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The Magnuson-Stack operation for recurrent anterior dislocation of the shoulder. A long-term follow up of 44 operations.

A retrospective review was carried out on 44 patients with recurrent anterior dislocation of the shoulder who were treated by the Magnuson-Stack operation. The average follow up was 12 years. There were 2 recurrences. Twenty-five patients had no symptoms, 3 had pain, 6 complained of subjective instability, and 8 had more than 10 degrees restriction of external rotation. No patients had signs of osteoarthritis in the joint. The satisfactory results and the ease of the operation are reasons for advocating this procedure.

Adolescent↗

Bilateral posterior fracture-dislocations of the shoulder after convulsive status epilepticus.

Presented is the case of a 30-year-old man who sustained bilateral posterior fracture-dislocations of the shoulder as an unusual complication of status epilepticus. Initial evaluation failed to reveal this unsuspected diagnosis. After improvement in the patient's mental status, his subjective complaints made the diagnosis evident. He subsequently underwent hemiarthroplasty for one shoulder and active assisted range of motion exercises for the other, with partial return of function in both arms.

Adult↗

Luxatio erecta humeri. A case report.

Luxatio erecta humeri is a rare type of glenohumeral dislocation. The pathomechanics of this injury involve either direct axial loading on a fully abducted extremity or leverage of the humeral head across the acromion by a hyperabduction force. The clinical presentation of this type of shoulder dislocation is unique, with the affected extremity held rigidly above the head in abduction. Reduction is accomplished by a form of traction-countertraction under intravenous sedation and analgesia. A variety of neurologic and vascular injuries may be associated with luxatio erecta humeri, involving the brachial plexus and axillary artery, respectively. Concomitant fracture of the acromion, clavicle, coracoid, greater tuberosity, and humeral head may also be seen. A computed tomography scan of the case reviewed here revealed a large humeral head defect oriented perpendicular to the classic Hill-Sachs lesion. Luxatio erecta humeri is associated with significant late morbidity, including recurrent dislocation, instability, and adhesive capsulitis.

Adult↗

[2 cases of habitual bilateral posterior dislocation of the shoulder treated with glenoid osteotomy].

In two cases of bilateral spontaneous posterior dislocation of the shoulder, the authors have detected an anomaly of orientation of the glenoid cavity. A technique of radiological examination which allows a study of the position of the joint surface relative to the acromion and the coracoid process is described. Osteotomy of the glenoid was completed by a posterior graft taken from the end of the acromion with satisfactory results in the two cases.

Adult↗

[Reduction of old unreduced anterior dislocations of the shoulder (author's transl)].

The authors have reviewed 15 old unreduced anterior dislocations of the shoulder. Most of the results were poor after resection or surgical reduction with reefing of the capsule. In two cases the technique described by Boyd was employed. After open reduction, the joint was stabilised by a transplant of the long head of biceps which was attached to the clavicle after passing in front of the joint behind subscapularis. This technique allows an early mobilisation and gave good results in two cases.

Adult↗

Persistent dislocation of the shoulder in elderly patients.

Four elderly patients with longstanding unrecognized dislocation of the shoulder were treated by physiotherapy only. Good functional results, associated with a greatly increased range of pain-free motion, demonstrate the usefulness of conservative treatment in cases of persistent dislocation of the shoulder in the elderly.

Aged↗

Bilateral anterior dislocation of the shoulder following a grand-mal convulsion.

Bilateral dislocation of the shoulders is an uncommon event. The majority are posterior and occur during a seizure, electrical shock or electroconvulsive therapy, and in patients with neuromuscular disorders and psychiatric disturbances. The literature contains only eight cases of traumatic bilateral anterior dislocations. This report describes only the second case sustained during a grand-mal convulsion.

Adult↗

A new method of shoulder reduction in the elderly.

A new method of reduction of shoulder dislocation has been employed in 35 elderly patients with excellent results. The surgeon stands behind the seated patient and inserts his flexed forearm into the axilla of the affected shoulder. His free hand applies traction on the flexed forearm of the patient. The surgeon's forearm pulls in a proximal and lateral direction and levers the head of the humerus into the socket. The method is relatively atraumatic, provides more direct control of the limb and applies more effective forces than the Kocher, Stimson, or hippocratic maneuvers.

Age Factors↗

Bilateral central dislocation of the hip. A case report.

Bilateral posterior shoulder dislocations and vertebral fractures are well described complications of convulsive activity. A 72-year-old woman with osteoarthritis of both hips and knees centrally dislocated both hips during a tonic-clonic seizure. Bilateral central fracture dislocation of the hip, although rare, must be suspected in the postictal patient who complains of hip and knee pain.

Aged↗

The anterior labroligamentous periosteal sleeve avulsion lesion: a cause of anterior instability of the shoulder.

Recurrent anterior unidirectional instability of the shoulder is not always associated with a classic Bankart lesion, which is an avulsion of the anterior labroligamentous structures from the anterior glenoid rim. Because the anterior scapular periosteum ruptures, the labrum and the attached ligaments are found to float out anterior to the glenoid rim when viewed arthroscopically. The anterior labroligamentous periosteal sleeve avulsion (ALPSA) of the supporting anterior inferior ligamentous and labral structures of the shoulder joint was found in four of eight acute primary anterior shoulder dislocations. This lesion differs from the Bankart lesion because the anterior scapular periosteum does not rupture, thereby allowing the labroligamentous structures to displace medially and rotate inferiorly on the scapular neck. These lesions eventually heal, and lead to recurrent anterior dislocations because of the subsequent incompetence of the anterior inferior glenohumeral ligament. An arthroscopic technique that converts the ALPSA lesion to a Bankart lesion and subsequently reconstructs the supporting anterior inferior structures of the shoulder has been successful in 26 cases (4 acute and 22 chronic) which were followed for > or = 2 years. Only one dislocation occurred, and it was the result of severe trauma.

Acute Disease↗