Dislocation is also called joint dislocation. The articular surfaces of the joint bones lose their normal alignment due to external forces or other reasons. Traumatic dislocation is caused by trauma; pathological dislocation is caused by joint disease; complete dislocation is caused by the complete loss of joint relationship between the joint surfaces after dislocation; subluxation is caused by partial loss. Traumatic dislocation is common and occurs mostly in young adults. The joint most prone to dislocation is the elbow joint, followed by the shoulder and hip joints. Local joint pain, swelling, mobility impairment and deformity after injury can often be diagnosed based on this. In order to determine the direction and extent of dislocation and whether it is associated with fractures, X-ray examination is necessary. Dislocated patients should undergo manual reduction in a timely manner, the sooner the better. After reduction, the joint should be fixed in a stable position for 2 to 4 weeks; after the fixation is released, active functional exercises should be performed to restore joint function. If manual reduction fails, surgical open reduction should be performed. Recurrent or commonly known as habitual shoulder dislocation is mainly divided into two categories: one is that the shoulder joint can be dislocated by oneself, and then returned to the normal position, that is, Patients can "perform" their own shoulder joints to move in and out freely; the second type is the most common, mainly due to trauma, that is, the sequelae of shoulder joint dislocation caused by external force. The first type of patients with habitual shoulder joint dislocation, There is no history of obvious trauma, and many joints on the body may be overextended and loose. For example, the thumb can easily bend back and touch the forearm; the main reason for excessive extension of the elbow or knee joint is congenital. Joint instability caused by loose tissue in the body is multi-directional. As for the second category, habitual dislocations caused by injuries are mostly due to obvious trauma, such as sports injuries, such as excessive throwing movements. Force, or sudden resistance during throwing, physical contact martial arts sports such as judo and wrestling; and unexpected movements such as supporting the ground with hands when falling, or landing on the shoulder, resulting in shoulder joint dislocation, almost always in the forward direction. Dislocation, reoccurrence of dislocation or subluxation after conservative treatment (joint reduction). The clinical manifestations of the first dislocation of the shoulder joint due to injury are very profound. The reason is nothing more than severe pain and feeling that the shoulder is prolapsed. And then it becomes stuck and unable to move. Most people need to use external force (Western medicine or traditional Chinese medicine) to "reset" the shoulder joint, and a small number of people can "pull" it back with the help of themselves or their companions. After a lot of trouble, the "shoulder that fell off came back". After several weeks of recuperation, the shoulder returned to normal function. But one day, when the patient was doing sports or work while doing movements such as lifting, external rotation and abduction of the shoulder, which was simply an action similar to throwing, the shoulder joint fell out again, causing it to get stuck and cause severe pain. If you "turn" it back by yourself, this is a recurrent dislocation; it may also be that you feel a "click", the shoulder is twisted and suddenly loses control, but you can turn it back by yourself, this is a recurrent subluxation. The chance of recurrence of dislocation is closely related to the age when the dislocation first occurred. According to statistics, if the first shoulder joint dislocation occurs due to trauma, if it occurs in a young person under 20 years old, the probability of recurrence of dislocation in the future is 60 to 95%; if it occurs in a person of 20 to 30 years old, the probability of recurrence is 40% to 70; if it occurs between the ages of 30 and 40, the probability of recurrence is 10 to 40%; if it occurs in young people who like sports, the probability of recurrence can be as high as 80%. If there is one, there are two, and if there are two, there are three... Once recurrent dislocation begins to occur, it will restrict the normal activities and movements of many shoulder joints. Not only will it be impossible to engage in many sports and work, no matter how careful and careful you are, , dislocation or subluxation often occurs inadvertently during activities of daily living, such as pulling heavy objects, putting on and taking off clothes, turning over while sleeping, etc. The more dislocations occur, the easier it will be for the shoulder joint to dislocate, and the better you will be at "self-reduction". Of course, the range of motion of the joint will be more restricted. Pathology The problem lies in the first injury. The important structure that maintains stability in the shoulder joint (the labral ligament) is torn from the edge of the glenoid due to joint dislocation and is separated from the bone. Although the joint was restored, the injured area did not heal, forming a permanent gap and unable to maintain the stability of the shoulder joint.

Dislocations of the shoulder joint above 90% all occur from the front, so the labral ligament stripping point is also located in the front and lower part of the glenoid; redislocations all occur during shoulder abduction and external rotation. In addition, as the number of dislocations increases, the joint capsule in front will be "stretched" and become looser, making dislocation more likely to occur. Once a dislocation occurs, the joint is injured, which will not only cause the articular cartilage to wear or peel off, but also cause the articular cartilage to wear out or peel off. It can even cause tearing of the superior labral ligament. Most patients don't care about the instability of the shoulder joint, thinking that it can be reduced by paying more attention to certain bad postures or avoiding certain activities. The chance of dislocation; some people also think that it will not have much impact after a long time of dislocation; some people think that they will be able to reset themselves more and more. Has the condition been alleviated? Recently, more and more research reports and our own experience show that long-term shoulder joint instability and accumulation of multiple dislocations or subluxations will cause the wear and tear of articular cartilage, and there is a high chance of shoulder joint damage. inflammation. Treatment: For the treatment of congenital habitual dislocation, since there are no obvious lesions and the problem lies in the loose tissue structure, in principle, conservative (non-surgical) rehabilitation treatment is mainly used to train the muscles around the shoulder joint to strengthen muscle strength. to help stabilize joints. The effectiveness is about 80%. Unless it is a last resort, the joint capsule is surgically tightened to reduce the range of joint movement to maintain stability. As for the treatment of traumatic shoulder dislocation, it can be divided into two aspects: in the acute phase, that is, when the first dislocation occurs, conservative joint reduction was used in the past and "wait and see" after surgery, but for young people And the high recurrence rate (80-95) of sports-loving patients also makes us start to think about better treatment methods to reduce the poor prognosis of "knowingly, it is bound to happen". In recent years, due to the development of arthroscopic surgery, minimally invasive surgical techniques have been used to repair the first dislocation of the shoulder joint in a timely manner for young people, athletes, sports-loving patients, or soldiers and policemen with special professions. The labral ligament of the shoulder is stripped to reduce the chance of future recurrence and the trouble caused by it, as well as the complexity of treatment after recurrence. The results of arthroscopic surgery can reduce the chance of recurrence in these patients with high recurrence rates to less than 10-20. On the other hand, conservative rehabilitation treatment is not very effective for post-traumatic habitual dislocation, with a success rate of less than 20%. However, if these lesions are corrected surgically, the torn ligaments are sutured and the loose joint capsule is tightened. After the operation, a shoulder sling is used for protection for two to four weeks, and passive joint activities are started. Muscle training is started at eight weeks, and after twelve weeks Return to activities of daily living and return to sports in four to six months. According to our statistics, the success rate of surgery has reached 95% in the past 10 years. In recent years, we have begun to use arthroscopic surgery to treat, in addition to the patients with first shoulder dislocation in the acute stage mentioned above, we have also repaired some patients with habitual dislocations whose injuries are not too serious. The advantages of arthroscopic surgery are that the wound is small (three small holes), less painful after surgery, easier to recover, less likely to stiffen the joints, and easier to restore normal range of motion and function. Short-term treatment results are similar to those of open surgery. It is recommended not to underestimate the importance of habitual shoulder dislocation. The diagnosis must be confirmed first (medical history inquiry, physical examination and magnetic resonance imaging) before deciding on the direction of treatment. Habitual dislocations not caused by injury are best treated with rehabilitation. Dislocations caused by injury are best treated surgically. Only by converting unstable joints into stable joints can you have the opportunity to enjoy unrestricted activities and reduce the chance of arthritis.