[AN OPERATION FOR HABITUAL DISLOCATION OF THE SHOULDER].
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The posterior dislocation of the shoulder is a rare but clinically and radiologically well-defined entity. Missing its diagnosis can lead to locked dislocations, incorrect treatment, and shoulder dysfunction. The cases in this series will illustrate the typical errors of diagnosis and treatment, and the possible and recommended management strategies.
Dislocation of the shoulder is a common and often disabling injury to an athlete. Most shoulder dislocations are traumatic in origin, occur in the anterior direction and result in stretching and detachment of the anterior capsule and labrum. The most frequent adverse sequel of shoulder dislocation is recurrence--an event that occurs most commonly in active individuals and less frequently with age. In the past, many operative procedures failed to address the anatomical disruptions of shoulder instability. Recently, an enhanced understanding of shoulder instability pathoanatomy and significant technological advances have resulted in surgical procedures for shoulder instability that are less interventional and have focused on restoring disrupted static constraints.
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Luxatio erecta, or inferior dislocation of the glenohumeral joint, is an extremely uncommon variety of shoulder dislocation. Several types of neurovascular injuries may be associated with luxatio erecta. Concomitant fracture of the coracoid, clavicle, acromion, greater tuberosity, and humeral head may also be noted. A case of luxatio erecta associated with a fracture of the greater tuberosity and transient mixed brachial plexus injuries is presented.
Recurrent traumatic anterior shoulder dislocation results in soft tissues lesions around the glenohumeral joint. The subscapularis muscle is a major active stabilizer of the shoulder and the hypothesis of the current study is that one would expect pathologic changes within its substance secondary to the trauma. A histomorphometric study of the subscapularis muscle was done of 52 patients operated on for recurrent traumatic anterior shoulder dislocation. At the time of surgery biopsy specimens were taken of the subscapularis muscle and the ipsilateral deltoid muscle as a comparison and to see if any changes were present. The results revealed interstitial fibrosis within the subscapularis muscle compatible with muscle scarring, and modifications in the ratio of fiber types as usually is seen with disuse atrophy. Both of these findings may alter strength and stability and therefore the function of the glenohumeral joint. The histologic findings were not compatible with a denervation pattern. After traumatic anterior shoulder dislocation rehabilitation of the subscapularis muscle is recommended.
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60 arthrograms of the shoulder were explored under morphologic and pathologic-anatomic aspects. Differentiation was made between acute and chronic pain. The possible findings in leaking of the contrast material out of the joint capsule are shown and discussed. Signs are quoted of degeneration of soft tissue and bone. The findings in patients with rheumatoid arthritis and a history of shoulder dislocation are summarised. Distension of the joint capsule without shoulder dislocation is described. Filling of the periarticular lymphatics is mentioned in different cases.
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