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Bilateral posterior shoulder dislocation is an uncommon complication of seizure activity. It may initially present in a manner that suggests other clinical entities. A case is reported of a man with blood pressure differences in his upper extremities after his first seizure who was found to have bilateral posterior dislocations of the shoulders.
14 shoulders with recurrent anterior dislocation were treated with a modified Bristow procedure and had a 38 to 66 months follow up after surgery. Postoperatively no patient had recurrent anterior dislocation. 4 patients had an average loss of external rotation of 10-15 degrees, one patient had a non-union of the transplanted coracoid. None of the patients was disappointed by the results.
Anterior shoulder dislocations, primary and recurrent, are among the most disabling injuries to the shoulder that can plague the athlete. The diagnosis is easily made by the following: the physical appearance of the shoulder; loss of capability by the athlete to internally and externally rotate the shoulder with the elbow at his side; by evaluating the mechanism of injury; and x-rays. Anterior shoulder dislocations should be reduced as soon as possible after diagnosis, to minimise the stretching effect on the neurovascular structures while the humeral head is dislocated. The reduction is not done to allow the athlete to return immediately to sport. Use of a simple traction method in the first 10 to 15 minutes following the injury will result in a successful reduction in the vast majority of dislocations. Reduction of the humeral head can be confirmed by the athlete regaining the capability to internally and externally rotate his shoulder with his elbow at his side. Following reduction, the athlete should begin a treatment regimen which includes a restrengthening programme emphasising the muscles of internal rotation and adduction plus rigid restrictions of activities until the goals of the rehabilitation programme are satisfied. The author's experience with this treatment regimen with athletes at the United States Naval Academy, has shown a decrease of the recurrence rate of primary anterior shoulder dislocations to 25% versus the 80% recurrence rate we have become familiar with from studies done which did not stress specific rehabilitation programmes. The athlete should also be instructed in a self-performed traction method for reduction should a redislocation occur, to minimise the stretching effect on the neurovascular structures and allow relief from discomfort. Surgery for primary and recurrent anterior dislocations should only be considered when the athlete fails to achieve the desired goals after participating in a specific, progressive, adequate rehabilitation programme.
Posterior shoulder dislocation is a very rare injury, accounting for only 1-2% of all shoulder dislocations. It is very often misdiagnosed because its clinical symptoms are not characteristic and the X-ray pictures are often misinterpreted. In many cases this means delayed treatment and impaired shoulder function. The most common cause of posterior shoulder dislocation is an epileptic seizure. In approximately 50% of all cases a ventral impression fracture of the humeral head is diagnosed. This is known as the "reverse Hill-Sachs lesion". About 10% of all posterior shoulder dislocations are associated with fracture of the lesser tuberosity of the humerus. In this paper a case of bilateral posterior shoulder dislocation with bilateral fracture of the lesser tuberosity of the humerus is described. The luxations were caused by an epileptic seizure following chronic alcohol abuse. Following early commencement of an exercise programme excellent results were obtained, and no redislocations occurred.
Acute anterior shoulder dislocation is a common disorder confronting the emergency physician. Traditional methods of reduction are often technically difficult, time consuming, and painful to the patient. Furthermore, they frequently require more than one physician and occasionally exacerbate the injury. Conversely, the recently described method of reduction by external rotation is a reliable and safe method. A single physician performs the reduction rapidly and patients tolerate it well.
Shoulder joint dislocations collected from a randomized population were investigated in Sweden, wherein nearly 50% of people with primary dislocations never visit hospitals nor are treated by a physician. Thus information obtained from surgically treated patients is of limited value because cases requiring operative repair represent only a small and selected percentage of the population. The incidence of shoulder dislocation in people from 18 to 70 years of age was at least 1.7% and was three times more common in males. Spontaneous healing of recurrent dislocations in a period of many years was not uncommon. Shoulder joint dislocation was more common among children than was generally appreciated, with the prognosis usually good. Recurrences of primary dislocations in people 15 to 25 years of age were not as frequent as was expected.
AIM: Sonography of the shoulder is an effective method for detecting tears of the rotator cuff and bone lesions. The purpose of this study was to evaluate prospectively the sonographic findings after shoulder dislocation. METHODS: Sonography was performed on 208 patients with 210 shoulder dislocations, which were all verified by radiography. RESULTS: We diagnosed 62 rotator cuff lesions (29.5%), which were all in the group with traumatic shoulder dislocation. The incidence of tears in patients with first traumatic dislocation (n = 134) was 36.5%. 12 tears (21.8%) of the rotator cuff were noted in recurrent dislocations (n = 55). 23 fractures or bony avulsions of the greater tuberosity of the humerus (11%) and 168 Hill-Sachs lesions (80%) were seen. CONCLUSION: Sonographic examination of the shoulder revealed a significant amount of information that would remain undetected without the aid of expensive and/or invasive diagnostic tools.
Recurrent anterior shoulder dislocation in the elderly is not as exceptional as it was once thought to be. That anterior shoulder dislocation in older patients is caused by a rotator cuff tear through the posterior mechanism is well accepted. However, in the subset of patients who have multiple recurrent or intractable dislocations develop, there may be combined pathologic conditions at work: large or massive rotator cuff tears together with anterior capsulolabral injuries such as a Bankart lesion or fracture of the glenoid rim. These patients have multiple recurrences because of disruption of both the anterior and the posterior stability mechanisms. We suggest a procedure that provides anterior stabilization with the capsular shift technique and that is supplemented by Bankart repair as necessary. The capsule transfer is performed superiorly and posteriorly to close the defect in the cuff. In this way a capsulodesis effect can be achieved that displaces the humeral head downward and produces active centering of the head in the course of abduction. Use of only the anterior capsule for the shift, and not the subscapularis tendon, does not compromise subscapularis function. Between 1990 and 1996, we used this technique to treat 16 patients older than 55 years of age with multiple recurrent anterior shoulder dislocation and massive rotator cuff tear. We report the results for the first 10 patients with a minimum follow-up of 2 years (range 2 to 7 years) and an average follow-up of 52 months. There were 7 excellent results, 2 good results, and 1 fair result according to the Rowe criteria. None of the patients had a recurrence of the dislocation. All the patients regained full or functional range of motion with stable shoulders, and most of them could perform activities of daily living without limitation. The average Constant score was 83%. This procedure appears to be successful in treating older patients with recurrent shoulder dislocation.
Posterior dislocation of the shoulder is an uncommon injury, accounting for between 2% and 4% of all shoulder dislocations. It occurs most frequently in patients following convulsions or direct anterior force to the shoulder. It is a particularly uncommon injury in sport. This paper reports an unusual case of bilateal locked posteriorly dislocated shoulders in a previously healthy young man who fell while playing football.
Arthrography of the shoulder was performed on 50 patients with acute traumatic shoulder dislocations. The mean interval between injury and arthrogram was 2.3 days, with a median interval of one day. Anterior dislocations occurred in 96% of patients, and posterior dislocations in 4%. Initial dislocations were present in 74%, and recurrent dislocations in 26%. The most frequent abnormality identified or arthrograms was an enlarged but intact shoulder capsule (58%), most commonly seen in shoulders subject to recurrent dislocations (77%). Shoulder joint capsular tears or disruptions were seen in 48% of the patients. The next most common lesion was fracture (52%), identified on standard roentgenograms. These included Hill-Sachs lesions (28%), greater tuberosity fractures (22%), and coracoid fractures (2%). Ruptures of the rotator cuff, present in 28% of the cases (14 patients), occurred more frequently in initial dislocations (62%) than in recurrent ones (36%). The high frequency of enlarged intact shoulder capsules, even after an acute initial joint dislocation (58%), suggests that the humeral head does not routinely rupture the capsule during dislocation, but rather tears the glenoid labrum at its bony attachment and dislocates subperiosteally, dissecting a false pouch below the periosteum and under the subscapularis.
BACKGROUND AND PURPOSE: Recurrent anterior shoulder dislocation is a serious condition, for which the Bankart procedure is a standard treatment. Having made three modifications to the original procedure, we examined the efficacy of this modified Bankart procedure in the treatment of patients with recurrent anterior shoulder dislocation. PATIENTS AND METHODS: The medical records of 21 patients who received a modified Bankart procedure for recurrent anterior shoulder dislocation during the period from 1989 through 1998 were retrospectively analyzed. The average age at initial dislocation was 22 +/- 5 years. The average postoperative follow-up period was 41 +/- 16 months. Three of the patients complained of mild shoulder pain before their operation. RESULTS: The postoperative loss of external rotation and abduction compared with the nonoperated side was 9 +/- 4 degrees and 5 +/- 4 degrees, respectively. There were no limitations in daily activities during follow-up. No patient had shoulder pain after surgery. Redislocation occurred in one patient during the follow-up period. Patient satisfaction was rated as excellent by 20 (96%) patients and poor by one. CONCLUSION: This modified Bankart procedure is a technically easy operation with a low complication rate, a high rate of patient satisfaction, and a low redislocation rate. It is a procedure of choice for the management of traumatic recurrent anterior shoulder dislocation.
We describe 3 patients whose shoulders dislocated as the movements of the arm were restricted during a generalized tonic clonic seizure over an 18-month period. The first patient had both shoulders dislocated when observers sat on his arms during the convulsion. The second patient had a convulsion while in a forced lateral decubitus position and dislocated the shoulder on that side. The third patient dislocated the shoulder and fractured the acromion as she was held by her arms in a chair during a convulsion. Despite the large number of patients with refractory epilepsy under our care, no cases of spontaneous shoulder dislocation occurred during that period of time.
We are reporting the results of labrum reconstruction following recurrent dislocations of the shoulder. From 1985 to 1988 35 patients (27 male/eight female) aged 28.4 years on the average (20 to 45 years old) had surgical treatment. 33 of these 35 came in for a follow-up about 40 months later (28 to 60 months). So far, only one patient suffered a re-dislocation from major trauma. In that case, therapy was continued on a conservative basis and the patient has been free of complaints and re-dislocation for three years. No one of the remaining 32 patients had another dislocation. Shoulder mobility is normal in 29 patients. One patient's abduction is impaired by 10 degrees and one has a 10 degrees to 15 degrees impairment of outward rotation. 30 patients have no complaints whatever. 32 patients consider the outcome satisfactory and only one does not. 30 of 33 patients say their dexterity in sports is the same as prior to the accident and only three feel slightly impaired during competitive sports.
161 consecutive patients with traumatic shoulder luxation between 1975 and 1983 are followed, concerning their evolution to recurrent shoulder dislocation. In 26 patients there was a recurrent shoulder dislocation in a mean time of 19 months after the first luxation. In literature the common level of recurrent dislocation is higher than our 16.1%, despite of the shorter immobilising time after the first shoulder luxation in our center. When there is no evolution to recurrent dislocation, a stable shoulder and a normal shoulder function without pain can be expected in 95%. The compression fracture of the humeral head and the avulsion of the glenoid margin were made responsible for the recurrent dislocation, mostly appearing in adult men, younger than 35 (55% of all recurrent dislocations). Because avulsion fractures of the tuberculum majus don't lead to an unstable fracture neither the existence of a compression defect in the humeral head is pathognomonic for an unstable shoulder, nor a lack of such radiological appearance excludes a recurrent dislocation. In first instance rotatory cuff injuries could be responsible for the instability of the shoulder joint. All patients with this invalidating injuries should be stimulated to an operative procedure, because after correction of an unstable shoulder by a derotation osteotomy of Weber or the elevation of the anterior margin of glenoid in the technique of Trillat good results with normal functional capacities of the shoulder can be expected.
Posterior shoulder dislocation is a relatively uncommon event, with an incidence of 1% to 4% of all shoulder dislocations. Because of the infrequency of this condition, the diagnosis is often missed, with significant consequences to the patient Injury in the athlete is usually from a direct blow or fall onto an outstretched arm. After such an injury, symptoms may be confused with a shoulder contusion or rotator cuff injury. Significant complications such as chronic posterior dislocation and degenerative disease of the shoulder can occur if the diagnosis is missed. A careful history and physical examination, complete radiographic evaluation, and a high level of suspicion are required to identify posterior shoulder dislocation. Treatment consists of prompt closed reduction, or operative repair if this is unsuccessful.
Posterior dislocation of the shoulder is rare. Only 2% of dislocated shoulders are displaced posteriorly, and these are chiefly of the subacromial type. Over 60% of the cases are not diagnosed initially because the arm is held in the normal position of adduction and internal rotation. The most consistent findings on physical examination are: the fixed internal rotation of the arm and the characteristic movement of the scapula with abduction of the upper extremity. It is essential that appropriate radiographs are obtained to correctly diagnose the dislocation. While the routine anteroposterior shoulder film is often enough to diagnose various anterior dislocations, it is not sufficient to diagnose the subacromial type of posterior dislocation. We recommend an anteroposterior view and an axillary lateral or tangential scapula view.
Posterior dislocations of the shoulder are rare, comprising only 4% of shoulder dislocations. Several operative procedures have been described in treating recurrent dislocations, and results have been varied. A retrospective review of eight shoulders in eight patients treated by posterior glenoidplasty with capsulorrhaphy and infraspinatus advancement revealed generally good results. Followup ranged from 10 to 114 months, with an average of 36 months. Seven patients were classified as recurrent traumatic dislocators and one as a recurrent atraumatic voluntary dislocator. Results graded as good, fair, and failure were based on pain, range of motion, return to activities, recurrence, and roentgenograms. Six patients had good results with return to full activity, full range of motion, no pain, no recurrence, and no degenerative changes of roentgenograms. One patient, who has not returned to athletic activities and has occasional pain and limited range of motion, was graded as a fair result. The patient classified as an atraumatic voluntary dislocator has occasional feelings of instability and slight pain with strenuous activity, but has not had a recurrence and has no difficulty with activities of daily living. She was also classified as a fair result. There have been no recurrences or degenerative changes on followup radiographs. Computerized tomography performed on two patients documented a definite change in orientation of the glenoid. We feel that glenoidplasty with capsular reefing and infraspinatus advancement, if performed carefully, provides an excellent operative treatment for recurrent posterior dislocations of the shoulder.
Dislocations of the shoulder are the most common joint dislocations seen in the emergency department, and complications of shoulder dislocations are more frequent than is generally believed. It is vital that emergency physicians have current knowledge of complications associated with shoulder dislocations because of their important role in recognition and prevention. Delayed recognition of complications can have an impact on the long-term outcome of patients. Prompt recognition and follow-up are essential. Most references address reduction methods rather than recognition of specific complications. Emergency physicians have few opportunities to update their knowledge of complications of shoulder dislocations. This article briefly reviews mechanisms of shoulder dislocation and discusses complications in light of the mechanisms of injury.