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PubMed1977

[Has the duration of cast fixation after shoulder dislocations an influence on the frequency of recurrent dislocation? (author's transl)].

102 primary shoulder dislocations have been evaluated. Some were retained in a Velpeau bandage reinforced with plaster immediately after reposition for three weeks, others were treated with a sling or tube gauze only. The frequency of recurrent dislocation in both groups was compared. It could be demonstrated that the results were equal for both groups. We conclude that fixation with Velpeau Sling and cast reinforcement does not significantly influence the occurrence of recurrent dislocations.

Adolescent↗
PubMed2005

The epidemiology of shoulder dislocation in a state-hospital: a review of 106 cases.

This retrospective study was conducted in a state hospital set-up and aimed at identifying the magnitude of shoulder dislocations and their demographic data, characteristics of the injury, mechanism and predisposing factors, and the instituted treatment. Patients with radiographic evidence of shoulder dislocation admitted to the hospital from January 1999 to December 2002 were included. Data were recorded from the case notes. There were 105 shoulder dislocations with male predomination in 77% cases and age ranged between 11 and 90 years (average 30.9 years). The right shoulder was affected in 68% of the cases. The contributing events were fall in 37% of cases, road traffic accident 23%, sports 17% and pathological conditions 13%. Anterior dislocation occurred in 96.2% of the cases. Posterior and inferior dislocations encountered in two patients for each type. Twelve dislocations were associated fracture of the greater tuberosity, two each with humeral neck fracture and cerebral injuries. First time dislocation occurred in 73.6% of the cases. The recurrences ranged between 2 to 6 times (average 3.4 times). Closed manipulative reduction and strapping was the definitive treatment in 92.4% of the cases and the remaining needed surgical reconstruction. Four patients had open reduction and internal fixation of the associated fractures while another four had arthroscopic Bankart's repair. In conclusion, shoulder dislocation represents the most common shoulder problems. It afflicted young adults of reproductive age (21-40 years) and participation in sports was a risk factor in men. Women over 40 years and fall were at risk to develop shoulder dislocation.

Adolescent↗
PubMed1997

[Treatment of recurrent traumatic shoulder dislocations with coracoid transfer--Latarjet-Bristow operation].

We reviewed 31 patients with recurrent traumatic anterior shoulder dislocations, being operated with the Latarjet-Bristow procedure consecutively between March 1991 and March 1994. The average follow-up time was 31.2 months. According to the Rowe-score results were estimated as excellent in 45.1% and as good in 38.7%. New shoulder dislocations occurred in one case, resulting in a new shoulder dislocation rate of 3.2 per cent. Deficits in the external rotation of more than 5 degrees compared with the not operated side were seen in 15 patients. In two patients 7 respectively 9 months after the operation loosenings of the screws happened, but were without any effect on the functional outcome of the operation. The Latarjet-Bristow procedure proved to be a very safe method with a low redislocation rate, few complications and good functional results. Because of limitations in external rotation, however, this method should only be performed in cases in which an anatomic labrum reconstruction is hardly possible.

Adolescent↗
PubMed1989

A biochemical evaluation of the restraints to posterior shoulder dislocation.

The biomechanics of posterior dislocation of the shoulder was evaluated using nine cadaver shoulders. Each was arthroscoped, roentgenograms were obtained, and then each was dislocated in a testing device. Force displacement data was obtained during testing, and posttesting roentgenograms, arthroscopic evaluation, and subsequent open dissections were performed to evaluate the pathology created. Although instability was created in all cases with displacement of the humerus to the diameter of the humeral head, force displacement of the humerus to the diameter of the humeral head, force displacement curves did not show an inflection point, implying a continuum between subluxation and dislocation. All shoulders had posterior Bankart lesions or posterior capsular lesions, or both. Anterior pathology was not seen. Posterior instability is most likely a continuum between subluxation dislocation with progressive injury to the posterior capsule and attachments such as the labrum as the principal restraint to posterior displacement.

Aged↗
PubMed1999

[The subacromial shoulder dislocation].

We report on a case of subacromial shoulder dislocation, which resulted from a combination of a cranial glenoid fracture and an acromial fracture. The patient sustained this rare injury while playing handball. The whole implication of the injury was revealed only after extensive workup with CT scan of the shoulder. After reduction of the shoulder dislocation, the glenoid fracture was stabilized by osteosynthesis. The postoperative results showed anatomical reconstruction of the glenoid joint surface. After completion of therapy, the patient has achieved good functional results with a full range of motion (abduction 180 degrees ) and has been able to work full-time again.

Acromioclavicular Joint↗
PubMed1989

A lesion of the musculocutaneous nerve. A rare complication of anterior shoulder dislocation.

A 47-year-old male patient with an anterior shoulder dislocation underwent reduction 3 days later. A residual neurologic injury remained, consisting primarily in weakness of shoulder and elbow flexion and sensory involvement of the ventral side of the forearm. Secondary sequelae included muscle atrophy with a concomitant frozen shoulder. The clinical examination and electromyography revealed a lesion of the musculocutaneous nerve, which is a very rare complication in shoulder dislocation.

Humans↗
PubMed1984

Axillary artery rupture caused by shoulder dislocation.

A case of axillary artery disruption following an anterior shoulder dislocation is reported, the eleventh such case in the past 25 years. As an alternative to dividing the pectoralis major tendon, two incisions, infraclavicular and transaxillary incisions, were used to repair the artery with an interposition Dacron graft. An absent radial pulse following a shoulder dislocation suggests the possibility of axillary artery injury, usually a dissected intimal flap but occasionally a ruptured vessel. Early arterial repair is indicated, preceded by arteriography, if available. Brachial plexus injury frequently accompanies arterial damage and is not affected by arterial repair. Permanent, partial motor dysfunction is common, especially involving the extensors of the hand.

Aged↗
PubMed1997

Anteroinferior shoulder dislocation: an auto-reduction method without analgesia.

OBJECTIVES: To describe a new reduction method for anteroinferior shoulder dislocations. DESIGN: Retrospective for the first thirty patients; prospective for the remaining seventy patients. SETTING: University hospital. PATIENTS: One hundred patients with anteroinferior shoulder dislocations. INTERVENTIONS: X-rays in two different projections were taken. The patient then was asked to sit on a relatively hard surface. The wrists were protected. The patients's forearms were placed around the homolateral knee, which is flexed at 90 degrees. The head of the examination table was lowered, and the patient was asked to lean backward with his or her neck in hyperextension. The patient had to push his or her shoulders (shrug) anteriorly, thus creating a rational movement of the scapula around a vertical axis. MAIN OUTCOME MEASURES: The authors analyzed initial prereduction x-rays and established a classification system based on the position of the humeral head, then assessed the success rate of the new technique with respect to the radiologic study. RESULTS: When using the reduction method described by Boss-Holzach-Matter, the authors attained an overall success rate of 60 percent, with a mean reduction time of three minutes and a time interval varying from fifteen seconds to nine minutes. CONCLUSION: The Boss-Holzach-Matter method is a reduction technique for anteroinferior shoulder dislocations that can be used without premedication or anesthesia. The authors recommend it for those patients who are not going to be sedated and for whom "quick" reduction and early discharge is desirable.

Adolescent↗
PubMed2003

[Chronic anterior shoulder dislocation treated by open reduction sparing the humeral head].

PURPOSE OF THE STUDY: Treatment options for unreduced anterior dislocation of the shoulder have varied from nonoperative treatment to different surgical options. Little has been written in the literature on the management of unreduced anterior dislocation or on the results of the different procedures. We report our experience and present the outcome after an open reduction joint-saving procedure used in five patients. MATERIAL AND METHODS: Five patients, mean age 39 years (range 17-69 years) underwent the joint-saving procedure for chronic anterior shoulder dislocation. Pain was predominant for two patients and functional impairment for three. The shoulder had been anteriorly dislocated for six weeks to up to 36 months (average 14 months). Open reduction was performed in all cases with reinsertion of the capsulo-labral complex onto the anterior glenoid rim. A bone graft was used in one patient to reconstruct an anterior glenoid bone defect involving more than half of the joint surface. No graft was used to fill the humeral head defect. RESULTS: At an average follow-up of 25 months (range 12-36 months), outcome was excellent in one patient, good in three, and poor in one (Rowe and Zarins score). Postoperatively, the overall score averaged 75 points (range 40-90). Pain score improved from 12 to 27 points. Three shoulders were totally pain free and two had mild to moderate pain. Motion improved from 12 to 28 points. Anterior active elevation averaged 126 degrees, external active rotation 17 degrees, and internal active rotation to the level of the first lumbar vertebral body. Functional score improved from 9 to 20 points. All the patients were able to perform daily living activities. The radiographic evaluation showed anterior subluxation of one shoulder one year after surgery. Osteoarthritis was also noted in one patient. No peroperative or postoperative complication was seen. DISCUSSION: Unreduced anterior shoulder dislocation should be treated with an open reduction and reconstruction of the specific lesions, unless the patient is old or debilitated. This operation can however be difficult and requires extensive soft tissue release, and occasionally use of a bone graft to reconstruct the anterior defect of the glenoid. The long-term results remain modest. When the humeral head cannot be saved because of extensive osteochondral lesions, shoulder arthroplasty must be the treatment of choice.

Accidental Falls↗
PubMed1994

[The value of pneumo-arthro-CT in diagnosis after traumatic shoulder dislocation].

Traumatic subluxation of the shoulder in young patients may result in reluxation after further injury. 18 patients with traumatic subluxation and 22 patients with recurrent subluxation of the shoulder (after primary trauma) were examined by arthroscopy and pneumo-arthro-CT. This minimally invasive procedure showed high accuracy in the diagnosis of the typical glenoid margin and humoral head abnormalities. Nevertheless, arthroscopy cannot be abandoned for planning suitable operative treatment.

Adolescent↗
PubMed1997

Arthroscopic extra-articular Bankart repair for the treatment of recurrent anterior shoulder dislocation.

This study describes a new arthroscopic procedure for the stabilization of recurrent anterior shoulder dislocations. The technique involves two important features. The first is the anterior inferior transmuscular approach through the subscapularis muscle, which permits self-locking implants to be inserted into the anterior inferior third of the glenoid rim so that they oppose the direction of pull of the capsule. This approach was studied on 79 cadaveric shoulders before clinical application. The second feature is the extracapsular (extra-articular) location of the self-locking implants, which permits a superomedial capsular shift as required. The technique offers a high degree of capsular stability. Of a total of 318 patients undergoing this procedure, the first 100 shoulders (98 patients) were evaluated postoperatively at an average of 35 months (range, 18 to 62 months). The diagnosis in all cases was traumatic recurrent anterior shoulder dislocation. Repair of the capsule was performed initially with screws and later with absorbable tacks. The overall recurrence rate was 9% (9 shoulders). Excluding the first 30 shoulders to take account of the learning curve, the recurrence rate for the subsequent 70 shoulders was only 5.7%. Limitation of external rotation at 0 degrees abduction averaged 6.7 degrees and 6.1 degrees at 90 degrees abduction for all shoulders; 61% of participants in overhead sports and 70% of participants in contact sports resumed their preinjury activities. The recurrence rate for patients involved in overhead sports was 10% and for collision sports it was 14%. There were no recurrences in the case of patients whose sports involve minimum risk to the shoulder (cycling, jogging). Most recurrences were observed in patients with lax shoulders and small Bankart lesions.

Adolescent↗
PubMed1993

Reduction of anterior shoulder dislocations by scapular manipulation.

STUDY OBJECTIVES: This study examined the success rate, time required, technical ease, and reported patient discomfort for the use of scapular manipulation in the reduction of anterior shoulder dislocation. This study included a new variation of this technique using the seated position. DESIGN: Prospective case series over a 19-month period. SETTING: The emergency departments of a university and a community hospital. TYPE OF PARTICIPANTS: Patients with anterior shoulder dislocations. INTERVENTIONS: Emergency medicine resident and attending physicians were instructed in the technique of scapular manipulation in a classroom setting and requested to use this method initially for the reduction of anterior shoulder dislocations. Premedication was at the physician's discretion. MEASUREMENTS AND MAIN RESULTS: There were 54 patients with 61 dislocations. Scapular manipulation was attempted by 19 residents and 12 attending physicians. The overall success rate of scapular manipulation was 79%, whereas that of physicians experienced with the technique was 86%. Of the successful reductions, 65% were performed in less than one minute, and physicians rated the technique as very easy or easy to perform in 74% of these cases. No premedication was used in 64% of the attempts at scapular manipulation, and these patients reported pain ratings similar to those of the premedicated groups. No complications were noted in this study. CONCLUSION: Scapular manipulation generally is a simple, rapid, and reliable technique for the reduction of anterior shoulder dislocation.

Adolescent↗
PubMed1993

Intraarticular pathology in acute, first-time anterior shoulder dislocation: an arthroscopic study.

Intraarticular soft tissue damage after first-time, acute shoulder dislocation has been poorly described in the literature. The present study describes 24 cases of first-time anterior shoulder dislocation that all were evaluated under anesthesia and examined via arthroscopy. All shoulders sustaining anterior dislocation show Bankart and Hill-Sachs lesions. They also show anterior instability. The arthroscopic findings were uniform and therefore cannot be used as predictors for future development of recurrent instability.

Adolescent↗
PubMed2002

Longer immobilization extends the "symptom-free" period following primary shoulder dislocation in young rugby players.

The purpose of this study was to evaluate the effect of longer immobilization following primary shoulder dislocation in young rugby players for the prevention of recurrence. We sent a questionnaire regarding shoulder dislocation to all senior high school and college rugby teams in the southwest region of Japan. We received replies from 5476 players in 196 teams (i.e., answers were received from 76% of the teams). Based on the answers from the 79 rugby players who had undergone shoulder dislocations and who were eligible for the study, we divided them into two groups; group I: immobilization for 0-3 weeks at the time of the initial dislocation (n = 61), and group II: immobilization for 4-7 weeks (n = 18). We compared the time-course from primary dislocation to recurrence between the two groups, using the Kaplan-Meier method. The age range at the time of the primary dislocation was 14-23 years (average, 16.7 years). The probability of recurrence in groups I and II, respectively, was 78% and 44% after 1 year; and 85% and 69% after 2 years. The median period from return to rugby to recurrence was 4 months in group I and 14 months in group II. The symptom-free period was extended when immobilization was carried out for 4 weeks or more, in comparison with the symptom-free period in those who had immobilization for 3 weeks or less.

Adolescent↗
PubMed1986

Closed reduction of anterior subcoracoid shoulder dislocation. Evaluation of an external rotation method.

We prospectively evaluated an external rotation method for closed reduction of acute anterior shoulder dislocations that had been described recently. Seventy-eight of 100 consecutive emergency patients who presented with anterior shoulder dislocations experienced successful reduction using this external rotation method. The method proved to be easy to perform and relatively safe. Based on our findings, we recommend that it be included in the physician's armamentarium for initial closed reduction of anterior shoulder dislocation.

Adult↗
PubMed1988

[Treatment of unreduced anterior shoulder dislocation].

We evaluated the results of treatment in six patients with unreduced chronic anterior dislocations of the shoulder. In three patients the dislocations had not been recognized by the initial treating physician. In the remaining three patients the dislocations initially had been diagnosed but reduction had failed and the dislocations had remained unreduced. In one of the six shoulders the dislocation was left unreduced. The dislocation existed for 3.5 years and there was absence of disabling functional impairment, pain or neurovascular disturbance. In five of six shoulders the function was severely impaired. One of five shoulders with an anterior dislocation of three weeks duration could be reduced by closed manipulation. Four shoulders underwent open reduction. In all patients the humeral head could be preserved. Associated osseous lesions of the glenoid or the humeral head (Hill-Sachs lesions, fractures) were treated by rotation osteotomies according to Weber and the Eden-Lange-Hybinette procedure. Preoperatively all shoulders were graded as poor. Postoperatively the results in one was graded as excellent, in three as good and in one (algodystrophy of the left arm) as fair.

Adolescent↗
PubMed1988

Reduction of shoulder dislocations under interscalene brachial blockade.

Even under short sedation, reduction of shoulder dislocations is often difficult, because of the reflectory contraction of the muscles around the humeroglenoidal joint in response to pain. Administration of interscalene brachial blockade produces analgesia and complete relaxation of the muscles of the shoulder joint. We report on ten consecutive shoulder dislocations which were reduced while the patients were under interscalene brachial blockade. In all cases, reduction was easy and free from complications.

Adolescent↗