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Acquired (traumatic) sprains


Occur in 80-90% of cases and therefore have the greatest practical significance. Some individual anatomophysiological features of a person (discrepancy in the size of joint surfaces, a wide capsule of the joint, the instability of the ligamentous apparatus, etc.) are predisposing factors. With indirect application of force, dislocations develop more often than from direct effects on the joint. Its capsule traumatic dislocations broken as a slit or a significant tissue defect.
Dislocations in the block joints (knee, elbow, ankle) are always accompanied by rupture of the ligamentous apparatus. There may also be ruptures of tendons in places where they attach to the bone, hemorrhage into surrounding tissues and joints. Simultaneous fracture of bone regions close to it, damage to large vessels, nerves complicates the treatment of dislocation (complicated dislocation).
Symptoms and course:
The circumstances of the injury and mechanism of injury revealed during questioning of the victim. Typical complaints are pain in the joint and the inability to move in it because of the increased pain. Sometimes there is numbness of the limb, which is associated with compression of the nerve trunks and fixation of the dislocated fragment with spasmodically contracted muscles.
The forced inappropriate position of the limb and the deformation of the joint region are noted. For example, with a dislocation in the shoulder joint, the shoulder is set aside at 15-30 ± and appears to be elongated, in the deltoid muscle region there is a sinking.
The displaced articular end of the bone with palpation often can be determined in an unusual place. Thus, when a dislocated shoulder he felt in the armpit or under the pectoralis major muscle.
Attempts to determine the possibility of passive movements in the joint give a sensation of a springing fixation: the dislocated bone, with forced displacement, again returns to its former position, which is explained by the action of spasmodically contracted muscles, sprained ligaments and capsules. This symptom is characteristic of dislocations.
Recognition:
The diagnosis of the dislocation is confirmed by an X-ray study, it also confirms or excludes concomitant fractures of the bone near the joints, which is of great importance for choosing the method of treatment.
Treatment:
The patient should be immediately sent to a medical institution. The wound is closed aseptic bandage.
The direction of the dislocation is easier and better for the first hours of the injury. Dislocations of two-five-day-old prescription are very difficult to adjust, and after 3-4 weeks often require surgical intervention, which gives much worse results.
A necessary condition for successful repositioning is complete relaxation of the muscles, which is achieved by good anesthesia.
Inadmissibility of the use of brute force, as This results in additional damage to the joint capsule, bones and subsequent relapse - a so-called "Habitual dislocations," they are most often found in the humerus and mandibular joints.
The methods of correction are based on stretching the muscles of the joint area with the use of a number of manipulations that seem to repeat in the reverse order the movements that caused the dislocation. Therefore, it is very important to imagine the mechanism of development and the sequence of movements that led to dislocation.
After the correction, a control X-ray photograph is taken, which confirms the correctness of its performance. The extremity is fixed for 6-10 days in a functionally advantageous position by bandage or stretching. Later, a complex of therapeutic exercises is regularly performed.