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At least 1,531 records · Page 85Linked to original sources
PubMed2003

Outcomes of acute arthroscopic repair and conservative treatment following first traumatic dislocation of the shoulder joint in young patients.

INTRODUCTION: The aim of this study was to compare patients who had arthroscopic repair done following the first traumatic dislocation with patients who were treated conservatively, in terms of stability and function. MATERIALS AND METHODS: Acute arthroscopic Bankart repair with absorbable tack was used in 30 shoulders after the first dislocation, while 32 patients who sustained traumatic anterior dislocation were treated conservatively at Gülhane Military Medical Academy, Department of Orthopaedics and Traumatology between March 1997 and April 2001. Preoperative and postoperative range of motion of the shoulder and Constant score of all patients were recorded. RESULTS: In the conservative group, the average pretreatment Constant score was 46.8 (range, 30 to 70) and the average post-treatment Constant score was 71.4 (range, 30 to 95). In the surgical group, the average preoperative Constant score in cases with Bankart lesion was 44.7 (range, 30 to 60) and the average postoperative Constant score was 92.3 (range, 65 to 100), (P = 0.0001). CONCLUSION: Our results support the use of acute arthroscopic repair of traumatic anterior shoulder dislocations with absorbable tacks. Arthroscopic repair is the treatment of choice in young and active patients who are having their first traumatic dislocation.

Adolescent↗
PubMed1998

[Results of posterior inferior capsular shift in posterior shoulder instability].

PURPOSE: The purpose of this study was the evaluation of our results after posteroinferior capsular shift in patients with a posterior shoulder instability. MATERIALS AND METHODS: In a prospective study we evaluated 12 patients (14 shoulder joints) with recurrent posterior shoulder dislocations who were stabilized by a posteroinferior capsular shift procedure. For the clinical documentation the Rowe-Score, the ASES-Score and the SF-36 were used. Furthermore the patients were submitted to standardized EMG-, isokinetic and proprioceptive tests. RESULTS: After an average follow-up of 22.2 months there were two recurrences which occurred during the first postoperative year. The Rowe-Score improved from 46.25 to 76.34 points. The ASES-Score showed an average of 42.43 points pre-operatively and at the time of follow-up an average of 78.86 points. Most parameters of the ASES-Score as well as the score in total had a constant positive tendency. Only the subjective rating of stability showed a slight decrease after the first six months due to the two redislocations. But even the stable shoulder joints demonstrated limitations when throwing a ball. The SF-36 showed a definite gain in the overall quality of living as well. The EMG-tests at follow-up showed a deficit for the patients compared with a control group; even more for the female than for the male patients. Similar tendencies were found with the isokinetic strength. The proprioception did not show any differences between the patients and the control group. CONCLUSION: With adequate patient selection and after failure of all possible conservative treatments the posteroinferior capsular shift is a therapeutical option in recurrent posterior shoulder instability.

Adolescent↗
PubMed1998

Kocher's painless reduction of anterior dislocation of the shoulder: a prospective randomised trial.

Forty-five patients with an anterior dislocation of the shoulder were randomised into one of two treatment groups and manipulation performed using Kocher's original method (without traction). A successful reduction was achieved in 80.9% of patients administered Entonox only and in 100% of patients sedated intravenously. No statistical significance was found in the pain scores between the two groups. The study shows that Kocher's original method is a reliable technique for reducing anterior dislocation of the shoulder and a successful outcome can be expected using nitrous oxide only, obviating the need for intravenous sedation and analgesia in the majority of patients.

Adolescent↗
PubMed1976

The upper-extremity amputee. Early and immediate post-surgical prosthetic fitting.

The results of immediate and early post-surgical prosthetic fitting in eighty-seven upper-extremity amputees as well as the results in nine patients with shoulder dislocation who were fitted with temporary devices were reviewed. No local wound complications occurred and the rate of prosthetic acceptance was high. A practice prosthesis, with a filler insert formed from liquid Silastic foam allowed to set between the walls of the practice prosthesis and the amputation stump, was used extensively in this series. With the Silastic insert and practice prosthesis, prosthetic training could be instituted during healing of the amputation wounds, proximal wounds, or fractures.

Amputation, Surgical↗
PubMed1997

[A case of posterior dislocation of the shoulder with fracture of the humeral neck].

A case of posterior dislocation of the shoulder with concomitant fracture of the humeral neck and diagnostic difficulties are discussed. An axial radiograph of the shoulder was omitted at the first examination and posterior dislocation was unrecognized. It was diagnosed only after one month. Surgical reduction with Steinman pin and Kirschner wires fixation rendered good final outcome.

Fracture Fixation↗
PubMed1996

Arterial injury of the axilla: an unusual case after blunt trauma of the shoulder.

The lesion of an axillary artery after a shoulder dislocation without bone fractures is very rare. The most common lesion is the subtotal transection of the vessel. Vascular injuries may be associated with nervous lesions whose incidence ranges from 27 to 44%. The nervous lesions are highly invalidating. The symptoms which recur most frequently are motor and sensitive deficiencies and a distal ischemia which, in some cases, may not be noted owing to the extensive collateral network. Whenever these symptoms are covered or absent, as in this case report, an angiography of the upper limb becomes essential for correct diagnosis and treatment.

Accidental Falls↗
PubMedDate not supplied

A long-term retrospective study of the modified Bristow procedure.

A retrospective follow-up study is presented on the results in 51 patients who underwent the modified Bristow procedure for recurrent anterior shoulder dislocation or subluxation between 1972 and 1982. The average follow-up period was 95 months. Postoperatively, 6% of the patients had recurrent anterior dislocation and 4% had recurrent anterior subluxations. Another 4% of the patients developed posterior subluxation after surgery. Seventy-six percent of the patients felt that there was no postoperative limitation in their activities. Eighteen percent felt limited in throwing sports and 4% felt limited in swinging sports. Fourteen percent of the patients had screw complications that involved screws causing pain (6%), fractured screws (4%), bent screws (2%), and loose screws (2%). Additional surgical procedures were required in 14% of patients: screw removal (8%), hematoma drainage (2%), and reoperation using the modified Bristow procedure (4%). Ninety-two percent of the patients assessed their surgical results as excellent or good.

Adult↗
PubMedDate not supplied

Irreducible acute anterior dislocation of the shoulder: case report.

A 91-year-old woman presented with an acute anterior dislocation of the shoulder which could not be reduced by closed manipulation. Open reduction demonstrated a fresh dislocation which could not be reduced until the subscapularis muscle was divided. Only 2 previous cases of irreducible anterior dislocation of the shoulder seem to have been reported in the recent or readily available literature.

Aged↗
PubMed1998

Prospective evaluation of MR arthrography performed with high-volume intraarticular saline enhancement in patients with recurrent anterior dislocations of the shoulder.

OBJECTIVE: The purpose of this study was to evaluate the accuracy of high-volume saline-enhanced MR arthrography in assessing the labrum, the ligaments, and the bony components of the glenohumeral joint. SUBJECTS AND METHODS: Forty-four patients with recurrent anterior dislocations of the shoulder underwent MR arthrography after intraarticular injection of 15-40 ml of saline solution. Two-dimensional fast low-angle shot and T1-weighted spin-echo sequences were prospectively evaluated by two observers. Anterior (Bankart) lesions, superior labral lesions extending from anterior to posterior, and Hill-Sachs lesions were diagnosed. Glenohumeral ligaments (GHLs) were identified and classified using a standard system. MR imaging results were compared with those of arthroscopy (n = 32) or open surgery (n = 12), either of which was the gold standard. RESULTS: Bankart lesions and superior labral lesions extending from anterior to posterior were revealed with a sensitivity of 93% and 89%, respectively, and a specificity of 80% and 89%, respectively. Diagnostic accuracy was 89% for both types of lesions. All six patients with bony Bankart lesions had high fat-marrow signal intensity within the fragment on T1-weighted MR images. For GHLs, MR imaging results and arthroscopy correlated in 25 of the 31 patients. In three patients all three GHLs were visible on MR imaging, but only two GHLs were detected with arthroscopy. In three patients two GHLs were detected on MR imaging but all three were visible on arthroscopy. Hill-Sachs lesions were revealed with a sensitivity of 95%, a specificity of 50%, and an accuracy of 81%. CONCLUSION: High-volume saline-enhanced MR arthrography is accurate in revealing the labrum, the ligaments, and the bony components of the glenohumeral joint Saline solution is inert and inexpensive, two advantages over gadopentetate dimeglumine.

Adult↗
PubMed1992

Technical note: modifications and improvements of the Milch technique for the reduction of anterior dislocation of the shoulder without premedication.

A method for the reduction of anterior dislocations of the shoulder based on the Milch technique is presented. We have been using this method for the last 2 years (75 dislocations) with excellent results. The reduction is easy, produces minimal pain and discomfort for the patient, and the success rate is as high as 94.5%. The modified Milch technique is less troublesome for the patient and the physician and we strongly recommend it.

Adolescent↗
PubMedDate not supplied

Elbow flexion analysis in Bristow patients. A preliminary report.

Seven male nonathletes who had Bristow procedures for shoulder dislocation were analyzed by dynamic electromyography (EMG) and Cybex strength measurement to evaluate the function of elbow flexion. Bilateral strength of elbow flexion also was measured in the 10 controlled subjects to compare the dominant and nondominant arms. The EMG data showed the operated short head of biceps function at low constant intensity, compared with the nonoperated side, while the long head of biceps and brachialis increased their activity. The strength measured by the Cybex demonstrated the elbow flexion on the operated side was not significantly different from the normal group. These data demonstrated that the Bristow procedure reduced the dynamic response of the short biceps which was compensated for by the increase in level of activity of the long heads and brachialis muscle. As a result, normal range of elbow function was restored. Our patients had had intense rehabilitation programs. This appears to be an essential part of the postoperative management to develop the needed compensatory muscle action.

Adult↗
PubMed1986

Latissimus dorsi transfer for recurrent dislocation of the shoulder.

The results of latissimus dorsi transfer for recurrent anterior dislocation of the shoulder performed during the past three decades were subjected to a failure analysis. Twenty patients operated on in the light of this had no episodes of dislocation and obtained full function. The mode of action of the latissimus dorsi transfer explains the apparent paradox of an operation that produces external rotation resulting in the prevention of anterior dislocation. The action of the transfer in pulling the humeral head posteriorly is the most important feature. If the transfer is not located correctly, this force will be less than that produced in external rotation and dislocation will recur.

Adolescent↗
PubMedDate not supplied

Surgical treatment of acute and chronic posterior fracture-dislocation of the shoulder.

Seventy-three shoulders (66 patients) with posterior fracture-dislocation of the shoulder were treated. Thirty patients were treated during the acute phase. One case was classified as subspinous, and 56 were considered subacromial; 4 cases had posterior fracture-dislocation in three parts, 3 in four parts, and 9 at the anatomic neck. Treatment consisted of closed reduction and immobilization in the emergency department, McLaughlin's procedure, hemiarthroplasty, total shoulder, open reduction with internal fixation, arthroplastic resection, and arthrodesis. Ten shoulders were treated conservatively. The University of California-Los Angeles rating score was used to analyze 56 shoulders during a mean follow-up period of 32.7 months. Good and excellent results can be achieved in those cases that are treated up to 2 years of the lesion; after 2 years results tend to be fair. We do not suggest total shoulder arthroplasty as a treatment option for those surgeons without the necessary expertise.

Acute Disease↗
PubMed1979

Axillary artery occlusion with erect dislocation of the shoulder.

Occlusion of the axillary artery occurred in a man with erect dislocation (luxatio erecta) of the shoulder. This combination of injuries has not previously been reported. The arterial injury was demonstrated by arteriography and repaired by a vein graft. There was an associated fracture of the greater tuberosity of the humerus, which required open reduction and internal fixation.

Adult↗
PubMed1982

Axillary nerve palsy following blunt trauma to the shoulder region: a clinical and electrophysiological review.

Although the commonest type of axillary nerve palsy occurs following shoulder dislocation on humeral fracture, another form is seen after blunt trauma to the shoulder region without associated fracture or dislocation. The former usually goes on to a full recovery whereas a failure to recover is common in the latter group. In our review of 13 patients with palsy after blunt shoulder trauma, seven patients showed minimal or no recovery of deltoid muscle function and six patients went on to complete or near complete recovery. Serial electromyographic examinations usually revealed the lesion to be in continuity although eventual clinical recovery was not satisfactory in a number of these patients. The mechanism of the palsy appeared to involve a stretch injury and this was confirmed at operation in two patients. Glenohumeral fixation was a troublesome complication which limited recovery of function in four patients. Further details of the type of trauma, clinical and electromyographic examination, assessment and management are discussed.

Adolescent↗