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PubMedDate not supplied

[Surgical treatment of injuries to the distal sections and terminal branches of the brachial plexus in traumatic shoulder dislocations].

Twenty-one patients with injury to the brachial plexus suffered as the result of traumatic dislocation of the shoulder were examined and operated on with the use of microsurgical techniques. Traumatic changes of the nerve trunks, the development of a cicatricial-adhesive process around and within them lead to stable disorders of conduction which do not yield to nonoperative treatment. Stable traumatic changes revealed in the nerve trunks on EMG in the first 4-6 weeks after the trauma as well as the absence of an effect of nonoperative treatment within this period of time were indications for surgery. Despite the coarse macroscopic external changes found in the nerves of the brachial plexus they should not be resected without preliminary intratruncal inspection of the fasciculi with intraoperative electrodiagnosis.

Adult↗
PubMed1985

[Trauma to the axillary artery in shoulder dislocations. Apropos of a case].

The authors have observed one case of injury to the axillary artery complicating anterior dislocation of the shoulder. It produced a marked haematoma of the axilla and ischaemia of the upper limb. At operation, avulsion of a posterior branch was associated with thrombosis of the trunk of the axillary artery. The result was good after saphenous vein grafting. This complication is very rare. Similar complications could arise from an excessively forceful reduction.

Adult↗
PubMed1982

[Treatment of habitual shoulder dislocation with the Brückner binding method].

101 patients with recurrent dislocation of the shoulder joint, who had undergone the Brückner-plasty between 1974 and 1981 were followed up. Good and very good results were obtained in 33.7%, moderate ones in 13.8% and poor ones in 52.8%. When following-up 135 operations, 49.0% of redislocations could be observed. Despite of its many advantages this method should in future only be practised in old people and children or in cases without the Hill-Sachs- and the Bankart-lesion.

Humans↗
PubMed1980

[Results following Trillat's surgery in habitual shoulder dislocation].

Following a review of the surgical methods to correct habitual dislocation of the shoulder we report on the method and the results of the Trillat procedure. The first 13 patients operated upon have been investigated 1 1/2 to 3 1/2 years postoperatively. All remained free of recurrence; the mean loss of external rotation was 13 degrees. Subjective results showed that 11 out of 13 patients were satisfied or highly satisfied.

Bone Screws↗
PubMed1996

[Arthroscopic reconstruction of the capsule-ligament using Landsiedl's technique for treating recurrent anterior shoulder dislocation].

Landsiedl arthroscopic capsuloligamentous reconstruction in treatment for recurrent anterior dislocation of the shoulder has been performed in 48 patients with follow-up between 6 months and 3 years. High efficacy and insignificant invasiveness make the method attractive. The success is secured by precise location of the canal for sutures within the neck of the scapula. It should be located in the original attachment of the lower glenohumeral ligament.

Adolescent↗
PubMed1994

[Bilateral anterior shoulder dislocation fracture after an epileptic seizure. A case report].

Fractures can occur during violent muscular violence such as occur in the course of epileptic seizures, though this is rare (0.3%). The proximal part of the humerus is most frequently affected. The typical lesion is bilateral posterior dislocation or fracture-dislocation. We present a rare case of bilateral anterior fracture-dislocation of the shoulder sustained as the result of an epileptic fit. The treatment given was open reduction, refixation of the anterior labrum and screw fixation of the fragments. A review of the literature revealed only 18 cases of bilateral anterior dislocations caused by convulsive seizures.

Bone Screws↗
PubMed2006

[Initial results of shoulder MRI in external rotation after primary shoulder dislocation and after immobilization in external rotation].

PURPOSE: A change in the strategy for treating primary anterior traumatic dislocation of the shoulder has occurred. To date, brief fixation of internal rotation via a Gilchrist bandage has been used. Depending on the patient's age, a redislocation is seen in up to 90 % of cases. This is due to healing of the internally rotated labrum-ligament tear in an incorrect position. In the case of external rotation of the humerus, better repositioning of the labrum ligament complex is achieved. Using MRI of the shoulder in external rotation, the extent of the improved labrum-ligament adjustment can be documented, and the indication of immobilization of the shoulder in external rotation can be derived. The aim of this investigation is to describe the degree of position changing of the labrum-ligament tear in internal und external rotation. MATERIALS AND METHODS: 10 patients (9 male, 1 female, mean age 30.4 years, range 15 - 43 years) with a primary anterior dislocation of the shoulder without hyper laxity of the contra lateral side and labrum-ligament lesion substantiated by MRI were investigated using a standard shoulder MRI protocol (PD-TSE axial fs, PD-TSE coronar fs, T2-TSE sagittal, T1-TSE coronar) by an axial PD-TSE sequence in internal and external rotation. The dislocation and separation of the anterior labrum-ligament complex were measured. The shoulders were immobilized in 10 degrees external rotation for 3 weeks. After 6 weeks a shoulder MRI in internal rotation was performed. RESULTS: In all patients there was a significantly better position of the labrum-ligament complex of the inferior rim in external rotation, because of the tension of the ventral capsule and the subscapular muscle. In the initial investigation, the separation of the labrum-ligament complex in internal rotation was 0.44 +/- 0.27 mm and the dislocation was 0.45 +/- 0.33 mm. In external rotation the separation was 0.01 +/- 0.19 mm and the dislocation was - 0.08 +/- 0.28 mm. After 6 weeks of immobilization in 10 degrees external rotation, the separation of the labrum was - 0.10 +/- 0.14 mm and the dislocation was - 0.23 +/- 0.21 mm. CONCLUSION: In anterior labrum-ligament tears, the axial MRI of the shoulder in external rotation demonstrates a more physiologic position of the glenoid. This may indicate an immobilization of the shoulder in external rotation, which results in a more anatomical healing of the glenoidal tear. Thus, in the case of labrum-ligament tears, MRI in external rotation is becoming indispensable.

Adolescent↗
PubMed1999

Arthroscopic lavage reduced the recurrence rate following primary anterior shoulder dislocation. A randomised multicentre study with 1-year follow-up.

Young individuals have a high recurrence rate following non-operative treatment of traumatic primary anterior shoulder dislocation. The present multicentre study was undertaken to find out whether the results could be improved by using arthroscopic lavage as treatment. Sixty patients aged 16-30 years, with traumatic primary anterior shoulder dislocation were randomised into two groups. One group was treated with arthroscopic lavage within 10 days, while the other group was treated non-operatively. Rehabilitation was otherwise identical. At 1-year follow-up, 4 of 30 patients (13%) in the lavage group had had redislocation compared with 13 of 30 (43%) in the group treated non-operatively (P = 0.01). The difference in recurrence rate was more pronounced in younger patients. The functional outcome according to the Rowe shoulder score was better in the lavage group (P = 0.003), as was the anterior stability according to the apprehension test (P = 0.008). We conclude that arthroscopic lavage reduced the recurrence rate and produced a better functional outcome at 1-year follow-up than the non-operative treatment in young individuals.

Absenteeism↗
PubMed1990

[A simple and effective method of the treatment of habitual shoulder dislocation].

The authors propose a method of surgical treatment of habitual dislocation of the shoulder which consists in partial section of the subscapular muscle tendon in 1/2 of its diameter and inserting the long head tendon of the musculus biceps brachii inke is fixed to the humerus by trans-osseous+ sutures. The operation was performed in 207 patients. The observation terms in 181 patients exceed 2 years, and in 26 patients they are less than 2 years. The relapses of the dislocation have been observed in 3 (1.6%) patients, in 2 of them they occurred 5 and 8 years after severe injuries.

Arthrodesis↗
PubMed2004

The epidemiology of shoulder dislocations in Malaysia.

The case notes of 102 patients (117 shoulder dislocations) were reviewed retrospectively to improve the understanding of the epidemiology of this common injury. Eighty-one dislocations were primary and 36 dislocations were second or recurrent dislocations. The age distribution was characterized by a peak in male patients aged between 21-30 years. The mean age for males was 30.5 years and 47.7 years for females. The male:female ratio in first time dislocations was 5:2, while it was 5:1 in recurrent dislocations. Ninety-eight percent were anterior dislocations and 2% were posterior dislocations. Greater tuberosity fractures were found in 17 patients and almost half of these patients were aged between 41-50 years. The most common cause of first time dislocation was a direct blow or fall onto the shoulder, accounting for 42 patients (55%). The majority of these patients were aged 40 years and above. Next common cause was motor vehicle accident which occurred mostly in the younger age group. Dislocations due to sporting injuries accounted for only 5.3% of all first time dislocations. Nearly 97% were successfully reduced without a general anaesthesia. Seventy-seven percent of the patients had their shoulders immobilized after reduction, mostly with body strapping only. Fifteen patients (14.7%) were referred for physiotherapy for stiffness. Few operations were performed for recurrent dislocations but surgery does not appear to be well accepted as yet by our patients.

Accidental Falls↗
PubMed1990

[The treatment of post-traumatic recurrent anterior shoulder dislocation using Du Toit's operation].

From 1.4. 1986 to 31.12. 1987 we operated 21 patients with a recurrent anterior dislocation of the shoulder with the Du Toit staple capsulorrhaphy. 20 patients we followed clinically and radiologically for an average period of one year and four months. By using a rating sheet 17 patients had an excellent and three patients a good result. There was, against other operation techniques, a minimally limiting of external rotation. We had no recurrents of dislocation. We concluded that the Du Toit staple capsulorrhaphy makes necessary only short postoperative immobilisation and renders an early return of motion and that a good function can be expected.

Adult↗
PubMedDate not supplied

A modification of the Bristow procedure for recurrent anterior shoulder dislocation and subluxation.

A modification of the Bristow procedure for recurrent anterior shoulder dislocation and subluxation is presented. This report includes 20 shoulders in 20 patients available for adequate followup operated on by senior author from April 1976 to August 1981. The average follow-up period was 42.5 months (3.5 years). The average age at the time of surgery was 24.7 years. No recurrences were noted in the follow-up period. Complications related to screw fixation with Woodruff screws occurred early in the series in three patients (15%), but did not result in instability. Range of motion measurements postoperatively emphasized quantitation of external rotation at 90 degrees of abduction in the operated as compared to the nonoperated shoulder. The average loss of external rotation was 10.3 degrees. Excluding one poor result, this equated to an average loss of only 7.4 degrees. Fourteen of 16 operated dominant arms (87.5%) returned to throwing and overhead motion sports postoperatively. A description of the operative procedure and postoperative rehabilitation course is included. This modification emphasizes accurate and firm repair of the Bankart lesion under excellent operative exposure allowing institution of early range of motion exercises.

Adolescent↗
PubMed1998

Primary traumatic anterior shoulder dislocation in patients 40 years of age and older.

During three consecutive ski seasons (1991 to 1994), 125 patients 40 years of age and older without previous shoulder injuries or surgery sustained a traumatic first-time anterior shoulder dislocation. At a minimum of 2 years' follow-up, patients were contacted to determine long-term outcome and to identify factors leading to prolonged morbidity or the need for surgical intervention. Fifty-two patients were available for interview. A modified Rowe shoulder score showed 32 excellent, nine good, eight fair, and three poor results. Eighteen (35%) rotator cuff tears were subsequently identified, with only 11 (61%) of these patients obtaining an excellent or good outcome (P = .011). Of the 11 patients with a fair or poor result, seven (64%) had a rotator cuff tear. Of the 12 patients with isolated cuff tears, 84% had an excellent or good result when treated surgically, compared with 50% when treated nonsurgically. Our findings indicate that recurrence is not a frequent complication of traumatic anterior shoulder dislocation in this age-group (4%). However, prolonged morbidity secondary to rotator cuff tear is more prevalent than in a younger population. We believe early diagnosis of rotator cuff pathology by either magnetic resonance imaging (MRI) or arthrogram with subsequent surgical repair can lead to faster restoration of function and a better outcome in these select individuals.

Adult↗
PubMed1995

Reduction of traumatic secondary shoulder dislocations with lidocaine.

The aim of the present study was to evaluate the value of local anaesthesia versus the commonly used intravenous pethidine/diazepam in the reduction of acute secondary shoulder dislocations. Patients with a traumatic secondary dislocation of the shoulder were randomized to either locally injected lidocaine or intravenously injected pethidine/diazepam. The local method was performed with 20 ml of 1% lidocaine. The patients were observed for any complication during and after the procedure, and the methods used were evaluated with a visual analogue scale (VAS). From November 1991 to September 1993, 62 patients were admitted to our departments of whom 52 were included in the study. Average age was 47 years (range 18-89 years) with 24 men and 28 women. Twenty-six patients were randomized to pethidine/diazepam; 22 had a successful reduction, and 4 were failures. Twenty-six patients received lidocaine, of whom 18 were successful and 8 not. Three patients treated with the intravenous method suffered respiratory depression, and one required an antidote. No systemic or local side-effects, no neurovascular damage and no early or late superficial or deep infection were recorded in the lidocaine group. There was no statistical difference between the average VAS value in the two groups. Lidocaine used to reduce acute secondary dislocations of the shoulder is a simple and safe method. It is as effective as the standard intravenous method and is well accepted by patients.

Adolescent↗
PubMed1992

[A modified procedure for repositioning shoulder dislocation].

A new method is presented for the reduction of shoulder dislocations and dislocation fractures, together with the follow-up results. This procedure is a modification of a method for reduction of the hip. Examination of our patients 1-3 years after the accident showed no sign of nerve lesions and little residual discomfort.

Adolescent↗
PubMed2001

Bilateral posterior shoulder dislocation: the importance of the axillary radiographic view.

Whilst posterior shoulder dislocation is rare, it remains a frequently missed diagnosis. In all patients with a history of seizure, electrocution or similar trauma, where external rotation of the shoulder is limited, we recommend that an axillary or modified axillary view be added to the standard two radiographic shoulder views as routine protocol, to avoid missing a posterior dislocation.

Accidents, Occupational↗
PubMed2006

Anterior-inferior labral lesions of recurrent shoulder dislocation evaluated by MR arthrography in an adduction internal rotation (ADIR) position.

PURPOSE: To introduce and evaluate the usefulness of the adduction internal rotation (ADIR) position in MR arthrography for discriminating the following subtypes of Bankart lesions: classic Bankart lesions, anterior labroligamentous periosteal sleeve avulsion (ALPSA) lesions, and Perthes lesions. MATERIALS AND METHODS: The study group consisted of 25 patients who had been referred for MR arthrography of the shoulder and then underwent arthroscopy due to recurrent episodes of shoulder dislocation. MR arthrography was performed in three different positions: neutral, abduction external rotation (ABER), and ADIR. The authors evaluated the statistical significance of the method's discriminative diagnostic ability for the subtypes of Bankart lesions according to the position changes. RESULTS: Twenty-three patients had the following single or complex labral lesions: classic Bankart (N = 8), ALPSA (N = 3), complex classic Bankart/ALPSA (N = 8), and complex ALPSA/Perthes (N = 4). Two patients had no visible anteroinferior labral lesions. The performance of ADIR positioning for differentiating ALPSA lesions was superior to the neutral or ABER positioning. The difference of the discriminative lesion detection ability was statistically significant (P <.01) only for detecting ALPSA lesions in the ADIR position. CONCLUSION: MR arthrography in the ADIR position provides high accuracy for the diagnosis of ALPSA lesions, and complements routine MR arthrography when used to diagnose labroligamentous lesions in patients with recurrent shoulder dislocations.

Adolescent↗