Outline:  
Dislocation of shoulder joint is actually a dislocation of scapulahumerus joint, and most cases are of anterior dislocation. It occurs generally in young and middle-aged people. According to the different ways of the force, it can be divided into subcoracoid dislocation, infraglenoid dislocation and subclavicular dislocation, possibly accompanied by avulsion fracture of the greater tuberosity of humerus and occasional damage of the axillary nerves and subaxillary blood vessels.

Major points for diagnosis
1. There is a definite traumatic history of shoulder joint.
 
2. There is a pain in the shoulder after the injury, which makes the shoulder unable to move.
 
3. There are "square shoulder" deformity, swelling, ecchymoses, and obvious tenderness in the injured shoulder, which fails to work. The round slipperyhead of humerus can be felt in the armpit or under the coracoid process. The upper arm is elastically fixed at an abducent position of 200 to 300. Dugas’ sign is positive, and the Straightedge test is also positive.
 
4. If there are accompanying damages to the nerves and blood vessels, corresponding manifestations would be present.

5. X-ray film can clearly show the direction and type of the dislocation and whether fracture is complicated or not.

Treatment  
(1) The manipulation of pulling by hand and stretching by foot:
Generally anesthesia is not necessary, or brachial plexus anesthesia is used. The patient takes a supine position. The operator stands by the bed on the side of the injured shoulder, holding the wrist of the injured arm with his hands and abducting the arm. Taking off his shoes, he places his foot against the armpit of the injured side with a cotton pad between the sole and armpit (the left foot for the left-shoulder dislocation and the right foot for the right-shoulder dislocation). The operator stretcheshis foot and pulls the patient's hand to adduct and laterally rotate the affected limbs gently, with the heel against the head of humerus outward. When the sound entering the cotyle is heard, the traction can be stopped, and at the same time, the operator adducts and rotates internally the injured arm.

(2) The chair-back manipulation:
The patient sits on a chair, putting his injured arm on the back of the chair with a cotton pad under his armpit. The operator binds up the middle part or the forearm of the injured hand with a wide cloth band. Holding the injured shoulder with one hand and the wrist with the other band, he abducts and rotates laterally the injured arm, flexes the elbow at 900, and then supinates the forearm with the palm facing upward. While holding the injured arm with his two hands, the operator gently pulls the other end of the band downward with his foot. When the reduction is accomplished, the traction can be loosened and the injured arm is to be adducted and rotated internally immediately. If there is an accompanying fracture of greater tuberosity of humerus, reduction is performed while the dislocation is corrected.

Old anterior dislocation of shoulder joint:
When the dislocation has lasted for more than three weeks and if the patients’ physical condition permits and he wants a manual reduction, some herbs may be orally given to relax muscles and tendons and promote blood flow. And fumigating-washing therapy with hot lotion of Chinese herbs may be used to benefit the joint motion. After giving the patient effective analgesia and anesthesia, the operator takes a ring hold of the injured shoulder and asks his assistant to hold the upper arm and elbow and move it in every direction, from a small range to a large range, but with no violence allowed. Then the adhesion of the shoulder can be relaxed, and the reduction can be conducted with the manipulations above for fresh dislocation.

Fixation:
Generally, chest wall bandage fixation is used. That is, put a cotton pad under the armpit of the injured shoulder. A bandage penetrating through the pad is tied up to the opposite shoulder for fixation. Herbal plaster is used to apply on the diseased area externally. The injured upper arm, kept in an adduction and intorsion position with the elbow bent at an angle of 600 to 900, is wrapped up with bandage and fixed against the Chest wall, and the forearm is suspended in front of chest with a cervical-carpal sling or triangular towel . The duration of fixation is 2 to 3 weeks.

Functional exercise:
After the reduction and fixation of a fresh dislocation, the patient is asked to exercise by clenching fist. Generally, no bed rest is needed. Two weeks after the injury, the range of elbow movement can be enlarged. After the third week, the fixation can be removed. If there is a fracture, the fixation can be properly prolonged. After the removal of fixation, full movement of the shoulder joint is preferable to restoring its function.

Herbal therapy  
Internal treatment based on syndrome differentiation  

1. In the early stage  
Main symptoms and signs:
Painful swelling in the shoulder with ecchymoses, difficulty in moving the shoulder; or accompanied by abdominal distension and fullness, nausea, vomiting, difficulty in urination and defecation.
 
Therapeutic methods:
Promoting blood flow to remove stasis, relieving swelling to stop pain.

Recipe and herbs:
Modified Zhishang Yifang (No. 1 Recipe for limb injury). Specifically, Danggui (Radix Angelicae Sinensis) 12 g, Chishaoyao (Radix PaeniaeRubrae) 12 g, Taoren (Semen Persicae) 10 g, Honghua ( Flos Carthmi ) 6 g, Huangbai ( Cortex Phellodedri ) 10 g, Fangfeng ( Radix Ledebouriellae Divaricatae ) 10 g, Ruxiang ( Gummi Olibanum ) 10 g, Mutong ( Caulis Akebiae ) 9 g, Shengdihuang ( Radix Rehmanniae ) 10 g, Zhechong ( Eupolyphaga seu Steleophaga) 10g, Sanqi (Radix Notoginseng) 3g and Gancao (Radix Glycyrrhizae ) 3 g.
 
2. In the late stage
Main symptoms and signs:
Aching pain in the shoulder, adhesion of muscles and tendons, rigidity of the joint with difficulty in movement.

Therapeutic methods:
Relaxing tendons and activating collaterals, freeing joint movement.

Recipe and herbs:
Modified Shujin Decoction. Specifically, Danggui ( Radix Angelicae Sinensis ) 12 g, Chenpi (Pericarpium Citri Reticulatae) 9 g, Qianghuo (Rhizoma seu Radix Notopterggii ) 9 g, Shenjincao (Herba Lycopodii Japonici ) 15g, Gusuibu ( Rhizoma Drgnarii) 9 g, Mugua ( Fructus Chaenomelis ) 9 g, Guizhi (Ramulus Cinnamomi Cassiae ) 6 g, Kuanjinteng ( Caulis Tinosporae ) 15 g, Sangjisheng ( Ramulus Loranthi) 9 g, Wujiapi (Cortex Acanthopanacis ) 9 g, Baishaoyao (Radix Paeoniae Alba) 9 g, Gancao (Radix Glycyrrhizae ) 3 g.
 
External therapy:
In the early stage, Xiaozhong Powder or Sanse Application is externally used. In the late stage, Shangke Xiaoyan Paste or Zhenghonghua Oil is externally applied; or fumigation and washing is performed with Haitongpi Decoction: Specifically, Haitongpi ( Cortex Erythrinae) 6 g, Tougucao (Herba Speranskiae seu Impatientis ) 6 g, Ruxiang (Gummi Olibanum) 6 g, Moyao ( Myrrha ) 6 g, Chuanjiao ( Pericarpium Zanthoxyli Bungeani) 10 g, Danggui (Radix Angelicae Sinensis ) 5 g, Chuanxiong ( Rhizoma Ligustici Chuanxiong ) 3 g, Honghua ( Flos Carthmi ) 3 g, Weilingxian ( Radix Clematidis ) 3 g, Gancao ( Radix Glycyrrhizae ) 3 g, Fangfeng (Radix Ledebouriellae Divaricatae ) 3 g and Baizhi ( Radix Angelicae Dahuricae ) 3 g. The injured shoulder is fumigated and washed with the hot decoction, 2 to 4 times daily.