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At least 1,693 records · Page 94Linked to original sources
PubMed1986

Anterior dislocation of the shoulder in the older patient.

A significant number of rotator cuff defects are brought to light following a first-time dislocation in older patients. Recurrence in this group of patients is low; however, standard anterior repairs may be employed effectively in such situations. Neurologic and vascular injuries, although infrequent, should be carefully ruled out as accompanying the initial injury. Knowledge of these facts will allow a better appreciation of the pathology associated with the anterior dislocation in the older patient. From this, more confident recommendations may be made regarding management of these difficult problems.

Adult↗
PubMedDate not supplied

Traumatic recurrent anterior dislocation of the shoulder: two- to four-year follow-up of an anatomic open procedure.

The purpose of this study was to evaluate the results of an anatomic open stabilization procedure. Twenty-three consecutive patients with traumatic, recurrent, anterior glenohumeral instability were managed with a modified open procedure. All had a Bankart lesion. A standardized, true anatomic capsulolabral reconstruction was performed with suture anchors. Two patients were lost to follow-up, and twenty-one were evaluated after 36 months [range, 24-49 months] by an independent observer. Shoulder stability and function were the principal outcome measures. None of the patients had subsequent dislocations. All returned to full working capacity, and 19 reached their previous level of sport activities. The mean loss in active abduction and flexion was 1 degrees, in internal rotation, one vertebral level, and in external rotation, 7 degrees (arm at 90 degrees of abduction). Two patients had a positive anterior apprehension test. No sign of shoulder osteoarthritis was observed. The open anatomic capsulolabral reconstruction provides excellent results and allows the restoration of stability with good function.

Adult↗
PubMed2004

The unstable shoulder.

Not all unstable shoulders are the same, and careful patient selection ensures proper treatment. Improved understanding of the mechanisms of stability, advances in imaging and arthroscopic technology mean that repeated visits to the emergency department with a painful dislocated shoulder should be a thing of the past.

Emergency Treatment↗
PubMed1988

Concurrent rupture of the rotator cuff and anterior dislocation of the shoulder in the older patient.

Thirty-one patients who were unable to abduct the involved arm after reduction of a primary anterior dislocation of the glenohumeral joint were found to have a ruptured rotator cuff. All of the patients were more than thirty-five years old. Twenty-nine of them were initially presumed to have had an injury to the axillary nerve, although this injury was confirmed in only four of the twenty patients who had electrodiagnostic studies. In eight patients, the subscapularis tendon and anterior part of the capsule had ruptured from the lesser tuberosity. Recurrent instability developed in all eight patients, and repair of these structures alone was successful in restoring stability. The association between primary anterior dislocation of the glenohumeral joint and rupture of the rotator cuff in the older patient who cannot abduct the arm after reduction is poorly appreciated, as it is often missed. In our series of such patients, the incidence of injury to the axillary nerve was 7.8 per cent, as compared with 100 per cent for rupture of the rotator cuff. However, the comparative rates of occurrence of these two entities in older patients who have an anterior dislocation have not been determined.

Adult↗
PubMed1989

Recurrent anterior dislocation of the shoulder. A comparison of the results after the Bankart and the Putti-Platt procedures.

A retrospective comparison of the results after the Bankart and the Putti-Platt procedures in the treatment of recurrent anterior dislocation of the shoulder showed no significant differences in the rate of redislocation or in the limitation of outward rotation. The dislocation recurrence rate after surgery was 13% for the Bankart procedure and 22% for the Putti-Platt procedure. Only 67% of the patients were satisfied with the operation. The poor results seem to be due to the fact that the operations were performed by 16 different surgeons who had varying approaches to the operations.

Adolescent↗
PubMed1983

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

The results of the follow-up studies of 152 Putti-Platt operations are presented. The procedure, if preceded by correct indication and performed with exact technique, proved successful for the prevention of recurrent anterior dislocation of the shoulder. Eighty-nine % of the operated patients returned to their former jobs even if it was hard physical work. Recurrence of the dislocation was noted only in less than 2% of all cases.

Adolescent↗
PubMed1997

The extremities and spine.

A variety of pearls, pitfalls, and updates related to the extremities and spine are discussed. Tricks of the trade regarding shoulder dislocations, easily missed fractures, radial head subluxation, and the approach to deep lacerations are discussed. In the pitfall section, potential difficulties in the evaluation of suspected nonaccidental trauma, compartment syndromes, partial cord syndromes, and hip pain in children are discussed. Finally, new information regarding cost-effective evaluation of knee and ankle injuries, as well as advances in ultrasound evaluation of shoulder and extremity injuries, is presented in the clinical updates section.

Adult↗
PubMed1998

Axillary nerve injuries in contact sports: recommendations for treatment and rehabilitation.

Axillary nerve injuries are some of the most common peripheral nerve injuries in athletes who participate in contact sports. Resulting deltoid muscle paralysis is secondary to nerve trauma which occurs following shoulder dislocation or a direct blow to the deltoid muscle. Compression neuropathy has been reported to occur in quadrilateral space syndrome as the axillary nerve exits this anatomic compartment. The axillary nerve is also extremely vulnerable during any operative procedure involving the inferior aspect of the shoulder, and iatrogenic injury to the axillary nerve remains a serious complication of shoulder surgery. Accurate diagnosis of axillary nerve injury is based on a careful history and physical examination as well as an understanding of the anatomy of the shoulder and the axillary nerve in particular. Inspection, palpation and neurological testing provide the bases for diagnosis. A clinically suspected axillary nerve injury should be confirmed by electrophysiological testing, including electromyography and nerve conduction studies. During the acute phase of injury, the athlete should be rested and any ligamentous or bony injury should be treated as indicated. Patients should undergo an extensive rehabilitation programme emphasising active and passive range of motion as well as strengthening of the rotator cuff, deltoid and periscapular musculature. Shoulder joint contracture should be avoided at all costs as a loss of shoulder mobility may ultimately affect functional outcome despite a return of axillary nerve function. If no axillary nerve recovery is observed by 3 to 4 months following injury, surgical exploration is indicated. Athletes who sustain injury to the axillary nerve have a variable prognosis for nerve recovery, although the return of function of the involved shoulder is typically good to excellent. We recommend that athletes who sustain axillary nerve injury may return to contact sport participation when they achieve full active range of motion of the shoulder and when shoulder strength is documented to be good to excellent by isometric or manual muscle testing.

Athletic Injuries↗
PubMedDate not supplied

Total shoulder arthroplasty: long-term survivorship, functional outcome, and quality of life.

This study examines long-term outcomes of total shoulder arthroplasty (TSA) via survivorship analysis, patient questionnaires, and minimum 10-year physical examinations. The study group consisted of 320 consecutive TSAs performed in 267 patients between 1974 and 1988. Diagnoses included rheumatoid arthritis (69%), osteoarthritis (22%), and juvenile rheumatoid arthritis (4.7%). Minimum 10-year physical examination follow-up was obtained on a subset of 72 TSAs at a mean (+/- SD) of 14.0 +/- 2.7 years. A Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire was obtained from 80 patients with 103 TSAs at a mean of 15.4 +/- 3.4 years after the index procedure (range, 10.4-23.2 years). Kaplan-Meier survivorship rates with revision as the endpoint at 5, 10, 15, and 20 years were 98%, 93%, 88%, and 85%, respectively. Of the shoulders, 22 (6.9%) required a revision, most commonly for loosening of one or both components (15 shoulders). Dislocation occurred earlier than other causes of revision or complication (P < .05, analysis of variance). Minimum 10-year physical examination follow-up revealed lasting, significant improvements in range of motion and strength. The patients' subjective assessments of TSA were favorable in that 92% felt that their shoulder was "much better" or "better" after TSA. The mean DASH score was 49 +/- 25; no significant differences were found among diagnoses. Long-term analysis of the Neer-type TSA revealed survivorship rates comparable to other joint replacements. The significant improvements in relief of pain, shoulder range of motion, and strength are associated with a high degree of patient satisfaction.

Adolescent↗
PubMedDate not supplied

Interscalene brachial plexus block for shoulder surgery.

BACKGROUND AND OBJECTIVES: To evaluate the efficacy of interscalene brachial plexus block as the primary anesthetic for shoulder surgery, the influence on blood loss, and the rate of complication. METHODS: Retrospective review of 676 reconstructive surgical procedures of the shoulder for anesthetic technique (regional or general), regional anesthetic technique (paresthesia versus nerve stimulator), local anesthetic agent selected, success rate, estimated blood loss by procedures, and complications. RESULTS: A total of 563 patients had interscalene anesthesia, exclusively, and 117 had general anesthesia. Mepivacaine, 1.4% with 1/200,000 epinephrine, was the most frequently used agent (480). Others included 0.5% bupivacaine (33) and 0.625% bupivacaine (50). Of 563 interscalene blocks attempted, 34 required general anesthesia to either initiate or complete the surgery (success rate, 94.1%) with 20 in the 0.5% bupivacaine group, 10 in the mepivacaine group, and 9 in the 0.65% bupivacaine group. For blood loss calculations, failed interscalene blocks were included with the general anesthesia group. Three surgical procedures were identified: total shoulder arthroplasty, acromioplasty with and without repair of the rotator cuff, and capsular advancement for recurrent shoulder dislocation. Comparing general and interscalene anesthesia, blood loss was less in the overall group and in the acromioplasty-rotator cuff group when interscalene block was compared to general anesthesia. There were four complications with two seizures and two subdural injections. CONCLUSIONS: Interscalene anesthesia is an effective anesthetic for elective shoulder surgery that may decrease intraoperative blood loss with a low complication rate.

Anesthesia, Conduction↗