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PubMed2000

Posterior shoulder dislocation: avoiding a missed diagnosis.

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.

Accidental Falls↗
PubMed1990

[Posterior shoulder dislocation. An often overlooked injury].

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.

Adult↗
PubMedDate not supplied

Operative treatment of posterior shoulder dislocations by posterior glenoidplasty, capsulorrhaphy, and infraspinatus advancement.

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.

Adolescent↗
PubMed1999

Complications of shoulder dislocation.

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.

Biomechanical Phenomena↗
PubMed2001

An easy method to reduce anterior shoulder dislocation: the Spaso technique.

OBJECTIVE: To introduce the Spaso technique for reducing anterior shoulder dislocation by reporting the success rate of the Spaso technique performed by junior emergency medicine residents. DESIGN: Retrospective case series. SETTING: Urban accident and emergency department. PARTICIPANTS: Patients with anterior shoulder dislocations. INTERVENTIONS: The Spaso technique was applied by the emergency medicine residents to reduce anterior shoulder dislocation. RESULTS: The emergency medicine residents applied the Spaso technique to reduce 16 cases of anterior dislocated shoulder during the study period. The Spaso technique was successful in 14 of 16 cases. The overall success rate was 87.5% (95% CI 60.4, 97.8%). No complications were noted. CONCLUSION: A new method has been introduced for reduction of anterior shoulder dislocation by reporting the experience of junior residents. The Spaso technique is simple, effective and able to be performed by single operator. Although the sample size was small, the result of the study could provide background information for planning a properly designed randomised controlled trial to evaluate the Spaso technique.

Adult↗
PubMed2001

Seizures, lateral decubitus, aspiration, and shoulder dislocation: Time to change the guidelines?

The recommendation to position a patient having a seizure on a lateral decubitus is aimed at minimizing the risk of aspiration. The authors reviewed the database of the Epilepsy Foundation Clinic of South Florida for patients with epilepsy treated for pneumonia between May 1999 and May 2000 and patients admitted to two university telemetry units who had dislocation of the shoulder during an epileptic seizure. Over 2 months, 2 of 733 adults with intractable seizures had aspiration pneumonia after a generalized tonic clonic seizure (GTCS). Although no study has specifically addressed the problem of aspiration pneumonia in adults with GTCS, our findings suggest this problem is not common. From the two epilepsy centers, 5 of 806 patients dislocated a shoulder during a seizure. Video recordings showed that these patients were positioned in a lateral decubitus by staff while still having the convulsion. The dislocated shoulder in all cases was on the lower side. The risk of shoulder dislocation in a convulsing patient positioned in a lateral decubitus is less than 1%. Nevertheless, dislocations can result in disabling recurrences and are easily preventable. Because aspiration is more likely in the postictal rather than ictal phase of a GTCS, when oral secretions are not usually increased and there is cessation of respiratory movements, lateral decubitus should only be implemented after cessation of the convulsion, In inpatients (such as those on telemetry), secretions may be better managed by bedside aspiration of the oral cavity.

Epilepsy↗
PubMed1995

Bone buttress operation for recurrent anterior shoulder dislocation in epilepsy.

Patients suffering from generalised convulsions may dislocate their shoulders either anteriorly or posteriorly. Those with anterior dislocation are likely to have recurrent episodes because of secondary bony damage to the anterior rim of the glenoid and head of the humerus. In such patients there is high rate of failure of the standard soft-tissue stabilisation procedures. We have therefore devised a bone buttress operation in which autograft or allograft is secured to the deficient anterior glenoid and shaped to form an extension of its articular surface. We report our experience in 14 patients with grandmal epilepsy and recurrent anterior dislocation of the shoulder. After the bone buttress operation there were no further dislocations and all patients were satisfied despite a small restriction in their range of movement. We believe this to be the operation of choice for patients with this difficult problem.

Activities of Daily Living↗
PubMed2001

[Injury pattern in shoulder dislocation in the elderly patient].

PROBLEM: Recurrent shoulder dislocation is reported to be rare in older patients. While injuries of the glenoid labrum and the anterior capsule following primary dislocation in younger patients seem to determine the rate of instability, the pattern of damages in the elderly has rarely been studied. METHODS: 91 patients with an age older than 40 years with the diagnosis of primary (group A, n = 50) or recurrent (group B, n = 41) anterior shoulder dislocation were included in a prospective study. By analysis of the findings in x-rays, MRI, CT-scans and in 36 patients of diagnostic arthroscopy the pattern of intra- and periarticular pathology was evaluated. RESULTS: While the incidence of bony Bankart- and Hill-Sachs lesions was constantly spread over the age groups the pattern of soft tissue damages was different. Up to the age of 60 years lesions of the glenoid labrum were leading while in older patients the prevalence of rotator cuff tears became about 70 percent. CONCLUSIONS: The development of secondary osteoarthritis and persisting symptoms in older patients with rotator cuff tears after traumatic shoulder dislocation requires early diagnosis and appropriate treatment.

Adult↗
PubMed2000

Shoulder dislocations in the young patient.

Shoulder dislocations are often seen in young patients, particularly those patients involved in collision sports. A conservative approach to treating these injuries includes protection from early re-injury, rehabilitation, and gradual return to athletics and use. It is important to recognize associated injuries such as fractures and nerve injuries. Surgical management is considered early for the small subgroup with the highest risk of recurrence: young athletes suffering a first traumatic dislocation returning to competitive athletics. Late operative repair is reserved for those who fail extensive nonoperative management.

Adolescent↗
PubMed1984

The posterior mechanism of acute anterior shoulder dislocations.

A tear of the rotator cuff often accompanies primary acute anterior dislocations of the shoulder in older patients. These structures, weakened by wear or degeneration, tear when the shoulder dislocates, permitting the humerus to hinge on intact anterior structures. Three typical cases illustrate the posterior structural reactions to acute anterior dislocation.

Acute Disease↗
PubMed2002

Axillary artery injury secondary to anterior shoulder dislocation: report of two cases.

Vascular injuries secondary to isolated shoulder dislocation are rare. Unawareness for closed axillary artery trauma by many physicians treating shoulder dislocations, counts often for missed or delayed diagnosis. The authors describe two cases that presented with an anterior shoulder dislocation, complicated by a disruption of the axillary artery with subsequent thrombosis. The various pathogenic mechanisms are discussed. The pathognomic triad consists of anterior shoulder dislocation, absent or diminished distal pulse and an axillary protruding hematoma. Prompt surgical arterial repair is mandatory.

Accidental Falls↗
PubMed2001

[Therapy of traumatic anterior shoulder dislocation: current status of therapy in Germany. Are there scientifically verified therapy concepts?].

There are no generally accepted concepts for the treatment of traumatic anterior shoulder dislocation. The objective of this study was to ascertain the current treatment for traumatic shoulder dislocations in German hospitals and to compare this with the data reported in the literature. A total of 210 orthopedic surgery departments were asked for their treatment strategy in an anonymous country-wide survey; 103 questionnaires (49%) were returned for evaluation. Additional imaging (ultrasound, CT, MRI) beyond the routine X-rays is performed in 82% of clinics for primary shoulder dislocation (94% in recurrent dislocation). A young, athletic patient (< 30 years old) would be operated on for a primary traumatic shoulder dislocation in 73% of hospitals (98% in recurrent dislocation). In contrast, a patient of the same age, with a moderate level of sporting activity would be treated conservatively in 67% of cases (14% in recurrent dislocation). Similarly, for an active, middle-aged patient with a demanding job, 74% of responses favored conservative treatment after a primary dislocation and 6% after a recurrent dislocation. Older patients (> 65 years old) are usually treated conservatively after a primary or recurrent shoulder dislocation (99%, 69%). For a primary shoulder dislocation the most popular surgical reconstruction is a Bankart repair (75%). For recurrent shoulder dislocation several different operative techniques are seen (Bankart 29%, T-shift 26%, Putti-Platt 8%, Eden-Lange-Hybbinette 22%, Weber osteotomy 13%). Based on our literature review, we found: (1) The clinical examination of both shoulders is important to diagnose hyperlaxity; (2) Routine CT or MRI is not necessary for primary traumatic shoulder dislocations; (3) A young, athletic patient should undergo surgical reconstruction after a primary shoulder dislocation; (4) The operation of choice for primary and recurrent dislocation is the Bankart repair; (5) There is no sufficient evidence that an arthroscopic Bankart repair is as good as an open procedure; (6) There are limited indications for other operative techniques, as they are associated with a higher recurrence and arthrosis rate.

Adolescent↗
PubMed1999

Intra-articular lignocaine versus Entonox for reduction of acute anterior shoulder dislocation.

We assessed, in a prospective randomised trial, the relative analgesic effects of Entonox and intra-articular lignocaine (IAL) in patients with acute anterior dislocation of the shoulder. A statistically significant reduction in pain scores was achieved with IAL (7.9 vs 5.2, P < 0.05), but the effect with Entonox was greater (7.8 vs 2.9, P < 0.001). We conclude that Entonox provides better analgesia than IAL in patients with acute anterior shoulder dislocation.

Acute Disease↗
PubMed1997

Anterior shoulder dislocation reduction technique--revisited.

Acute anterior shoulder dislocations are extremely painful conditions that force patients to present to emergency rooms or physicians' offices immediately. The diagnosis usually is established through a careful history and examination, and may be confirmed by appropriate radiography. The immediate treatment objective is to achieve reduction as early as possible, preferably through a closed reduction method with the least discomfort. Current methods of reduction are based on either traction or leverage maneuvers, with each having its own merits and disadvantages. This article, however, revisits the subject by a comprehensive literature review. It addresses obstacles to reduction and reports a closed reduction technique for the acute anterior dislocations of the shoulder that uses both traction and leverage maneuvers simultaneously. In addition, the technique eliminates failing factors of current reduction methods such as the surgeons' weakening or slippery grip when using traction methods. It is expected, by virtue of the method, that it would reduce the chances for complications such as humeral shaft fractures as can occur in leverage maneuvers. This method addresses all potential anatomical and pathological features of acute anterior dislocations of the shoulder to facilitate an earlier and more comfortable reduction.

Adolescent↗
PubMed1995

A modified Bristow procedure for recurrent anterior shoulder dislocation.

BACKGROUND: Dislocation of the shoulder is one of our earliest frequent injuries. Many procedures have been evaluated for treatment of the condition since the mid 1960s. The modified Bristow procedure was initially described in 1970 by May. Technically easy, the procedure is very effective in prevention of redislocation, and has gained popularity over two decades of use. METHODS: A retrospective study was done of 32 patients with recurrent anterior shoulder dislocation, who had received modified Bristow procedure during the years 1987 through 1991 in this Hospital. Average followup period was 26 months. RESULTS: At postoperative evaluation, average loss of external rotation and abduction as compared to the nonoperated side were 15 and 10 degrees, respectively. There was no limitation on daily activity, but some little restriction in extreme throwing sports was found. Postoperative complications included three patients who had bone block resorption and one patient who had superficial wound infection. There was no redislocation nor implant loosening in the study. CONCLUSIONS: This procedure is technically easy, had a low rate of complication, a high degree of patient satisfaction and very effectively prevents redislocation.

Adolescent↗
PubMed1993

[Nuclear magnetic tomography in shoulder dislocation].

Sixty-two patients with anterior shoulder dislocations were examined by magnetic resonance imaging (MRI). After a primary dislocation, 30 patients showed 23 (77%) tears of the glenoid labrum, 13 (45%) anterior-inferior separation of the capsula, 24 (83%) Hill-Sachs lesions, 6 fractures of the greater tuberosity and 4 glenoid rim fractures. Thirty-two patients with recurrent shoulder dislocation had 14 (44%) tears and 15 (47%) defects of the glenoid labrum, 16 (50%) anterior-inferior separation of the capsula, 28 (88%) Hill-Sachs lesions and 3 glenoid rim fractures. MRI permits complete non-invasive documentation of glenohumeral instability if joint effusion is present. In the absence of joint effusion, diagnostic accuracy can be improved by application of a contrast medium.

Adolescent↗
PubMedDate not supplied

Anterior shoulder dislocation. A simple and rapid method for reduction.

Anterior shoulder dislocation is a common skiing injury. Several methods are available for reduction of shoulder dislocations. We evaluated a method for reduction of anterior shoulder dislocation that has not previously appeared in the literature. This method is performed with the patient seated in a chair with the chair used as countertraction. The physician applies traction to the affected shoulder using downward pressure on a loop of stockinette wrapped around the patient's forearm. Our method was successful in 97% of 118 anterior dislocations with no complications. Ninety-three percent were performed without the use of narcotic analgesia.

Adolescent↗