Persistent severe shoulder pain

Introduction Sustained severe shoulder pain, often caused by dislocation of the shoulder joint. There is a clear history of trauma.

Cause

Usually caused by trauma.

an examination

Traumatic anterior dislocation of the shoulder has a significant history of trauma, shoulder pain, swelling and dysfunction. The injured limb is elastically fixed in the mild abduction internal rotation, elbow flexion, and the affected side forearm is supported by the contralateral hand. The appearance is a "square shoulder" deformity, the shoulder peak is prominent, and the shoulder is empty. The humeral head can be touched under the armpits, under the condyles or under the collarbone. Mild abduction of the injured limb can not be close to the chest wall. If the elbow is attached to the chest, the palm cannot touch the opposite shoulder at the same time (Dugas sign, that is, the shoulder test is positive). The upper arm is placed on the outside of the upper arm to simultaneously contact the acromion and the external iliac crest (straight rule test). X-ray examination can determine the type of dislocation and determine the presence or absence of fracture.

X-ray signs are the normal parallel relationship between the two articular surfaces of the shoulder, shoulder and humeral heads that make up the shoulder joint. According to the degree and direction of separation of the humeral head, it is divided into the following types:

1. Shoulder joint subluxation: the joint gap is wide and narrow. The humeral head moves down, and half of the humeral heads are facing the shoulders.

2. Dislocation of the shoulder joint: the most common. Among them, dislocation under the condyle is especially common. The anterior slice shows that the humeral head overlaps the shoulder blade and the scapula neck, and is located 0.5 cm-1.0 cm below the condyle. The humeral head showed an external rotation and the humeral shaft was slightly abducted. Dislocation of the humeral head under the clavicle and dislocation of the underarm are less common.

3. Dislocation of the shoulder joint: rare. It is worth noting that the alignment of the humeral head and the scapula is still good, and the joint space exists, which is easily missed. Only in the lateral or sacral position can the humeral head be released backwards, behind the shoulder blade.

The shoulder test (Dugas) is positive. When the affected side is leaning against the chest, the palm cannot be placed on the opposite shoulder. Traumatic anterior dislocation of the shoulder has a significant history of trauma, shoulder pain, swelling and dysfunction. The injured limb is elastically fixed in the mild abduction internal rotation, elbow flexion, and the affected side forearm is supported by the contralateral hand. The appearance is a "square shoulder" deformity, the shoulder peak is prominent, and the shoulder is empty. The humeral head can be touched under the armpits, under the condyles or under the collarbone. Mild abduction of the injured limb can not be close to the chest wall. If the elbow is attached to the chest, the palm cannot touch the opposite shoulder at the same time (Dugas sign, that is, the shoulder test is positive). The upper arm is placed on the outside of the upper arm to simultaneously contact the acromion and the external iliac crest (straight rule test).

Differential diagnosis

Differential diagnosis of persistent severe shoulder pain:

Dislocation of the shoulder joint is divided into anterior dislocation and posterior dislocation according to the position of the humeral head. The anterior dislocation of the shoulder joint is common, often caused by indirect violence. For example, when the fall, the upper extremity abduction and external rotation, the palm or elbow touches the ground, and the external force impacts along the longitudinal axis of the humerus. The humeral head is from the subscapularis and the greater muscle. The weak part avoids the joint capsule and dislodges forward and downward to form a anterior dislocation. The humeral head is pushed under the scapula condyle and forms a dislocation under the condyle. If the violence is large, the humeral head moves forward again to the subclavian, forming a dislocation of the subclavian. Posterior dislocation is rare, mostly due to the anterior and posterior violent effects of the shoulder joint or the landing of the hand when the internal rotation of the shoulder joint falls. The posterior dislocation can be divided into the subscapular gangue and the subacromial dislocation. If the shoulder dislocation is improperly treated at the initial stage, habitual dislocation can occur.

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