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PubMedDate not supplied

Irreducible posterior dislocation of the shoulder: MR and CT findings.

Failure to reduce an acute posterior dislocation of the shoulder is rare and is usually due to the interposition of a structure into the joint. In this paper we report the MR and CT findings of a failed reduction due to interposition of a dislocated biceps tendon between the humeral head and anterior glenoid fossa. This was associated with an avulsed subscapularis tendon with its attachment to the lesser tuberosity and a nondisplaced fracture of the humeral neck, findings which were only evident on MR.

Adult↗
PubMed2001

Long-term results of the Boytchev procedure for the treatment of recurrent dislocation of the shoulder.

The authors present the long-term results obtained with the Boytchev technique in the treatment of recurrent anterior dislocation of the shoulder. Recurrence, clinical outcome and functional limitations were evaluated. A total of 27 shoulders in 25 patients were studied. The average follow-up period was 13.3 years. There were no immediate neurovascular complications and no residual pain. The average recovery time was 4.3 months. Dislocation recurred in five shoulders (18%) and 18.5% of the patients were left with restricted mobility. All patients resumed their previous employment although sporting capacity recovered to pre-injury levels in only 9 of 15 patients. The results were classified as good in 18.5% and as excellent in 40.7% of the patients, but the remaining 40.7% had a fair or poor result. In conclusion, the recurrence rate is high and nearly 20% of the patients are left with limited shoulder mobility. Furthermore, although all the patients were able to return to their job, only 60% of those engaged in sports regained their previous level. This technique, although attractive, is better avoided.

Activities of Daily Living↗
PubMed1994

[Traumatic posterior dislocation of the shoulder in adults. Apropos of 25 cases].

In a series of 25 traumatic posterior dislocations of the shoulder treated from 1960 to 1985, 16 were overlooked and the time from injury to treatment ranged from 3 weeks to 14 months. 11 cases were secondary to motor vehicle accident and 14 occurred after a convulsive fit. Early closed reduction was effective in only 4 cases; in 2 cases, reduction was unstable and further screwing of an associated fracture of the tuberculum majus was performed to prevent redislocation; 3 locked dislocations necessitated open reduction and stabilization by subscapularis transposition into the defect of the humeral head. Most of the 16 chronic unreduced dislocations were treated by the same procedure. Overall, 21 cases were reviewed with a mean follow-up of 14 years. Functional outcome was more often satisfactory in acute (5/7) than in old unreduced dislocations (6/14). Mc Laughlin or Neer's procedures yielded good results in 9 out of 14 cases; they are indicated irrespective of the patient's age whenever Mc Laughlin's notch does not involve more than one third of the articular surface of the humeral head.

Adult↗
PubMed1993

Anterior dislocation of the shoulder and rotator cuff rupture.

Thirty-seven patients older than 40 years of age were seen after sustaining primary anterior dislocations of the shoulder. An associated rupture of the rotator cuff in each patient had been missed, often being mistaken for an axillary neuropathy. Eleven of these patients developed recurrent anterior instability that was due to rupture of the subscapularis and anterior capsule from the lesser tuberosity. In no patient was there a Bankart lesion. Repair of the capsule and subscapularis restored stability in all of the patients with recurrence.

Adult↗
PubMed2000

A clinical and radiographic comparison of absorbable and non-absorbable suture anchors in open shoulder stabilisation.

The aim of this study was to compare the clinical and radiographic results using either absorbable or non-absorbable suture anchors in patients with recurrent unidirectional, post-traumatic shoulder dislocations. All patients had a Bankart lesion. One surgeon operated on 33 consecutive patients, 27 males and six females. Group A comprised 15 shoulders and group B 18 shoulders, all of which underwent a standardised open Bankart reconstruction using 3.7-mm TAG suture anchors. In group A, absorbable anchors were used, while in group B, non-absorbable ones were used. There was one re-dislocation in each group. In group A, the Rowe and Constant scores were 89 (69-98) and 89 (76-99) points, respectively. The corresponding values in group B were 87 (44-98) (not significant; NS) and 90 (71-100) points (NS). The strength measurements revealed 8.1 (3.8-12.3) kg in 90 degrees abduction in group A and 10.0 (6.7-12.0) kg in group B. Healthy control shoulders revealed 10.2 (4.5-13.2) kg (NS A and B versus controls). The external rotation in abduction was 70 degrees (40-90) in group A and 80 degrees (40-100) in group B. The value for the controls was 90 degrees (80-120) [P < 0.001 (A versus controls), P < 0.05 (A versus B) and P < 0.001 (B versus controls)]. The radiographs revealed that 9/15 (60%) in group A and 10/15 (66%) in group B had visible drill holes or cystic formations in conjunction with the drill holes (NS). Furthermore, 11/15 (73%) in group A and 10/15 (66%) in group B had signs of minor degeneration (NS). We conclude that, in terms of stability and clinical results, no differences were found between the study groups. Both groups demonstrated a restriction in external rotation as compared with the healthy shoulders in the same cohort. On the radiographs, visible drill holes or cystic formations in conjunction with the drill holes were seen with equal frequency, regardless of whether absorbable or non-absorbable suture anchors were used.

Absorbable Implants↗
PubMed1986

Treatment of recurrent anterior dislocation of the shoulder by duToit Staple capsulorrhaphy. Results of long-term follow-up study.

DuToit Staple Capsulorrhaphy was performed on 79 patients during a period of ten and one-half years. Sixty-five patients were followed for an average period of nine years (26 months to ten and one-half years). Separation of the glenoid labrum from the glenoid rim was noted in 94% of the cases. A markedly lax and redundant capsule was noted in 6% of the cases. A bucket-handle tear of the glenoid labrum was noted in 4% of the cases. Fracture of the anterior rim of the glenoid was noted in 6% of the cases. There was one recurrence of dislocation (1.78%); 94% were rated as excellent; 4% were rated good; and 2% were rated poor. Out of 70% of the patients who were participating in athletic activities, 58% returned to athletic activities after surgical repair. Stapling the glenoid labrum to the glenoid is an effective method of treatment of recurrent anterior dislocation of the shoulder.

Adolescent↗
PubMed2006

Posterior dislocation of the shoulder with ipsilateral humeral shaft fracture: A case report and review of literature.

Isolated posterior dislocation of the shoulder with ipsilateral humeral shaft fracture is a rare combination. Three cases of such co-existence have been reported so far. We report a fourth case and review the literature. Our aim is to highlight the importance of this rare co-existence. A high index of suspicion is necessary to diagnose posterior dislocation of the shoulder as most concentration is on the humeral shaft fracture. Delayed diagnosis has a poorer prognosis.

Humans↗
PubMed2006

Closed reduction for traumatic posterior dislocation of the shoulder using the 'lever principle': two case reports and a review of the literature.

Traumatic posterior dislocation of the shoulder is frequently missed because of its rarity and the absence of characteristic symptoms. Several signs should be emphasised: an overlap of the humeral head and glenoid rim in a true anteroposterior view and the light-bulb sign in the anteroposterior view. To make an accurate and early diagnosis, use of multidirectional radiographs combined with computed tomography is recommended. Closed reduction was successfully performed under general anaesthesia using the DePalma method with slight modification--the lever principle--by pushing the medial side of the upper arm laterally to adduct the shoulder as far as possible. The dynamics of the lever principle make it a safer and more effective method of achieving a closed reduction of a posterior dislocation of the shoulder than the conventional method of solely pushing the humeral head anteriorly, especially in patients with locking of the glenohumeral joint and impression fractures.

Aged↗
PubMedDate not supplied

Treatment of locked posterior fracture-dislocations of the shoulder by total shoulder arthroplasty.

Total shoulder arthroplasty is indicated in the treatment of locked posterior fracture-dislocations of the shoulder where there is extensive damage to the articular surfaces of the humerus and glenoid. This report reviews the surgical technique, postoperative rehabilitation program, and functional results of seven shoulders in five patients who had locked posterior dislocations of the shoulder. Activities involving overhead positioning of the arm and heavy lifting continued to be challenging for this group of patients. The American Shoulder and Elbow Surgeons' Shoulder Score improved from 20.1 before surgery to 55.6 after surgery (p = 0.018). The extrication of the posteriorly dislocated humeral head may be difficult from an anterior deltopectoral approach. The authors describe the use of a secondary posterior incision facilitating the extrication of the humeral head. In this series total shoulder arthroplasty reliably decreased the patients' level of pain, improved their range of motion, and significantly improved their level of function.

Adult↗
PubMed1997

Posterior fracture-dislocation of the shoulder with infraspinatus interposition: the buttonhole phenomenon.

We present a case with a posterior fracture-dislocation in which interposition of the infraspinatus precluded closed reduction by means of standard manipulation. The fractured greater tuberosity included the lesser tuberosity, allowing the infraspinatus to dislocate anterior to the dislocated humeral head and interpose between the humeral head and the glenoid cavity. The infraspinatus constricted the humeral neck together with the teres minor. Traction in the zero-position was thus required for resolution of constriction and subsequent reduction. Computed tomography was useful to demonstrate interposition of the infraspinatus and to plan the treatment.

Adult↗
PubMed2006

The success of closed reduction in acute locked posterior fracture-dislocations of the shoulder.

We retrospectively reviewed the results of closed treatment in 7 patients with acute locked posterior fracture-dislocations of the shoulder. Shoulders were reduced with patients under general anesthesia and were splinted in neutral rotation for 6 weeks. Follow-up averaged 46 months (range, 24-88 months). All shoulders were reduced within 14 days. Humeral head defects ranged from 18% to 32% of the articular surface, and all patients had documented posterior instability under anesthesia after relocation. Of the 7 patients, 6 had a stable shoulder. The mean American Shoulder and Elbow Surgeons shoulder index was 93.5 (range, 83-100). The mean findings with regard to motion were active forward elevation to 169 degrees , external rotation to 73 degrees , and internal rotation to T11. All patients without preexisting shoulder pathology were treated successfully. Closed management of acute posterior fracture-dislocations can be highly successful, even in the face of instability under anesthesia and a 30% humeral head defect.

Acute Disease↗
PubMed1982

The forward elevation maneuver for reduction of anterior dislocations of the shoulder.

The simplicity, safety, and physiologic nature of the forward elevation maneuver for reductions of anterior dislocations and fracture-dislocations of the shoulder, is illustrated in a report of 50 cases. The method is effective and free of complications. The maneuver requires very little, if any, sedation and is particularly useful in all well-muscled young athletes with anterior dislocations of the shoulder.

Adolescent↗
PubMed1996

[Arthroscopy in trauma related anterior dislocation of the shoulder].

Arthroscopy allows for noninvasive management for certain lesions resulting from traumatic anterior dislocation of the shoulder. Primary reconstruction of the labrum and ligamentous complex prevents recurrence of the dislocation. Encouraging results after arthroscopic procedures make them an attractive alternative for traditional conservative management.

Adolescent↗
PubMed1978

Arthrography of the shoulder in anterior dislocation: a study of African and Asian patients.

Arthrography of the shoulder was performed in 16 consecutive cases of primary anterior dislocation and in 11 cases of recurrent dislocation. All the primary dislocations were in African Negro patients and showed an unusually high incidence of capsular rupture rather than labral detachment. It is suggested that this is due to stronger soft tissue attachment to bone in Africans, resulting in fewer labral detachments and thus accounting for the low incidence of recurrent dislocation in the African populace. The series of recurrent dislocations, consisting of African and Asian patients, confirmed the low incidence in Africans but demonstrated labral detachment and humeral head defects common to both racial groups.

Adolescent↗