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Results for “Shoulder Dislocation”

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PubMed1993

Arthroscopic management of instability of the shoulder.

Anterior shoulder dislocation in the young athlete may be difficult to treat and, without proper care, usually results in recurrent episodes of instability. By permitting direct visualization of all intraarticular pathology, the arthroscope assists in the diagnosis and helps to determine appropriate therapeutic interventions. Numerous techniques have been developed for arthroscopic reconstruction of unstable shoulders. These can be classified according to the type of fixation employed. The categories include metal devices such as staples or screws, absorbable devices, and suture-based methods, both anterior and transglenoid. An anterior suture anchor method using a new suture passing device known as a Shuttle Relay (Linvatec Corp, Largo, Fla), which allows the surgeon to incorporate non-absorbable mattress sutures in the repair, is described in detail.

Adolescent↗
PubMed2002

Allograft reconstruction after resection of malignant tumors of the scapula.

The oncologic and functional outcomes of six patients who had scapular allograft reconstruction after scapulectomy for malignant tumors were reviewed. Five patients had Stage IIB and one patient had Stage IB tumors. Total scapulectomy was done in five patients, and partial scapulectomy (glenoid and neck) was done in one patient. Frozen glycerolized scapular allografts were implanted and fixed with plates and screws. The scapular muscles were reattached to the allograft. Tendon reconstruction to replace the excised muscles was done in two patients. The patients were followed up for an average of 3.8 years (range, 2-6 years). Cosmesis, elbow, and hand function were good in all patients. There were no infections, nonunions, or shoulder dislocations. One patient fractured the body of the allograft after a fall. One patient had local recurrence and had scapulectomy 5 years postoperatively. Two patients died 3 and 5 years postoperatively with lung metastases but with functioning grafts. The mean functional result using the Musculoskeletal Tumor Society functional score was 82 (range, 77-87). In this series, scapular allograft reconstruction restored cosmesis, shoulder stability, and function. Preservation or reconstruction of rotator cuff muscles is recommended.

Adult↗
PubMed1997

Traumatic Anterior Glenohumeral Instability: The Role of Arthroscopy.

The static and dynamic stabilizers of the glenohumeral joint act together to ensure joint stability throughout the wide range of normal shoulder motion. These structures are functionally altered after a traumatic anterior shoulder dislocation, often resulting in recurrent instability. The arthroscope has enhanced the surgeon's ability to examine and repair the unstable glenohumeral joint. The rate of recurrence of instability after arthroscopic stabilization has historically been unacceptably high compared with that after open stabilization techniques. The authors offer a treatment algorithm and suggest guidelines for the use of arthroscopic techniques in the treatment of the unstable shoulder.

Journal Article↗
PubMedDate not supplied

Direct injury to the axillary nerve in athletes playing contact sports.

We performed long-term followup (31 to 276 months) of 11 contact athletes who had sustained isolated injuries to their axillary nerves during athletic competition. There were no known shoulder dislocations. Electromyographs were taken of 10 patients, and all patients had confirmation of clinically defined injuries that were confined to their axillary nerves. Nine injuries were sustained while tackling opposing players in football; two were sustained in hockey collisions. In seven athletes, the mechanism of injury was a direct blow to the anterior lateral deltoid muscle. In four athletes, there were simultaneous contralateral neck flexion and ipsilateral shoulder depression. At followup, all patients had residual deficits of axillary sensory and motor nerve function. There had been no deltoid muscle improvement in three patients, moderate improvement in two patients, and major improvement in six patients. However, shoulder function remained excellent, with all athletes maintaining full range of motion and good-to-excellent motor strength. Axillary nerve exploration and neurolysis in four patients did not significantly affect the outcomes. Although no patient had full recovery of axillary nerve function, 10 of 11 athletes returned to their preinjury levels of sports activities, including professional athletics.

Adolescent↗
PubMed1990

Arthroscopic surgery of the shoulder.

Arthroscopy of the shoulder is well established as a diagnostic procedure. It carries a greater degree of accuracy than conventional imaging techniques and in addition allows the assessment of instability and the degree of mechanical derangement inside the joint. Arthroscopic surgical procedures in the shoulder are in the developing stage. Arthroscopic acromioplasty for impingement syndrome has been shown to be a safe, effective procedure and probably better than conventional surgery. In the older patient, arthroscopic debridement of the rotator cuff is very effective at relieving pain. Arthroscopic surgery for removal of loose bodies and of a torn glenoid labrum would be the current recommended procedure rather than open surgery. Other rapidly developing areas of potential benefit are in the arthroscopic stabilisation of the dislocating shoulder and synovectomy of the shoulder in rheumatoid arthritis and other synovial conditions. The role of arthroscopy in the frozen shoulder is not clearly established although certainly it is the diagnostic tool of first choice in this condition.

Arthroscopy↗
PubMed2004

[Fractures of the scapula].

Two thirds of the fractures of the scapula refer to its body, one third to its neck, and one forth to the glenoid. They are indicative of high-energy blunt trauma. Traffic injuries are their main cause. Associated ipsilateral upper torso injuries are common and have to be considered!Scapular fractures may be classified as being extra- or intraarticular. Extraarticular fractures concern the scapular body, its processes, or the scapular neck. A fracture of the surgical neck of the scapula accompanied by an injury to the coracoclavicular connection is regarded as a "floating shoulder". In this case the broken suspension of the glenoid has to be reconstructed. Most intraarticular fractures are of the Bankart variety, where a shoulder dislocation spreads an oblique fragment of the glenoid. They should be treated by internal fixation, if the size of the fragment is bigger than 16 mm. Where surgery is advisable, an appropriate approach has to be chosen depending on the type of the fracture. The anterior approach of Neer and the dorsolateral approach of Brodsky are very suitable. As a basic principle dislocated or unstable fractures of the scapular processes and of the glenoid should be treated by internal fixation, since their functional result may be less than fair if they are treated conservatively. Most other fractures heal uneventful under a conservative regimen.

Accidents, Traffic↗
PubMed1992

Radiographic and geometric anatomy of the scapula.

In an effort to study anatomic parameters of the scapula that may be of clinical importance, scapulae were harvested from cadavers and stripped of their soft tissues. For each scapula, three roentgenograms then were obtained: a Y-scapular view, an axillary lateral view, and a glenoid fossa (or true anteroposterior) view. Computed tomographic pneumoarthrograms and randomly selected antero-posterior chest roentgenograms of skeletally mature adults were studied also to measure further roentgenographic parameters of the normal scapula. The geometric anatomy of the scapula is of fundamental importance in the pathomechanics of rotator cuff disease, total shoulder arthroplasty, and recurrent shoulder dislocation. This study presents in detail the exact geometry of scapula anatomy, giving precise figures for distances, angles, and radii of curvature of the scapula. All results then are discussed in terms of their clinical relevance to the above problems.

Arthrography↗
PubMed2006

Effectiveness of locked nailing for displaced three-part proximal humeral fractures.

BACKGROUND: Published reports about locked nailing for displaced comminuted proximal humeral fractures are few and the results contradictory. METHODS: Locked nailing was used to treat 27 selective patients with displaced three-part proximal humeral fractures. The average age of patients was 54.3 years. The operative indications were persistent severe displacement, intact or minimally displaced lesser tuberosity, tolerance of anesthesia, and adherence to rehabilitation programs. Three patients had associated shoulder dislocation and two had fractures with diaphyseal extension. By transdeltoid approach, the fractures were reduced and then fixed by antegrade nailing with either upward or downward locking screws. The patients were prospectively followed up for an average of 24 months. RESULTS: All fractures achieved eventual union. Three patients with proximal screw loosening required screw removal. On the basis of Neer criteria, excellent or satisfactory results were obtained in 21 patients whose scores averaged 87.5 points. Six patients had unsatisfactory outcomes, with an average of 75.8 points. Two patients with the complication of avascular necrosis still had a satisfactory outcome. Varus deformity of shoulder joints, deformity of the greater tuberosity, collapse of the humeral head, and old age could adversely affect shoulder elevation. However, the anatomic abnormalities might have limited effects on the pain scale, muscle power, and shoulder stability. CONCLUSIONS: Locked nailing can be an effective treatment for selected severely displaced three-part proximal humeral fractures. It is particularly useful for fractures with diaphyseal involvement. Familiarity with the fracture deformity and experience with the surgical techniques are critical for successful treatment results.

Adult↗
PubMed1998

Vascular trauma associated with fractures and dislocations.

Vascular trauma occurs relatively infrequently in association with general orthopedic trauma but may be seen more often in injuries involving joint dislocations and areas in which vascular structures are tethered at the fracture site. The mechanisms of vascular trauma are identified, and the general principles in managing these injuries, including the operative approach to the injury itself and the options in repairing both arterial and venous injuries, are discussed. The role of fasciotomy and primary amputation are also reviewed. Several specific injuries, including pelvic fracture, knee dislocation, shoulder and upper limb injuries, complex tibial fractures, and iatrogenic injuries, are examined from diagnostic and management perspectives. Despite an ongoing evolution in the diagnosis and management of these often challenging injuries, the essential requirements for a good clinical outcome remain early recognition of the dysvascular limb and rapid institution of therapy.

Angiography↗
PubMed2000

Bankart operation for recurrent anterior dislocation of the shoulder using suture anchor.

Between June 1989 and December 1994, a total of 19 patients (20 shoulders) underwent open repair of Bankart lesions using suture anchors. Subscapularis muscle and anterior capsule were cut as one layer and sutured end to end without overlap. Coracoid osteotomy was not necessary. Average follow-up was 53.6 months (range: 24-90 months). Clinical evaluation using the Rowe functional grading system showed 15 shoulders had excellent results, 3 shoulders had good results, and 1 patient was lost to follow-up. There were no complications and no failures with recurrence of dislocation.

Adult↗
PubMedDate not supplied

Comparative functional analysis of the Bristow, Magnuson-Stack, and Putti-Platt procedures for recurrent dislocation of the shoulder.

Literature on anterior shoulder instability deals most often with elimination of recurrence following reconstruction. We analyzed the subjective function, loss of motion and shoulder strength of three operative procedures: Magnuson-Stack, Bristow, and Putti-Platt. A retrospective review of 27 patients, 9 in each surgical group, with no postoperative dislocations or on-going pain was performed. All patients were male, right hand dominant with the right shoulder affected. Average time of followup was 6.75 years (range, 4.2 to 10.3 years). All patients completed a questionnaire and had their range of motion measured by a hand-held goniometer and their shoulder strength tested on the Cybex II Dynomometer. Peak torque as a percent of body weight and side-to-side differences were calculated for six arm positions and compared to nine right hand dominant controls of similar age and recreational activity. Sixty percent returned to throwing sport. One Magnuson-Stack and Bristow patient felt full functional return to preinjury level. Three patients in each of these two groups returned to unmodified throwing sport whereas no Putti-Platt patient attained this level. Deficit of external rotation at shoulder neutral measured 4.7 degrees, Magnuson-Stack; 12.2 degrees, Bristow; and 21.8 degrees, Putti-Platt. At 90 degrees shoulder abduction, similar deficits in external rotation measured 6.4 degrees, 11.6 degrees, and 28.8 degrees respectively. These values were statistically significant employing analysis of variance. We compared the operative groups as a whole to the controls and compared the operative groups to each other.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2005

Suprascapular nerve entrapment.

It is important to be aware of neuropathy involving the suprascapular nerve. While direct trauma to the suprascapular nerve is the usual cause (direct blow to the base of the neck or posterior shoulder, shoulder dislocation or fracture), the problem may result from overuse injuries (such as repetitive tennis serving or spiking of a volley ball), excessive horizontal adduction, weight lifting, backpacking or no apparent reason. These last three years we have operated 8 cases of suprascapular nerve neurolysis at the level of suprascapular incision, and section of the transverse scapular ligament through the back supraspinal approach.

Brachial Plexus Neuropathies↗
PubMed1994

Isolated nerve injuries about the shoulder.

Infraclavicular nerve injuries are rare and potentially disabling problems. A retrospective study of 24 patients with 28 nerve injuries is presented, including 18 axillary, 7 suprascapular, and 3 musculocutaneous nerve injuries. Vague shoulder pain and weakness of the involved muscle groups were the main symptoms of nerve injury in these patients. All patients had atrophy of the specific muscles involved. Diagnosis of these nerve lesions can often be difficult because of this vague presentation. Followup from date of injury averaged 60 months and included evaluation by questionnaire, repeat physical examinations, and serial electromyograms. There were 21 complete or satisfactory nerve recoveries, while 7 patients had unsatisfactory results. The etiology of the injury appeared to be an important factor with respect to outcome. Eight of 10 nerve injuries secondary to blunt trauma went on to complete recovery, and 4 of 6 nerve injuries secondary to shoulder dislocation recovered completely. None of the 7 nerves injured during surgery recovered completely. No patient with spontaneous onset of nerve dysfunction had an unsatisfactory result. Poor results were noted in patients with initial total denervation as shown by electromyogram and in patients with intraoperative nerve damage.

Adolescent↗
PubMed1996

Proprioception and joint stability.

In the present paper the current clinical knowledge about proprioception is given for the shoulder, knee, ankle, elbow and the radiocarpal joint. Proprioceptive capabilities are decreased after joint injuries such as ACL or meniscus tears, shoulder dislocation, ankle sprain and in joints with degenerative joint disease. Some surgical procedures seem to restore the proprioceptive abilities; others do not. Elastic knee bandages or ankle braces increase different proprioceptive factors like ankle reproduction capability or sports-specific abilities. The present information on proprioception will influence our clinical practice in the future. We should choose surgical procedures that not only reconstruct the anatomy, but also the neurophysiologic feed-back mechanism.

Algorithms↗