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At least 325 records · Page 18Linked to original sources
PubMed2006

Axillary arterial thrombosis secondary to anterior shoulder dislocation.

We report the case of a 59-year-old male patient who returned to the Hospital with severe pain in the right upper arm, 9 hours after reduction of an anterior dislocation of the right shoulder. A thrombosis of the axillary artery was quickly diagnosed and the rapid treatment allowed revascularisation in the arm without any major consequences.

Axillary Artery↗
PubMedDate not supplied

Arthroscopic transglenoid suture repair for initial anterior shoulder dislocation.

PURPOSE: To evaluate the long-term results after arthroscopic transglenoid suture repair for initial anterior shoulder dislocation. TYPE OF SYUDY: Outcome study. MATERIALS AND METHODS: Selection for surgery was based on the sporting ambitions of the patients and the documentation of instability. Evidence of instability included the sonographic documentation of ventral drawer compared with the unaffected opposite shoulder as well as instability testing under anesthesia. Patients with preoperatively stable shoulder or multidirectional instability underwent conservative therapy. All patients underwent surgical repair with a transglenoid suture technique, initially using a single drill hole; in recent years, however, we have used 2 drill holes placed in the 3 o'clock and 5 o'clock positions. Postoperative care was initiated with 4-week immobilization in a Gilchrist bandage. Subsequently, physiotherapeutic mobilization was started, avoiding rotational movements for the first 3 weeks. In the period between 1988 and 1995, 72 patients with traumatic first-time dislocation underwent arthroscopic stabilization at the Department of Trauma Surgery of the Krankenhaus der Barmherzigen Brüder Eisenstadt. The patients included 61 men and 11 women with an average age of 27.2 years (range, 19 to 39 years). RESULTS: The clinical instability documented showed a significant correlation to the instability found under anesthesia that was documented immediately before arthroscopic exploration. Arthroscopic exploration revealed a Bankart lesion in 25 cases (34.7%), with a small bone fragment found in 6 of these cases. Forty-three patients showed an avulsion of the capsulolabral complex displaced medially to the neck of the scapula, combined with a bucket-handle lesion of the superior anteroposterior labrum in 12 of these cases. Sixty-seven patients (93%) were available for clinical follow-up after an median of 66 months (range, 24 to 108 months) with patients achieving an average 91.3 points in the Carter-Rowe score. Five of the patients (6.9%) (average age, 20.4 years) experienced postoperative redislocation after 3 to 11 months being the result of an adequate trauma in 2 of the patients. All patients with redislocation had originally presented with a Bankart lesion, with medially displaced capsulolabral complex combined with a bucket-handle lesion of the proximal labrum in 2 patients. Eighty-five percent of the patients have resumed full sporting activity and presently have full load-bearing capacity of the operated shoulder. CONCLUSIONS: Compared with the poor results after conservative therapy with recurrence rates of up to 90% for young, athletically active patients, arthroscopic treatment has been shown to be highly efficient.

Adult↗
PubMed1994

[Traumatic pseudoaneurysm of the axillary artery after shoulder dislocation].

By means of a case report the diagnostic and therapeutic procedures and prognosis of a pseudo-aneurysm of the axillary artery after shoulder dislocation are demonstrated. The diagnosis of aneurysms of the axillary artery is difficult in some cases. It is important to mention a possible vascular injury in case of close reduction of the shoulder. Therefore in all patients with a penetrating or blunt trauma of the shoulder or the upper arm a thorough neurovascular examination is required. In patients with neurologic deficits or alteration of the pulse a duplex ultrasound examination should be performed and in dubious cases an additional arteriography is indicated.

Aged↗
PubMed2000

[Diagnosis and therapeutic management following traumatic anterior shoulder dislocation according to extrinsic prognostic factors].

We examined the importance of preoperative CT- and NMR-imaging concerning the detection of a bankart-lesion by a retrospective evaluation of 36 patients with primary traumatic or posttraumatic recurrent shoulder dislocations. Because of unfavourable extrinsic prognostic factors, we advised shoulder arthroscopy and surgical stabilization in all cases. Intraoperatively 35 of 36 patients (97%) presented a bankart-lesion. Preoperatively a bankart-lesion was detected in 32 cases (91%) by CT (n = 29) or NMR (n = 7). We could predict the probability of a bankart-lesion with a high reliability by clinical evaluation alone due to several risk-factors. All patients had at least 2 unfavourable prognostic factors. Under these circumstances we could assume a bankart-lesion with a probability of 97%. Therefore in our opinion preoperative CT or NMR is not advised as standard diagnostic procedure in patients with high-risk of recurrence according to extrinsic prognostic factors. We recommend preoperative CT or NMR when the estimation of prognostic factors concerning the risk of redislocation is doubtful and in case of difficult clinical and ultrasound examination regarding shoulder laxity or rotator cuff lesions.

Adolescent↗
PubMed1999

Posterior shoulder dislocation associated with fracture of the humeral anatomic neck: treatment guidelines and long-term outcome.

OBJECTIVE: We describe here 10 cases of posterior shoulder dislocation associated with fracture of the humeral anatomic neck. METHODS: Patients were treated according to our uniform treatment guidelines, in which only the dislocated humeral head (closed, if possible) was reduced, without any concomitant repositioning or internal fixation for fractures. RESULTS: Reduction resulted in an acceptable repositioning of the fractured fragments in all but one case. Anatomic neck fractures were impacted by applying longitudinal pressure for stabilization. Although early physiotherapy was initiated, redisplacement of the bone fragments did not occur. Of nine patients who were followed for more than 2 years, complete recovery of function was achieved in all but two patients. The completely detached humeral head became avascular necrotic accompanied by subchondral collapse in one case, and in the other case the displaced lesser tuberosity caused a decreased range of movement. CONCLUSION: We recommend initially treating such patients by either open or closed reduction of the dislocated humeral head and impaction of the fracture, with neither repositioning nor internal fixation of any of the fractured fragments. A completely detached humeral head or bone fragments displaced more than 10 mm after reduction of the dislocated humeral head contraindicate the use of this method.

Adult↗
PubMedDate not supplied

[Surgical treatment of recurrent anterior shoulder dislocation using the Bazy-Savić method. 40 years' experience].

The fourty-year experience in the treatment of 328 patients with recurrent anterior shoulder dislocations using the Bazy-Savić method has been presented. Reintervention due to recurrent dislocation was performed in 12 (3.6%) patients. During a ten-year period questionnaires were sent to 105 operated patients and 76 patients replied. Satisfactory results were achieved in 69 (90.7%) patients.

Adolescent↗
PubMed2006

Survey of the management of acute traumatic first-time anterior shoulder dislocation among trauma clinicians in the UK.

INTRODUCTION: The aim of this work was to survey how acute traumatic first-time anterior shoulder dislocation (AFSD) is managed among trauma clinicians in UK using a postal questionnaire. PATIENTS AND METHODS: A total of 150 questionnaires were sent out to active consultant members of the British Trauma Society in the UK. Questions were laid out in two 'workgroups'. In Workgroup One, an assortment of questions was included regarding choices and methods of analgesia, methods of monitoring used, methods of reduction, and position of immobilisation. In Workgroup Two, three different case scenarios were analysed to look into the 'post-reduction' management. RESULTS: The response rate was 60%. Of respondents, 22% have a local protocol for managing AFSD. Almost all respondents recommended pre- and post-reduction X-rays as standard practice. Most respondents favoured systemic analgesia and sedation with airways' monitoring, as opposed to intra-articular anaesthesia (68 versus 9). Eighty-four respondents advocated immobilisation in internal rotation compared to six in external rotation. Only 19% (16 of 84) of respondents would perform an immediate arthroscopic stabilisation in young, fit patients presenting with this type of injury. CONCLUSIONS: This survey revealed variations among trauma clinicians in managing AFSD on the 'front-line'. There is a need to address the issue of intra-articular analgesia, immobilisation technique and management of AFSD in the young patient with regards to immediate surgical intervention. We suggest that these issues be revised and clarified, ideally in a randomised, controlled, clinical trial prior to the introduction of a protocol for managing this problem.

Adolescent↗
PubMedDate not supplied

A prospective arthroscopic study of acute first-time anterior shoulder dislocation in the young: a five-year follow-up study.

A prospective arthroscopic study was conducted on 31 patients with an acute first-time anterior shoulder dislocation (AFASD). The patients were aged between 16 and 39 years. The mean age was 24 years. None had a history of shoulder problems. All were evaluated after 1, 2, and 5 years. The Constant score, Rowe score, recurrence rate, and instability rate were evaluated, as well as patient satisfaction and sports participation. We conclude that after a prolonged follow-up, an increase in the instability rate in young patients with AFASD may become apparent. The overall instability rate was 55% (17/31) after 5-year follow-up. In patients aged younger than 18 years the instability rate was 71% (5/7). Age was the only predictive factor in shoulder instability. The mean Rowe score was 87 (range, 57-100; SD, 14). Three patients had undergone a stabilization operation at the 5-year follow-up. The intraarticular pathology found at arthroscopy was not predictive of shoulder instability. We could not find a correlation between sporting activities and shoulder instability. On the basis of our results, it appears unlikely that arthroscopic lavage reduces redislocation rates after AFASD in the young patient.

Adolescent↗
PubMed2006

Evaluation of propofol and remifentanil for intravenous sedation for reducing shoulder dislocations in the emergency department.

OBJECTIVES: To assess the combination of propofol and remifentanil for sedation to reduce shoulder dislocations in an ED. METHODS: Eleven patients with anterior glenohumeral dislocation were given propofol 0.5 mg/kg and remifentanil 0.5 microg/kg iv over 90 seconds and then further doses of 0.25 mg/kg and 0.25 microg/kg, respectively, if needed. Another practitioner attempted reduction using the Milch technique. RESULTS: Reduction was achieved in all patients within four minutes of giving sedation (range 0.3-4; mean 1.6). Seven required one attempt at shoulder reduction, three required two attempts, and one required three attempts. Mean time to recovery of alert status was three minutes (range 1-6). The mean pain score during the reduction was 1.7 out of 10 (range 0-5). Nine patients had full recall, one had partial recall, and one had no recall at all. Eight patients were "very satisfied" with the sedation and three were "satisfied". There were no respiratory or haemodynamic complications that required treatment. CONCLUSIONS: Propofol and remifentanil provide excellent sedation and analgesia for the reduction of anterior glenohumeral dislocation, enabling rapid recovery.

Adolescent↗
PubMedDate not supplied

Shoulder dislocation in Swedish ice hockey players.

1. Humeroscapular dislocation, primary or recurrent, is found in 8% of elite ice hockey players in Sweden. 2. The dislocation recurs in 90% of greater than 20-year-old players and the frequency diminishes with increasing age. 3. The duration of immobilization after the first dislocation bears no sure relation to the risk of recurrence. 4. In 80% of the cases, the operated shoulder was the one that predominates in ice hockey, usually the left. Of the 32 operated players, 30 have been able to continue with ice hockey and relatively marked postoperative loss of mobility has been tolerated well. 5. Even without an operation, a recurrent shoulder dislocation did not prevent one-third of the players from continuing with ice hockey.

Adult↗