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PubMed1982

Scapular manipulation for reduction of anterior shoulder dislocations.

Scapular manipulation is an effective, safe method to reduce an acute anterior shoulder dislocation. The method described by Bosley and Miles in 1979 has been used by the Orthopaedic Staff at Henry Ford Hospital since February 1979. It was the initial reduction method used in 51 patients and was successful in 47. With experience, and a properly executed technique, the method is relatively simple and can be applied to all patients.

Female↗
PubMed1999

Electromyographic findings in shoulder dislocations and fractures of the proximal humerus: comparison with clinical neurological examination.

There is no consensus of opinion about the frequency of associated nerve lesions in anterior shoulder dislocations and fractures of the proximal humerus. We undertook a prospective study to assess the incidence, the severity of the nerve injury and the diagnostic value of electromyographic examination; 215 patients were included. We performed neurological examination and needle electromyography (EMG). Nerve injury was graded according to a denervation score at the EMG. EMG disorders were seen in 133 patients (62%). Testing of sensibility and clinical reflexes proved not to be a reliable indicator for EMG abnormalities. Detection of axonal lesions by grading muscle strength based on the MRC score after these shoulder traumas is difficult. The findings of this study imply that by clinical examination alone a large number of axonal lesions remain undetected.

Adolescent↗
PubMed1995

Acute shoulder dislocation. Indications and techniques for operative management.

The acute management of the initial, anterior shoulder dislocation is dependent on the age and activity demands of the patient. After a thorough examination and appropriate radiographs, a gentle closed reduction is the initial treatment. Previous authors have recommended a period of immobilization followed by a rehabilitation program emphasizing rotator cuff strengthening. Restricting return to athletic activities to allow adequate soft tissue healing is also recommended. This will effectively treat the vast majority of patients with this injury. In patients older than 25 years of age, one would expect a relatively low recurrence rate, especially in patients with low activity demands or in patients willing to modify activity. In active, young patients desiring a return to strenuous activity, however, most studies and our own experience demonstrate high recurrence rates. In the authors' experience, the examination under anesthesia and arthroscopic evaluation have confirmed an avulsion of the anterior-inferior capsulolabral complex as the primary injury component. The special circumstances of an initial dislocation with a hemarthrosis and excellent tissue quality make it ideal for arthroscopic stabilization. Our early results are encouraging and we believe this approach is a viable option in the management of this common injury in young athletes. As arthroscopic techniques for glenohumeral instability improve, we would expect an improvement on these initial results. Acute operative stabilization for the initial anterior dislocation is considered for: (1) initial dislocation that requires a reduction; (2) a young, athletic, high demand patient (<25 years of age) who is unwilling to modify his lifestyle; (3) subjects with no prior shoulder subluxation or impingement history; (4) subjects with no neurologic injury; and (5) subjects with no greater tuberosity fracture.

Acute Disease↗
PubMed1995

[Results of treatment after traumatic shoulder dislocation. Thoracic abduction plaster case or Desault dressing].

In 80 patients with primary traumatic shoulder dislocation treated at the Heidelberg Orthopaedic University Hospital we had a follow-up examination. We wanted to know about age and sex of the patients, the number of redislocations in correlation to time and way of fixation. We had 70% male and 30% female patients with 97.5% of anterior dislocation. The minimum age was 16 and the maximum 87 years with an average of 44 years. 48 patients had a Desault bandage for 2 weeks and 32 had a shoulder-arm plaster cast for 3 weeks. There was no difference between both ways of fixation. We also could not see any better results after more than a 3 weeks' fixation. The most important fact for redislocation is the age and activity of the patients. A young man has a very high risk of redislocation within the first year.

Adolescent↗
PubMed1989

Operative therapy for recurrent shoulder dislocation with special regard to long-term clinical and radiological results using M. Lange technique.

Besides a general description of the operative techniques for the management of recurrent shoulder dislocation, a full description of the M. Lange procedure is given. We offer reasons for its variation from original methods and suggest limiting its indications with regard to clinical and radiological long-term results. After an average postoperative period of 13.5 years, clinical and radiological results of 21 shoulders in 20 patients were determined. In 19 of the 21 cases patients reported outstanding-to-satisfying postoperative results. Real postoperative redislocation was found in only one case, but striking radiological signs of osteoarthritis were seen in 57%. Despite the lack of comparable results, this should be taken into consideration in choosing an adequate operative procedure.

Adolescent↗
PubMed1990

Damage of the long thoracic and dorsal scapular nerve after traumatic shoulder dislocation: case report and review of the literature.

A judo injury resulted in an anterior shoulder dislocation with a concomitant lesion of the long thoracic and the dorsal scapula nerve. This injury led to loss of function and extreme instability of the shoulder. Stabilization of the glenohumeral joint was successfully accomplished by surgery. The athlete declined further operative approaches to stabilize the scapula. The patient was able to return to the former level of athletic activity.

Adult↗
PubMed1989

Muscle activity during shoulder dislocation.

EMG activity from eight shoulder muscles in parallel was recorded from 4 patients with generalized joint laxity. During external rotation of the humerus in 45 degrees abduction, humeroscapular dislocation occurred in 2 patients and subluxation in the 2 others. The activity level in the subscapularis was low, and the activation speed was slow. The low muscle activity and delay in activation of the subscapularis muscle may contribute to the instability.

Adult↗
PubMedDate not supplied

Posterior shoulder dislocation with ipsilateral humeral shaft fracture. A case report.

A 41-year-old man incurred the unusual combination of subacromial posterior dislocation of the shoulder and ipsilateral humeral shaft fracture. The importance of inspection of joints proximal to long bone fractures cannot be overemphasized. The transscapular view is easily adapted to the diagnosis of this injury. When recognized early, closed reduction is the preferred treatment; open reduction, as in the present case, is reserved for chronic dislocation.

Adult↗
PubMed1989

The incidence of Hill-Sachs lesions in initial anterior shoulder dislocations.

We undertook a prospective study using arthroscopy to determine the intraarticular derangement caused by initial anterior shoulder dislocations. Of our 32 patients, 15 (47%) had a grade I, grade II, or grade III Hill-Sachs lesion. The patients were 29 men and 3 women whose ages ranged from 15 to 28 years (mean 22 years). All of the patients studied were United States military personnel or members of their families. None of the patients had had prior injuries of the affected shoulder, and all underwent arthroscopy within 72 h of injury. Few reports describe a Hill-Sachs lesion in a patient following a single anterior dislocation. Early reports of this lesion were based on indirect (radiographic) evidence. Our arthroscopic findings indicate that the incidence of this lesion after one anterior dislocation is higher than previously thought.

Adolescent↗
PubMed1992

Anterior shoulder dislocations.

The glenohumeral joint of the shoulder is the most commonly dislocated joint in the body. When dislocation occurs, it is usually anterior. The primary care physician usually sees the patient after reduction has been performed. Thus, treatment is directed at recovery of function and preventing recurrences. The prognosis and likelihood of recurrence in a first-time anterior dislocation depends on the mechanism of injury, treatment, rehabilitation, sex, age, and complications. Non-operative treatment after reduction usually involves immobilization and rehabilitation. Studies to date seem to indicate that age and activity level are more important factors for recurrence than length of immobilization. Traditionally, if there are recurrences after conservative treatment, then surgery is contemplated.

Adult↗
PubMed2002

Bilateral anterior shoulder dislocation--a case report and review of the literature.

Bilateral dislocations of the shoulders are uncommon. Of the cases which do present, the majority are posterior and occur secondary to seizures associated with epilepsy, electrocution and hypoglycaemia. Bilateral anterior dislocations are thought to be very rare. This report describes such a case which occurred following minor trauma in an elderly lady. The literature review which follows would seem to suggest that this may not be as rare as previously thought.

Accidental Falls↗
PubMed1984

[Traumatic shoulder dislocation. Late functional results with reference to the frequency of redislocation].

This study reports on the after-examination of 86 out of 107 patients with primary shoulder dislocation. Of greatest interest was the question which period of immobilisation would yield the best results. The most frequent type of dislocation was the subcoracoid position in 62% of all cases. In 44% the dislocations were associated with fractures especially of the greater tuberosity. The greatest number of dislocations occurred between 61 and 80 years of age (= 42%). The second highest number was found between 21 and 40 years of age (= 29%). In 47% of all cases the shoulder was immobilised for a week, in 40% between one and two weeks and in 13% for more than two weeks. The incidence of recurrence was 15% (13 patients). In 8 cases (= 9%) a recurrent dislocation of the shoulder resulted, whereas in 5 cases (= 6%) only one relapse occurred due to a repeated intense trauma. The function of the injured shoulder is most significantly impaired and rendered worse by the factors: higher age (greater than 41 years) and associated fractures. The duration of immobilisation itself has neither a significant influence on posttraumatic function of the shoulder nor on the incidence of recurrence. Therefore, an uncomplicated dislocation of the shoulder should be immobilised for a short period only. However, in cases of associated fractures, immobilisation will be necessary for a longer time.

Adolescent↗
PubMedDate not supplied

Arthroscopic findings after shoulder dislocation.

The purpose of this study was to evaluate prospectively the arthroscopic findings of the unstable shoulder, to provide insights into the causes and mechanisms of shoulder instability, and to establish a rationale for using special surgical procedures. Arthroscopic examination was performed on 212 patients who had at least 1 documented shoulder dislocation. Of these 212 patients, 184 (87%) patients had anterior glenoid labral tears, 168 (79%) patients had ventral capsule insufficiency, 144 (68%) patients had Hill-Sachs compression fractures, 116 (55%) patients had glenohumeral ligament insufficiency, 30 (14%) patients had complete rotator cuff tendon tears, 26 (12%) patients had posterior glenoid labral tears, 14 (7%) patients had superior labrum anterior and inferior lesions. As this prospective study shows, multiple morphologic changes are associated with instability of the glenohumeral joint; there is no single cause for an unstable shoulder. Arthroscopic examination of the shoulder before surgery revealed a significant amount of information that would have been undetected without the aid of expensive diagnostic tools. For instance, the labrum and rim of the anteroinferior glenoid showed typical abnormalities corresponding to different entities of anterior instability.

Adult↗