aspect often leads to the fact that, out of ignorance, patients are often confused with a dislocated collarbone dislocation of the shoulder joint.However, an injury to distinguish one from the other simply by knowing the following symptoms:
A) When the dislocation of the clavicle is marked swelling and deformation caused by the protrusion of the outer end of the bone (he stands up and slightly back).In the case of dislocation of the shoulder joint swelling occurs rarely.
B) dislocation of the shoulder joint is accompanied by the feeling that the arm is not in place, and any attempt to move a limb accompanied by a sharp twinge.If there was a dislocation of the clavicle, the pain is moderately restrictive.
internal dislocation (sternal) end of the clavicle
Unlike external, internal dislocation, sternal end of the clavicle confused with anything else is difficult.This is due to the specifics of the joint bones to the chest.Depending on the nature of the injury front-distinguished, above and retrosternal types of dislocations.For all of them are characterized by pain in the area where the collar bone connects to the sternum, pain during deep breathing, deformity and swelling of soft tissues, as well as a significant shortening of the shoulder girdle with a damaged hand.If sprained bone touches vessels, which often occurs when retrosternal dislocation, apparently will mark the specific symptoms (eg, change of skin color).
Thus there are symptoms that are characteristic for each individual type of dislocation.So, first, perednegrudinny type of dislocation is the most common and easily determined by the protrusion of the inner end of the clavicle forward.In the case of the suprasternal dislocated collarbone protrudes forward and upward.For the third type of dislocation, according to its title, there is a retraction of the inner end of the clavicle.Zagrudny dislocation of the inner end of the clavicle is considered to be the most dangerous, because in this case there is a serious risk of damage to important anatomical structures.
Note: for all variants dislocated collarbone characteristic symptom is that when you click on the protruding end of the clavicle, it is easy to reduce a into place, but when the pressure ceases, comes back.This phenomenon is called the "key effect."It allows you to not confuse the dislocation of the clavicle fracture with her.
avoid confusion also helped by the fact that in the case of a fracture besides swelling and deformation occur limiting the mobility of the shoulder, bruising and soft tissue tear splinters of broken bones.Further displacement at fracture, as opposed to dislocation usually occurs forwardly and downwardly.However, to avoid the presence of bone fractures, should do X-rays.
Warning: people suffering from obesity, the outward signs of a dislocation of the clavicle may be less noticeable.
First aid for dislocation of the clavicle
If there is a suspicion of a dislocated collarbone, urgently need to neatly hang and fix the limb by applying bandages (for this fit like a bandage, and scarf).In the axilla should put a cotton-gauze roll or rolled up into it a piece of cloth.
reduce swelling can be attached to the place of cold injury.
should be monitored carefully when transporting the victim to the emergency room for the fact that he was comfortable.Before the arrival of a medical facility is not recommended to take potent pain medications (which can interfere with the decision of a proper diagnosis).Exceptions are cases when a person has a low pain threshold.
Attention: before the introduction of a strong analgesic effect of the drug should consult a doctor.
As for the bans, then the first aid is not necessary to try to reduce a dislocation of their own, as in other cases, even medical equipment dislocation correction can not guarantee a 100% result.Moreover, the clavicle is located on a number of important structures of the body.Therefore, self can be extremely dangerous to your health.
Diagnostics dislocated collarbone
diagnose a dislocated collarbone possible by their appearance (characteristic bulging external or internal end of the bone, pain, soft-tissue swelling).However, in addition to external examination, the doctor is obliged to carry out palpation of the injured site and make a radiographic image.
In the case of dislocation of the outer end of the collarbone X-ray diagnosis much easier, as it allows to consider the position of the outer ridge of the blade with respect to the lower edge of the clavicle: the dislocation they are arranged at an angle to each other.If they are at the same level, the outer end of the deformation is not caused by a dislocation, and pathology of the clavicle.
the diagnosis of the inner end of the clavicle is mandatory x-ray film.With the help of a comparison both internal joints collarbone to the rib cage, and so there is determination of the presence of dislocation (the projection of the displaced end noted above normal, and its shadow covers the shadow of the vertebrae).
In some cases, the doctor may also prescribe a CT scan of the damaged area.
Treatment of dislocation of the clavicle
Therapy dislocation of the clavicle is held as a conservative methods, and by means of surgical intervention.Specifics of the procedure is that straighten the protruding end of the clavicle - not a difficult task.It is much more difficult to capture and hold it in the correct position.
Treatment of dislocation of the outer end of the clavicle is performed using invasive and non-invasive techniques.In most cases, one embodiment of a method of conservative therapy is sufficient.But if at the end of treatment no result, or else it is not satisfactory, the doctor may suggest surgery.
most common form of non-invasive treatment of dislocation of the outer end of the clavicle bandage is Volkovich.Prior to its application the damaged area anesthetize dose (20-30 ml) solution of procaine 1% and reduce a collarbone.Then, in the armpit embedded cotton-gauze roll, and acromioclavicular joint is applied cotton-gauze Pelota, which is fixed plaster in the following sequence:
1) towards the rear and downwards from the outer ridge of the blade to the shoulder girdle;
2) on the back of the shoulder to the elbow;
3) The girth of the elbow;
4) on the front of the shoulder blades to the acromion process.
As an analogue to the first embodiment can be applied bandage desault.Prior to its application to the armpit and put cotton-gauze roll.The dressing is applied as follows:
1) Double-wrap the chest with a bandage on the arm by an injured collarbone and under the arm - from the healthy limbs;
2) flipped the bandage diagonally across his chest, following through the armpit from the undamaged hand to the shoulder girdle from damage;
3) Lower the bandage on the back of the shoulder to the elbow;
4) round the elbow and forearm bandage to hold the limb with an injured hand to the armpit healthy;
5) flipped the bandage diagonally back, following through the armpit from the undamaged hand to the shoulder girdle from damage;
6) round the shoulder girdle to hold the bandage on the front of the shoulder from injury, to have the elbow, forearm skirting.
7) Repeat steps 4 - 6 to complete immobilization of the damaged shoulder girdle.
bandage desault with dislocation of the clavicle
recommended to apply to the damaged area cold (this helps eliminate swelling and pain to stop) the treatment of dislocation of the outer end of the clavicle with the help of flexible (soft) dressings on the first day of therapy.In that case, if the pain does not go away, you should take a painkiller.
Remember: self-injurious to health, so taking an analgesic and its type should be discussed with your doctor.
Despite the possibility of using flexible dressings, the best way to fix the clavicle without surgery is considered to be a plaster bandage.As a rule, for its overlay technique used bandages desault.
type and duration of wearing a particular type of bandage is determined exclusively by specialized personnel.On average, you need to wear a bandage from a month to two.A stay at the hospital during this period is not required.
Surgery at the dislocation of the clavicle
Surgery in the treatment of dislocation of the outer end of the clavicle is assigned only if conservative therapies have failed.
Today there are many options for invasive therapy external dislocation.This may be by means of fixing clavicle metal wires, screws, or "buttons", etc.
clavicle fixation with metal spokes - this is the most budget option for the surgical treatment of dislocation.But it is ineffective (bundle / bundles that connect the outer end of the clavicle to the scapula acromion process and are not restored).Moreover, after the cases are frequent relapse.
clavicle fixation using screws gives a more secure hold and significantly reduces the risk of relapse.However, as good fixation often entails restriction of mobility and a reduction of the clavicle, which directly affects the functionality of the limbs, the shoulder girdle which was damaged.
Technique clavicle fixation using buttons is a kind of synthesis of the first and second type of fixations.It is considered quite safe in terms of the forecasts for the postoperative state and restore trudosoposobnosti limbs.But Inserting buttons leaves a trail.And cases where this embodiment and the outer end invasive therapy dislocation causes frequent relapses, is also not rare.
Thus, the most effective and safest way is considered plastic ligaments.During the operation of synthetic surgical materials to create artificial bundle / bunch and replace it / them injured structure.
After any kind of intervention the shoulder girdle is fixed plaster cast, which must be worn 1.5 - 2 months.
Remember: every kind of invasive therapy has its indications, disadvantages and risks.In view of what is important to find out all the details of this type of therapy by a doctor, who appoints the surgery.
Therapy dislocation of the inner end of the clavicle is almost does not provide conservative therapies.Of course, it is possible to consider a method of closed reduction.It is performed in the following order:
1) analgesic dose of novocaine damaged area;
2) Relax the muscles of special preparation (muscle relaxant);
3) The patient is placed on the table by placing a shoulder cotton-gauze roll;
4) Produce tension arms with simultaneous pressure on the collarbone;
5) Raise the patient on the table and fix the collarbone vosmiobraznoy bandage.
But such a method of treatment of internal dislocation resorted seldom as, in most cases, when lifting from the table, the collarbone again coming out of its normal position.Thus, the best result is achieved exclusively by means of invasive therapy damage.
As a rule, before the operation the doctor holds a closed reduction of dislocation, and in the course of the intervention of the clavicle to the sternum is attached mechanically by means of needles, rods, plates or U-shaped transossalnyh seams.Material and type of fastening depends on the type of dislocation and appointed doctor.Alternatively, by analogy with the external dislocation surgery, the ligaments can be plastic.
After surgery, the damaged area is applied diverting bus or cast for a period of 3 - 4 weeks.A full disabled limbs restored for 1.5 - 2 months.
By re-diagnosis of the end of treatment as a dislocation of the outer and the inner end of the clavicle is held (including X-rays and, if necessary, tomography) and assigned rehabilitation.
Full disabled limbs restored for 1.5 - 2 months with both conservative and the surgical method of treatment of dislocation.
Important: remember that many of the indicators depends on the characteristics of each individual organism (pain threshold, the ability to regenerate, allergic factor, etc.).Therefore, in the course of consultations with a specialist is necessary to clarify his views (complete / incomplete), type (front / top / rear), the preferred methods of treatment and methods of anesthesia, the timing of treatment for dislocation of the clavicle (as acromion and sternal), possible complications, waysrehabilitation and return terms of efficiency.
Rehabilitation after dislocation of the clavicle
Rehabilitation dislocation of the clavicle is a complex reducing procedures, which includes a number of specialized physical exercise, aimed at restoring the normal functioning of the shoulder girdle and the return limb mobility, therapeutic massage, manual therapy and UHF.He appointed an expert with regard to the type and the type of dislocation, its methods of treatment and individual patient characteristics.
Treatment of dislocation of the clavicle can not be postponed, because after 3 - 4 weeks after the trauma dislocation is considered stale.If dislocation was incomplete, that the passage of time, he practically does not disturb the patient.But running a full dislocation in the future accompanied by pain in the area of damage, weakening and decline in limb function.
Keep in mind that chronic dislocation of the clavicle are not subject to conservative therapy treatments.Their reduction is carried out exclusively by surgical intervention, and the forecasts for the success of the operation and its results fall significantly even if the use of the most expensive and innovative therapies.
Ed.doctor traumatologist Savchenko VR