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Bilateral inferior glenohumeral dislocation: luxatio erecta, an unusual presentation of a rare disorder.

Luxatio erecta, or inferior shoulder dislocation, is a rare form of shoulder dislocation. The case of a patient presenting with bilateral luxatio erecta, which was initially felt by EMS personnel to be an hysterical reaction, is discussed. An awareness of this rare entity, the potential-associated musculoskeletal and neurovascular injuries, and the proper treatment are essential for emergency physicians.

Aged↗

Bulk effect of rotator cuff on inferior glenohumeral stability as function of scapular inclination angle: a cadaver study.

Eleven fresh cadaver shoulders were studied to determine the static contribution (bulk effect) of the rotator cuff on inferior glenohumeral stability provided by scapular inclination. All musculature, including the rotator cuff, was removed. The position of the humerus relative to the scapula was recorded using an electromagnetic tracking device under conditions of no force and 1.5 kg of inferior translation force applied to the humerus, with the arm in the hanging position (sulcus test) and then in 90 degrees abduction (Abduction-Inferior Stability test = ABIS test), with the scapula inclined referable to the vertical line at -15 degrees, 0 degrees, 15 degrees and 30 degrees in the sulcus test and at 15 degrees, 30 degrees, 45 degrees and 60 degrees in the ABIS test. In the sulcus test without load, all shoulders dislocated at scapular inclination angles of -15 degrees and 0 degrees, whereas no shoulders dislocated at 30 degrees. The angle of scapular inclination had a significant effect on humeral head positions (p < 0.0001), with the head position at -15 degrees and 0 degree being lower than at 15 degrees, which was lower than at 30 degrees. In the ABIS test, none of the shoulders dislocated, although the effect of the angle of scapular inclination was significant (p < 0.0001), with the position of the humeral head being higher at 15 degrees than at other angles of inclination. Comparison of these data and previously reported data with the cuff intact showed no significant effect of rotator cuff removal on humeral head position and displacement in both tests. Therefore, we conclude that the static condition of the rotator cuff has no significant effect on the stabilizing function of scapular inclination. The stabilizing mechanism of scapular inclination seems to be associated with the bony configuration and/or anatomy and biomechanical properties of the superior capsuloligamentous structures.

Adult↗

Traumatic anterior dislocation of the shoulder in a child.

Dislocation of the shoulder joint is a rare occurrence in children. This paper reports on traumatic anterior dislocation of the shoulder in a 3-year-old boy and a 9-year-old boy, together with a discussion of the relevant literature.

Accidents↗

Anatomy and function of the glenohumeral ligaments in anterior shoulder instability.

The anatomy of the glenohumeral ligaments has been shown to be complex and variable and their function is highly dependent on the position of the humerus with respect to the glenoid. The superior glenohumeral ligament with the coracohumeral ligament was shown to be an important stabilizer in the inferior direction, even though the coracohumeral ligament is much more robust than the superior glenohumeral ligament. The middle glenohumeral ligament provides anterior stability at 45 degrees and 60 degrees abduction whereas the inferior glenohumeral ligament complex is the most important stabilizer against anteroinferior shoulder dislocation. Therefore, this component of the capsule is the most frequently injured structure. An appropriate surgical procedure to repair the inferior glenohumeral ligament complex after shoulder dislocation must be considered. In addition, a detached labrum can lead to recurrent anterior instability and a compromised inferior glenohumeral ligament complex. However, additional capsular injury usually is necessary to allow anterior dislocation.

Biomechanical Phenomena↗

Management of posterior fracture-dislocations of the shoulder.

Posterior fracture-dislocation of the shoulder is rare. Comprehensive treatment guidelines for posterior fracture-dislocation of the shoulder with fracture of the humeral head have not been previously published. Although open reduction and internal fixation of the proximal humerus for posterior fracture-dislocation has been reported in several series, the successful reconstruction of the articular surface by rigid internal fixation of a large osteochondral fragment has not been reported. This paper describes two cases of posterior fracture-dislocation of the shoulder with a substantial defect of the anteromedial humeral head resulting from the cleavage of a large osteochondral fragment. Preoperative computed axial tomographic (CAT) scanning of the injured shoulders helped in operative planning by precisely defining the extent of the articular injury. Accurate reconstruction of the articular surface restored joint stability and gave excellent clinical results. Large humeral head osteochondral fracture fragments require accurate reduction and internal fixation.

Adult↗

Multidirectional voluntary glenohumeral dislocation in a 7-year-old patient: a case report.

A case of multidirectional voluntary shoulder dislocation developing at the age of seven is reported. The authors present the process that leads to the diagnosis of voluntary shoulder dislocation. The treatment of young patients with this condition is difficult. If no underlying pathology exists, most authors agree it should consist of conservative treatment and skillful neglect. The role of surgical treatment in a maturing skeleton should be reserved only if conservative treatment fails.

Child↗

Axillary nerve injury after anterior glenohumeral dislocation: MR findings in three patients.

OBJECTIVE: We performed this study to demonstrate the MR imaging findings that indicate an anterior dislocation has caused an axillary nerve injury. CONCLUSION: MR images of the shoulder can show findings indicating that an axillary nerve injury has been caused by an anterior shoulder dislocation. All MR examinations should be evaluated for these findings, particularly if the patient has a history of anterior shoulder dislocation.

Aged↗

Locked anterior-inferior shoulder subluxation presenting as luxatio erecta.

Shoulder subluxation may present as a complication of either traumatic injury to a joint, repetitive mictrotrauma, or atraumatic joint laxity. The case of a middle-aged man who presented with a confusing clinical picture similar to inferior shoulder dislocation, luxatio erecta, with a radiographic diagnosis of anterior-inferior shoulder subluxation is discussed. An understanding of the differential diagnosis of shoulder dislocation and subluxation and the management of atypical presentations is critical to the emergency physician.

Diagnosis, Differential↗

A prospective outcome evaluation of arthroscopic Bankart repairs: minimum 2-year follow-up.

BACKGROUND: Arthroscopic treatment of anterior shoulder dislocation has become possible through improvements in instruments and techniques. OBJECTIVE: To prospectively evaluate results of arthroscopic Bankart repairs at a minimum 2-year follow-up for patients with histories of shoulder dislocation and an anterior-inferior labral tear at the time of diagnostic arthroscopy. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: A consecutive series of 85 patients (70 men, 15 women; mean age, 26 years) with Bankart lesions were treated with arthroscopic repair using suture anchors; 18 patients (27%) had extension of the labral injury into the superior labrum affecting some or all of the biceps anchor. Anchors were loaded with no. 2 nonabsorbable braided suture and placed 2 mm into the edge of the glenoid surface. A low anterior (5-o'clock) portal through the subscapularis tendon was used in all patients; 72 patients were evaluated at a minimum of 2 years postoperatively (mean, 46 months). RESULTS: Seven patients (10%) experienced recurrent instability after repair. Four patients had redislocations; 3 experienced recurrent subluxations. One patient had pain with the apprehension test without a clear history of recurrent instability. Of 18 collision athletes, 2 had dislocations at 22 and 60 months postoperatively. There were no complications, including no neurologic deficits. Clinical strength testing of the subscapularis muscle was normal in all patients. The mean Rowe score was 88 of 100 points, with 90% excellent or good results. Simple Shoulder Test responses improved from 66% positive preoperatively to 88% positive postoperatively. The American Shoulder and Elbow Surgeons scoring index averaged 92 of 100 points postoperatively. Pain analog scales improved from 5.5 preoperatively to 0.35 postoperatively on a 10-point scale. SF-12 scores improved for physical function. Patient satisfaction was rated 8.9 on a 10-point visual analog scale. CONCLUSION: Bankart repairs performed arthroscopically using properly implanted suture anchors and nonabsorbable sutures and in which associated pathoanatomy is addressed demonstrate low recurrence rates (10%) similar to historical open controls.

Adult↗