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[Post-traumatic shoulder instability in adolescence].

BACKGROUND: Post-traumatic shoulder instability in adolescence represents a very rare condition. However, most of these patients develop recurrent shoulder dislocations over time. METHODS: We report about a retrospective study, which included 32 patients younger than 16 years of age. The mean follow-up was 5 years. Our evaluation focussed on patients' age at the time of first shoulder dislocation, type of injury, and the results after conservative and operative treatment. RESULTS: After the first dislocation, all shoulders were immobilized for 3 weeks and were treated with physiotherapy afterwards. Of these 32 patients, 30 (94%) developed recurrent shoulder dislocations. Eight patients remained in a conservative regimen (age <15 years) and 21 patients were operated for persistent shoulder instability (age >15 years). The recurrence rate was 8 of 21 patients (36.5%) in the operative group and 4 of 8 patients in the conservative group. At the time of follow-up, 4 of 8 conservatively treated patients had returned to their former sports activities and 15 of 21 (71%) in the operated group. CONCLUSIONS: Our results on post-traumatic shoulder instability in adolescence show high recurrence rates in both conservative and operative groups. After adolescence, including ossification of the glenoid, operative treatment is able to decrease the recurrence rate and to increase the sports ability of these young patients.

Adolescent↗

Bilateral luxatio erecta complicated by venous thrombosis.

Inferior shoulder dislocation or luxatio erecta is an exceedingly rare form of shoulder dislocation and compromises less than 0.5% of all shoulder dislocations. Furthermore, bilateral luxatio erecta is reported only nine times in the English literature. This paper documents the tenth case of bilateral luxatio erecta. This tenth patient suffered an axial load injury to his outstretched arms and displaced both humeral heads inferiorly. After closed reduction, the patient was discharged home on hospital day two. However, he developed an axillary vein thrombosis 3 days later and required anticoagulation therapy. This report reviews the mechanisms of injury associated with inferior shoulder dislocations as well as the presentation and treatment of luxatio erecta. The complication of axillary vein thrombosis and its treatment in this patient are discussed also.

Accidents, Traffic↗

[Posterior dislocation fracture of the shoulder].

Posterior dislocation fracture of the shoulder is a rare injury that often occurs in association with a grand mal seizure. Our aim with this paper is to emphasize diagnosis and therapy. In the past 5 years seven patients with nine posterior dislocation fractures were treated operatively. In six patients a grand mal seizure was the cause of the injury and in one a direct trauma. Three four-part fractures were found in two patients and six locked posterior dislocation fractures in five patients. Clinical examination in locked posterior dislocation fractures showed a lack of external rotation, and flexion was performed by movement of the scapula. Radiological examination demonstrated an overlapping of the contours of the humeral head and the glenoid and the "trough line". The operations were performed in the time between 4 h and 10 days later. Two of three four-part fractures (in one patient) were treated with hemiarthroplasties, and one was fixed with screws. Closed reduction was attempted in six shoulders but was possible only in one patient. In this patient a redislocation occurred 3 days later and a combined anterior and posterior approach was done. A fracture of the anatomical neck was produced in another shoulder. Six open reductions and stabilizations with screws were performed, and three times we fixed the subscapular tendon in the reversed Hill-Sachs lesion with anchor sutures. Patients after grand mal seizures may have a posterior shoulder dislocation, and clinical and radiological examination should be emphasized. In locked posterior dislocation we favour early open reduction, fixation of the subscapular tendon with anchor sutures in the reversed Hill-Sachs lesion and stabilization of the lesser tuberosity with screws.

Adult↗

Shoulder arthroplasty for locked posterior dislocation of the shoulder.

Currently, there are no published series with mid- to long-term results on patients undergoing shoulder arthroplasty for locked posterior dislocation of the shoulder. We reviewed the results of patients who underwent shoulder arthroplasty for locked posterior dislocation of the shoulder to determine the results, the risk factors for an unsatisfactory outcome, and the rates of failure. Twelve shoulder arthroplasties were performed at our institution, between January 1, 1980, and December 31, 1997, in 12 patients who had a locked posterior dislocation of the shoulder. All 12 patients were followed up for a minimum of 5 years (mean, 9.0 years) or until the time of revision surgery. There was significant pain relief (P <.001) as well as improvement in external rotation from -13 degrees to 28 degrees (P =.001). On the basis of a modified Neer result rating system, there was 1 excellent, 6 satisfactory, and 5 unsatisfactory results. Three patients underwent revision surgery for posterior instability (two) and component loosening (one). Recurrent instability occurred in two patients in the early postoperative period. There were no cases of recurrent instability greater than 1 year from the time of surgery. The data from this study suggest that shoulder arthroplasty for locked posterior dislocation provides pain relief and improved motion. Among those with recurrent posterior instability, it usually appears in the early postoperative period.

Adult↗

Arthroscopic findings in luxatio erecta of the glenohumeral joint: case report and review of the literature.

PURPOSE: We report the case of an inferior glenohumeral dislocation of the shoulder in which arthroscopic assessment showed an extensive detachment of the labral-biceps tendon complex (Bankart and superior labrum anterior posterior [SLAP] lesions). We sought to review the literature to compare our findings with the reported lesions in this type of shoulder dislocation. CASE SUMMARY: A young patient presented with an inferior dislocation of his right shoulder (erect dislocation) after having sustained a motorcycle accident. Conventional radiographs revealed the humeral shaft parallel to the scapular spine and an anteroinferior position of the humeral head with a large avulsion of the greater tuberosity. Preceding arthroscopy showed a complete detachment of the anterior labrum and ligament complex (SLAP lesion). After open reduction and internal fixation of the greater tuberosity, the capsulolabral complex was reduced and securely fixed with three bone anchors at the glenoidal rim. The patient recovered well reaching full shoulder function after 5 months and regaining the former sports activity level within 9 months after surgery. DISCUSSION: Arthroscopy identified the location and extent of an important labral detachment that, in combination with the stability testing under anesthesia, proved the need for a labral refixation. The literature regarding reported pathology in inferior glenohumeral dislocation is reviewed, and the additional information on associated soft-tissue lesions by means of arthroscopy are discussed. RELEVANCE: No prior case of arthroscopic assessment in inferior glenohumeral dislocation of the shoulder has been reported. Recognizing the extent and site of accompanying labral detachments contributing to the instability of the joint may enhance our knowledge of the full pathology in these dislocations and thus allow an adequate surgical treatment.

Accidents, Traffic↗

Bilateral shoulder fracture dislocations and radiculopathies secondary to electrical injury (a case report).

INTRODUCTION: In this report a case of bilateral shoulder fracture dislocations and C5 radiculopathy developed after an electrical injury is presented. CASE: A 29 year-old male patient referred to our hospital with complaints of inability to raise his hands overhead starting 3 months ago after an electrical injury. The first physical examination revealed loss of strength (3/5) in deltoid muscles bilaterally, bilateral shoulder fracture dislocations and C5 radiculopathies. An open reduction and internal fixation (using K wire, cortical screw) procedure was applied for the right side in the Department of Orthopedics. Postoperatively active (A) and passive (P) ranges of motion (ROMs) were restricted extremely in the right and left shoulder respectively. Since applications of 15 sessions of electrical stimulation for deltoid muscle and physical treatment for both shoulders failed to achieve satisfactory ROMs, K wire extraction was instituted with resultant increase in the right shoulder A/P ROMs after 10 sessions of physical therapy postoperatively. At the last examination which was 18 months after the injury, ROMs of the right shoulder were increased, but not normal. CONCLUSION: It must be remembered that in electrical injury, fractures and dislocations might occur in affected sites without any evidence of trauma with associated neurologic complications, and that these cases must be promptly detected and managed without any delay.

Bone Screws↗

Conservative management following closed reduction of traumatic anterior dislocation of the shoulder.

BACKGROUND: Acute anterior dislocation is the commonest type of shoulder dislocation and usually results from an injury. Subsequently, the shoulder is less stable and more susceptible to redislocation, especially in active young adults. OBJECTIVES: To compare methods of conservative (non-surgical) management versus no treatment or different methods of conservative management after closed reduction of traumatic anterior dislocation of the shoulder. Interventions include methods of postreduction immobilisation and rehabilitation. SEARCH STRATEGY: We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (March 2005), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 3, 2005), MEDLINE, EMBASE, the National Research Register (UK), conference proceedings and reference lists of articles. SELECTION CRITERIA: Randomised or quasi-randomised controlled trials comparing various conservative interventions versus control (no or sham treatment) or other conservative interventions applied after closed reduction of traumatic anterior dislocation of the shoulder. DATA COLLECTION AND ANALYSIS: All authors selected trials, assessed methodological quality and extracted data. Study authors were contacted for additional information. MAIN RESULTS: One flawed quasi-randomised trial was included. A "preliminary report" gave the results for 40 adults with primary traumatic anterior dislocation of the shoulder treated by post-reduction immobilisation with the arm in either external or internal rotation. There was no statistically significant difference between the two groups in the failure to return to pre-injury sports by previously active athletes, in redislocation or shoulder instability. Similar numbers of participants of the two groups removed their immobiliser before one week had passed. AUTHORS' CONCLUSIONS: There is a lack of evidence from randomised controlled trials to inform the choices for conservative management following closed reduction of traumatic anterior dislocation of the shoulder. Sufficiently powered, good quality, well reported randomised controlled trials with long-term surveillance of conservative management are required. In particular, trials examining the type and duration of immobilisation would be useful.

Humans↗

Luxatio erecta: the inferior glenohumeral dislocation.

Luxatio erecta, or inferior glenohumeral dislocation, is a rare shoulder dislocation usually caused by a hyperabduction injury to the arm. We have reviewed the literature consisting of 80 cases of luxatio erecta and also discuss six additional cases that we have treated. The literature shows that either a fracture of the greater tuberosity or a rotator cuff tear was associated with this injury in 80% of patients; 60% of the patients reviewed sustained some degree of neurologic compromise, most commonly to the axillary nerve. These injuries usually resolved; the time for recovery varied from 2 weeks to 1 year. Only 3.3% of the cases demonstrated significant vascular compromise, but this is the highest incidence for any shoulder dislocation. Doppler studies of the affected arm or observation of the patient overnight are recommended because of the potentially disastrous complications of vascular insufficiency. If there is any indication of a vascular problem, immediate arteriogram is indicated. Although usually fairly easily reduced by overhead traction, the lesion is so rare that few physicians are familiar with the technique of reduction. Fluoroscopy was used in our most recent cases and was helpful in obtaining a complete and safe reduction.

Adolescent↗

[The management of complete shoulder joint dislocation without metallic implants].

In 14 patients reduction of the acromioclavicular joint was reinforced by completely absorbable polydioxanon cord. In 3 cases parts of the cord were rejected and a fistula formed through the scar without further impairment following as a result of healing local treatment. Altogether we had 12 good and 2 poor results with respect to function, X-ray appearance and pain. The complication rate and general outcome of the method described do not differ substantially from those of other commonly used procedures. However, no second operation for removal of the metal implants is necessary.

Acromioclavicular Joint↗

Post seizure anterior dislocation of shoulder--beware of recurrence.

Glenohumeral instability following seizures is usually of the posterior type. Rarely patients can have anterior dislocation of the shoulder following an epileptic seizure. Although these are treated similar to usual anterior dislocations of the shoulder they need regular follow up to detect any recurrent shoulder instability for which the treatment will involve skeletal reconstruction. We report a case.

Adult↗

Anterior recurrent dislocation of shoulder treated by the Latarjet technique: our experience.

Transposition of the coracoid process in the preglenoid site according to the Latarjet method in 15 cases of anterior recurrent dislocation of shoulder is reported. Indications, surgical stages, and results are discussed with emphasis on the simplicity of surgery followed by nearly complete functional recovery and rapid resumption of professional and sports activity.

Adolescent↗

Agreement between magnetic resonance imaging and arthroscopic evaluation of the shoulder joint in primary anterior dislocation of the shoulder.

OBJECTIVE: To determine the effectiveness of magnetic resonance imaging in identifying shoulder pathology in patients with primary traumatic dislocation of the shoulder and to compare these findings with findings at the time of arthroscopic surgery. DESIGN: Correlation between arthroscopy and magnetic resonance imaging. PATIENTS: Sixteen patients, aged 18 to 30 years, who were randomized to the surgical arm of a study comparing the effectiveness of immediate arthroscopic surgery with immobilization and rehabilitation for primary traumatic anterior dislocation of the shoulder, were included in this study. INTERVENTIONS: Each patient underwent magnetic resonance imaging and a videotaped "tour" of the shoulder prior to any surgical intervention. MAIN OUTCOME MEASURE: Magnetic resonance scans and videotapes were reviewed for the presence or absence of abnormalities in 8 features of the shoulder, and concordant and discordant findings were evaluated. RESULTS: There was moderate correlation for superior labral lesions (kappa = 0.60) and fair agreement for rotator cuff tear (kappa = 0.355). When the joint capsule was assessed, there was only fair agreement for both the presence of an abnormality (kappa = 0.310) and redundancy and tear (kappa = 0.394). Both methods were sensitive for the detection of Hill-Sachs lesions (kappa = 1.0), although there was only moderate agreement (kappa = 0.44) on estimation of size. There was perfect agreement for the detection of Bankart lesions or equivalent capsulolabral disruption (kappa = 1.0). CONCLUSIONS: Magnetic resonance imaging can be considered a valuable tool for the detection of Hill-Sachs and Bankart lesions associated with primary traumatic anterior dislocations of the shoulder. Its ability to detect other pathologic lesions, however, is limited.

Adolescent↗

Purtscher's retinopathy after fracture dislocation of shoulder joint.

Purtscher described sudden blindness in patients with severe head trauma due to a remote retinopathy, characterised by bilateral retinal haemorrhages, cotton wool spots, and optic disc swelling seen on fundoscopy. A similar retinopathy has been reported in compressive chest trauma, long bone fractures, and acute pancreatitis. It is less well recognised that Purtscher's retinopathy can occur unilaterally and following less severe trauma. We present a case of unilateral remote traumatic retinal angiopathy following a fracture dislocation of the shoulder joint.

Accidents, Traffic↗