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20.03.2005 Версия для печати

Травмы плеча

Введение

Рентген здорового плечаПлечевой сустав связан с острыми (например, внезапное падение) травмами или хроническими заболеваниями (например, повторные растяжения). В этой статье я сконцентрируюсь на общих острых проблемах, которые затрагивают плечевой сустав и возникают при несчастных случаях в зимнем спорте. В этой статье не будет глубокой оценки или описания ортопедического лечения, но приведены упрощенные описание травм и их лечения. Дополнительную информацию о плечевом суставе можно найти на сайте American Academy of Orthopaedic Surgeons.

Не удивительно, что два основных фактора связанных с травмами плеча на склонах - падения и столкновения.

Падения могут повредить плечо одним из трех путей:

  1. Случайное падение прямо на плечевой сустав.
  2. В процессе падения, случайное приземление на вытянутую руку и сила падения передается вверх по руке в плечевой сустав.
  3. Снова случайное падение на вытянутую руку, но также в момент падение тело случайно прокручивается вокруг вытянутой руки, что прилагает крутящие силы в плечевой сустав.

Как и при других травмах в зимних видах спорта, механизм получения травмы совместно с прилагаемыми силами в момент травмы определяют вид и серьезность травмы.

Статистика травм плеча в зимних видах спорта

Травмы плеча составляют 10% горнолыжных травм, 15% всех сноубордических травм и около 5% все травм скиборда. Виды травм плеча в зимних видах спорта приведены ниже (данные взяты из базы данных по травмам в Шотландии). Травмы плечевого сустава включают в себя вывихи, подвывихи плеча.

Статистика травм плеча

Вывихи плеча

Рентген вывиха плечаВывих плеча чрезвычайно болезненная травма. Обычно она возникает в процессе падения на вытянутую руку, и совместным моментом вращения тела. В таком случае плечо выворачивается из сустава (даже описание звучит больно!). Конечный результат - головка плечевой кости (верхняя кость руки) выкидывается из своего нормального положения в плечевом суставе. В большинстве случаев, она оказывается впереди и внизу относительно нормальной позиции - это называется передний вывих (смотри слева). Намного реже плечо может быть вывихнуто в обратном направлении (задний вывих), который сложнее для диагностирования и требует дополнительного рентгеновского снимка!

Диагноз вывихнутого плеча обычно клинический случай - ты можешь часто его поставить, как только травмированный зайдет в дверь кабинета! Те, у кого вывихнуто плечо стараются медленно ходить, стараясь беречь поврежденную руку от любых движений руки (из-за чрезвычайной боли). У них определенное положение тела наклоненное вперед и вбок. При обследовании, поврежденный плечевой сустав теряет свою гладкую скругленную форму, и ты часто можешь почувствовать промежуток в том месте, где обычно сидит головка кости.

Исследования показывают, что большинство вывихов не требуют дополнительной рентгенограммы перед вправлением (помещение кости на место). Для вправления мы используем метод Кочера и можем вправить 90% вывихов в комнате лыжного патруля или в нашей клинике. Чем быстрее будет вправлена кость, тем лучше. Иногда, невозможно вправить плечо и в этих случаях пациент перевозится в больницу, где ему вправляют плечо под общим наркозом. Это бывает в трех случаях:

  1. Прошло много времени перед вправлением плеча (произошла судорога).
  2. Очень мускулистый пострадавший (снова судорога + врач должен применить стероиды, чтобы иметь хоть какой-нибудь шанс!).
  3. В процессе получения травмы часть мягких тканей плечевого сустава заклинило и мешает простому вправлению. В этом случае может потребоваться открытое вправление.

После вправления, пациент обычно испытывает внезапное и значительное уменьшение боли. По наблюдениям (обычно) плечо необходимо иммобилизировать (при помощи шины) на срок не менее трех недель, перед тем как приступить активным упражнениям – идеально, если это будет происходить под наблюдением физиотерапевта.

К сожалению, если ты вывихнул плечо один раз, есть 85% риск что плечо будет вывихиваться и впредь в том же самом месте - потому что исходная целостность плеча была нарушена и сустав никогда не будет так же силен как раньше. Следовательно, в последствии потребуется меньшая сила, чтобы снова вывихнуть плечо... Так что берегите себя! В этом деле есть одна хорошая новость - повторные вывихи обычно не так болезненны, как первичные и обычно проще вправляются врачами. Есть несколько хирургических операций (например, восстановление Бэнкхарта (Bankhart repair)) которые можно проделать для стабилизации плеча.

Переломы ключицы

Ключица - самая часто ломаемая кость во всем теле! Также это один из самых распространенных переломов плечевого сустава у лыжников и сноубордистов и наиболее часто ломаемая часть верхней части тела у лыжников (у сноубордистов идет после запястья). Вследствие этого многие видели переломы ключицы и распознают их правильно, если они происходят. Перелом ключицы происходит в случае передачи силы падения по верхней части руки в ключицу, которая вследствие этого ломается. Такой перелом довольно легко диагностируется из-за локализации боли вдоль кости, обычно сопровождаемой опухолью в месте перелома. Кость может быть разделена на три сегмента - внутренний, средний и внешний. Переломы обычно происходят в самой слабой точке кости, которая является местом соединения средней и внешней части.

Вследствие простоты диагностирования обычно не требуется рентгеновский снимок для подтверждения диагноза (это предотвращает твое свечение в темноте). Иногда рентгенограмма полезна для различения между переломом конца ключицы или повреждением сустава (смотри ниже).

К счастью, большинство переломов ключицы быстро проходят, обычно используется поддержка в форме ключицы и манжета или поддержка руки для снижения боли, но обычно перелом быстро проходит и плечо можно нагружать. Ранее использовавшиеся восемь бандажей (которые теоретически соединяли плечо и помогали срастаться нескольким обломкам ключицы) теперь расцениваются как устаревшие. В редких случаях, один из фрагментов кости может сильно давить на хожу - в таких случаях, может потребоваться хирургическое вмешательство, чтобы соединить вместе два куска кости при помощи хирургической проволоки.

В целом, ты жуткий неудачник, если у тебя после перелома ключицы развилось нарушение двигательных функций, (т.е. ты сможешь делать все что угодно рукой) но чтобы напомнить себе о переломе тебе будет достаточно слегка ударить по кости...

Растяжение связок акромиально-ключичного сустава

Нормальный плечевой суставАкромиально-ключичный сустав располагается между внешним концом ключицы и частью лопатки известной как акромион. Связка соединяет эти части и удерживает сустав вместе. Падение с прямым ударом на внешнюю часть верхней части руки может привести к повреждению этой связки и ее разрыву, позволяя суставу деформироваться (так называемый подвывих, так же известен как "треснувший" акромиально-ключичный сустав) или может полностью разъединиться (вывих). Чтобы запутать тебя, скажу, что оба этих случая называются одним общим термином "растяжение связок"!!

Как и в случае со всеми растяжениями связок, повреждение акроминально-ключичного сустава делится на три класса в зависимости от степени - на рисунке справа в качестве примера приведена 3 степень растяжения связки и заметь очевидную разницу между контурами двух плеч - рядом рентгеновский снимок сзади. Нажми на картинку, чтобы посмотреть увеличенные картинки. Иногда сложно отличить растяжение связок акромиально-ключичного сустава от перелома конца ключицы. Осторожное (и нежное!) ощупывание, тем не менее, обычно покажет в чем дело, так как болезненность растяжения очень локализована, в то время как при переломе ключичной кости область боли обширна.

Растяжение связок акромиально-ключичного сустава 1 и 2 степени обычно лечатся консервативно - фиксация и хорошими болеутоляющими средствами. С большинством растяжений третьей степени можно обращаться аналогично, но необходимо в дальнейшем относиться к этому суставу бережно - как и с переломом ключичной кости происходит быстрое восстановление функций плеча - но при ударах ты получишь напоминание о растяжении. Реабилитация в идеале должна проходить под наблюдением физиотерапевта. Если плечо не держится на месте, возможно, потребуется внутренняя фиксация плечевого сустава.

Переломы плечевой кости

Рентген здорового плечевого суставаПлечевая кость, как видно из диаграмм на этой странице, кость верхней части руки соединяющая плечо с локтем. Существует три типа переломов, получаемых при занятии зимним спортом, которые мы рассмотрим:

  • Переломы верхней части кости - обычно затрагивают головку и шейку кости (часть кости в форме лампочки).
  • Переломы тела кости (середина).
  • Переломы нижней части кости - они называются надмыщелковые переломы (потому что обычно они происходят выше (отсюда над) мыщелки (костяной вырост на конце) локтя. Такие переломы чаще встречаются у детей.

Первые два перелома обычно происходят при травмах плечевой кости - т.е. столкновении с каким-нибудь объектом или тяжелом падении на кость. Переломы тела кости происходит при применении гнущих сил (напоминает ломание палки). Надмыщелковые переломы происходят в результате передачи силы удара вверх, при падении на вытянутую руку - в локтевом суставе происходит удар в нижнюю часть плечевой кости и надмыщелковая часть ломается. (Я люблю говорить технически!)

Рентген перелома верхней части плечевой костиПереломы верхней части плечевой кости

Эти переломы обычно происходят в шейке кости (как показано на рисунке слева) - есть сложные системы классификации, но в сущности что важно - было ли смещение кости и/или раздробление или нет. Наиболее устойчивые переломы (даже притом, что на рентгеновском снимке могут выглядеть чрезвычайно внушительными!) не требуют ничего кроме отдыха руки в широкой повязке - вес руки удерживает фрагменты в нужном месте и кость срастается сама. Операция редко требуется. Смещенные переломы могут потребовать вправления под анестезией, чтобы фрагменты кости сидели вместе.

Переломы тела кости

Эти переломы обычно довольно болезненны, но снова могут не требовать операции в зависимости от точной природы травмы. Обычно руку помещают в гипс, чтобы придать дополнительный вес и удерживать руку (удерживать кости ровно) и защищать ее. Иногда при такой травме происходит повреждение лучевого нерва и это должно быть проверено. Хотя традиционное лечение обычно успешно, есть небольшой риск того, что кости не достаточно плотно стоят вместе в результате смещения, что известно как неправильно сросшийся перелом.

Надмыщелковые переломы

Эти травмы подразделяются на 3 степени в зависимости от степени смещения. Первая степень лечится традиционной иммобилизацией, другие требуют операции как закрытого или открытого вправления, так и внутренней фиксации. К счастью, такие травмы происходят в детстве, и такие травмы быстро проходят, так как детские кости отлично срастаются (потому что они еще растут).

Повреждения вращающей манжеты

Нормальные мышцы и сухожилия плечаРазрыв вращающей манжетыТермин вращающая манжета относится к 'манжете' мускулов и мягких тканей, которые обычно скрепляют плечо и определяют степень его движения. Не сюрприз, что любой внезапный выкручивание плечевого сустава в результате несчастного случая может повредить эти части, что ведет к травме известной как разрыв вращающей манжеты. К счастью большинство таких травм, не смотря на то, что поначалу очень болезненны и ограничивают движение плеча, успокаиваются довольно быстро и не приводят к хроническим проблемам. Очевидно, что это зависит от степени травмы. Проблема обычно легко локализуется, так как ограничивает движение (при правильной оценке).

Лечение обычно проводится при помощи противовоспалительных средств, ранней физиотерапией и обездвиживанием плеча. Худшее что может произойти - плечо слишком долго нужно держать в повязке - что приводит к атрофированию плеча, что намного хуже. Может потребоваться агрессивное физическое лечение и/или введение кортизона, но лучше всего избегать таких травм!

Восстановление плеча после травмы

Как ты заметил, на протяжении всей статьи я утверждал, что травмы плеча должны лечиться под наблюдением физиотерапевта. Под их опытным руководством, плечо может выздороветь и восстановить все свои функции с минимальным риском следующего повреждения. Ниже приведены ссылки на упражнения, которые помогут после травм плеча. Они должны выполняться под контролем физиотерапевта или твоего доктора.

Упражнения вращающей манжеты

Упражнения American Academy of Orthopedic Surgeons

Руководство от American Physical Therapy Association

Полезные вебсайты

Wheeless' Textbook of Orthopaedics shoulder page - http://www.ortho-u.net/orthoo/43.htm [Фантастическая и точная информация, хотя и медицинская!!]

Портал на сайты посвященные плечам - http://omni.ac.uk/browse/mesh/detail/C0037009L0037009.html

Руководство Medline по сайтам о плечах - http://www.nlm.nih.gov/medlineplus/shoulderinjuriesanddisorders.html

И одна из лучших ссылок... - http://www.niams.nih.gov/hi/topics/shoulderprobs/shoulderqa.htm

Автор: Dr Mike Langran.
Источник: www.ski-injury.com.
Перевод: k0ry.

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Отлично расписали, спасибо. Я правда самодиагностику провести все равно не смог, но все равно спасибо. Кстати думаю что будет уместным в тексте разместить 3д фото плечевого супового набора, например отсюда http://www.peakorthopaedics.co.uk/shoulder.htm Сразу понятнее становится где что.
[03.08.2011 / 08:10]

Здравствуйте,со мной произошёл глупый случай я дома упала и повредила правую руку,так как было уже 11 вечера я решила подождать до утра,а у утром мы с мужем поехали в травмпункт (рука была сильно распухшая с плеча и до локтя)снимок сделали ,но врач сказал что перелома нет вот только её беспокоила моя опухоль.А второй раз когда я пришла на приём мне сказали,что у меня перелом плеча и гипс на это место не делают,врач был другой и очень удивился,что я нечего не знаю.Я Просто хочу знать кладут гипс на плече или нет?
[17.05.2011 / 08:21]

Здравствуйте, очень надеюсь на вашу помощь. Дело в том, что вчера на тренировке я получил травму. А именно, удар в нижнюю челюсть коленом. Получил(как мне кажется незначительные повреждения) разрыв губы, и чувствую боль в районе мыщелкового отростка, как справой так и с левой стороны. Некомфортно жевать пищу, во время укуса особых раздражающих факторов не чувствую. Первое, что сделал это приложил лед. После этого ничего не делал. К врачу не обращался, так как нахожусь за границей и спортивных врачей тут просто нет. Так же во время тренировки мой друг получил травму плеча( в районе стыка ключицы и плечевой кости) чувствует болевые ощущения во время вращательных движений руки. Лед не прикладывал, перед сном использовал разогревающую мазь. Вид спорта- самбо. Скажите как восстанавливаться после таких травм? Спасибо.
[29.12.2010 / 18:09]

Здравствуйте! Помогите, пожалуйста!!!! 27 ноября 2010 года моя мама упала у метро, сразу поехали в травмпункт, где ей сказали что у нее перелом шейки плеча с небольшим смещением, сказали что требуется операция и прямо оттуда нас забрали на скорой в больницу. В больнице врачи не могли решить делать операцию или оставить так. В итоге решили что надо. Но надо ждать 5 дней - просто так лежать в больнице. Нам это не понравилось. Смысл лежать просто так. Уехали домой. На завтрашний день поехали в др.травмпункт в др.районе, в надежде, что там при повторном снимке скажут поточнее диагноз(так как первый снимок был совершенно безобразный и нечеткий) там сказали что никакого смещения нет. не бойтесь. наложили тугой и противный гипс который мама не выдержала и сняла на след.утро. вобщем, операция не нужна. спустя 1 день решили перестраховаться, позвонили знакомому врачу,а через него вышли на одного опытного травмотолога (вроде опытного))) он всего лишь посмотрел снимки и тоже сказал что операция не нужна. назначил бандаж или просто косынку из обыч.платка. и в таком положении не двигаться 6 недель. на 8 прийти к нему, а там уже посмотрит что делать. Но на счет разрабатывания руки - не сказал ничего Уже прошло ровно 32 дня. Это не так много для женщины 62 лет. Думаю для пожилых людей требуется большее время на срастание костей, нежели молодым) Но проблема в том, что ее беспокоят сильные,ноющие боли от лопатки и непосредственно от самого плеча до кисти левой руки......боли не прекращаются. Пить бесконечно кетаролы и кетановы нежелательно. проблемы с желудком. Что делать? С чем это связано? сколько еще терпеть боли? Связано ли это с нервами? Может стоит обратиться к невропатологу?.. Когда начинать разрабатывать руку? Вот вопрос, который нас беспокоит и на который так никто внятно и не дал ответа. Рано ли еще? 32 дня? или можно начинать? или лучше идти сразу к физиотерапевту после дней 40-45 хотя бы?... У кого похожие случаи и кому не лень - дайте совет, ради Бога. переживаю за маму.....она у меня одна на свете..а переломы в последние годы частые ( до этого ломала обе руки..ногу..)
[22.10.2010 / 05:51]

помогите,пожалуйста,подскажите что делать!ребёнок 13лет,в мае была травма,перелом шейки плеча со смещением,была сделана операция,поставлены спицы,проходил с ними три месяца,а как оказалось должен был три недели.прошло уже 6 месяцев с момента операции,и три с момента удаления спиц.плечевой сустав не работает как положено.операция была проведена в другом городе,а наблюдаемся в нашем.на приёме на просьбы начать какую нибуть восстановительную терапию говорит хирург что ещё рано,что линия перелома ещё якобы просматривается.А НЕ БУДЕТ ЛИ ПОТОМ ПОЗДНО!?
[10.10.2010 / 17:40]

У меня тоже привычный вывих левого плеча. год назад сделали операцию. но опять выскакивает. обращался к доктору,сказал надо ждать когда будет вывих, тогда и придёшь.Что делать,куда обратиться?
[05.07.2010 / 23:09]

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[25.06.2010 / 18:09]

все только и задают вопросы,а на них никто не отвечает почти(((
[23.04.2010 / 17:26]

ломала шейку плеча...ничего не почувствовала, когда произошёл перелом.) узнала только после того, когда сделали снимок в больнице...гипс носила 4 недели, рука востоновилось буквально за считанные дни после перелома)
[12.04.2010 / 23:29]

ломал шейку плеча год назад,вставили пластину.как не разрабатывал на сто процентов плечо не работает.вот приер,от пола отжимаюсь всего 6 раз а потом боли.ВОТ ТАКИЕ ДЕЛА..........
[06.03.2010 / 00:11]

я вывихнул плече, при задержании преступника т.к., я сотрудник мвд первоночальную медицинскую помощь получил в травмпункте, мне там наложили повязку ДЕЗО которую я проносил 3-и недели после чего мой врач после снятия данной повязки приписал мне лечение греть 3 разаза в день нагретой солью плечевой сустав, скажите это правильное назначеное лечение
[02.03.2010 / 21:16]

Перелом шейки плеча.Сейчас прошло 40 дней.Делаю физиотерапию,массаж.Рука не поднимается полноценно.Пожалуйста,подскажите:как разработать.Стоит ли мазать мазью и разрабатывать её через боль? Через какое время она должна восстановиться?
[23.02.2010 / 17:19]

>Вот я уже как 4 года занимаюсь греблей, всё было хорошо, ни каких травм. 10 >февраля 2010 года я пришёл домой после тренировки в отличном состоянии >(тренируюсь я 6 раз в неделю), и я пр К доктору иди
[22.02.2010 / 20:56]

Вот я уже как 4 года занимаюсь греблей, всё было хорошо, ни каких травм. 10 февраля 2010 года я пришёл домой после тренировки в отличном состоянии (тренируюсь я 6 раз в неделю), и я просто так начал делать вращательные движения плечом (вверх- вниз) и тут раз, заклинило руку, теперь мне больно её подымать вверх, сгибать локоть (не могу шапку на голову одеть: больно).Хирург сказал согревающей мазью мазать. Но боль всё равно не проходит. Подскажите, что мне делать ??
[22.02.2010 / 20:47]

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[30.12.2009 / 09:19]

Был привычный вывих плеча(оч.давно)- делал вращения с малым весом, гантелькой 1,5 - 2,5 кг, в разные стороны, круговые вращения. Количество повторений большое - около 100 раз, подходов 1 или 2 по состоянию здоровья, вес отягощения вегда небольшой (независимо от комплекции). Меньше месяца ежедневных занятий и плечо перестало выскакивать и по сей день. Есть ещё методика укрепления суставов статическими упражнениями - схоже с комлексом упр. по реабилитации мениска после операции.
[16.12.2009 / 21:54]

14.12.2009 перепрыгивал заборчик( сокращал путь) и во время прыжка весь вес тела пришелся на правую(опорную) руку. Но из-за заскользившей перчатки рука съехала с начальной позиции и рука стала как-будто парализованной. Через пару часов чувствительность вернулась, но продолжаются адские боли на всём протяжении плеча и предплечья. Также плохо слушается кисть. Посоветуйте что нибудь, что может хотя бы умешьнить боли. Мази не помогают.
[26.11.2009 / 12:59]

15 ноября споткнулась и сильно упала на левую руку. В травмпункте сделали снимок - перелом большого бугорка со смещением, наложили гипс.24 ноября была на приеме у травматолога, гипс прибинтовали потуже. Сегодня второй день отекает рука, до этого отеков не было. Подскажите: что делать.
[20.10.2009 / 11:03]

подскажите пожалуйста - 3 октября с.г. на прогулке со своей собачкой я пострадала от сторожевого пса. который набросился на нас. в результате потасовки я упала на левую руку и скорая доставила в больницу.снимки констатировали перелом хирургической шейки левого плеча со смещением. гипс не накладывали. подложили валик под мышку - фиксации никакой. кроме платка. на котором лежит рука. боль страшные. принимаю обезболивающие средства. и вот прошло две недели - назначили щадящие упражнения 4 вида для разработки. а 22.10.09 надо явиться на лфк. при упражнениях испытываю сильные боли. поэтому решила спросить - надо ли так рано заниматься физкультурой? прошло только 2 недели. ведь боль сильная. может ещё и мозоль не образовалась??? на сайте прочитала что лучше для плеча покой. а вдруг плечо не так тогда срастётся? когда надо начинать разработку руки? а можно не носить валик под мышкой? жду вашего понимания и помощи. спасибо. фролова валентина николаевна. мне 73.5 лет
[14.10.2009 / 17:36]

Подскажите пожалуйста, два года назад на тренеровке по волейболу нанося удар по мячу вдруг почувствовал страшную боль в плече, после этого при любых попытках что-либо кинуть или при других активных действиях плечевого сустава у меня плечо как-бы \\\"вылетает из орбиты\\\" и боль просто невыносимая. Ходил к травматологу, он прописал фастум-гель, но мазь особо не помогает! Мне сказали, что это на всю жизнь и вылечить это полностью не возможно! Что это за травма и как её лечить? Заранее ОГРОМНЕЙШЕЕ СПАСИБО!
[06.10.2009 / 08:15]

Всем привет! Подскажите пожалуйста, пол года назад на соревнования по рукопашному бою нанося прямой удар я промазал и почувствовал страшную боль, после этого при любых попытках что-либо кинуть или при других активных действиях плечевого сустава у меня плечо как-бы \"вылетает из орбиты\" и боль просто невыносимая. Ходил к травматологу, он сказал делать упражнения, если не поможет затем какой-то массаж, а мой хороший знакомы учится на медицинском он сказал у меня разрыв кокой-то мышцы и нужна операция. Подскажите кто-нибудь прав мой знакомы или все-же травматолог??? Заранее ОГРОМНЕЙШЕЕ СПАСИБО!
[19.08.2009 / 17:55]

При игре в волейбол было падение на прямую руку. После этого 2-3 недели относительного покоя руки, но без обездвиживания. Применял эмульгель Вольтарен. После травмы прошло уже 6 мес. но боли еще периодически беспокоят, особенно во время сна. Как долго проходит период восстановления?
[13.06.2009 / 11:32]

связки (сухожилия) по своему устройству, составу, предназначению) не могут растягиваться.Выражение \"растяжение связок\" - медицински - малограмотное, (простонародное). Связки (сухожилия) при превышающих нагрузках на них могут только рваться (частично или полностью). В этой связи автор подстатьи \"Растяжение связок акромиально-ключичного сустава\" не внушает доверия.
[25.02.2009 / 11:14]

Ольга, это нормально, если без процедур. Вы правильно сделали что держали руку в покое три недели...в течение года функциональность руки восстановится, не волнуйтесь и не перенапрягайте её...делайте каждый день легкие упражнения, со временем, ход руки будет увеличиваться и придет в норму. Удачи
Урий
[29.01.2009 / 21:10]

да-да долобене-гель, и таблеточки найз - nise, недавно убрался с бокса, хирург прописал...
k0ry
[22.01.2009 / 01:11]

Так, не на правах рекламы а чисто из благодарности изобретателям... При растяжениях, вывихах и прочих юзаю \"шаманскую мазь\" (с) Долобене-гель - не воняет, не жжет и отлично помогает:) Проверено на многих испытуемых:)
анна
[21.01.2009 / 17:01]

при вывихах прекрасно помагает ванночки с теплой водой и куском мыла
k0ry
[26.12.2008 / 09:12]

Странно... а там гипсы всякие и прочие спицы?
Ирина
[25.12.2008 / 16:00]

Упала, сказали перелом плеча, носить повязку в виде платка. лечения не назначили. Что делать?
Ольга Радева
[18.12.2008 / 21:45]

Необходимо проконсультироваться - желательно в клинике в Санкт Петербурге - о правильности лечения перелома ключицы, который произошел 11-го ноября. Это срочно! И мы находимся далеко.
PREY
[19.04.2008 / 23:29]

Ваше жестоко!!(( Нехотелбы чет подобное испытать! (хотя было чет подобное с вывихом растяжением и переломом и все вместе!!((()
Nessy
[21.02.2008 / 03:49]

Народ! много всего прочитала, ничего не поняла, так что ответьте, плиз, кто РЕАЛЬНО знает, по пунктам (СРОЧНЯК НАДО): Ситуация: сестра сломала ключицу, перелом со смещением, наложили 8-повязку (рентгены до и после - врачи куда-то к себе заныкали), три дня ходила - потом в травмотологию (другую) там 11 часов вечера - только деж. врач(не травмотолог по сути своей) снова рентген (выглядит так будто и не вправляли вовсе) говорит - нужна операция. теперь, значит: 1. нужна ли вообще операция - тут на разных сайтах пишут, что в 98% не нужна и что и так все срастается (но деж.врач сказал, что тогда будет хрень величиной с кулак - а моя сестра, доложу вам, красотка и нах. ей такая хрень?! - а еще он сказал, что если еще раз сломается, то по причине неправильного сращивания, эта кость вообще уйдет куда-то во внутрь и зарежет ее нафиг. 2.если операция, то какая лучше всего (не с точки зрения финансов, а реально лучше) и, все-таки, сколько она стОит 3. какие железяки потом вынимают, а какие нет 4. наркоз общий или местный (когда вставляют железяки и когда их вынимают соответственно) 5. сколько с этой фигней инородной ходить и сколько потом вообще приходить в себя 6. шрам большой будет? 7. как спать? -в форумах написано \"полусидя\" - это реально полусидя, как в кресле-кочалке? а то моя сестра лежит на валике 8. где лечиться? (на этот вопрос отвечать тем, кто молиться на врачей, его излечивших) БЛИН! кто знает ответы - не поленитесь ответить, а то я ВСКРЫВАЮСЬ! (а время не ждет!)
Дмитрий
[29.01.2008 / 19:05]

Был перелом в нижней части плечевой кости (Надмыщелковый перелом), сделали операцию, установили пластину, сейчас жду следущей операции по извлечению пластины!Травму получил при занятиях армрестлингом(боролся ну руках), как лучше разрабатывать руку и что принимать для быстрейшего сращивания? 19 лет заранее благодарен, Дмитрий!
михаил
[09.11.2007 / 18:12]

Получил растяжение акромиально-ключичного сустава. Несколько раз вылетело. Как лечить?
Геннадий
[09.11.2007 / 18:08]

20.03.2005 Травмы плеча Введение Плечевой сустав связан с острыми (например, внезапное падение) травмами или хроническими заболеваниями (например, повторные растяжения). В этой статье я сконцентрируюсь на общих острых проблемах, которые затрагивают плечевой сустав и возникают при несчастных случаях в зимнем спорте. В этой статье не будет глубокой оценки или описания ортопедического лечения, но приведены упрощенные описание травм и их лечения. Дополнительную информацию о плечевом суставе можно найти на сайте American Academy of Orthopaedic Surgeons. Не удивительно, что два основных фактора связанных с травмами плеча на склонах - падения и столкновения. Падения могут повредить плечо одним из трех путей: Случайное падение прямо на плечевой сустав. В процессе падения, случайное приземление на вытянутую руку и сила падения передается вверх по руке в плечевой сустав. Снова случайное падение на вытянутую руку, но также в момент падение тело случайно прокручивается вокруг вытянутой руки, что прилагает крутящие силы в плечевой сустав. Как и при других травмах в зимних видах спорта, механизм получения травмы совместно с прилагаемыми силами в момент травмы определяют вид и серьезность травмы. Статистика травм плеча в зимних видах спорта Травмы плеча составляют 10% горнолыжных травм, 15% всех сноубордических травм и около 5% все травм скиборда. Виды травм плеча в зимних видах спорта приведены ниже (данные взяты из базы данных по травмам в Шотландии). Травмы плечевого сустава включают в себя вывихи, подвывихи плеча. Вывихи плеча Вывих плеча чрезвычайно болезненная травма. Обычно она возникает в процессе падения на вытянутую руку, и совместным моментом вращения тела. В таком случае плечо выворачивается из сустава (даже описание звучит больно!). Конечный результат - головка плечевой кости (верхняя кость руки) выкидывается из своего нормального положения в плечевом суставе. В большинстве случаев, она оказывается впереди и внизу относительно нормальной позиции - это называется передний вывих (смотри слева). Намного реже плечо может быть вывихнуто в обратном направлении (задний вывих), который сложнее для диагностирования и требует дополнительного рентгеновского снимка! Диагноз вывихнутого плеча обычно клинический случай - ты можешь часто его поставить, как только травмированный зайдет в дверь кабинета! Те, у кого вывихнуто плечо стараются медленно ходить, стараясь беречь поврежденную руку от любых движений руки (из-за чрезвычайной боли). У них определенное положение тела наклоненное вперед и вбок. При обследовании, поврежденный плечевой сустав теряет свою гладкую скругленную форму, и ты часто можешь почувствовать промежуток в том месте, где обычно сидит головка кости. Исследования показывают, что большинство вывихов не требуют дополнительной рентгенограммы перед вправлением (помещение кости на место). Для вправления мы используем метод Кочера и можем вправить 90% вывихов в комнате лыжного патруля или в нашей клинике. Чем быстрее будет вправлена кость, тем лучше. Иногда, невозможно вправить плечо и в этих случаях пациент перевозится в больницу, где ему вправляют плечо под общим наркозом. Это бывает в трех случаях: Прошло много времени перед вправлением плеча (произошла судорога). Очень мускулистый пострадавший (снова судорога + врач должен применить стероиды, чтобы иметь хоть какой-нибудь шанс!). В процессе получения травмы часть мягких тканей плечевого сустава заклинило и мешает простому вправлению. В этом случае может потребоваться открытое вправление. После вправления, пациент обычно испытывает внезапное и значительное уменьшение боли. По наблюдениям (обычно) плечо необходимо иммобилизировать (при помощи шины) на срок не менее трех недель, перед тем как приступить активным упражнениям – идеально, если это будет происходить под наблюдением физиотерапевта. К сожалению, если ты вывихнул плечо один раз, есть 85% риск что плечо будет вывихиваться и впредь в том же самом месте - потому что исходная целостность плеча была нарушена и сустав никогда не будет так же силен как раньше. Следовательно, в последствии потребуется меньшая сила, чтобы снова вывихнуть плечо... Так что берегите себя! В этом деле есть одна хорошая новость - повторные вывихи обычно не так болезненны, как первичные и обычно проще вправляются врачами. Есть несколько хирургических операций (например, восстановление Бэнкхарта (Bankhart repair)) которые можно проделать для стабилизации плеча. Переломы ключицы Ключица - самая часто ломаемая кость во всем теле! Также это один из самых распространенных переломов плечевого сустава у лыжников и сноубордистов и наиболее часто ломаемая часть верхней части тела у лыжников (у сноубордистов идет после запястья). Вследствие этого многие видели переломы ключицы и распознают их правильно, если они происходят. Перелом ключицы происходит в случае передачи силы падения по верхней части руки в ключицу, которая вследствие этого ломается. Такой перелом довольно легко диагностируется из-за локализации боли вдоль кости, обычно сопровождаемой опухолью в месте перелома. Кость может быть разделена на три сегмента - внутренний, средний и внешний. Переломы обычно происходят в самой слабой точке кости, которая является местом соединения средней и внешней части. Вследствие простоты диагностирования обычно не требуется рентгеновский снимок для подтверждения диагноза (это предотвращает твое свечение в темноте). Иногда рентгенограмма полезна для различения между переломом конца ключицы или повреждением сустава (смотри ниже). К счастью, большинство переломов ключицы быстро проходят, обычно используется поддержка в форме ключицы и манжета или поддержка руки для снижения боли, но обычно перелом быстро проходит и плечо можно нагружать. Ранее использовавшиеся восемь бандажей (которые теоретически соединяли плечо и помогали срастаться нескольким обломкам ключицы) теперь расцениваются как устаревшие. В редких случаях, один из фрагментов кости может сильно давить на хожу - в таких случаях, может потребоваться хирургическое вмешательство, чтобы соединить вместе два куска кости при помощи хирургической проволоки. В целом, ты жуткий неудачник, если у тебя после перелома ключицы развилось нарушение двигательных функций, (т.е. ты сможешь делать все что угодно рукой) но чтобы напомнить себе о переломе тебе будет достаточно слегка ударить по кости... Как лечить растяжение связок акромиально-ключичного сустава. Помогите пожалуйста.Вылетело 4 раза.
Ольга
[03.05.2007 / 11:14]

Я получила вывих плеча в автокатастрофе. Нахожусь под наблюдением травмотологов уже 6 недель. Вывих вправили сразу. Носила 3 недели повязку. Сейчас боли нет. Но не могу поднять вверх руку. Физиотерапию проходить не могу. Подскажите, как разработать руку. Спасибо.
Sania
[21.11.2006 / 04:12]

hotelos\' by pobol\'we uznat\' o podvyvixe i ego le4enii

 

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