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PubMed1981

[Recurring anterior dislocation of the shoulder].

The paper makes a pathogenetic study of habitual dislocation of the shoulder, an analysis of the surgical techniques most widely used, and a review of the case histories collected at the G. Pini Orthopaedic Hospital for patients operated by the Bankart-Delitala method. After a short introduction on the general features of the lesion, and on normal human anatomy, the paper sets out the pathological anatomy, aetiopathogenesis and the radiological and clinical picture. Lastly consideration is given to the most widely known and diffused procedures for treatment, divided into: --Operations on the anterior capsule and the glenoidal pad. --Arthroereisis operations. --Tendinous transposition operations. --Tendinous suspension operations. The case histories cover nineteen subjects treated by the Bankart-Delitala method and rechecked at a distance ranging from a year to six years after the date of the operation. Statistical data are presented on age, sex, side affected and final functional data. These results comprise fifteen perfect cases with total recovery of activity and absence of pain. Three cases reported occasional pain, and one a slight sensation of hindrance of movements. No fresh dislocation. The Authors conclude by stressing the complete efficacy of the Bankart-Delitala method, as regards both functional recovery and the capacity for preventing further dislocations.

Humans↗
PubMed1990

[Fractures-dislocations of the shoulder in middle-aged and elderly patients].

114 patients with fracture dislocations of the proximal end of humerus have been treated and observed. 83 of them were subjected to conservative and 31--to surgical treatment. Clinical, roentgenologic and radiologic evaluation of the immediate and long-term results allowed to formulate recommendations as to the selection of the treatment method of humerus fracture dislocations depending upon their type and general state of the patients.

Age Factors↗
PubMed2000

Mechanical properties of the posterior rotator cuff.

BACKGROUND: The infraspinatus is an important active and passive stabilizer of the glenohumeral joint. It functions as external rotator and participates in elevation of the arm. As its main posterior component, it is frequently involved in rotator cuff tears. OBJECTIVE: The purpose of this study was to determine the structural and mechanical properties of the infraspinatus tendon structure, including the midsubstance and insertion regions, in the superior, mid-superior, mid-inferior, and inferior portions, in two joint positions. METHODS: The infraspinatus tendons from 22 fresh frozen cadaver shoulders were divided into four strips. The tendons were held in a cryo-jaw and tested with a material-testing machine in 0 degrees or 60 degrees of glenohumeral abduction corresponding to 90 degrees arm abduction. Ultimate load, displacement and failure mode were recorded. Stiffness, ultimate stress and elastic modulus were calculated. RESULTS: Significant differences between glenohumeral abduction positions were detected only for the elastic modulus. The mid-superior (676.5 N, S.D. 231.0 N) and the inferior portion (549.9 N, S.D. 284.6 N) had the highest failure loads while the superior (462.8 N, S.D. 237.2 N) and the mid-inferior portions (315.3 N, S.D. 181.5 N) were weaker. Similar trends across the tendon strips were shown for stiffness, ultimate stress and elastic modulus. RELEVANCE: Position dependent changes in mechanical properties of the infraspinatus tendon probably do not play a role in the pathomechanism of posterior shoulder dislocation. Peaks in stiffness in mid-superior and inferior tendon sections explain the low incidence of posterior dislocations. The low ultimate failure loads in the superior portions might explain the frequent extension of rotator cuff ruptures into the infraspinatus tendon.

Aged↗
PubMed1996

Allograft reconstruction of segmental defects of the humeral head for the treatment of chronic locked posterior dislocation of the shoulder.

The recognized options for the treatment of chronic locked posterior dislocation of the shoulder are dependent on the size of the anteromedial defect of the humeral head. Transfer of the lesser tuberosity with its attached subscapularis tendon into the defect is recommended for defects that are smaller than approximately 40 per cent of the joint surface. Prosthetic replacement is preferred for larger defects. Four consecutive patients who had a chronic locked posterior dislocation of the glenohumeral joint associated with a defect of the humeral head that was at least 40 per cent of the articular surface were managed with reconstruction of the shape of the humeral head with use of an allogeneic segment of the femoral head. Stability was restored and maintained in each patient at an average of sixty-eight months (range, sixty to seventy-six months) after the procedure. Three patients reported little or no pain and no or slight functional restrictions in the activities of daily living, and they considered the result to be satisfactory. The fourth patient had mild pain and moderate-to-severe dysfunction secondary to avascular necrosis of the remaining portion of the humeral head after a symptom-free period of six years.

Activities of Daily Living↗
PubMed1990

Complete infraclavicular brachial plexus palsy with occlusion of axillary vessels following anterior dislocation of the shoulder joint.

Two cases of complete infraclavicular brachial plexus palsy after anterior dislocation of the shoulder joint are reported. Both patients had transient motor brachial plexus paralysis and extensive anesthesia of the whole upper limb. Additionally, one of them had occlusion of the axillary vessels. Vascular recovery occurred immediately after manipulation and reduction of the affected shoulder joint. Neurological recovery occurred 9 to 12 months later in both cases without surgery, other than closed reductions. Such neurological and vascular complications after anterior dislocation of the shoulder joint are unique.

Axillary Artery↗
PubMed1984

Swedish research in sports traumatology.

With long-established traditions in both sports medicine and trauma in Sweden, investigations are in progress on prevention, diagnosis, treatment, and rehabilitation, with special emphasis on soft-tissue injuries. The following subjects are of current interest: injuries to the ankle ligaments, compartment syndromes, knee ligament and meniscus injuries, thigh and groin muscle injuries, shoulder dislocation, lateral epicondylitis, and rupture of the ulnar collateral ligament of the thumb. Skiing injuries and the prevention of trauma in soccer players represent important unsolved problems.

Achilles Tendon↗
PubMed2003

Accelerated rehabilitation after arthroscopic Bankart repair for selected cases: a prospective randomized clinical study.

PURPOSE: Increased stress within a certain limit enhances ligament healing and improves joint function. In this prospective randomized clinical trial, we compared the clinical results of early motion versus conventional immobilization after arthroscopic Bankart repair in a selected patient population. TYPE OF STUDY: Prospective randomized clinical trial. METHODS: We performed an arthroscopic Bankart repair using suture anchors in 62 patients with traumatic recurrent anterior instability of the shoulder. Patients were randomized into 2 groups; group 1 (28 patients; mean age, 28 years) was managed with 3 weeks of immobilization using an abduction sling and conventional rehabilitation program, and group 2 (34 patients; mean age, 29 years) was managed with an accelerated rehabilitation program that consisted of staged range of motion and strengthening exercises from the immediate postoperative day. Selection criteria were nonathletes with recurrent anterior shoulder dislocation and a classic Bankart lesion with a robust labrum limited to 1 cm from the midglenoid notch. The patients were followed up for a mean of 31 months (range, 27 to 45 months; standard deviation, 9 months). Analysis of outcome included pain scores at 6 weeks and at final follow-up evaluation, range of motion, return to activity, recurrence rate, patient satisfaction with each rehabilitation program, and shoulder scores assessed by the American Shoulder and Elbow Surgeons Shoulder Index, the rating system of the University of California at Los Angeles, and another scoring system. RESULTS: The recurrence rate was not different between the 2 groups (P =.842). None of the groups developed recurrent dislocation. Two patients from each group were positive for anterior apprehension signs. Patients who underwent accelerated rehabilitation resumed functional range of motion faster (P <.001) and returned earlier to the functional level of activity (P <.001). Accelerated rehabilitation decreased postoperative pain (P =.013), and more patients were satisfied with this program (P <.001). Shoulder scores, return to activity, pain score, and range of motion were not different between the 2 groups at the final follow-up evaluation (P >.05). CONCLUSIONS: Early mobilization of the operated shoulder after arthroscopic Bankart repair does not increase the recurrence rate in a selected group of patients. Although the final outcomes are approximately the same for both groups, the accelerated rehabilitation program promotes functional recovery and reduces postoperative pain, which allows patients an early return to desired activities.

Adolescent↗
PubMed1991

Results of the Putti-Platt operation for recurrent anterior dislocation of the shoulder.

Between 1973 and 1981, 101 patients had a Putti-Platt repair for recurrent dislocation of the shoulder; 89 of them were followed up and 43 underwent a clinical examination, 23 being assessed with the Cybex dynamometer. The 46 who did not attend were interviewed by telephone. The mean follow up time was 8 +/- 2 years (range 5-14 years). Redislocation occurred in 18 patients (20%), but this was twice as high in patients who were aged under 26 years at the time of operation compared with those who were older (29% versus 13%). The time of recurrence was between 1 and 11 years after operation. A decrease in strength and power of abduction, internal and external rotation, was found in the affected shoulder. Restriction of all measured movements, particularly external rotation, was also found in all patients. Nevertheless most had a high functional score and relatively few symptoms. We conclude that the Putti-Platt procedure has a high recurrence rate in younger patients, and we hesitate to recommend it for young active individuals.

Adolescent↗
PubMed1996

[Treatment of recurrent anterior dislocation of the shoulder with pectoralis minor muscle-bone flap].

We treated 10 patients with recurrent anterior dislocation of the shoulder by transplantation of pectoralis minor muscle-bone flap transplanted to the upper part of the humerus. All patients were followed-up for an average 31 months and no recurrent was found. We consider that the muscle beily exerts a protective effect like a barrier on the weak anterio inferior region of the shoulder and increases the force for extending the shoulder and lifting the arm. The operation is based on biomechanics. Meanwhile, suturing the laxative joint capsule and repairing the weak anteroinfeior region of the shoulder is more beneficial to prevent from redislocation of the humerus head.

Adult↗
PubMed1993

Arthroscopically assisted repair of acute Bankart lesion.

Acute traumatic anterior shoulder dislocations are associated with high recurrence rates in young athletic individuals. Arthroscopically assisted stabilization of acute initial traumatic anterior dislocation was carried out in 11 young athletes. The average age was 20 years, with nine males and two females. The anterior acute Bankart lesion was surgically repaired using the technique described by Caspari/Morgan. There were no surgical complications. All patients were able to return to their sport without restriction. One patient had a transient episode of instability 8 months postoperatively associated with trauma, but no further sequelae. Using the Rowe scale there were nine excellent and two good results. Using repair of a Bankart lesion provides a stable shoulder with minimal loss of function and low recurrence rate. Early intervention should be considered in young, highly competitive athletes.

Adolescent↗
PubMedDate not supplied

Radiographic evaluation of the Hill-Sachs lesion in patients with recurrent anterior shoulder instability.

The Hill-Sachs lesion is an important bony sign of previous anterior shoulder dislocation and instability. Using orthographic projection, we evaluated the Hill-Sachs lesion in 30 shoulders in 27 patients with recurrent anterior shoulder instability. This produced a clear and undistorted view of the posterolateral notch. For orthographic imaging, the patient was placed supine with the arm in 135 degrees of flexion and 15 degrees of internal rotation. The x-ray beam was angled vertically through the humeral head. The width and depth of the posterolateral notches were measured on the orthographic radiographs. The average posterolateral notch depths were 3.9 +/- 0.9 mm in the dislocation group and 2.1 +/- 1.0 mm in the subluxation group. A shallow Hill-Sachs lesion was indicative of a greater degree of anterior instability of the shoulder.

Adolescent↗
PubMed2003

Unusual presentation and complication of the prone position for spinal surgery.

Patient positioning for operative procedures has long been associated with perioperative complications. We present a case report of shoulder dislocation, which occurred following positioning in the prone position, and was detected by axillary artery occlusion resulting in the loss of the radial artery blood pressure line waveform. We discuss the diagnosis and consequences of this complication.

Acetabulum↗
PubMedDate not supplied

[Traumatic rupture of the rotator cuff in an adolescent--case report].

A traumatic rotator cuff tear is a very rare condition, especially in the adolescent. We report about a 14-year-old boy who fell onto the right arm while riding his bicycle. Immediately after the accident he described some kind of click in his right shoulder. he was referred to our institution 3 days after the trauma. The MRI showed a huge defect of the labrumligament complex including the rotator interval. Intraoperatively, we found a complete disruption of the subscapularis and supraspinatus tendons as well as of the anterior stabilizers. We performed a modified Bankart repair and a reconstruction of the ruptured rotator cuff. The patient returned to his former sports as cyclist 3 months after surgery. This case is of clinical relevance because of the traumatic disruption of an intact rotator cuff in a young patient. Not the bone but rather the tendons and ligaments were the weakest link in this situation. In cases of primary traumatic shoulder dislocation, we have to look for bony and soft-tissue damage including the rotator cuff. With the present high standards in ultrasound and MR imaging we have to keep these techniques in mind in order not to overlook this type of accompanying injury.

Adolescent↗
PubMed1984

Rotational humeral osteotomy for recurrent anterior dislocation of the shoulder associated with a large Hill-Sachs lesion.

Rotational subcapital osteotomy of the humerus for recurrent anterior dislocation of the shoulder associated with a large Hill-Sachs lesion was performed first by us in 1964 as a trial. From 1967 through 1981, 207 rotational humeral osteotomies were performed. Follow-up was possible on 180 of these shoulders. The over-all redislocation rate was 5.7 per cent and the rate of non-traumatic redislocation, 1.1 per cent. Limitation of motion of more than 10 degrees was present in only 3.9 per cent, the maximum limitation of external rotation being 15 degrees in one patient. The average loss of external rotation was less than 5 degrees, without noticeable diminution of power or function in most patients. The results as graded by a standard rating scale were good to excellent in 90 per cent, fair in 3 per cent, and poor in 7 per cent of the patients. The fair and poor results were due to redislocation, delayed union or non-union, post-traumatic arthritis, and over-rotation at the osteotomy site. Reoperation was necessary in two patients with a non-traumatic recurrence, in six patients with delayed union or non-union, and in one patient with excessive rotation at the osteotomy site. Plate removal was performed one to two years postoperatively in 107 of the 180 shoulders. Of the 321 recurrent dislocations seen over the fourteen-year period, 65 per cent were associated with a moderate to severe posterior-superior impression fracture of the humeral head (Hill-Sachs lesion).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2000

[Surgical repair of the axillary nerve. Results of a five-year follow-up].

INTRODUCTION: We report a series of 19 cases of axillary nerve lesions, which were operated between 1981 and 1995. MATERIAL AND METHODS: There were 14 isolated lesions of the axillary nerve and in 5 patients the lesion to the axillary nerve was associated either with a lesion of the radial nerve or with a lesion of the suprascapular nerve. Fourteen patients sustained shoulder stretch injury, three had fractures of the scapular girdle and two anterior shoulder dislocation. Patients were operated on 9 months after trauma through a combined anterior and posterior approach. The lesion was located in the quadrilateral space. In 17 cases the neuroma was excised and the nerve was reconstituted, using sural nerve grafts. In two cases the nerve was only freed from the surrounding scar tissue. RESULTS: Results were considered as satisfactory in 10 out of 14 isolated axillary nerve lesions. According the Constant score there were 2 very good, 8 good and 2 fair results. In this study, neurolysis and axillary nerve associated with suprascapular nerve lesions gave poor results. DISCUSSION: The successfully reinnervated deltoid muscle adds strength and endurance to the affected shoulder. Electromyographic study remains important in detecting spontaneous return of muscle function and determining the most favorable operative period before severe amyotrophy appears.

Adolescent↗
PubMed1987

Locked posterior dislocation of the shoulder.

Of forty patients with forty-one locked posterior dislocations of the shoulder, the diagnosis had been missed by the initial physician in the majority. A motor-vehicle accident, a seizure, an alcohol-related injury, or electroshock therapy had caused the dislocation in these patients, and the average interval from injury to diagnosis was one year. Twenty-five of the forty-one dislocations had been diagnosed in less than six months. An axillary radiograph confirmed the diagnosis in all shoulders and demonstrated the approximate size of the impression defect. There were no associated displaced fractures of the humerus, but in twenty of the shoulders there was an undisplaced fracture of the proximal part of the humerus. The average length of follow-up was 5.5 years. For seven shoulders the deformity was accepted. Treatment in the others consisted of closed reduction, which was attempted in twelve shoulders and was successful in six of the twelve; transfer of the subscapularis tendon, which was attempted in nine shoulders and was successful in four; transfer of the lesser tuberosity, which was successful in all four shoulders that were so treated; hemiarthroplasty, which was performed in nine shoulders and was successful in six (the other three required revision); and total arthroplasty in ten shoulders, one of which dislocated postoperatively and was not treated. Once the diagnosis is established, the majority of patients with this lesion can be successfully managed.

Adolescent↗
PubMed1987

Arthroscopic Bankart suture repair: technique and early results.

Twenty-five recurrent traumatic unidirectional anterior shoulder dislocators were stabilized arthroscopically with a transglenoid absorbable suturing technique. A Bankart lesion was documented and repaired in all cases. Postoperative follow-up averaged 17 months (range 1 year to 30 months). All results were rated excellent. All patients achieved full, painless range of motion (ROM), and no instances of postoperative instability occurred. There were no complications. The details of the operative technique are described.

Adolescent↗