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PubMedDate not supplied

Prospective evaluation of arthroscopic stabilization of acute, initial anterior shoulder dislocations in young athletes. Two- to five-year follow-up.

From March 1992 to November 1998, 57 patients sustained 58 acute, initial, traumatic anterior shoulder dislocations at the United States Military Academy. Six patients selected nonoperative treatment. Three patients underwent primary open repair after diagnostic arthroscopy revealed no Bankart lesion amenable to repair with the bioabsorbable tissue tack. The remaining 48 patients with 49 anterior dislocations were treated with arthroscopic primary repair. There were 45 men and 3 women with an average age of 20 years (range, 17 to 23) and an average follow-up of 37 months (range, 24 to 60). The average Rowe score was 92 (range, 30 to 100). The average single assessment numeric evaluation patient rating was 95.5% (range, 50% to 100%). The average Short Form-36 score (physical function) for the stable shoulders was 99 (range, 95 to 100). Forty-three shoulders remained stable (88%). There were six failures (12%). Factors associated with failure included a history of bilateral shoulder instability, a 2+ sulcus sign, and poor capsulolabral tissue at the time of repair. All patients with stable shoulders returned to their preinjury levels of athletic activity. With follow-up of 5 years, we have observed significantly better results compared with nonoperative treatment in young, active adults at the United States Military Academy.

Acute Disease↗
PubMed1989

[Shoulder dislocation and -subluxation].

The diagnosis and treatment of shoulder instability require basic differentiation between unidirectional, multidirectional, and voluntary dislocation. Within unidirectional instability primary dislocation, recurrent dislocation, and recurrent subluxation need to be considered separately.--Primary dislocation: In 160 patients with primary dislocation a follow-up was done by questionnaire. In the case of atraumatic primary dislocation the redislocation rate was 100%. Predisposing factors inherent in the bony, cartilaginous, and capsular components of the joint favoured the tendency of primary dislocation. In the case of traumatic primary dislocation the redislocation rate was lower after immobilisation of the joint than without when it had not been immobilised.--Recurrent subluxation: In 52 patients with a clinical diagnosis of recurrent subluxation a tear of the glenoid labrum was found by arthroscopy. In 21 cases the detached labrum was refixed arthroscopically and in 18 cases the repair was done by an open Bankart procedure. Seventy-two percent of the patients who underwent arthroscopic repair showed good to excellent results. In all cases but one in which the Bankart procedure was applied the results were excellent.--Recurrent dislocation: Since 1984 a total of 183 patients were operated on for recurrent shoulder dislocation. All these patients were examined preoperatively by CT scan. The CT findings were used in selection of the appropriate procedure. In 114 patients the Bankart procedure was applied and in 39 cases, a bone-block method. The remaining patients were subjected to various other procedures. Not one of the patients showed postoperative redislocation. (ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2004

Combined anterior and posterior shoulder dislocation as a manifestation of a brain tumour.

Seizures are sometimes the first manifestation of a brain tumour. They may give rise to shoulder fractures or fracture-dislocations. When bilateral, these lesions tend to be symmetrical. The patient reported here suffered from a previously undiagnosed brain tumour, the first manifestation of which were seizures, which provoked a bilateral shoulder dislocation in opposite directions. The posterior dislocation was recognized with a delay of 16 days. After an episode of seizures, shoulder dislocation can occur in either direction, and bilateral shoulder dislocations may not be symmetrical.

Accidental Falls↗
PubMed1998

Bioabsorbable tacks for arthroscopic treatment of recurrent anterior shoulder dislocation.

Seventy-eight patients (82 shoulders) with symptomatic, recurrent anterior post-traumatic shoulder instability and Bankart lesions were operated on with bioabsorbable tacks (Suretac fixators). All the patients were followed by an independent observer, with a median follow-up period of 27 (21-63) months. The recurrence rate was 8/82 (10%). The median Rowe score was 93 (37-100) points. The median Constant score for the index shoulders was 90 (34-100) points, compared with 93 (80-100) points for 59 non-operated healthy shoulders from the same cohort (P=0.03). The external rotation in abduction was 93 (50-135) degrees compared with 105 (75-145) degrees for the control shoulders (P=0.0018). Arthroscopic shoulder stabilization using bioabsorbable Suretac fixators appears to produce reliable results if used in patients with post-traumatic shoulder instability and a Bankart lesion.

Absorbable Implants↗
PubMed2002

Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. Intra-articular lidocaine for acute anterior shoulder dislocation reduction.

A short cut review was carried out to establish how intra-articular lidocaine compared with intravenous analgesia and sedation during reduction of anterior shoulder dislocations. Altogether 146 papers were found using the reported search, of which three presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of these best papers are tabulated. A clinical bottom line is stated.

Acute Disease↗
PubMed1981

Reduction of acute anterior shoulder dislocations using the Milch technique: a study of ski injuries.

During the 1977-78, 1978-79, and 1979-80 ski seasons, 76 acute anterior shoulder dislocations were treated by one of three Orthopedic Surgeons at the Rutland Vermont Hospital Emergency Room: 68 (89.4%) were reduced on first attempt using the Milch technique of abduction and external rotation. Four (5.2%) required general anesthesia and four were reduced using meperidine hydrochloride (Demerol, Winthrop) and diazepam (Valium, Roche) and a traction-countertraction technique. Of the 68 shoulders reduced with the Milch technique, 47 (69.1%) required no analgesics or muscle relaxants. There were no complications attributable to the technique itself. Males were injured more frequently than females in a 4.4:1 ratio. Left shoulder injuries were as common as right. Recurrent dislocations occurred more frequently in younger individuals. Fractures of the greater tuberosity were associated injuries in five (6.6%) of all dislocations. These all occurred in individuals older than age 39 years and were coincident with primary dislocations.

Adult↗
PubMed1984

The treatment of recurrent anterior shoulder dislocation by the modified Bristow-Helfet procedure.

South African orthopaedic surgeons have been in the forefront of the development of reconstructive procedures performed for recurrent anterior shoulder dislocation. In addition to the Johannesburg stapling operation described by G. T. du Toit and D. Roux, Professor A. Helfet of Cape Town was the first to describe the coracoid transplantation operation in 1958. A modified form of this operation was performed on 31 patients between August 1975 and February 1981. Patients were followed up for a mean period of 38 months, and no recurrences were encountered in patients who had had true involuntary recurrent subluxation or dislocation. The operative technique is described in detail as it is considered that adequate exposure and accurate placement of the coracoid process are very important factors in obtaining a satisfactory result and in the prevention of complications. It has been postulated that this operation, which does not attempt to shorten the capsular structures or subscapularis tendon, affords a superior result in respect of patients who participate in throwing sports. It has been noted that patients who play cricket, baseball and basketball have encountered problems in regaining their ability to throw overhand after having had operations such as the Putti-Platt procedure, which entails intentional shortening of the capsular structures and subscapularis tendon.

Bone Screws↗
PubMedDate not supplied

Acromion fracture associated with posterior shoulder dislocation.

We report a case involving combined acromion fracture and posterior glenohumeral dislocation. To our knowledge, this combination of injuries has not been reported previously in the literature. In our case, the shoulder dislocation was initially missed. The utility of additional radiographic views to detect this type of injury is emphasized. The mechanism of injury, course of treatment, and clinical outcome are presented.

Acromion↗
PubMed2002

Anterior shoulder dislocation: an unusual complication.

A case of transection of anterior circumference humeral artery, a branch of the 3rd part of the axillary artery is reported, after a simple anterior shoulder dislocation. This complication though rare could potentially result in catastrophic consequences for the patient. It should therefore be recognised early and a coordinated prompt vascular and orthopaedic surgical treatment given for better upper limb functional outcome.

Aged↗
PubMed1990

Roentgenographic evaluation of suspected shoulder dislocation: a prospective study comparing the axillary view and the scapular 'Y' view.

This study compares the axillary and the scapular "Y" view in 75 consecutive patients with suspected shoulder dislocation who were evaluated according to a prospective protocol. In each patient, an AP, axillary, and scapular "Y" view was obtained. Evaluation was by the following criteria: accuracy of diagnosis; patient preference; ease of technique; and diagnosis of associated pathology. In 69 cases (92%), the scapular "Y" view and axillary view resulted in the same diagnosis. However, in six cases (8%), the axillary view failed to give the correct diagnosis when compared to the scapular "Y" view. Sixty-one patients (81%) preferred the scapular "Y" view to the axillary view because of less pain. Once the technician was adept with the scapular "Y" view, it was preferred and was considered easier to obtain than the axillary view. With the exception of the Hill-Sachs lesion, the axillary view and scapular "Y" view visualized associated pathology equally well. A new method to obtain the scapular "Y" view is described. The technique is easy to use, and routinely results in an accurate diagnosis with minimal patient discomfort.

Adolescent↗
PubMedDate not supplied

Recurrent anterior shoulder dislocation: preliminary experience in 29 cases treated by the Neer method and Statak screws.

The authors describe the surgical method used and present the preliminary results obtained in 29 patients affected with recurrent anterior dislocation of the shoulder treated by Neer capsuloplasty and Statak screws. The long-term results were evaluated based on the Rowe system: the score was excellent in 18 cases, good in 2, fair in 4, and poor in 5. All of the patients resumed work activity, with no restrictions, within 4 months of the onset of functional rehabilitation. The use of Statak screws allows us to simplify surgery, while guaranteeing repair of the Bankart lesion, when present. The method reported permits correction of instability, without excessive reduction of joint movement.

Adolescent↗
PubMed1993

[Results of treatment of multiple ventral shoulder dislocation and surgical stabilization by Weber rotational osteotomy. 78th Annual Meeting of the Swiss Society of Trauma Surgery and Occupational Diseases 4-5 September 1992 in Olten].

The treatment of recurrent anterior shoulder dislocation with the rotational humeral osteotomie by Weber showed best results in the follow-up of 53 operations when combined with a shortening of the capsule and the musculus subscapularis. Rotational humeral osteotomie alone showed in 20% redislocations. The rate of redislocation could significantly be reduced by additional shortening of the soft tissue.

Adolescent↗
PubMed1999

Anesthetic methods for reduction of acute shoulder dislocations: a prospective randomized study comparing intraarticular lidocaine with intravenous analgesia and sedation.

A prospective, randomized, nonblinded clinical trial was undertaken to evaluate whether local intraarticular lidocaine injection (IAL) is equally effective in facilitating reduction of acute anterior shoulder dislocations (AASD) as intravenous analgesia/sedation (IVAS). The setting was an urban, Level 1, trauma center. Patients enrolled presented to the emergency department (ED) with radiographically confirmed AASD and were randomized either to the IVAS group or the IAL group. Ease of reduction and pain associated with reduction were measured subjectively using a 10-point scale. There were 49 patients entered into the study, 20 in the IVAS group and 29 in the IAL group. There was no statistically significant difference between mean +/- SD pain scores of 3.32+/-2.39 in the IVAS group and 4.90+/-2.34 in the IAL group (P = .18), or mean +/- SD ease of reduction scores of 3.32+/-2.36 in the IVAS group and 4.45+/-2.46 in the IAL group (P = .12). Although IVAS tended to have a higher success rate (20 of 20) than IAL (25 of 29) in this study, Kaplan-Meier estimates for delayed time-events curves applying the log-rank test showed that this difference was not statistically significant overall (P = .16). However, with reduction rate evaluated as a function of time delay in seeking treatment, patients presenting 5.5 hours after dislocation were more likely to fail treatment with IAL (P = .00001). Additionally, half of the patients in the IAL group who had experience with IVAS did not favor IAL. Emergency physicians should be aware of IAL as an alternative technique that may be considered in patients when there are reasons to avoid systemic analgesia or sedation.

Adult↗