(1) Hippocratic method: The patient lies on his back with the operator on the affected side. He held the wrist of the affected limb with both hands and put his heel under the armpit of the affected side. Pull both hands with steady and continuous strength. During traction, the heel pushes the humeral head outward, rotates at the same time, and retracts the upper arm. You can hear the sound when resetting.
(2) Kirchl law. This method is easy to succeed when the muscles are relaxed. Don't use too much force to prevent humeral neck fracture caused by excessive torsional force. Operating steps: One hand holds the wrist and bends the elbow 90 degrees to relax the biceps brachii, while the other hand holds the elbow for continuous traction and slight abduction, and gradually rotates the upper arm outward, then retracts the elbow along the midline of the chest wall, and then rotates the upper arm inward, at this time, it can be reset. You can hear the noise.
(3) The injured person lies on his back by traction and massage. One assistant pulls the chest to the healthy side with a piece of cloth, the second assistant pulls the affected limb to the upper outside with a piece of cloth under the armpit, and the third assistant holds the wrist of the affected limb for downward traction and external rotation and adduction, and the three aspects are slowly and continuously pulled at the same time. The surgeon pushes the humeral head outward to the armpit by hand to reset it. Two people can also do traction reset.
After reduction, the shoulder recovered to a blunt and plump normal shape, and the dislocated humeral head could not be felt in the armpit, coracoid process or subclavian, and the shoulder-knee test turned negative. X-ray examination showed that the position of humeral head was normal. In most cases, the avulsion fracture of humeral tubercle will be reset after the dislocation of shoulder joint is reset, because there is periosteal connection between the fracture block and humeral shaft.
Treatment after reduction: After the reduction of anterior dislocation of shoulder joint, the affected limb should be kept in adduction and internal rotation position, padded with cotton pad under the armpit, and then fixed to the chest with triangle towel, bandage or plaster. After 3 weeks, the shoulder joint should swing and rotate gradually, but excessive abduction and external rotation should be prevented to prevent dislocation again. After reduction, the posterior dislocation was fixed in the opposite position (abduction, external rotation and backward extension).
2. Surgical reduction A few cases of shoulder dislocation need surgical reduction. Indications are: anterior dislocation of shoulder joint combined with backward slippage of long head tendon of biceps brachii hinders manual reduction; Avulsion fracture of greater tubercle of humerus, the fracture block is stuck between humeral head and glenoid, which affects reduction; Complicated with surgical neck fracture of humerus, which can not be reduced by manipulation; Combined with coracoid process, acromion or glenoid fracture of shoulder joint, with obvious displacement; Accompanied by axillary vascular injury.
3. Treatment of old dislocation of shoulder joint. Those who have not been restored for more than three weeks after shoulder dislocation are old dislocation. The joint cavity is covered with scar tissue, and some scar tissue adheres to the surrounding tissue, and the surrounding muscles contract, and the fracture patient forms callus or abnormal healing. These lesions have hindered the reduction of humeral head. Treatment of old dislocation of shoulder joint: the dislocation is within three months, young and strong, the dislocated joint still has a certain range of motion, and there is no osteoporosis or ossification inside and outside the joint on X-ray film, so manual reduction can be tried. Before reduction, the olecranon of the affected side can be traction 1 ~ 2 weeks; If the dislocation time is short and the joint movement disorder is light, traction is not needed. The reduction is carried out under general anesthesia, shoulder massage and gentle shaking activities to relieve adhesion and muscle spasm, which is beneficial to reduction. The reduction operation adopts traction massage or pedaling, and the treatment after reduction is the same as fresh dislocation. We must pay attention to avoid rough operation, so as to avoid fracture and damage to axillary nerves and blood vessels. If manual reduction fails, or dislocation has been more than three months, young and middle-aged wounded people can consider surgical reduction. If it is found that the articular surface of humeral head has been seriously damaged, shoulder joint fusion or artificial joint replacement should be considered. After shoulder joint reduction surgery, the activity function is often not ideal. For elderly patients, surgery is not suitable, and patients are encouraged to strengthen shoulder activities.
4. Treatment of habitual anterior dislocation of shoulder joint Habitual anterior dislocation is more common in young adults. The reason is generally believed that although the injury caused by the first traumatic dislocation has been alleviated, it has not been properly and effectively fixed and rested. Due to the tear or avulsion of the articular capsule, the glenoid lip and glenoid margin were injured, the fracture of the posterolateral depression of the humeral head became isomorphic and the joint was loose. Dislocation can occur repeatedly under slight external force or some actions, such as abduction and supination of upper limbs. The diagnosis of habitual dislocation of shoulder joint is relatively easy. X-ray examination, in addition to the shoulder before and after the plain film, but also before and after the upper arm internal rotation 60 ~ 70 degrees of plain film, such as humeral head defect can be clearly shown.