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PubMed1995

Epidemiology of scapular fractures. Incidence and classification of 338 fractures.

We have studied scapular fractures, with special reference to intraarticular glenoid fractures, during a 10-year period in 2 Swedish counties. There were 338 scapular fractures in 322 patients. The annual incidence was 10/10(5) inhabitants, of which 30 percent affected the glenoid cavity. Out of 100 intraarticular glenoid fractures, 55 occurred in men and 45 in women. The mean age of the women at the time of fracture (64 years) was significantly higher than the mean age of men (49 years). The most common intraarticular glenoid fracture type was the anterior chip fragment fracture which, in about two-thirds of the cases, was associated with shoulder dislocation.

Adult↗
PubMed1980

Recurrent dislocation of the shoulder after age fifty.

Recurrent dislocation of the shoulder is infrequent in patients over the age of 50. In a small group of 6 patients with an average age of 64 years and multiple recurrences, 4 subsequently were treated by anterior capsulorraphy (Bankart). There was an unusual degree of loose jointedness in all 6 cases. When compared with a group of patients under the age of 30 with recurrent dislocation of the shoulder, the older group was functionally rated 19.4 out of a possible score of 25 points, compared with a rating of 10.8 in the younger group. In the older population, recurrent dislocation may become a problem if the patient is loose-jointed. Immobilization for 3 to 4 weeks may not be helpful in this group of patients. Anterior capsulorraphy is as successful as in younger patients and is not followed by unusual joint stiffness.

Age Factors↗
PubMed2006

[Arthroscopic Bankart operation using absorbable suture anchors].

OBJECTIVE: Arthroscopic refixation of the labrum-ligament complex at the glenoid. INDICATIONS: Posttraumatic anterior or anterior-inferior shoulder instability with Bankart or ALPSA lesion (anterior labral periosteal sleeve avulsion). CONTRAINDICATIONS: Atraumatic shoulder instability. Instabilities due to blunted or frayed degeneration of the labrum-ligament complex. HAGL lesion (humeral avulsion of the glenohumeral ligaments) with humeral detachment of the glenohumeral ligaments. Larger bony glenoid defects. SURGICAL TECHNIQUE: Mobilization of the labrum-ligament complex from the neck of the glenoid, superior tightening and refixation at the glenoid rim with the aid of absorbable suture anchors. POSTOPERATIVE MANAGEMENT: Immobilization of the affected arm for 4 weeks in an immobilization bandage with abduction pillows. Daily pendulum exercises. Active flexion up to 70 degrees and abduction up to 40 degrees, all in neutral or internal rotation. Avoidance of external rotation for a total of 6 weeks. RESULTS: From January 1999 to December 2001, 58 patients with a Bankart or ALPSA lesion were treated with arthroscopic shoulder stabilization using absorbable suture anchors and slowly absorbable braided sutures. 56 patients underwent a follow-up clinical examination after, on average, 31 months (24-48 months). None of these patients had suffered more than five shoulder dislocations before the operation (average 2.8). Of the intraoperative lesions, a plain Bankart lesion was present in twelve patients (21.4%), 44 patients had an ALPSA lesion (78.6%), of which one in two were combined with an SLAP 2 or SLAP 3 lesion (superior labrum from anterior to posterior). In the evaluation using the Rowe Score, there was an excellent result for 40 patients (71.4%), and a good result for twelve (21.4%). Four patients suffered a repeat dislocation and were therefore classified as poor results (7.2%).

Absorbable Implants↗
PubMed2006

[Nordic pole walking injuries--nordic walking thumb as novel injury entity].

BACKGROUND: Nordic pole Walking (NW) as trend sport is associated with beneficial effects on the cardiovascular system. Data regarding the injury and overload injury rates are pending. METHODS: 137 athletes (74 % females, 53 +/- 12 years, weight 73 +/- 13 kg, height 169 +/- 11 cm) were prospectively ask using a two-sided questionnaire. Mean NW experience was 212.8 weeks with 2.9 +/- 1.8 hours/week. The overall exposure was 29 160 h. RESULTS: NW injury rate was 0.926/1000 h. Falls were evident in 0.24/1000 h. The upper extremity was involved more frequently (0.549/1000 h) than the lower extremity (0.344/1000 h). The most severe injury was a concomitant shoulder dislocation and luxation of the proximal interphalangeal joint of the index finger after a fall. The most frequent injury in NW was a distorsion of the ulnar collateral ligament of the thumb (0.206/1000 h) after fall. Shoulder injuries account for 0.171/1000 h with 0.069/1000 h shoulder dislocations. Distal radius fractures were rare as ankle sprains and shinspints (0.034/1000 h). Muscle injuries were encountered only at the gastrocnemius muscle (0.137/1000 h). No knee ligament injuries were noted. In 5%, NW injuries caused interruption of the performance, with all patients returning to sport within 4 weeks on the same level as before. DISCUSSION: Nordic Walking is safe. Most frequently, a Nordic walking thumb is encountered during a fall with the athlete holding on to the NW pole until the very last moment before the hand hits the ground with the pole handle as hypomochlium that forces the thumb into abduction and extension. Modifications of the grip construction as well as information of the athlete and behaviour changes may be preventive measures.

Accidental Falls↗
PubMed1989

Glenoid labrum: preliminary work with use of radial-sequence MR imaging.

The authors describe a magnetic resonance imaging method for examination of the glenoid labrum of the shoulder joint that utilizes a radial fast-imaging sequence. Seven shoulders were examined: a total of five in three healthy asymptomatic volunteers, one in a symptomatic patient not suspected of having a lesion of the glenoid labrum, and one in a patient with recurrent shoulder dislocation and surgical proof of an extensive tear of the labrum. The preliminary results suggest that this technique may advantageously demonstrate pathologic changes in the glenoid labrum and may contribute to the evaluation of the unstable and painful shoulder.

Adult↗
PubMed1995

Humeral head torsion in recurrent anterior dislocation of the shoulder.

We measured torsion of the humeral head in 38 patients (40 shoulders) with recurrent anterior dislocation of the shoulder (RADS) and in 40 normal subjects. We found a reduced mean retroversion in the patients with RADS at 4.3 +/- 10.56 degrees (17 degrees anteversion to 32 degrees retroversion) as compared with 16.1 +/- 11.07 degrees in the control group (0 degrees to 49 degrees) (p = 0.0001). There was anteversion in 11 of the 40 shoulders in the RADS group (27.5%) and in none of the control group. The first dislocation had occurred after minimal force in 18 of 25 patients with less than 10 degrees retroversion, but in only three of 15 with over 10 degrees retroversion. We conclude that decreased retroversion of the humeral head is often associated with RADS and with first dislocation of the shoulder caused by minimal force.

Adolescent↗
PubMed1983

A free bone block operation for recurrent anterior dislocation of the shoulder joint.

An operation to prevent recurrent anterior dislocation of the shoulder by insertion of a free iliac bone graft into an anterior glenoid osteotomy is described and has been performed on 16 shoulders in 15 patients. No additional fixation of the graft was used and the divided subscapularis tendon was not sutured. The average follow-up was 7 years and 8 months, no serious complications occurred, there were no recurrences, there was no evidence of degenerative osteoarthrosis and only 4 patients had any detectable loss of power. Only 2 patients had noticed any restriction of movement. There was some loss of external rotation in 13 shoulders. All patients returned to their desired levels of work and sporting activity after operation. The operation is technically easy to perform and has comparably excellent results to other published series.

Adolescent↗
PubMed1989

Arthroscopic stapling repair for shoulder instability: a retrospective study of 50 cases.

Fifty arthroscopic stapling repairs of detached glenoid labra were done on 50 shoulders in 47 patients with chronic shoulder dislocation or subluxation. This method offers a shorter rehabilitation period and decreases the morbidity associated with traditional repair. No arthrotomies were done. The follow-up period ranged from 18 to 54 months with an average of 39.4 months. Eight shoulders in seven patients, or 16% of the series, sustained additional trauma that caused redislocation or resubluxation. We felt that this relatively high redislocation rate was due to failure to immobilize these shoulders for 3 weeks postoperatively. This resulted from the lack of instruction from the surgeon or lack of compliance by the patient. For the past 29 months, because a mandatory 3-week immobilization in a sling has been required, there have been no further redislocations. Complications were few and basically were related to the failure to use the equipment in the precise technical manner outlined by the manufacturer. All of the hardware complications were managed without undue difficulty, and although they were a source of consternation to the surgeon, they did not affect the patients adversely. A successful outcome requires good surgical technique by the surgeon and compliance and cooperation by the patient postoperatively.

Adolescent↗
PubMed1980

Posterior dislocation and fracture-dislocation of the shoulder.

Two cases of posterior dislocation (PD) and four cases of posterior fracture-dislocation (PFD) of the shoulder are reported. There was one bilateral PD and two bilateral PFD. One PD was treated with closed reduction but in three cases of PFD operative reduction was necessary. All measures were applied in the late phase within 1 to 10 months after the injury with good primary results. However, because of posttraumatic arthrosis, the final result was poor. The average follow-up period was 4 years. The diagnosis of posterior dislocation is often missed. An axillary X-ray is essential.

Adolescent↗
PubMed1996

[The importance of medical history taking in diagnosis of shoulder arthropathy].

The data collected at taking medical history were analyzed on the basis of clinical, radiographic and sonographic differential diagnosis in shoulder pathology. Material included 236 patients. Hedtmann and Fett classification has used. Age of the patient, duration of the condition and its relation to the trauma in a broad meaning are of paramount importance. The authors recommend sonographic examination in all cases of shoulder contusion with no bony abnormalities on radiographs and in all cases of anterior shoulder dislocation in order to assess rotator cuff condition.

Adolescent↗
PubMed1989

Shoulder arthroscopy.

The results of 50 shoulder arthroscopies are presented. A great variety of different lesions were seen. In 27 of the 50 cases the diagnosis was changed or refined. In particular, unexpected rotator cuff tears and radiolucent loose bodies were found. The presence of Bankart and Hill-Sachs lesions confirmed the diagnosis of recurrent dislocation in clinically subluxing patients with no radiological evidence of dislocation. Shoulder arthroscopy promises to increase diagnostic precision in patients with shoulder pain and may have therapeutic potential with minimal morbidity.

Arthroscopy↗
PubMed1983

The coracoid transfer for recurrent dislocation of the shoulder. Technical aspects of the Bristow-Latarjet procedure.

One hundred and twelve shoulders with recurrent anterior dislocation were treated with the Bristow-Latarjet procedure and had a two to five-year follow-up after surgery. The incidence of redislocation was 6 per cent, and an additional 7 per cent of the patients reported occasional subluxation. In 106 shoulders, a radiographic study was carried out in order to determine the importance of factors such as healing and position of the transferred coracoid process with regard to the postoperative clinical results. No redislocation or subluxation occurred in the forty patients in whom the transplant showed osseous or fibrous union at the scapula and was located inferior to the equator of the glenoid and less than one centimeter medial to its rim. In shoulders in which either the transplant had migrated more than 1.5 centimeters from that position or was placed one centimeter or more medial to the glenoid rim, the incidence of redislocation or subluxation was significantly increased.

Adolescent↗
PubMed2005

Prospective randomized clinical trial comparing the effectiveness of immediate arthroscopic stabilization versus immobilization and rehabilitation in first traumatic anterior dislocations of the shoulder: long-term evaluation.

PURPOSE: To report the long-term results of a prospective randomized clinical trial comparing the effectiveness of immediate arthroscopic stabilization versus immobilization and rehabilitation after a first traumatic anterior dislocation of the shoulder. TYPE OF STUDY: Randomized clinical trial. METHODS: Forty subjects younger than 30 years with a first traumatic anterior shoulder dislocation were randomized to receive immediate anterior stabilization plus rehabilitation or immobilization followed by rehabilitation. Patients completed the American Shoulder and Elbow Surgeons (ASES), Disabilities of the Arm, Shoulder and Hand (DASH), and the Western Ontario Shoulder Instability Index (WOSI) questionnaires. RESULTS: At an average follow-up of 75 months, there was a significant difference in the rate of redislocation between the groups but no statistical significant difference in shoulder function with the ASES or the DASH. The mean difference between the 2 groups with the WOSI estimates a small, but clinically significant difference. CONCLUSIONS: It is recommended that immediate arthroscopic stabilization is the treatment of choice in a subset of patients who are younger than 30 years and are higher level athletes, and the timing for surgery is good or their sport is risky, i.e., rugby, football, kayaking, rock climbing. LEVEL OF EVIDENCE: Level II.

Adult↗
PubMedDate not supplied

Terrible triad of the shoulder.

The purpose of this study was to assess the functional outcome of the terrible triad of the shoulder, a rare combination of anterior shoulder dislocation, massive rotator cuff tear, and neurologic injury. Six patients with this condition have been treated at our institution since 1990. The mean age was 57 years. All patients underwent rotator cuff repair (RCR). The mean time from injury to surgery was 5 months. Follow-up averaged 5.6 years. Functional outcome was recorded by use of the Shoulder Pain and Disability Index. Preoperative mean active forward elevation was 24 degrees, as compared with 98 degrees postoperatively. Strength improved from 3 lb to a mean of 12 lb in forward elevation and from 2 lb to 16 lb in external rotation. Clinically, 5 of 6 patients achieved recovery of their nerve injury. Total Shoulder Pain and Disability Index postoperative scores revealed good or excellent results in 4 of 6 patients. For this injury pattern, performing an RCR offers the patient the best chance for a favorable outcome. Waiting for neurologic recovery before performing RCR is not recommended.

Adult↗
PubMed1984

Bilateral dislocation of the shoulders.

Ninety cases of bilateral dislocation of the shoulders, including seven previously unreported cases are discussed. Forty-nine per cent were due to convulsive seizures or electrocution, 23 per cent were traumatic and 36 per cent were atraumatic. This paper indicates that many attributed to trauma were probably due to unrecognized seizure, and neurological examination is indicated in all cases. Dislocations as a result of seizures or electrocution were often diagnosed late.

Adult↗