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PubMed1998

[The results of treatment of posterior shoulder dislocation].

The paper reports results of treatment for 5 posterior dislocations of the shoulder in 4 patients. Closed reduction was successful in 2 cases (2 days and 14 days after injury). Spontaneous reduction after removal of the Desault plaster cast 3 weeks after injury was observed in one case. Two patients with inveterate dislocation have been operated on. The defect within humeral head was filled with an allogenic bone graft in one patient and by lesser tuberosity transposition in another. Modified Constant score was used for clinical evaluation at the follow-up ranging from 5.5 months to 56 months (mean 30.4 months). Two excellent and one good result were achieved in conservatively treated cases. After surgery one result was rated poor (allograft case) and one good (lesser tuberosity transposition).

Adult↗
PubMed1992

[Posterior shoulder dislocation in a patient sample of the Swiss Accident Insurance Service].

We report on 17 posterior shoulder dislocations which were investigated by SUVA's medical service during the past three years. We can confirm the information in the literature, that the diagnosis is initially often missed (4 out of 17) and that the injury is often sustained in epileptic fits (4 out of 17). Among our patients, however, the time at which the diagnosis was made did not obviously influence the results of the treatment. After treatment, over half of our patients have an impairment which, in three cases, resulted in integrity compensation, in one case in a recommendation for vocational retraining, in one case in a change of profession and in one case in a pension.

Adolescent↗
PubMed1986

[Posterior shoulder dislocation].

Posterior dislocations of the shoulder can be caused by various mechanisms, the most common one, being epileptic seizures. Therefore many patients or their relatives hesitate to admit, how the injury has actually occurred. Spängler et al. published in 1975 several reasons why the diagnosis of "posterior subluxation of the humeral head" is often missed. Usually very typical errors in the evaluation of the clinical findings lead to misinterpretation of the radiograms. In spite of the fact that long-term results of untreated posterior subluxations can be surprisingly good, reduction must be achieved as soon as possible. Deep impression-fracture of the humeral head are the cause of recurrent dislocations. Various methods have been described to treat this condition by filling the defect with subscapularis tendon or cancellous bone. Avulsion-fractures of the posterior rim of the glenoid can successfully be refixed with small screws. In case of dislocation fractures through the anatomical neck, prosthetic replacement of the head leeds to satisfying results. So-called habitually dislocations are more common in boys and do usually not require surgery, as the inclination to dislocate becomes less frequent in later years. Only in adults operation may be indicated. Posterior apposition of a bone graft can be recommended.

Adult↗
PubMed2005

[Traumatic anterior shoulder dislocation].

The purpose of this paper is to outline the present state of treatment for traumatic anterior shoulder dislocation. Pathoanatomic changes as well as intrinsic and extrinsic prognostic factors are discussed. Based on these, treatment options for first time traumatic dislocations and chronic posttraumatic instability are recommended.

Arthroplasty↗
PubMed1995

Arthroscopic stabilization for recurrent anterior shoulder dislocation: results of 59 cases.

Fifty-nine patients with recurrent anterior dislocation of the shoulder underwent the Morgan arthroscopic stabilization with transglenoidal suture of the inferior glenohumeral ligament. All patients were followed-up for an average of 49 months (range, 29 to 71 months). Using Rowe's scoring system, the overall objective results were disappointing. There were 33% excellent results, 9% good, 9% fair, and 49% poor. Twenty-six patients had a further dislocation, and 3 others had recurrent subluxation on average 13 months after the operation. The failures were associated with a preoperative clinical finding of inferior hyperlaxity as demonstrated by a positive sulcus sign, a preoperative radiological finding of a bony lesion on the anterior edge of the glenoid, or an arthroscopic finding of extended ligamentous lesions at the time of operation. The results of this study are clearly worse than those reported by other investigators. Direct comparison between the reported studies is problematic and is discussed. It was concluded that arthroscopic stabilization should only be performed by interested specialists as part of controlled clinical trials.

Adolescent↗
PubMedDate not supplied

[Late clinical and roentgenologic results following surgical treatment of chronic shoulder dislocation using Lange's technic].

In German speaking countries the M. Lange procedure is a well known method in the treatment of recurrent shoulder dislocations. In order to study the longterm results 21 shoulder joints of 20 patients were examined clinically and radiologically after an average postoperative period of 13.5 years. According to the subjective judgment of the patients good results were obtained in 19 of the 21 cases. True recurrent dislocation occurred in 5.2%. In 57% of the cases signs of degenerative arthritis of the shoulder joints were found radiologically. Our examination shows that the M. Lange procedure is a reliable method with good longterm results. It should be used in cases of glenoidial dysplasia and in cases of a defect of the anterior glenoid rim.

Adolescent↗
PubMed2002

[Coracoid pseudarthrosis caused by anterior shoulder dislocation with concomitant coracoid fracture].

Fractures of the coracoid process are rare and represent only 2-5% of all fractures of the scapula. The most frequent cause of a coracoid fracture is direct trauma, but indirect trauma may also lead to a fracture of this kind. Avulsion injuries as part of an acromioclavicular dislocation are the most frequent forms of trauma. For the rare cases of an anterior shoulder dislocation with concomitant coracoid fracture, two different mechanism are discussed. One cause of the coracoid fracture could be direct impact of the dislocated head of the humerus on the coracoid process, another may be the occurrence of a sudden strong pull of the muscles inserting at the coracoid process during shoulder dislocation.In the majority of cases, conservative treatment with six weeks of immobilization is appropriate. If a pseudarthrosis occurs and there is persistent pain, we recommend the operative fixation of the distal coracoid fragment by insertion of cancellous bone graft taken from the iliac crest and stabilization with a cannulated AO titanium small fragment screw and PDS cord.

Adult↗
PubMedDate not supplied

Arthroscopic lavage compared with nonoperative treatment for traumatic primary anterior shoulder dislocation: a 2-year follow-up of a prospective randomized study.

A prospective randomized study was performed on 30 consecutive patients with traumatic primary anterior shoulder dislocation to compare treatment results of arthroscopic lavage with results of conventional nonoperative treatment. The patients were between 18 and 30 years of age and had no history of shoulder problems. At the 2-year follow-up, 3 (20%) of 15 patients in the lavage group had a redislocated shoulder compared with 9 (60%) of 15 patients in the nonoperative group (P = .03). Two of the patients in the lavage group compared with 6 of the patients in the control group had been operated on or were scheduled for stabilizing surgery. Functional outcome according to the Constant and Rowe shoulder scores did not reveal any significant difference (P = .07) between the groups. However, by the Rowe classification 2 of 15 patients in the lavage group had poor results versus 8 of 15 in the control group, indicating an advantage for the lavage treatment. The study showed that arthroscopic lavage reduced the risk for recurrent dislocation when compared with nonoperative treatment.

Adolescent↗
PubMed1998

[Long-term outcome of Putti-Platt operation in recurrent traumatic ventral shoulder dislocations].

In the present study, we reviewed 25 patients who had been treated by Putti-Platt procedure for recurrent traumatic anterior shoulder dislocations between 1988 and 1991. The average follow up time was 6.8 years. Redislocations occurred in nine cases (36%), five of these patients had to undergo a second shoulder reconstruction. Clinical examination with exclusion of the reoperated patients revealed signs of instability in further six patients. Six patients showed decreases in external rotation of more than 40 degrees compared with the nonoperated shoulder. According to the Rowe-score, results were judged as excellent or good only in 55% while they had to be estimated as poor in 30%. At follow up, 13 patients still suffered from limitations in their shoulder functions, only six out of 15 patients were able to return to their sporting activities postoperatively. Thus, the Putti-Platt procedure revealed rather disappointing long-term results and cannot be recommended.

Adolescent↗
PubMed2005

Incidence of rotator cuff tears in shoulder dislocations and results of therapy in older patients.

INTRODUCTION: In older patients we documented the incidence of additional injuries in shoulder dislocations in a non-randomised, prospective study and compared the results of conservative and of operative therapy of rotator cuff tears. MATERIAL AND METHODS: Between 1993 and 1999 a total of 87 patients were prospectively enrolled. In the case of documented tears of the rotator cuff in combination with symptoms persisting after conservative therapy patients were free to decide between surgical and conservative treatment. Patients were monitored for function, subjective stability, and satisfaction over a minimum follow-up period of 1 year. RESULTS: In 54% of the patients enrolled a cuff tear was documented; the frequency increased with advancing age to 100% in patients over the age of 70. Surgical treatment of the cuff tears resulted in better function and satisfaction. There were three recurrences in the conservative treatment group, while no recurrences were documented in surgically treated patients. The significant benefit of cuff repair was confirmed by regression analysis. CONCLUSION: In this selected patient group, we believe surgical repair of the symptomatic rotator cuff tear should be discussed with the patient.

Adult↗
PubMedDate not supplied

Pathologic changes associated with shoulder dislocations. Arthroscopic and physical examination findings in first-time, traumatic anterior dislocations.

This prospective observational study was performed on young patients, less than 24 years old, with first-time, traumatic anterior shoulder dislocations. These patients were offered either arthroscopic or nonoperative treatment. Fifty-three patients chose nonoperative treatment. Sixty-three patients elected to have arthroscopic procedures. The average patient age was 19.6 years. There were 59 men and 4 women. All procedures were performed within 10 days of dislocation. All 63 patients had hemarthrosis. Sixty-one of 63 (97%) patients treated surgically had complete detachment of the capsuloligamentous complex from the glenoid rim and neck (Perthes-Bankart lesion), with no gross evidence of intracapsular injury. Of the other two patients, one had an avulsion of the inferior glenohumeral ligament from the neck of the humerus, and one had an interstitial capsular tear adjacent to the intact glenoid labrum. Fifty-seven patients had Hill-Sachs lesions; none were large. There were six superior labral anterior posterior lesions, two with detachment of the biceps tendon. There were no rotator cuff tears. Of the 53 nonoperatively treated patients, 48 (90%) have developed recurrent instability. In this population, the capsulolabral avulsion appeared to be the primary gross pathologic lesion after a first-time dislocation. These findings, associated with the 90% nonoperative recurrence rate, suggest a strong association between recurrent instability and the Perthes-Bankart lesion in this population.

Adolescent↗