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PubMed1995

Arthroscopic Bankart suture repair for recurrent traumatic unidirectional anterior shoulder dislocations.

We report our experience with arthroscopic repair of the Bankart lesion following traumatic unidirectional anterior shoulder dislocation. Thirty consecutive patients (7 women, 23 men; average age, 26.5 years) were followed for an average of 38 months (minimum 2-year follow-up) after arthroscopic Bankart suture repair for recurrent shoulder dislocation. The study included patients who had pure shoulder dislocations (excluding those with instability secondary to subluxation, multidirectional instability, or an atraumatic origin), had experienced an initial frank shoulder dislocation (documented radiographically or requiring the assistance of medical personnel for reduction), and had a Bankart lesion, visualized arthroscopically. Clinical evaluation using the Rowe functional grading system showed 11 patients rated as excellent, 8 as good, 3 as fair, and 8 as poor. Six of 8 patients were rated as poor because they frankly redislocated following their arthroscopic shoulder stabilization. Our study shows a 27% failure rate in this group. Critical reevaluation of the transglenoid arthroscopic Bankart procedure is mandatory to identify the appropriate patient population for this procedure.

Adult↗
PubMed2003

Treatment of shoulder dislocation: is a sling appropriate?

Acute anterior shoulder dislocations, when managed non-operatively, have traditionally been treated by placing the arm in a sling. There is no formal evidence that this treatment is of benefit. Three recently reported studies, one in cadavers and two in patients, suggest that the detachment of the structures in the front of the shoulder is made worse when the shoulder is placed in internal rotation, as when the arm is in a sling. By contrast, the structures are realigned when the arm is placed in external rotation. Shoulder dislocations, if managed non-operatively, should not be treated by placing arms in a sling. Rather, placing them in a splint or using a pillow so that the the arm is externally rotated should be considered.

Humans↗
PubMed1980

[Recurrence frequency following traumatic shoulder dislocation].

99 cases of primary traumatic shoulder dislocation were evaluated in regard of the influence of the time of immobilization on recurrency. 3 weeks of strict immobilization gave a recurrency rate as low as 6.4% whereas a shorter immobilization resulted in 12% of recurrency within 1--6 years. A survey from 46 other clinics as well as the literature has given no evidence of clear rules of treatment and thus the discussion of treatment remains open.

Adult↗
PubMed1993

[The initial traumatic shoulder dislocation. Prospective study].

The goal of this prospective study was to investigate possible factors which might prevent the recurrence of dislocation after a first time traumatic shoulder dislocation. Of the 504 patients initially recorded, 376 were followed up clinically and radiologically after 1 year, and 324 were followed up after 5 years. 20% (64/324) of the patients examined after 5 years sustained a recurrent dislocation of the shoulder. We can confirm age dependency in the occurrence dislocations (50% of the patients > 30 yrs; 15% > 30 yrs). However, we were unable to find a relationship between the duration of immobilization and the incidence of recurrence redislocation (20% recurrence for 0, 1, 2, 3, > 3 weeks of immobilization). A simultaneous avulsion fracture of the tuberculum majus seems to improve the prognosis for recurrent shoulder dislocation (3/114 = 3%), whereas other bony injuries detected using conventional radiology do not appear to influence the incidence of recurrence. A shoulder stabilisation operation had to be carried out in a total of 10% of the follow-up cases. Based on our experience, we recommend a sufficiently long immobilization period of the freshly injured shoulder. In young patients, extensive and invasive procedures (arthro-MRI, pneumo-arthro-CT, shoulder arthroscopy) should be carried out after the first redislocation.

Adult↗
PubMed1989

A study of glenohumeral orientation in patients with anterior recurrent shoulder dislocations using computerized axial tomography.

Thirty-six patients with recurrent anterior shoulder dislocations and 11 normal patients who had no history of shoulder problems were evaluated by a G.E. 8800 fourth generation computerized axial tomographer to quantitate humeral head retrotorsion and glenoid tilt. The study objective was to determine if osseous orientation was a major etiologic factor in patients with recurrent anterior shoulder dislocations. The normal position of the humeral head as determined by CT scan is 30 degrees retroversion with respect to its distal articular axis. In dislocations this value changes to a more anteverted position of 24 degrees retroversion. Glenoid tilt could not be given a single value since it changes from retroversion superiorly toward more anteversion inferiorly. This change in glenoid tilt was greater in the dislocators with inferior sections measuring 2 degrees anteversion in the dislocators and 1 degree retroversion in the uninvolved shoulder and in the normal population. The change in humeral retroversion and glenoid tilt in the recurrent dislocators was statistically significant when compared with the uninvolved shoulder and to the normal population. Thus, the glenoid humeral orientation appears to be a significant predisposing factor to recurrent anterior shoulder dislocations.

Adult↗
PubMed1996

Arthroscopic stabilization of acute initial anterior shoulder dislocation: the West Point experience.

Arthroscopic stabilization for acute initial shoulder dislocation has been the subject of thorough investigation at West Point over the past decade in an attempt to improve on the natural history of shoulder instability in our young athletic population. From January 1986 to December 1995, 127 patients were treated for acute initial shoulder dislocation at the United States Military Academy. Of the 55 patients treated nonoperatively, 47 (85%) have had recurrence of instability. Seventy-two patients were treated operatively during three separate phases in the evolution of arthroscopic management at our institution. The initial phase (1986 to 1988) of operative treatment included either arthroscopic abrasion or staple repair. The low recurrence rate (2 of 9) was promising. In the operative technique for the second phase (1988 to 1991) transglenoid sutures were used. Of the 21 patients treated in this manner, 18 (86%) had no recurrent instability at last follow-up (average, 32 months). In the third phase (1991 to 1993), patients were treated with a bioabsorbable tack and interscalene anesthesia, and in the sitting position. Thus far, 39 of the latest 42 cadetathletes with acute initial anterior shoulder dislocations have had stabilization with this bioabsorbable cannulated fixation device. The average age was 19.5 years (range, 17 to 23 years). Follow-up averaged 22 months. There were no perioperative complications. Of these 39 patients, 35 (90%) have a stable shoulder and have returned to preinjury performance status. One of 2 patients with recurrent subluxation and 1 of 2 patients with a traumatic redislocation required an open Bankart repair. In young athletes known to have high recurrence rates with nonoperative treatment, acute arthroscopic stabilization appears to be an effective minimally invasive treatment option that favorably alters the natural history of shoulder instability.

Adolescent↗
PubMed1995

Treatment of shoulder dislocation with ipsilateral humeral shaft fracture.

A case presentation of shoulder dislocation with ipsilateral humeral shaft fracture is presented along with a review of the literature regarding nine reported cases. In the current case, closed treatment of the humeral shaft fracture was undertaken with an unsuccessful attempt at closed reduction of the anterior shoulder dislocation, resulting in a radial nerve deficit. Successful treatment required open reduction of the humeral fracture with compression plating followed by closed reduction of the shoulder dislocation. We compare this treatment (with outcome) to other methods of treatment.

Adult↗
PubMed1996

Clinically significant abnormalities in postreduction radiographs after anterior shoulder dislocation.

STUDY OBJECTIVE: To determine the incidence of clinically significant fractures or other abnormalities seen on postreduction shoulder radiographs which were not seen on postreduction should radiographs which were not seen on the prereduction films obtained for anterior shoulder dislocations. METHODS: Retrospective chart review of 131 patients who presented with a total of 175 anterior shoulder dislocations to the emergency department of an urban, university-affiliated, Level 1 Trauma Center with an emergency medicine residency program. All patients had complete medical records, radiographs before and after reduction, and no fractures reported on the prereduction films. RESULTS: There were three avulsion fractures (1.7%; 95% confidence interval [CI], 0% to 4.5%) detected on postreduction radiographs. In all three cases, a radiologist who was blinded to the original interpretations and the purpose of the study also noted the fractures on the prereduction films, although these fractures were not detected on the original interpretations. There were 14 new Hill-Sachs deformities (8%; 95% CI, 4% to 12%). In one case (.6%; 95% CI, 0% to 2.8%), the postreduction radiograph demonstrated a persistent dislocation, which was subsequently reduced in the ED. This was the only postreduction finding that altered acute management. CONCLUSION: Postreduction radiographs rarely reveal any clinically significant abnormality after an anterior shoulder dislocation has been reduced. Emergency physicians and orthopedic surgeons should question whether the time and expense of obtaining routine postreduction films in the ED for anterior shoulder dislocations is justified. A prospective study is needed to validate our findings.

Adult↗
PubMedDate not supplied

Bilateral shoulder dislocation: an unusual occurrence.

Bilateral shoulder dislocation is an unusual clinical entity. Proposed mechanisms are via various traumatic insults, atraumatic occurrences, and through extreme muscular contractions. A case involving traumatic dislocation as a result of a diving incident is reported. A brief review of this rare clinical condition is presented.

Adult↗
PubMed2003

Questionnaire reveals variations in the management of acute first time shoulder dislocations in the Netherlands.

AIM: To collect information about the management of patients with acute first time shoulder dislocation by (orthopaedic) surgeons in the accident and emergency departments of Dutch hospitals. DESIGN: Questionnaires were sent to 131 (orthopaedic) surgeons of 74 Dutch hospitals. METHOD: We enquired whether patients with acute first time shoulder dislocation are managed according to protocols in accident and emergency departments; which radiographs are deemed necessary before and after reduction; which reduction methods are generally performed; and what kind of pain relief or sedatives are generally administered. Furthermore, we enquired into the method and duration of immobilization after reduction. RESULTS: The response rate was 73%. Sixty-five per cent of the hospitals are used to managing acute first time shoulder dislocation according to protocols. Making prereduction and postreduction radiographs is standard practice in almost all hospitals. The most favoured methods of reduction are those according to Kocher and Hippocrates. In 85% of cases sedatives are administered before reduction, and in addition to that systemic analgesia is administered in 30%, whereas intra-articular analgesia is preferred in 25% of cases. CONCLUSION: Apparently, a protocol for the management of acute first time shoulder dislocation is not standardly available in all hospitals. On the basis of current literature and the results of this questionnaire it may be useful to establish a guideline for diagnostic procedures and the management of acute first time shoulder dislocation in accident and emergency departments.

Acute Disease↗
PubMed1984

Acute shoulder dislocations: factors influencing diagnosis and treatment.

The Bankart lesion is the most important single causative factor in traumatic anterior shoulder dislocations (85%). Capsular rupture occurs in approximately 15% of traumatic anterior shoulder dislocations and may or may not heal with redundancy. If so, recurrent dislocation in possible. Surgical repair of traumatic anterior dislocations requires that the capsule be opened for correct identification of the lesion and correct repair. Limitation of external rotation is not necessary for repair of anterior shoulder dislocations and should be considered as an untoward complication. While multiple procedures are available, all of which may be satisfactory at one time or another, no one procedure repairs all traumatic anterior shoulder dislocations.

Arthrography↗
PubMed1988

Double-contrast computed tomographic examination techniques in habitual and recurrent shoulder dislocation.

Preoperative planning of recurrent shoulder dislocation requires an accurate knowledge of bone and soft tissue lesions affecting the joint. A new method of double-contrast CT examination is presented which allows an accurate evaluation of the soft tissue structures important for the stability of the joint. Forty-two patients were examined with this technique, twenty-seven of whom (28 shoulders) were operated on, the procedure being selected on the basis of the CT findings. In all cases the preoperative CT findings corresponded to the intraoperative findings.

Contrast Media↗
PubMed1993

[A new self-repositioning technique for fresh, anterior-lower shoulder dislocation].

In case of a shoulder dislocation there is always a question of a safe and atraumatic reduction technique if possible without analgetics or even general anesthesia. The dislocated humeral head is reduced anatomically with the help of the patient's own body weight under muscular relaxation without injuring manipulations. Even with displaced fractures of the greater tuberosity or an impression fracture of the humeral head successful reductions were obtained. We have been using this method for over three years with a primary success rate of over 60%.

Humans↗
PubMedDate not supplied

Shoulder dislocation after infraclavicular coracoid block.

OBJECTIVE: We report a case of shoulder dislocation after a brachial plexus block with a double-injection technique using the infraclavicular coracoid approach. CASE REPORT: An obese woman with no previous episodes of joint dislocation developed an anterior dislocation of the head of the humerus after an infraclavicular coracoid block performed for hand surgery. Dislocation was probably because of a combination of unrecognized glenohumeral instability, paralysis of some muscles of the shoulder, and positioning of her arm on a board below her torso. Shoulder dislocation was recognized after surgical positioning of her arm, and painless reduction was achieved. There were no sequelae after 10-day follow-up. CONCLUSIONS: When motor block of the muscles of the shoulder occurs after brachial plexus anesthesia, special care must be taken in patient positioning to avoid shoulder dislocation.

Carpal Tunnel Syndrome↗
PubMed1993

[Analgesic-free self-reduction of acute shoulder dislocation].

Incidence and severity of shoulder lesions are increasing especially in alpine skiing accidents. In case of a shoulder dislocation there is always the question of a safe and atraumatic reduction technique if possible without analgetics or even general anesthesia. We present a new reduction technique with the help of the patient's own body weight under muscular relaxation. Even in the presence of displaced fractures of the greater tuberosity or a depression fracture of the humeral head successful reductions were obtained. After the reduction, the arm is immobilized in a Gilet. The patient is able to leave immediately after a radiographic control. We have been using this method for some years with a primary success rate of about 60 per cent.

Adult↗
PubMed1999

Prereduction radiographs in clinically evident anterior shoulder dislocation.

The main study objective was to determine if experienced emergency physicians can accurately identify a subgroup of patients with anterior shoulder dislocation for whom prereduction radiographs do not alter patient management. Our prospective study evaluated 97 patients who presented to 2 ski-hill clinics and to our rural emergency department with possible shoulder dislocation between November 1996 and May 1997. Emergency physicians were certain of shoulder dislocation by clinical examination alone in 40 of 59 cases (67.8%) of possible dislocation. All 40 cases were found to have a dislocation (100%; 95% Cl, 91.19% to 100%), and the prereduction radiograph did not affect management of the injury. Prereduction radiographs added 29.6 +/- 12.68 minutes to treatment. We conclude that shoulder dislocation is often readily apparent from history and physical examination. When the experienced emergency physician is certain of the diagnosis of anterior shoulder dislocation, prereduction radiography delays treatment and does not alter management.

Adolescent↗
PubMed2002

Etomidate and midazolam for reduction of anterior shoulder dislocation: a randomized, controlled trial.

STUDY OBJECTIVE: We determine whether patients with acute, anterior shoulder dislocation undergoing emergency department procedural sedation and analgesia (PSA) with intravenous etomidate would experience a reduced time of impaired consciousness when compared with a group of patients receiving intravenous midazolam. METHODS: This study was a prospective, double-blinded, randomized, institutional review board-approved trial of ED patients with anterior shoulder dislocation. Patients were randomized to receive intravenous boluses of etomidate (0.1 mg/kg) or midazolam (0.033 mg/kg) during PSA. The primary outcome for comparison was PSA duration. RESULTS: Forty-six patients with anterior shoulder dislocation were enrolled: 22 in the etomidate group and 24 in the midazolam group. Three patients sustained reduction without physician or sedative intervention. Two patients were excluded from protocol because of unavailable study drug or fracture dislocation. The median lowest modified postanesthetic recovery score observed during PSA was 5 (95% confidence interval [CI] 4 to 7) in the etomidate group and 6 (95% CI 6 to 7) in the midazolam group. The median time of PSA for patients receiving etomidate was 10 minutes (95% CI 8 to 15) compared with 23 minutes (95% CI 16 to 30) for patients receiving midazolam, with a difference between the group medians of 13 minutes (95% CI 5 to 22). Reduction success was achieved in 37 (90%) of 41 patients: 2 did not experience reduction with etomidate and 2 did not experience reduction with midazolam. There were 15 PSA complications reported. CONCLUSION: Etomidate provides effective PSA for reduction of ED patients with anterior shoulder dislocation. When compared with midazolam, etomidate use confers a significantly shorter period of PSA.

Adult↗
PubMed1998

The value of ultrasonography in the diagnosis of labral lesions in patients with anterior shoulder dislocation.

OBJECTIVE: To evaluate the ability of ultrasonography to detect labral lesions in patients with anterior shoulder dislocation. METHODS: We examined 29 patients with anterior shoulder dislocation with ultrasonography prior to arthroscopy. RESULTS: Twenty-six patients had labral lesions diagnosed by arthroscopy. These lesions were detected by ultrasonography with a sensitivity of 88% and a specificity of 67%. All lesions affected the anterior labrum, while six extended to the posterior labrum. The latter were not visualized by ultrasonography. CONCLUSION: Ultrasonography is valuable in the detection of anterior labral lesions even in patients with recent shoulder dislocation.

Adolescent↗