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Kauffman TJ, Campbell JE. A massive rotator cuff tear in association with a posterior dislocation of the long head biceps tendon: a review of the literature on posterior long head biceps tendon dislocation. Skeletal Radiol 2025:10.1007/s00256-025-04970-x. [PMID: 40490587 DOI: 10.1007/s00256-025-04970-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2025] [Revised: 05/06/2025] [Accepted: 05/23/2025] [Indexed: 06/11/2025]
Abstract
We report a complex case detailing a patient with an anterior shoulder dislocation, with an associated, severe, massive rotator cuff tear (MRCT), further complicated by an unusual occurrence of a posterior long head biceps tendon (LHBT) dislocation. A 38-year-old female presented with significant pain and limited active and passive range of motion of the left shoulder following a traumatic anterior shoulder dislocation. MRI revealed full-thickness retracted tears of the entire cuff as well as a posterolateral LHBT dislocation. The patient underwent an initial open repair of the shoulder and long head of biceps tenodesis. At 5 months follow-up, MRI confirmed a full-thickness re-tear of the supraspinatus, infraspinatus, and subscapularis tendons. Patient subsequently underwent a combined open transfer of the lower trapezius tendon to the greater tuberosity and the latissimus dorsi to the lesser tuberosity. At the final, one-year, postoperative follow-up, the patient exhibited improvements in pain and stability, though continued to experience ongoing range of motion and strength limitations. This report provides a comprehensive review of 12 previous reports describing posterior LHBT dislocation. Among the limited literature on posterior LHBT dislocation, only one case exhibited a posterior LHBT in the context of a MRCT similar to that described in this report. The combination of an unusual occurrence of a posterior LHBT dislocation in the context of a MRCT involving full thickness tears of the supraspinatus, infraspinatus, subscapularis, and teres minor tendons, is rarely documented, making this case report both clinically challenging and unique.
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Affiliation(s)
- Tyson J Kauffman
- School of Medicine, Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI, 53226, USA.
| | - Jonathan E Campbell
- Department of Orthopaedic Surgery, Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI, 53226, USA.
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Yuan P, Tang R, Zhou Y, Liao L, Ren S, Tang M. Tang's method is an effective new treatment for anterior shoulder dislocation. Sci Rep 2025; 15:17705. [PMID: 40399562 PMCID: PMC12095469 DOI: 10.1038/s41598-025-03097-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2025] [Accepted: 05/19/2025] [Indexed: 05/23/2025] Open
Abstract
The principal aim of this study was to present a novel approach to manipulative repositioning for the management of anterior shoulder dislocation. This was evaluated in comparison with the established repositioning method to ascertain its clinical efficacy. Seventy-six patients with anterior dislocation of the shoulder joint were randomly assigned to one of two groups. Each group underwent reducing using either Tang's method or Hippocrates' method, respectively. The patients were then monitored for six months. The researchers analyzed and compared the general condition, reduction time, reduction success rate, VAS score, and ASES score of the patients in the two groups. No statistically significant difference was observed in the general condition of the patients prior to the reduction between the two groups. The mean reduction time for the Tang's method group (70.9 ± 11.88) was found to be significantly shorter than that observed for the Hippocrates method group (411.6 ± 50.41). The reduction success rate was significantly higher in the Tang's method group (100.00%) than in the Hippocrates method group (80.56%). No statistically significant difference was observed in VAS scores between the two groups prior to the reduction. However, the Tang's method group demonstrated superior outcomes compared to the Hippocrates method group during and following the reduction. No statistically significant difference was observed in ASES scores between the two groups prior to the reduction. However, at one, three, and six months post-reduction, the Tang's method group exhibited significantly superior outcomes compared to the Hippocrates method group. The Tang's method is a safe and effective method of reducing for anterior dislocation of the shoulder. It is significantly superior to the traditional Hippocrates method.
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Affiliation(s)
- Peng Yuan
- Department Orthopedics of Suzhou Hospital of Anhui Medical University, Anhui, Suzhou, 234000, China
| | - Ruixin Tang
- Department Orthopedics of Suzhou Hospital of Anhui Medical University, Anhui, Suzhou, 234000, China
| | - Ye Zhou
- Department Orthopedics of Suzhou Hospital of Anhui Medical University, Anhui, Suzhou, 234000, China
| | - Lutian Liao
- Department Orthopedics of Suzhou Hospital of Anhui Medical University, Anhui, Suzhou, 234000, China
| | - Sijun Ren
- Department Orthopedics of Suzhou Hospital of Anhui Medical University, Anhui, Suzhou, 234000, China
| | - Miao Tang
- Department Orthopedics of Suzhou Hospital of Anhui Medical University, Anhui, Suzhou, 234000, China.
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Hochberger F, Rupp MC, Boenke F, Scheiderer B, Siebenlist S, Muench LN, Berthold DP. Excellent functional outcomes in patients aged 40 years or older undergoing isolated rotator cuff repair for rotator cuff tears after primary traumatic anteroinferior shoulder dislocation. Arch Orthop Trauma Surg 2025; 145:233. [PMID: 40205146 PMCID: PMC11982164 DOI: 10.1007/s00402-025-05785-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 02/12/2025] [Indexed: 04/11/2025]
Abstract
PURPOSE To investigate the functional outcomes of patients over 40 years of age who underwent isolated rotator cuff (RC) repair (RCR) for full-thickness RC tears resulting from a primary traumatic anteroinferior shoulder dislocation and to compare these outcomes with a control group of patients who underwent RCR for instability-independent RC tears, with a minimum follow-up of two years. MATERIALS AND METHODS Patients aged 40 years and older were included for RCR following primary traumatic anteroinferior shoulder dislocation between 01/2012 and 06/2020 with a minimum follow-up of two years. Patients were excluded if they received an additional labral repair or capsular shift. Outcomes were compared to a control group of patients who underwent RCR without history of previous dislocations. Primary outcome measures included passive range of motion (ROM) as well as patient reported outcomes comprising the Western Ontario Shoulder Instability Index (WOSI) and Rowe score. Rates of re-dislocation were evaluated as secondary outcomes. RESULTS Thirty-six patients were enrolled and divided into 2 groups (n = 18, respectively). Demographic characteristics did not significantly differ (p > 0.05). At final follow-up, patients affected by instability-related RC tears showed comparable functional outcomes in terms of WOSI (427.2 ± 238.9instability group (IG) vs. 431.1 ± 252.1control group (CG); p = 0.962) and Rowe (87.5 ± 12.0IG vs. 91.1 ± 10.2CG; p = 0.339) scores as well as in terms of passive ROM (abduction: 88.1 ± 4.6°IG vs. 86.7 ± 11.5°CG; p = 0.637, forward elevation: 87.8 ± 6.2°IG vs. 88.3 ± 5.1°CG; p = 0.772, external rotation: 55.3 ± 10.5°IG vs. 50.8 ± 15.3°CG; p = 0.312, internal rotation: 65.3 ± 8.5IG vs. 68.8 ± 4.9CG, p = 0.388). No patient experienced a re-dislocation. CONCLUSION Patients ≥ 40 years who underwent isolated RCR without labral repair or capsular shift for a concurrent RC tear after experiencing a primary traumatic anteroinferior shoulder dislocation, achieved favorable functional outcomes along with absence of re-dislocations. STUDY DESIGN Retrospective case series; Level of Evidence IV.
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Affiliation(s)
- Felix Hochberger
- Department of Sports Orthopaedics, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
- Department of Orthopaedic Surgery, Julius-Maximilians University Wuerzburg, Koenig- Ludwig-Haus, Brettreichstrasse 11, 97074, Wuerzburg, Germany
| | - Marco-Christopher Rupp
- Department of Sports Orthopaedics, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Felix Boenke
- Department of Sports Orthopaedics, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Bastian Scheiderer
- Department of Sports Orthopaedics, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Sebastian Siebenlist
- Department of Sports Orthopaedics, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Lukas N Muench
- Department of Sports Orthopaedics, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Daniel P Berthold
- Department of Sports Orthopaedics, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
- Orthocenter Munich, Maximilianstraße 10, 80539, Munich, Germany
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Sifi N, Madani A, Zeghdoud M. Acute irreducible anterior shoulder dislocation due to interposition of the subscapularis muscle and the lesser tuberosity: a case report. JOURNAL OF TRAUMA AND INJURY 2025; 38:38-43. [PMID: 39442563 PMCID: PMC11968308 DOI: 10.20408/jti.2024.0044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2024] [Accepted: 08/29/2024] [Indexed: 10/25/2024] Open
Abstract
Efforts to reduce an anterior shoulder dislocation can fail due to numerous mechanical obstructions caused by soft tissue interposition (long head of the biceps, rotator cuff muscles, labrum, musculocutaneous nerve) and/or bony elements (displaced fragment of a greater tuberosity or glenoid fracture, bone impaction such as a Hill-Sachs lesion fixed on the glenoid rim, a bony Bankart lesion). Herein, we report the case of a 35-year-old man who sustained an anterior shoulder fracture-dislocation of his left shoulder after a fall. Despite a postreduction radiological examination that appeared misleadingly reassuring, subtle signs of persistent subluxation raised concerns. A computed tomography (CT) scan revealed subscapularis muscle entrapment along with avulsion of its bony insertion from the lesser tuberosity of the humerus, and a comminuted avulsion fracture of the greater tuberosity of the humerus. The patient underwent surgery using a deltopectoral approach. This involved releasing the entrapped subscapularis muscle and fixing the two fractured fragments. The lesser tuberosity was reduced and secured with two cannulated screws, and the comminuted fragment of the greater tuberosity was reattached using transosseous sutures. At 12-month follow-up, the patient achieved a Constant-Murley score of 85 of 100, with limitation in internal rotation at L3 but no signs of instability or new dislocation episode. This case underscores the importance of confirming shoulder reduction on at least two orthogonal views and paying close attention to the patient's feedback about sensation in their shoulder. Additionally, it highlights the utility of CT or magnetic resonance imaging scans if doubt exists about the integrity of the reduction.
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Affiliation(s)
- Nazim Sifi
- Orthopaedic and Trauma Surgery Unit, Centre Hospitalier de Gonesse, Gonesse, France
| | - Ahmad Madani
- Orthopaedic and Trauma Surgery Unit, Centre Hospitalier de Gonesse, Gonesse, France
| | - Mahdi Zeghdoud
- Orthopaedic and Trauma Surgery Unit, Centre Hospitalier de Gonesse, Gonesse, France
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Gunsoy Z, Oguzkaya S, Sayer G, Golgelioglu F, Dinc M, Misir A. The Impact of the Position of the Humeral Head Relative to the Glenoid on Iatrogenic Fractures During Shoulder Dislocation Reduction. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1816. [PMID: 39597001 PMCID: PMC11596267 DOI: 10.3390/medicina60111816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2024] [Revised: 10/18/2024] [Accepted: 10/30/2024] [Indexed: 11/29/2024]
Abstract
Background and Objectives: The aim of this study was to investigate the relationship between the position of the humeral head relative to the glenoid and the occurrence of iatrogenic surgical neck fractures of the humerus during anterior glenohumeral dislocation reductions. Materials and Methods: Patients with first-time anterior shoulder dislocations without generalized joint hyperlaxity were included. The humeral head displacement ratio was calculated as the distance between the medial border of the humeral head and the anterior glenoid rim divided by the diameter of the humeral head. Demographic data, concomitant tuberculum majus fractures, and the deltoid tuberosity index were recorded. Patients were divided into three groups: Group 1 (iatrogenic fracture development during closed reduction (CR)), Group 2 (failed CR), and Group 3 (successful reduction without iatrogenic fracture). Complicated dislocations were included in Groups 1 and 2, while uncomplicated dislocations were those in Group 3. Results: The study included 89 patients with a mean age of 46.44 ± 19.02 years (64 males, 25 females). Concomitant tuberculum majus fractures occurred in 37 (41.6%) cases. Iatrogenic surgical neck fractures occurred in 10 patients (Group 1), and CR was unsuccessful in 8 patients (Group 2), totaling 18 cases of complicated dislocations. Reduction without iatrogenic fracture was achieved in 71 cases (Group 3). The mean humeral head displacement ratio was higher in the complex dislocation group (92.91 ± 15.34 vs. 75.01 ± 13.80; p < 0.001). Complicated dislocations were more frequent in patients with tuberculum majus fractures (p = 0.031). Subgroup analysis showed higher humeral head displacement ratios in Groups 1 and 2 compared to Group 3 (p = 0.010 and p = 0.06, respectively). Tuberculum majus fractures were more frequent in Group 1 compared to Group 3 (p = 0.013), with no significant difference between Groups 2 and 3. Conclusions: In patients experiencing first-time traumatic anterior shoulder dislocations, a greater medial displacement of the humeral head relative to the glenoid rim significantly increases the risk of iatrogenic humeral fractures and the likelihood of unsuccessful closed reduction attempts.
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Affiliation(s)
- Zeki Gunsoy
- Department of Orthopedics and Traumatology, Bursa City Hospital, 16110 Bursa, Turkey; (Z.G.); (G.S.); (M.D.)
| | - Sinan Oguzkaya
- Department of Orthopedics and Traumatology, Bursa City Hospital, 16110 Bursa, Turkey; (Z.G.); (G.S.); (M.D.)
| | - Gokhan Sayer
- Department of Orthopedics and Traumatology, Bursa City Hospital, 16110 Bursa, Turkey; (Z.G.); (G.S.); (M.D.)
| | - Fatih Golgelioglu
- Department of Orthopedics and Traumatology, Elazig Fethi Sekin City Hospital, 23280 Elazig, Turkey;
| | - Mustafa Dinc
- Department of Orthopedics and Traumatology, Bursa City Hospital, 16110 Bursa, Turkey; (Z.G.); (G.S.); (M.D.)
| | - Abdulhamit Misir
- Department of Orthopedics and Traumatology, Bahcesehir University Medical Park Goztepe Hospital, 34730 Istanbul, Turkey;
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Tasaki A, Nozaki T, Tamaki T, Saito M, Mashimo S, Kitamura N. A comparison of conventional 3.0-Tesla nonenhanced magnetic resonance imaging and arthroscopic findings of the anteroinferior capsulolabral complex in patients with traumatic anterior shoulder instability. JSES Int 2024; 8:963-969. [PMID: 39280150 PMCID: PMC11401548 DOI: 10.1016/j.jseint.2024.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2024] Open
Abstract
Background This study aimed to evaluate the association between specific, reproducible findings of an anteroinferior capsulolabral complex obtained using conventional 3.0-Tesla nonenhanced magnetic resonance imaging (MRI) and pathologic arthroscopic findings and to assess the confidence level of the findings. Methods Of 125 cases of traumatic anterior instability surgery from January 2017 to November 2019, 66 patients (52 men, 14 women; 23.5 ± 7.9 year old) who underwent conventional 3.0-Tesla MRI at our hospital were reviewed. The following anteroinferior capsulolabral complex features were observed on the T2-star axial image: size difference of the labrum (swelling, diminished), difference in marginal and internal signals (irregularity), and capsule edema image (capsular thickening). We also reviewed fraying, flattening, cracking, and capsular hypertrophy as pathologic arthroscopic findings of the capsulolabral complex. These findings allowed for the simultaneous description of the MRI and arthroscopic evaluations. Three orthopedic surgeons and one radiologist measured the interobserver reliability. We investigated the correlation between the MRI and arthroscopic findings. Results The interobserver reliability of MRI irregularities was low (κ = -0.16), whereas reliability was moderate (κ = 0.554-0.595) for swelling in 22 cases (33%), diminished in 34 cases (52%), and capsular thickness in 40 cases (59%). Labral detachment was found in 26 patients (39%) and fluid collection in 24 patients (36%). The agreement of MRI findings with arthroscopic findings was κ = 0.46 (95% confidence interval [CI]: 0.268-0.654) for swelling to fraying; κ = 0.42 (95% CI: 0.202-0.638) for swelling to capsular hypertrophy; and 0.46 (95% CI: 0.268-0.654) for flattening to diminished. Conclusion The swelling and diminished findings of the anteroinferior capsulolabral complex on conventional MRI were moderately related to pathologic arthroscopic findings in patients with traumatic anterior shoulder instability. These findings contribute to achieving an accurate clinical diagnosis.
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Affiliation(s)
- Atsushi Tasaki
- Department of Orthopedic Surgery, St. Luke's International Hospital, Tokyo, Japan
| | - Taiki Nozaki
- Department of Radiology, St. Luke's International Hospital, Tokyo, Japan
| | - Tomoshige Tamaki
- Department of Orthopedic Surgery, St. Luke's International Hospital, Tokyo, Japan
| | - Masayoshi Saito
- Department of Orthopedic Surgery, St. Luke's International Hospital, Tokyo, Japan
| | - Shota Mashimo
- Rehabilitation Center, St. Luke's International Hospital, Tokyo, Japan
| | - Nobuto Kitamura
- Department of Orthopedic Surgery, St. Luke's International Hospital, Tokyo, Japan
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Mastrantonakis K, Karvountzis A, Yiannakopoulos CK, Kalinterakis G. Mechanisms of shoulder trauma: Current concepts. World J Orthop 2024; 15:11-21. [PMID: 38293258 PMCID: PMC10824064 DOI: 10.5312/wjo.v15.i1.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 12/08/2023] [Accepted: 12/29/2023] [Indexed: 01/16/2024] Open
Abstract
Acute traumatic injuries to the glenohumeral articulation are common. The types of injuries depend on age, muscle strength, bone density, and biomechanics of the traumatic event. Understanding the different mechanisms of trauma and how they affect the functional anatomical structures of the shoulder joint is crucial for the treatment of these lesions. Therefore, when clinicians have knowledge of these mechanisms they can accurately diagnose and treat shoulder pathology and predict distinct injury patterns. Here, we have described the fundamentals of the mechanisms of injury of the glenohumeral dislocation, dislocation with fracture of the humeral head, and the proximal humerus fracture. We have focused on common injury mechanisms and the correlation with radiological diagnostics. Radiological and laboratory findings of distinct types of injury were also discussed.
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Affiliation(s)
| | | | - Christos K Yiannakopoulos
- Department of Orthopaedic Surgery, National and Kapodistrian University of Athens, Athens 11527, Greece
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Knapik DM, Kuhn AW, Ganapathy A, Gibian JT, Yaeger LH, Matava MJ, Smith MV, Brophy RH. Global variations in treatment and outcomes reported for anterior shoulder instability: a systematic review of the literature. JSES REVIEWS, REPORTS, AND TECHNIQUES 2023; 3:469-476. [PMID: 37928980 PMCID: PMC10625007 DOI: 10.1016/j.xrrt.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
Background Anterior shoulder instability is a common problem around the world, with a high risk for recurrence following the index dislocation. Surgical stabilization is commonly indicated for persistent instability, particularly in patients at high risk for recurrence, to minimize the risk of further labral injury and glenoid bone loss. However, there is little known about global geographic differences in the surgical management of anterior shoulder instability. As such, the purpose of this study was to evaluate and systematically review regional differences in the surgical treatment of anterior shoulder instability, particularly the indications for and outcomes from bony stabilization procedures compared to soft tissue procedures. Methods A systematic review, in accordance with the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, was performed. Inclusion criteria consisted of level I and II evidence studies evaluating indications, techniques, and outcomes following operative management of anterior shoulder instability published from January 2000 to September 2021. Studies meeting inclusion criteria were grouped into four global regions (Asia, Europe, North America, South America) based on primary study location. Patient demographics, procedural details, patient reported outcomes, and complications (recurrence and reoperation rates) were compared between regions. Results Sixty (n = 60) studies (5480 patients) were identified. Eighty-six percent of all patients were male, with a mean age of 26.7 years. There was no difference in mean patient age, though patients undergoing bony stabilization procedures were older than those undergoing soft-tissue stabilization procedures (P = .0002) in all regions. The proportion of bony versus soft-tissue procedure groups did not differ significantly among regions. The indications for bony stabilization procedures varied significantly. Mean final follow-up was 3.5 years. Recurrent instability was 5.0% and did not vary across regions. However, recurrent instability occurred more frequently following soft-tissue compared to bony stabilization procedures (P = .017). South American studies utilized fewer anchors during soft tissue stabilization (P < .0001) and reported a higher reoperation rate compared to other regions (P = .009). Conclusion There is global variation in the reporting of outcomes following surgery for anterior shoulder instability. The proportion of bony and soft-tissue procedures is similar, irrespective of geographic region. Recurrent instability does not vary by region but occurs more frequently following soft-tissue compared to bony stabilization procedures. There are a number of potential medical and nonmedical factors that may affect global variation in the surgical treatment of anterior shoulder instability.
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Affiliation(s)
- Derrick M. Knapik
- Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Andrew W. Kuhn
- Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | | | - Joseph T. Gibian
- Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Lauren H. Yaeger
- Becker Medical Library, Washington University School of Medicine, St. Louis, MO, USA
| | - Matthew J. Matava
- Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Matthew V. Smith
- Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Robert H. Brophy
- Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO, USA
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Kokkalis Z, Giannatos V, Papagiannis S, Kouzelis A, Panagopoulos A. Terrible Triad of the Shoulder: A Case Series and Literature Review. Cureus 2023; 15:e47699. [PMID: 38022223 PMCID: PMC10674095 DOI: 10.7759/cureus.47699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2023] [Indexed: 12/01/2023] Open
Abstract
INTRODUCTION The shoulder terrible triad is an underdiagnosed injury pattern consisting of anterior shoulder dislocation, rotator cuff tear, and nerve injury from the brachial plexus in its original description. The purpose of this study is to raise awareness of the condition, suggest treatment strategies, and emphasize the difficulties in treating this condition. METHODS This case series of seven patients from the same institution. All patients underwent x-rays before and after the reduction of the dislocation, MRI to assess the musculoskeletal injuries, and EMG and clinical examination to assess the nerve lesions. Early arthroscopic repair was opted for the rotator cuff tears. A conservative approach was chosen for the nerve lesions. Active forward flexion and external rotation, Constant score, and Visual to Analogue Scale (VAS) were recorded pre- and post-operatively. RESULTS All the patients showed an improvement in function postoperatively. However, four of the seven patients did not recover fully. The mean Constant and VAS scores were improved from 15.2 +/- 2.8 (12 to 19) to 67 +/- 16.6 (44 to 86) and from 7.5 +/- 1 (6 to 9) to 2.3 +/- 0.8 (1 to 3), respectively. The patients were followed up for a mean time of 28.2 +/- 10.1 months (18 to 43 months). Time-to-surgery shorter than four weeks showed better results, but not statistically significant. CONCLUSIONS The diagnosis of the shoulder terrible triad requires a high level of suspicion. Early arthroscopic repair for the rotator cuff tears and waiting for the nerve recovery is suggested. Delayed time from injury to surgery might be related to worse outcomes, but higher-level research is needed in this direction.
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Affiliation(s)
- Zinon Kokkalis
- Orthopedics and Traumatology, University General Hospital of Patras, Patras, GRC
| | - Vasileios Giannatos
- Orthopedics and Traumatology, University General Hospital of Patras, Patras, GRC
| | - Spyridon Papagiannis
- Orthopedics and Traumatology, University General Hospital of Patras, Patras, GRC
| | - Antonis Kouzelis
- Orthopedics and Traumatology, University General Hospital of Patras, Patras, GRC
| | - Andreas Panagopoulos
- Orthopedics and Traumatology, University General Hospital of Patras, Patras, GRC
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Fu S, Xue G, Jiang L, Xue H, Cui L. High-Resolution Ultrasound Imaging of Axillary Nerve and Relevant Injury. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:2115-2123. [PMID: 37159482 DOI: 10.1002/jum.16233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 03/30/2023] [Accepted: 04/02/2023] [Indexed: 05/11/2023]
Abstract
OBJECTIVE To evaluate the feasibility of axillary nerve (AN) visualization in healthy volunteers and the diagnostic value of AN injury via high-resolution ultrasonography (HRUS). METHODS AN was examined by HRUS on both sides of 48 healthy volunteers and oriented the transducer according to three anatomical landmarks: quadrilateral space, anterior to subscapular muscle, and posterior to axillary artery. The maximum short-axis diameter (SD) and cross-sectional area (CSA) of AN were measured at different levels, and AN visibility was graded by using a five-point scale. The patients suspected of having AN injury were assessed by HRUS, and the HRUS features of AN injury were observed. RESULTS AN can be visualized on both sides in all volunteers. There was no significant difference in SD and CSA of AN at the three levels between the left and right sides or in SD between males and females. However, the CSA of males at different levels was slightly larger than those of females (P < .05). In most volunteers, AN visibility at different levels was excellent or good, and AN was best displayed anterior to subscapular muscle. Rank correlation analysis revealed that the degree of AN visibility had correlation with height, weight, and BMI. A total of 15 patients diagnosed with AN injury, 12 patients showed diffuse swelling or focal thickening in AN, and 3 patients showed AN discontinuity. CONCLUSION HRUS is able to reliably visualize AN, and it could be considered as the first choice for diagnosing AN injury.
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Affiliation(s)
- Shuai Fu
- Department of Ultrasound, Peking University Third Hospital, Peking University, Beijing, China
| | - Guoyan Xue
- Department of Ultrasound, Yuncheng Central Hospital, Yuncheng, China
| | - Ling Jiang
- Department of Ultrasound, Peking University Third Hospital, Peking University, Beijing, China
| | - Heng Xue
- Department of Ultrasound, Peking University Third Hospital, Peking University, Beijing, China
| | - Ligang Cui
- Department of Ultrasound, Peking University Third Hospital, Peking University, Beijing, China
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Eren TK, Kaptan AY, Bircan R, Tosun MF, Kanatlı U. Lesion prevalence and patient outcome comparison between primary and recurrent anterior shoulder instability. J Shoulder Elbow Surg 2023; 32:1812-1818. [PMID: 37419438 DOI: 10.1016/j.jse.2023.05.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 05/07/2023] [Accepted: 05/21/2023] [Indexed: 07/09/2023]
Abstract
BACKGROUND The purpose of this study was to compare lesion prevalence and treatment outcomes in patients with primary and recurrent anterior shoulder instability. METHODS Patients who were admitted to the institution with a diagnosis of anterior shoulder instability and who underwent arthroscopic surgery between July 2006 and February 2020 were retrospectively evaluated. Minimum follow-up duration of the patients was 24 months. The recorded data and magnetic resonance imaging (MRI) of the patients were examined. Patients aged ≥40 years, with a history of shoulder region fracture, inflammatory arthritis, a history of epilepsy, multidirectional instability, nontraumatic dislocation, and off-track lesions were excluded from the study. Shoulder lesions were documented and patient outcome evaluation was made with the Oxford Shoulder Score (OSS) and visual analog scale (VAS). RESULTS A total of 340 patients were included in the study. The mean age of patients was 25.6 years (±6.49). The recurrent instability group had a significantly higher rate of anterior labroligamentous periosteal sleeve avulsion (ALPSA) lesions compared to the primary instability group (40.6% vs. 24.6% respectively) (P = .033). Twenty-five patients (43.9%) had superior labrum anterior and posterior (SLAP) lesions in the primary instability group and 81 patients (28.6%) had SLAP lesions in the recurrent instability group (P = .035). OSS increased for both primary (from 35 [16-44] to 46 [36-48]) (P = .001) and recurrent instability groups (from 33 [6-45] to 47 [19-48]) (P = .001). There was no significant difference between the groups regarding postoperative VAS and OSS scores (P > .05). CONCLUSIONS Successful results were obtained in patients younger than 40 years with both primary and recurrent anterior shoulder instability after arthroscopic treatment. ALPSA lesion prevalence was higher whereas SLAP lesion prevalence was lower in patients with recurrent instability. Although the postoperative OSS was comparable between the patient groups, the failure rate was higher in the recurrent instability patients.
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Affiliation(s)
- Toygun Kağan Eren
- Department of Orthopedics and Traumatology, Ankara Training and Research Hospital, Ankara, Turkey
| | - Ahmet Yiğit Kaptan
- Department of Orthopaedics & Traumatology, Harran University School of Medicine, Şanlıurfa, Turkey.
| | - Resul Bircan
- Department of Orthopedics and Traumatology, Mardin Training and Research Hospital, Mardin, Turkey
| | - Muhammed Furkan Tosun
- Department of Orthopedics and Traumatology, Gazi University Faculty of Medicine, Besevler, Ankara, Turkey
| | - Ulunay Kanatlı
- Department of Orthopedics and Traumatology, Gazi University Faculty of Medicine, Besevler, Ankara, Turkey
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12
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Spagna G, Boehm E, Lorenz C, Moroder P, Scheibel M. [Treatment strategies for traumatic anterior shoulder dislocation]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2023:10.1007/s00113-023-01340-x. [PMID: 37341735 DOI: 10.1007/s00113-023-01340-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 05/11/2023] [Indexed: 06/22/2023]
Abstract
Anterior glenohumeral instability is the most frequent type of shoulder instability. This is often associated with labral and osseous lesions leading to recurrent instability. A detailed medical history, a physical examination and targeted diagnostic imaging are necessary to assess possible pathological soft tissue alterations as well as bony lesions of the humeral head and the glenoid bone. Early surgical treatment has been shown to reduce the risk of recurrence, especially in young active athletes, and can avoid secondary damage. Shoulder dislocations in older patients also require a detailed assessment and selection of treatment as persisting pain and limitation of movement can occur due to rotator cuff lesions and nerve injuries. The purpose of this article is to provide an overview of the currently available evidence and results regarding diagnostic considerations and conservative vs. surgical treatment and time to return to sport after treatment of a primary anterior shoulder dislocation.
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Affiliation(s)
- Giovanni Spagna
- Klinik für Schulter- und Ellbogenchirurgie, Schulthess Klinik Zürich, Lengghalde 2, 8008, Zürich, Schweiz.
| | - Elisabeth Boehm
- Klinik für Schulter- und Ellbogenchirurgie, Schulthess Klinik Zürich, Lengghalde 2, 8008, Zürich, Schweiz
| | - Christina Lorenz
- Klinik für Traumatologie, Universitätsspital Zürich, Zürich, Schweiz
| | - Philipp Moroder
- Klinik für Schulter- und Ellbogenchirurgie, Schulthess Klinik Zürich, Lengghalde 2, 8008, Zürich, Schweiz
| | - Markus Scheibel
- Klinik für Schulter- und Ellbogenchirurgie, Schulthess Klinik Zürich, Lengghalde 2, 8008, Zürich, Schweiz
- Centrum für Muskuloskeletale Chirurgie (CMSC), Charité-Universitätsmedizin Berlin, Berlin, Deutschland
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13
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Iyengar KP, Beale D, Neal J, Botchu R. Combined long head of biceps anchor avulsion with anterior dislocation of the shoulder: an unusual presenting injury. BMJ Case Rep 2022; 15:e251457. [PMID: 36123008 PMCID: PMC9486189 DOI: 10.1136/bcr-2022-251457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2022] [Indexed: 11/03/2022] Open
Affiliation(s)
- Karthikeyan P Iyengar
- Department of Trauma and Orthopaedics, Southport and Ormskirk Hospital NHS Trust, Southport, UK
| | - David Beale
- Department of Radiology, Heath Lodge Clinic, Knowle, UK
| | - James Neal
- Clinical Physiotherapy, Leicester Tigers, Leicester, UK
| | - Rajesh Botchu
- Department of Radiology, Royal Orthopaedic Hospital, Birmingham, UK
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14
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Liechti DJ, Shepet KH, Glener JE, Neumann EJ, Sraj S. A Systematic Review of Acute Irreducible Shoulder Dislocations in the 21st Century. Orthop J Sports Med 2022; 10:23259671221121633. [PMID: 36147793 PMCID: PMC9486286 DOI: 10.1177/23259671221121633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 06/09/2022] [Indexed: 11/16/2022] Open
Abstract
Background Rarely, closed reduction cannot be achieved in patients with acute shoulder dislocation, necessitating open management. A paucity of literature exists regarding these cases. Purpose To perform a systematic review on the mechanism, management, and outcome data of acute irreducible shoulder dislocations. Study Design Systematic review; Level of evidence, 4. Methods A systematic review of the literature was performed using the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, PubMed, and MEDLINE between 2000 and 2020. Inclusion criteria were as follows: human participants, acute irreducible shoulder dislocation requiring open management, English language, and publication within the past 20 years. We excluded basic science articles, technique articles, reviews, editorials, and studies of chronic shoulder dislocations or dislocations with ipsilateral humeral shaft fractures. Results Twelve articles fit the inclusion criteria and were considered for review. All studies were single case reports (level 4 evidence). Ten of the 12 studies were of male patients. The direction of dislocation included 7 anterior/anteroinferior, 2 posterior, 1 inferior, 1 bilateral inferior, and 1 superolateral. Most dislocations were irreducible owing to a mechanical block to reduction. The most common type of block was an incarcerated long head of the biceps tendon, followed by interposition of 1 of the rotator cuff tendons. The axillary and musculocutaneous nerves, displaced fracture fragments, and Hill-Sachs and bony Bankart lesions were other causes of blocks to reduction. Eleven patients were treated with open surgery, while 1 patient was treated arthroscopically. Procedures performed were dependent on concurrent pathology. Final follow-up ranged from 6 weeks to 2 years, with no repeat dislocation episodes reported. Complications after open reduction included 1 case of brachial plexopathy (posterior cord) and 1 case of musculocutaneous nerve palsy. Conclusion There is a paucity of literature on the management of irreducible acute shoulder dislocations. The most common irreducible dislocation found in this systematic review was anterior with a mechanical block attributed to interposition of the long head of the biceps tendon. When patients were treated with an open or arthroscopic procedure, recurrence was low, with none reporting recurrent dislocation in limited follow-up.
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Affiliation(s)
- Daniel J Liechti
- Department of Orthopaedics, West Virginia University, Morgantown, West Virginia, USA.,Black Hills Orthopedic and Spine Center, GIllette, WY, USA
| | - Kevin H Shepet
- Bellin Health Titletown Sports Medicine and Orthopedics, Green Bay, Wisconsin, USA
| | - Julie E Glener
- Department of Orthopaedics, West Virginia University, Morgantown, West Virginia, USA
| | - Eric J Neumann
- Department of Orthopaedics, West Virginia University, Morgantown, West Virginia, USA
| | - Shafic Sraj
- Department of Orthopaedics, West Virginia University, Morgantown, West Virginia, USA
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15
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Frank FA, Papp K, Toft F. Open reduction and rotator cuff repair of irreducible traumatic shoulder dislocation with sleeve-avulsion and glenohumeral interposition of the cuff: a case report and review of the literature. JSES REVIEWS, REPORTS, AND TECHNIQUES 2022; 2:399-405. [PMID: 37588855 PMCID: PMC10426483 DOI: 10.1016/j.xrrt.2022.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Affiliation(s)
- Florian A. Frank
- Orthopaedic and Trauma Surgery, Kantonsspital Aarau, Aarau, Switzerland
| | - Kata Papp
- Orthopaedic and Trauma Surgery, Kantonsspital Aarau, Aarau, Switzerland
| | - Felix Toft
- Orthopaedic and Trauma Surgery, Kantonsspital Aarau, Aarau, Switzerland
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16
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Primary traumatic shoulder dislocation associated with rotator cuff tear in the elderly. Int J Surg Case Rep 2022; 95:107200. [PMID: 35594787 PMCID: PMC9121268 DOI: 10.1016/j.ijscr.2022.107200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 05/11/2022] [Accepted: 05/11/2022] [Indexed: 01/08/2023] Open
Abstract
Introduction and importance The shoulder is one of the most unstable joints of the body. Shoulder dislocation accounts for up to 60% of all major joint dislocations. This study reports two cases of primary traumatic shoulder dislocation and shows that in the elderly, primary traumatic shoulder dislocation is associated with a rotator cuff tear (RCT). Case presentation A case report and narrative review included two female patients, aged 63 and 100 years. Presenting symptoms were instability, pain, and restricted shoulder movement. Both were successfully treated by surgery. Arthroscopy was performed in the first patient and open reduction in the second patient. Clinical discussion In the first case, we found synovitis around the rotator interval, long head of the biceps tendinitis, and tears of the subscapularis tendon, supraspinatus tendon, and subacromial bursitis. The anterior labrum was normal. In the second case, complete detachment of the infraspinatus tendon was found. In both cases, rotator cuff repair was performed. Primary traumatic shoulder dislocation in the elderly is often associated with rotator cuff injury. Therefore, a detailed evaluation and management of the rotator cuff injury is essential. Rotator cuff injuries cause loss of dynamic stabilization of the shoulder, leading to recurrent shoulder dislocation and chronic shoulder instability. Conclusion The associated pathology of the primary traumatic shoulder dislocation in elderly are rotator cuff tear. The management of the rotator cuff tear in primary traumatic shoulder dislocation can prevent further shoulder instability events.
Primary traumatic shoulder dislocation in the elderly is highly associated with rotator cuff tear. The rotator cuff acted as a dynamic shoulder stabilizer. Early identification and treatment of the associated rotator cuff tear can prevent further shoulder instability.
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Effiom DN, Bartlett JD, Raja H, Aresti N. When can anterior dislocations of the shoulder with an isolated fracture of the greater tuberosity be safely reduced in the emergency department? Br J Hosp Med (Lond) 2022; 83:1-8. [DOI: 10.12968/hmed.2021.0309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Following dislocation of the glenohumeral joint with an isolated greater tuberosity fracture, closed reduction in the emergency department can lead to fracture propagation or iatrogenic fractures. This article assesses the evidence regarding when anterior dislocations of the shoulder with an isolated fracture of the greater tuberosity can be safely reduced in the emergency department, as there is currently no clear guidance on this. A total of eight articles described 172 cases which underwent closed reduction, which resulted in 22 cases of iatrogenic fractures. Female sex, increased patient age and fragments of the greater tuberosity were associated with an increased risk of iatrogenic fractures. Closed reduction in the emergency department appears to be a safe option in younger patients and those with greater tuberosity fractures less than 40% of the width of the humeral head.
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Affiliation(s)
- Derek N Effiom
- Department of Obstetrics and Gynaecology, North Manchester General Hospital, Manchester, UK
| | - Jonathan D Bartlett
- Department of Trauma and Orthopaedics, Rotorua Hospital, Rotorua, New Zealand
| | - Hassan Raja
- Department of Trauma and Orthopaedics, Whipps Cross University Hospital NHS Trust, London, UK
| | - Nick Aresti
- Department of Trauma and Orthopaedics, Barts Health NHS Trust, The Royal Hospital, London, UK
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18
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Ernat JJ, Rakowski DR, Casp AJ, Lee S, Peebles AM, Hanson JA, Provencher MT, Millett PJ. Shoulder Arthroscopy in Conjunction With an Open Latarjet Procedure Can Identify Pathology That May Not Be Accounted for With Magnetic Resonance Imaging. Arthrosc Sports Med Rehabil 2022; 4:e301-e307. [PMID: 35494302 PMCID: PMC9042768 DOI: 10.1016/j.asmr.2021.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 09/22/2021] [Indexed: 11/26/2022] Open
Abstract
Purpose To review arthroscopic findings at the time of open Latarjet procedures to determine whether preoperative magnetic resonance imaging reports (MRRs) correlate with arthroscopic findings, as well as whether the arthroscopic findings critically affected surgical interventions performed at the time of a Latarjet procedure. Methods This was a retrospective case series of all patients who received a Latarjet procedure between 2006 and 2018. Patients were excluded if they had inadequate records or underwent revision of a bony reconstruction procedure. Both primary Latarjet procedures and Latarjet procedures for revision of a failed arthroscopic procedure were included. MRRs, arthroscopic findings, and diagnoses were collected, and differences were noted. A “critical difference” was one that affected the surgical intervention in a significantly anatomic or procedural fashion or that affected rehabilitation. Results In total, 154 of 186 patients (83%) were included. Of these, 96 of 154 (62%) underwent revision Latarjet procedures. The average bone loss percentage reported was 20.6% (range, 0%-40%). A critical difference between MRR and arthroscopic findings was noted in 60 of 154 patients (39%), with no difference between Latarjet procedures and revision Latarjet procedures. Of 154 patients, 29 (19%) received an additional 52 intra-articular procedures for diagnoses not made on magnetic resonance imaging, with no difference between primary and revision procedures. This included biceps and/or SLAP pathology requiring a tenodesis, debridement, or repair; rotator cuff pathology requiring debridement or repair; complex (>180°) labral tears requiring repair; loose bodies; and chondral damage requiring debridement or microfracture. Patients undergoing revision Latarjet procedures were less likely to have bone loss mentioned or quantified in the MRR. Conclusions Diagnostic imaging may not reliably correlate with diagnostic arthroscopic findings at the time of a Latarjet procedure from both a bony perspective and a soft-tissue perspective. In this series, diagnostic arthroscopy affected the surgical plan in addition to the Latarjet procedure in 19% of cases. We recommend performing a diagnostic arthroscopy prior to all Latarjet procedures to identify and/or treat all associated intra-articular shoulder pathologies. Level of Evidence Level IV, diagnostic case series.
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19
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Arthroscopic Axillary Nerve Neurolysis From the Anteroinferior Glenoid Through the Quadrilateral Space to the Terminal Deltoid Branches. Arthrosc Tech 2022; 11:e373-e377. [PMID: 35256978 PMCID: PMC8897587 DOI: 10.1016/j.eats.2021.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Axillary nerve compression is a rare cause of posterolateral shoulder pain. Once the diagnosis is confirmed and after failure of conservative measures, open procedures have been the mainstay of treatment for several decades. More recently, arthroscopic techniques have been proposed, which offer several advantages, including improved access to difficult locations, better visualization, and less surgical morbidity. The objective of this Technical Note is to describe an arthroscopic neurolysis of the axillary nerve from the inferior humeral pouch, through the quadrilateral space and into the subdeltoid recess.
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20
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Incidence and Risk Factors for Pseudosubluxation of the Humeral Head Following Proximal Humerus Fracture. JSES Int 2022; 6:338-342. [PMID: 35572447 PMCID: PMC9091873 DOI: 10.1016/j.jseint.2022.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Humeral head pseudosubluxation (HHPS) in relation to the glenohumeral joint is a common finding following fractures of the proximal humerus. The temporary inferior subluxation of the humeral head may be secondary to a transient axillary nerve neuropraxia, pain inhibition of the deltoid, or hemarthrosis or capsular disruption that alters the physiologically negative pressure in the glenohumeral joint. Despite the frequency of this finding, it is not well described in the literature. This study sought to describe the incidence, risk factors, and rate of resolution of HHPS following proximal humerus fracture. Methods The practice of two fellowship-trained shoulder and elbow surgeons was queried for proximal humerus fractures. Patient radiographs were reviewed at the time of injury and all subsequent follow-ups through one year after injury. Data collection included the presence of HHPS, type of fracture based on the Neer classification, operative vs. nonoperative management, and resolution of HHPS. Exclusion criteria included skeletally immature patients, fracture-dislocations, patients treated with reverse shoulder arthroplasty, inadequate follow-up, or those patients with incorrect International Classification of Diseases coding. Results The incidence of HHPS was 20.0% (103 out of 515 patients) overall. Patients who required surgical intervention were more likely to develop pseudosubluxation than those who were treated conservatively (P < .001). There was an increasing incidence of pseudosubluxation based on the Neer classification, with 0-part fractures demonstrating a 2.56% (2/78) rate, whereas 4-part fractures were found to have HHPS in 35.1% (20/57) of cases (P < .001). All patients were found to have resolution of their HHPS at the final follow-up or one year after injury. None of age, sex, obesity, or injury to the dominant arm was associated with the occurrence of HHPS. There was, however, a statistically significant difference in the body mass index of those who developed HHPS (28.4, ± 5.77) vs. those who did not (26.2, ± 5.32, P < .01). Conclusion This retrospective radiographic study is the largest to date investigating the incidence of HHPS following proximal humerus fracture and first to correlate with Neer classification and operative intervention. We found that HHPS occurs in one-fifth of acute proximal humerus fractures and resolves regardless of intervention. More complex fractures, including those with increasing Neer parts or requiring operative intervention, developed HHPS at higher rates than simpler fracture patterns. This study will help both general orthopedists as well as shoulder surgeons understand the epidemiology of HHPS and provide reassurance to patients that PS is a benign finding with expected spontaneous resolution by one year.
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21
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Bao MH, DeAngelis JP, Wu JS. Imaging of traumatic shoulder injuries – Understanding the surgeon’s perspective. Eur J Radiol Open 2022; 9:100411. [PMID: 35265737 PMCID: PMC8899241 DOI: 10.1016/j.ejro.2022.100411] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 02/13/2022] [Accepted: 02/23/2022] [Indexed: 12/18/2022] Open
Abstract
Imaging plays a key role in the assessment and management of traumatic shoulder injuries, and it is important to understand how the imaging details help guide orthopedic surgeons in determining the role for surgical treatment. Imaging is also crucial in preoperative planning, the longitudinal assessment after surgery and the identification of complications after treatment. This review discusses the mechanisms of injury, key imaging findings, therapeutic options and associated complications for the most common shoulder injuries, tailored to the orthopedic surgeon’s perspective.
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22
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Spross C, Farei-Campagna JM, Gerhard P, Jost B, Yates PJ, Lam LO. Osteochondral Shearing Fracture of the Humeral Head Associated with Traumatic Anterior Shoulder Dislocation: A Case Report. JBJS Case Connect 2021; 11:01709767-202109000-00023. [PMID: 34264877 DOI: 10.2106/jbjs.cc.20.00938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE Osteochondral shearing fracture of the humeral head after an anterior shoulder dislocation is a condition that has rarely been reported in literature. We report a case of a large posteriorly located fragment of such a fracture in a 23-year-old man. We performed open reduction and internal fixation with resorbable pins through a deltopectoral approach and subscapularis tenotomy. CONCLUSION In our case of a large osteochondral fracture of the posterior humeral head, treatment by open reduction and internal fixation showed an excellent radiographic result at 1 year and clinical result up to 5 years postoperatively.
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Affiliation(s)
- Christian Spross
- Department of Orthopaedic Trauma, Fiona Stanley Hospital, Perth, Western Australia , Australia
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Jan M Farei-Campagna
- Department of Orthopaedic Trauma, Fiona Stanley Hospital, Perth, Western Australia , Australia
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Pascal Gerhard
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Bernhard Jost
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Piers J Yates
- Department of Orthopaedic Trauma, Fiona Stanley Hospital, Perth, Western Australia , Australia
| | - Li-On Lam
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital St. Gallen, St. Gallen, Switzerland
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23
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Pan X, Yao Y, Yan H, Wang J, Dai L, Qu X, Fang Z, Feng F, Zhou Y. Iatrogenic fracture during shoulder dislocation reduction: characteristics, management and outcomes. Eur J Med Res 2021; 26:73. [PMID: 34247652 PMCID: PMC8274043 DOI: 10.1186/s40001-021-00545-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 07/05/2021] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Shoulder dislocation and the cases of iatrogenic fractures during manual reduction are becoming increasingly common. The aim of this study was to investigate the characteristics, management, and patient outcomes of iatrogenic proximal humeral fracture during the manual reduction of shoulder dislocation. METHODS A retrospective and multi-center study was performed to identify all patients presenting with shoulder dislocation from January 2010 to January 2020. The sex and age of patients, associated injuries, first-time or habitual shoulder dislocation, type of anesthesia, time from injury to revision surgery, and functional outcomes were analyzed. RESULTS A total of 359 patients with a mean age of 62.1 ± 7.3 years (range 29-86 years) were included. Twenty-one patients (female/male ratio 17:4) with an average age of 66.3 ± 9.7 years (range 48-86 years) were identified with a post-reduction iatrogenic fracture. Female cases with greater tuberosity fractures (GTF) were more likely than male cases to have iatrogenic fractures during reduction (P = 0.035). Women aged 60 years or older experienced more iatrogenic fractures during manual reduction (P = 0.026). Closed reduction under conscious sedation was more likely than that under general anesthesia to have iatrogenic fractures (P = 0.000). A total of 21 patients underwent open reduction and internal fixation (ORIF) when iatrogenic fractures occurred. The mean follow-up period was 19.7 ± 6.7 months (range 12-36 months). The mean Neer scores were 80.5 ± 7.6 (range 62-93), and the mean visual analog score (VAS) was 3.3 ± 1.5 (range 1-6). Significant differences were observed in the Neer score and VAS with the time (more or less 8 h) from injury to revision surgery (P < 0.05). CONCLUSION A high risk of iatrogenic proximal humeral fracture is present in shoulder dislocation with GTF in senile females without general anesthesia. ORIF performed in a timely manner may help improve functional outcomes in the case of iatrogenic injury.
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Affiliation(s)
- Xiaohui Pan
- Department of Orthopedics, Luotian County People's Hospital, Luotian, 438600, Hubei, People's Republic of China
| | - Yong Yao
- Department of Orthopedics, The Central Hospital of Enshi Autonomous Prefecture, Enshi Clinical College of Wuhan University, Enshi, 445000, Hubei, People's Republic of China
| | - Hongyong Yan
- Department of Orthopedics, Jiangxia District Hospital of Traditional Chinese Medicine, Jiangxia, 430200, Hubei, People's Republic of China
| | - Jun Wang
- Department of Orthopedics, Huangshi Second People's Hospital, Huangshi, 435000, Hubei, People's Republic of China
| | - Lei Dai
- Department of Orthopedics, Huangmei County Hospital of Traditional Chinese Medicine, Huangmei, 438500, Hubei, People's Republic of China
| | - Xincong Qu
- Department of Orthopedics, Luotian County People's Hospital, Luotian, 438600, Hubei, People's Republic of China
| | - Zuyi Fang
- Department of Orthopedics, Luotian County People's Hospital, Luotian, 438600, Hubei, People's Republic of China
| | - Feng Feng
- Department of Orthopedics, Luotian County People's Hospital, Luotian, 438600, Hubei, People's Republic of China
| | - Yan Zhou
- Department of Orthopedics, Renmin Hospital of Wuhan University, #238 Jiefang Road, Wuhan, 430060, Hubei, People's Republic of China.
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Porschke F, Loew M, Schnetzke M. Traumatische vs. degenerative Rotatorenmanschettenläsion. ARTHROSKOPIE 2021. [DOI: 10.1007/s00142-021-00438-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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25
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Patel BH, Lu Y, Agarwalla A, Puzzitiello RN, Nwachukwu BU, Cvetanovich GL, Chahla J, Forsythe B. Maximal Medical Improvement Following Shoulder Stabilization Surgery May Require up to 1 Year: A Systematic Review. HSS J 2020; 16:534-543. [PMID: 33380993 PMCID: PMC7749924 DOI: 10.1007/s11420-020-09773-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 06/15/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND There is increased emphasis on properly allocating healthcare resources to optimize value within orthopedic surgery. Establishing time to maximal medical improvement (MMI) can inform clinical decision-making and practice guidelines. PURPOSE We sought (1) to evaluate the time to MMI as predicted by commonly used patient-reported outcome measures (PROMs) for evaluation of shoulder stabilization and (2) to evaluate typical time to return to sports and employment following surgery. METHODS A systematic review of the Medline database was conducted to identify outcome studies reporting sequential follow-up at multiple time points, up to a minimum of 2 years after shoulder stabilization surgery. The included studies examined the outcomes of arthroscopic or open surgical techniques on anterior instability. Clinically significant improvements were evaluated utilizing the minimal clinically important difference specific to each PROM. Secondary outcomes included range of motion, return to sport/work, and recurrent instability. RESULTS Ten studies comprising 590 surgically managed cases of anterior shoulder instability were included (78% arthroscopic, 22% open). Clinically significant improvements in PROMs were achieved up to 1 year post-operatively for Rowe, Western Ontario Instability Index (WOSI), American Shoulder and Elbow Surgeons (ASES), and Simple Shoulder Test (SST) scores. For the three most utilized tools (Rowe, WOSI, ASES), the majority of improvement occurred in the first 6 post-operative months. Clinically significant improvements in Constant Score and Oxford Shoulder Instability Score (OSIS) were achieved up to 6 months and 2 years after surgery, respectively. No clinically significant improvements were achieved on the Disabilities of the Arm, Shoulder, and Hand (DASH) tool. CONCLUSION Maximal medical improvement as determined by commonly utilized PROMs occurs by 1 year after operative management of anterior shoulder instability. The DASH tool does not appear to demonstrate a reliable time frame for clinically significant outcome improvement.
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Affiliation(s)
- Bhavik H. Patel
- Department of Orthopaedic Surgery, University of Illinois at Chicago, Chicago, IL USA
| | - Yining Lu
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN USA
| | - Avinesh Agarwalla
- Department of Orthopaedic Surgery, Westchester Medical Center, Valhalla, NY USA
| | | | | | - Gregory L. Cvetanovich
- Department of Orthopaedic Surgery, The Ohio State University Wexner Medical Center, Columbus, OH USA
| | - Jorge Chahla
- Department of Orthopaedic Surgery, University of Illinois at Chicago, Chicago, IL USA
| | - Brian Forsythe
- Department of Orthopaedic Surgery, University of Illinois at Chicago, Chicago, IL USA
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Neurotization of isolated axillary nerve palsy in a teenage patient. Int J Surg Case Rep 2020; 77:222-224. [PMID: 33176257 PMCID: PMC7662838 DOI: 10.1016/j.ijscr.2020.10.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 10/21/2020] [Accepted: 10/21/2020] [Indexed: 11/29/2022] Open
Abstract
Isolated axillary nerve palsy is a very rare condition, resulting most often from shoulder dislocation, motor vehicle accidents or iatrogenic injury. Loss of shoulder sensibility and abduction are the mean symptoms. And Electromyography (EMG) test helps to confirm the diagnoses. Long head triceps branch transfer to the axillary nerve is a good surgical procedure. Favorable results are associated with young age, early intervention time and adequate rehabilitation. Background and aim The aim of this article was to study isolated axillary nerve injury, his etiologies, symptomatology and treatment via nerve transfer or neurotization. Methods We describe the procedure of long head triceps radial branch transfer to the axillary nerve motor branch in adolescent patient with right deltoid muscle palsy and shoulder anesthesia following a motorcycle crush six months ago. Results Total recovery of the shoulder sensibility, abduction and extension at one-year follow-up, and patient returned progressively to his normal live and sports activities without any functional effect on the donor muscle. Conclusion The advantages of the axillary nerve transfer are demonstrated through many publications. It is a good therapeutic option if it concerned a young patient and practiced at early time followed by adequate rehabilitation.
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Endoscopic brachial plexus neurolysis in the management of infraclavicular nerve injuries due to glenohumeral dislocation. Injury 2020; 51:2592-2600. [PMID: 32778326 DOI: 10.1016/j.injury.2020.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 07/30/2020] [Accepted: 08/02/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Infraclavicular brachial plexus (BP) injury secondary to glenohumeral joint (GHJ) dislocation is a rather common complication, which may be accountable for long-lasting deficits. The purpose of this study was to assess the potential benefits of BP neurolysis in such presentation, using an endoscopic approach. MATERIALS AND METHODS All patients who underwent endoscopic BP neurolysis in the setting of infraclavicular BP palsy due to GHJ dislocation were included. Preoperative physical examination was conducted to classify the observed motor and sensitive deficits into nerves and/or cord lesions. Six weeks after the trauma, examination was repeated and endoscopic BP neurolysis was elected if no significant improvements were observed. If nerve ruptures and/or severe damages were identified during surgery, nerve reconstructions were conducted within a month; in other cases, follow-up examinations were conducted at 6 weeks, 3 and 6 months to assess the course of postoperative recovery. RESULTS Eleven patients were included, including 6 men and 5 women, with a mean age of 43 ± 23 years (16;73). Six patients had at least one cord involved, four patients had isolated axillary nerve palsy, and one patient had a complete BP palsy. In 7 patients with cord lesions and/or isolated axillary nerve palsy, at least grade-3 strength, according to the British Medical Research Council grading system, was noted in all affected muscles within 6 weeks following the neurolysis; after 3 months of follow-up, grade-4 strength was observed in all muscles, and all but patients but one had fully recovered within 6 months. In 3 patients with isolated axillary nerve palsy, complete nerve ruptures (n=2) and severe damages (n=1) were identified under scopic magnification; secondary nerve transfers were conducted to reanimate the axillary nerve, and all patients fully recovered within a year. In one patient with complete BP palsy, improvements started after 6 months of follow-up, and full recovery was yielded after 2 years. No intra- and/or postoperative complications were noted. CONCLUSIONS At the cost of minimal additional morbidity, endoscopic BP neurolysis appears to be a safe and reliable procedure to shorten recovery delays in most patients presenting with BP palsy due to GHJ dislocation.
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Distribution of Peripheral Nerve Injuries in Patients with a History of Shoulder Trauma Referred to a Tertiary Care Electrodiagnostic Laboratory. Diagnostics (Basel) 2020; 10:diagnostics10110887. [PMID: 33143188 PMCID: PMC7693958 DOI: 10.3390/diagnostics10110887] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 10/29/2020] [Accepted: 10/29/2020] [Indexed: 11/17/2022] Open
Abstract
Peripheral nerve injury after shoulder trauma is an underestimated complication. The distribution of the affected nerves has been reported to be heterogeneous in previous studies. This study aimed to describe the distribution of peripheral nerve injuries in patients with a history of shoulder trauma who were referred to a tertiary care electrodiagnostic laboratory. A retrospective chart review was performed for all cases referred to a tertiary care electrodiagnostic laboratory between March 2012 and February 2020. The inclusion criteria were a history of shoulder trauma and electrodiagnostic evidence of nerve injury. Data on patient demographics, mechanism of injury, degree of weakness, clinical outcomes at the final follow-up, and electrodiagnostic results were retrieved from medical records. Fifty-six patients had peripheral nerve injuries after shoulder trauma. Overall, isolated axillary nerve injury was the most common. A brachial plexus lesion affecting the supraclavicular branches (pan-brachial plexus and upper trunk brachial plexus lesions) was the second most common injury. In cases of shoulder dislocation and proximal humerus fracture, isolated axillary nerve injury was the most common. Among acromioclavicular joint injuries and clavicular fractures, lower trunk brachial plexus injuries and ulnar neuropathy were more common than axillary nerve or upper trunk brachial plexus injuries. Patients with isolated axillary nerve lesions showed a relatively good recovery; those with pan-brachial plexus injuries showed a poor recovery. Our study demonstrated the distribution of peripheral nerve injuries remote from displaced bony structures. Mechanisms other than direct compression by displaced bony structures might be involved in nerve injuries associated with shoulder trauma. Electrodiagnostic tests are useful for determining the extent of nerve damage after shoulder trauma.
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Zhang Q, Xiang M, Li YP, Yang JS. Arthroscopic Management of Glenoid and Greater Tuberosity Bipolar Fractures. Orthop Surg 2020; 12:1405-1412. [PMID: 33078582 PMCID: PMC7670139 DOI: 10.1111/os.12786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 07/16/2020] [Accepted: 07/26/2020] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE To report the clinical and radiological outcomes of arthroscopically assisted surgery for combination of glenoid and greater tuberosity fractures after traumatic shoulder dislocation. METHODS From December 2013 to December 2018, patients with concomitant fracture of the greater tuberosity and glenoid who underwent arthroscopically assisted surgery were retrospectively reviewed. Fifteen patients were included. Preoperative computed tomography (CT) scans with 3D reconstruction were performed to evaluate the fracture configuration and associated fractures. All patients underwent arthroscopically assisted surgery under general anesthesia with brachial plexus anesthesia in the lateral position. Under the arthroscopic approach, a comprehensive inspection of the joints was firstly conducted to examine the injury of bones and other tissues. With arthroscopy support, closed reduction and internal fixation of both fractures were performed with suture anchors, with or without additional cannulated screws. At the same time, other injuries were also repaired under the arthroscope. Patients were followed up (6 weeks，8 weeks，3 months，6 months，1 year after surgery) regularly for at least 1 year. At the follow-up, clinical outcomes (Constant score, ASES score, range of motion, and VAS score) and radiological outcomes were analyzed. RESULTS Of the 15 patients, there are seven cases of men, eight cases of women; aged 22-66 years, with an average age of 48 years; left shoulder for five cases, 10 cases of the right shoulder. The injury mechanisms were: a simple fall (n = 9), an epileptic seizure (n = 1), a high fall injury (n = 2), and a traffic accident (n = 3). Of the 15 cases of glenoid fracture, 11 cases were type Ia and four cases were type II according to the Ideberg Classification System. The mean size of the glenoid fracture fragment was 28.4% (range, 8.7%-47.2%). According to the Mutch classification system, the fractures of the greater tuberosity were divided into: five cases of avulsion, one case of compression, and nine cases of split. Average time of follow-up was 38.2 months (range, 12-70 months), and one case was lost to follow-up. With fractures healing well, almost all patients had a good joint function. At the final follow-up, mean anterior flexion was 157°; mean external rotation was 40°; mean internal rotation was T11 level; the mean Constant-Murley score was 94.6 points (range, 70-100 points); the mean ASES score was 94.6 points (range, 79-100 points); and the mean VAS score was 0.4 points (range, 0-2 points). No recurrent instability or re-dislocation occurred. No patient had revision surgery. CONCLUSION Arthroscopic management of glenoid and greater tuberosity bipolar fractures was useful and effective with minimal injury, and it achieved satisfactory clinical and radiological outcomes at a mean follow-up time of more than 3 years.
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Affiliation(s)
- Qing Zhang
- Department of Upper Limb, Sichuan Provincial Orthpaedics Hospital, Chengdu, China
| | - Ming Xiang
- Department of Upper Limb, Sichuan Provincial Orthpaedics Hospital, Chengdu, China
| | - Yi-Ping Li
- Department of Upper Limb, Sichuan Provincial Orthpaedics Hospital, Chengdu, China
| | - Jin-Song Yang
- Department of Upper Limb, Sichuan Provincial Orthpaedics Hospital, Chengdu, China
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Functional outcome and tendon integrity of rotator cuff reconstruction after primary traumatic glenohumeral dislocation. Arch Orthop Trauma Surg 2020; 140:1073-1079. [PMID: 32236714 DOI: 10.1007/s00402-020-03416-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Rotator cuff tears (rct) subsequent to glenohumeral dislocation are relevant concomitant injuries, can lead to impaired shoulder function and increase risk of recurrent dislocation. AIM The aim of this study was to determine the functional outcome, recurrent dislocation rate and tendon integrity after rotator cuff repair after primary traumatic shoulder dislocation. MATERIALS AND METHODS In this retrospective case series, 23 patients (age 56.4 years ± 6.3) who underwent a rotator cuff reconstruction after primary traumatic shoulder dislocation with confirmed combination of full-thickness RCT and Bankart lesion were enrolled after a minimum follow-up of 2 years. Clinical outcome (age and gender adjusted Constant Murley Score (CMS), DASH, Rowe Score) (n = 23) and sonographic tendon integrity (n = 19) were studied. RESULTS After a mean follow-up of 58 ± 32 months, a CMS of 85.1% ± 14.7, DASH of 14.2 ± 20.5, and Rowe Score of 82.4 ± 15.2 indicated good functional outcome. In 4 of 19 patients (21.1%) a re-tear was found during sonographic evaluation. In 3 cases (13%), a revision was performed (2 × stiff shoulder, 1 × postoperative infection). One patient had a single traumatic re-dislocation (4.3%). CONCLUSIONS Patients undergone reconstruction of the rotator cuff following a primary traumatic shoulder dislocation can achieve good functional results and a low rate of recurrent dislocation. Postoperative tendon integrity is comparable with known data about non traumatic tears.
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Wright CJ, Brandon BA, Reisman EJ. Closed-Reduction Techniques for Glenohumeral-, Patellofemoral-, and Interphalangeal-Joint Dislocations. J Athl Train 2020; 55:0. [PMID: 32688375 DOI: 10.4085/1062-6050-0311.19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Joint dislocations account for a small but important portion of all athletic injuries, with most occurring at the glenohumeral, patellofemoral, and interphalangeal joints. Athletic trainers are responsible for managing acute joint-dislocation injuries, which may include performing closed-reduction techniques when appropriate. To achieve optimal patient outcomes, the clinician should be formally trained and skilled in performing various techniques and familiar with the evidence supporting the selection of each technique. In this clinical review, we outline general reduction procedures and then summarize and synthesize the existing literature on common closed-reduction techniques for glenohumeral-, patellofemoral-, and interphalangeal-joint dislocations. When appropriate, the content has been adapted to be specific to the athletic trainer's scope of practice.
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Affiliation(s)
| | - Barbara A Brandon
- University of Washington School of Medicine, Spokane Teaching Health Center
| | - Edward J Reisman
- University of Washington School of Medicine, Spokane Teaching Health Center
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Gutkowska O, Martynkiewicz J, Urban M, Gosk J. Brachial plexus injury after shoulder dislocation: a literature review. Neurosurg Rev 2020; 43:407-423. [PMID: 29961154 PMCID: PMC7186242 DOI: 10.1007/s10143-018-1001-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 05/17/2018] [Accepted: 06/21/2018] [Indexed: 12/01/2022]
Abstract
Brachial plexus injuries are among the rarest but at the same time the most severe complications of shoulder dislocation. The symptoms range from transient weakening or tingling sensation of the upper limb to total permanent paralysis of the limb associated with chronic pain and disability. Conflicting opinions exist as to whether these injuries should be treated operatively and if so when surgery should be performed. In this review, available literature dedicated to neurological complications of shoulder dislocation has been analysed and management algorithm has been proposed. Neurological complications were found in 5.4-55% of all dislocations, with the two most commonly affected patient groups being elderly women sustaining dislocation as a result of a simple fall and young men after high-energy injuries, often multitrauma victims. Infraclavicular part of the brachial plexus was most often affected. Neurapraxia or axonotmesis predominated, and complete nerve disruption was observed in less than 3% of the patients. Shoulder dislocation caused injury to multiple nerves more often than mononeuropathies. The axillary nerve was most commonly affected, both as a single nerve and in combination with other nerves. Older patient age, higher energy of the initial trauma and longer period from dislocation to its reduction have been postulated as risk factors. Brachial plexus injury resolved spontaneously in the majority of the patients. Operative treatment was required in 13-18% of the patients in different studies. Patients with suspected neurological complications require systematic control. Surgery should be performed within 3-6 months from the injury when no signs of recovery are present.
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Affiliation(s)
- Olga Gutkowska
- Department of Traumatology, Clinical Department of Traumatology and Hand Surgery, Wroclaw Medical University, ul. Borowska 213, 50-556 Wroclaw, Poland
| | - Jacek Martynkiewicz
- Department of Traumatology, Clinical Department of Traumatology and Hand Surgery, Wroclaw Medical University, ul. Borowska 213, 50-556 Wroclaw, Poland
| | - Maciej Urban
- Department of Traumatology, Clinical Department of Traumatology and Hand Surgery, Wroclaw Medical University, ul. Borowska 213, 50-556 Wroclaw, Poland
| | - Jerzy Gosk
- Department of Traumatology, Clinical Department of Traumatology and Hand Surgery, Wroclaw Medical University, ul. Borowska 213, 50-556 Wroclaw, Poland
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Seo JB, Yoon SH, Yang JH, Yoo JS. Irreducible posterior fracture and dislocation of shoulder with massive rotator cuff tear due to incarceration of biceps tendon: A case report. J Orthop 2020; 21:6-9. [PMID: 32071525 DOI: 10.1016/j.jor.2020.02.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 02/02/2020] [Indexed: 12/15/2022] Open
Abstract
Acute traumatic posterior glenohumeral dislocation in association with a massive rotator cuff tear is rare. Moreover, only few cases with interposition of the long biceps head of the tendon has been described to prevent reduction in posterior dislocation of the shoulder. In addition, combined scapula fracture with posterior shoulder dislocation also extremely rare. We present a case of Irreducible posterior fracture and dislocation of shoulder with massive rotator cuff tear due to incarceration of biceps tendon. For the treatment arthroscopic in situ superior capsule reconstruction was performed using the long head of the biceps tendon with rotator cuff repair.
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Affiliation(s)
- Joong-Bae Seo
- Department of Orthopaedic Surgery, Dankook University College of Medicine, Cheonan, South Korea
| | - Sung-Hyun Yoon
- Department of Orthopaedic Surgery, Dankook University College of Medicine, Cheonan, South Korea
| | - Jong-Heon Yang
- Department of Orthopaedic Surgery, Dankook University College of Medicine, Cheonan, South Korea
| | - Jae-Sung Yoo
- Department of Orthopaedic Surgery, Dankook University College of Medicine, Cheonan, South Korea
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Boettcher BJ, Jelsing EJ. Selective Brachialis Atrophy Following an Anterior Glenohumeral Joint Dislocation, a Rare Cause of Musculocutaneous Neuropathy: A Case Report. Curr Sports Med Rep 2019; 18:319-321. [PMID: 31503042 DOI: 10.1249/jsr.0000000000000627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Brennan J Boettcher
- Primary Care Sports Medicine, Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Elena J Jelsing
- Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine and Science, Rochester, MN
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Liang D, Qiu Z, Liu H, Lu W. [Research progress of surgical treatment for anterior shoulder dislocation and combined injuries]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2019; 33:768-773. [PMID: 31198008 DOI: 10.7507/1002-1892.201901021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To summarize the research progress of surgical treatment for anterior shoulder dislocation and combined injuries. Methods The related literature was reviewed, and the surgical treatment options for the anterior shoulder dislocation and its combined injuries were summarized. Results Anterior shoulder dislocation can combine with anteroinferior capsular ligament complex injury (Bankart injury), bony Bankart defect, and Hill-Sachs lesion. For Bankart and bony Bankart injuries, arthroscopic repair or coracoid osteotomy combined with bony graft reconstruction can be performed. For Hill-Sachs lesion, conservative treatment, soft tissue repair, or bony reconstruction should be selected based on the extent of the bone defect. For bipolar injury, the Bankart repair, Remplissage, or arthroplasty should be selected based on the extent of the glenoid defect. Conclusion With the development of arthroscopy and the improvement of the surgical concept, there is a complete set of surgical options for various injuries of the anterior shoulder dislocation. When choosing a surgical procedure, the patient's specific injury and age, exercise level, and other relating factors should be comprehensively assessed in order to achieve the best results.
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Affiliation(s)
- Daqiang Liang
- Department of Sports Medicine, the First Affiliated Hospital of Shenzhen University (Shenzhen Second People's Hospital), Shenzhen Guangdong, 518035, P.R.China
| | - Zhihe Qiu
- Department of Sports Medicine, the First Affiliated Hospital of Shenzhen University (Shenzhen Second People's Hospital), Shenzhen Guangdong, 518035, P.R.China
| | - Haifeng Liu
- Department of Sports Medicine, the First Affiliated Hospital of Shenzhen University (Shenzhen Second People's Hospital), Shenzhen Guangdong, 518035, P.R.China
| | - Wei Lu
- Department of Sports Medicine, the First Affiliated Hospital of Shenzhen University (Shenzhen Second People's Hospital), Shenzhen Guangdong, 518035,
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Yoon JS, Park JH, Levin J, Roh EY, Park HJ, Won SJ. Ultrasonographic measurement of the cross-sectional area of the axillary nerve. Muscle Nerve 2019; 60:95-99. [PMID: 30927449 DOI: 10.1002/mus.26480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 03/24/2019] [Accepted: 03/26/2019] [Indexed: 11/12/2022]
Abstract
INTRODUCTION The objectives of this study were to determine normal reference values for ultrasonographic measurement of the cross-sectional area (CSA) of the axillary nerve and to standardize the measurement methods. METHODS Sixty healthy volunteers were evaluated. Ultrasonography was performed with the shoulder positioned in 100°-120° abduction and 90° external rotation. The CSA of the axillary nerve was measured bilaterally. RESULTS The normal CSA of the right axillary nerve was 2.9 ± 1.1 mm2 . The side-to-side discrepancy was 22.8% ± 17.8%. DISCUSSION These reference values may be helpful for investigating pathologies involving the axillary nerve.
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Affiliation(s)
- Joon Shik Yoon
- Department of Rehabilitation Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Jung Hyun Park
- Department of Rehabilitation Medicine, Rehabilitation Institute of Neuromuscular Disease, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Joshua Levin
- Department of Orthopaedic Surgery, Division of Physical Medicine and Rehabilitation, Stanford University School of Medicine, Stanford, California, USA.,Department of Neurosurgery, Stanford University, Palo Alto, California, USA
| | - Eugene Y Roh
- Department of Orthopaedic Surgery, Division of Physical Medicine and Rehabilitation, Stanford University School of Medicine, Stanford, California, USA
| | - Hye Jung Park
- Department of Rehabilitation Medicine, Yeouido St Mary's Hospital, 10, 63-ro, Yeongdeungpo-gu, College of Medicine, The Catholic University of Korea, Seoul, 07345, South Korea
| | - Sun Jae Won
- Department of Rehabilitation Medicine, Yeouido St Mary's Hospital, 10, 63-ro, Yeongdeungpo-gu, College of Medicine, The Catholic University of Korea, Seoul, 07345, South Korea
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Bockmann B, Lechler P, Boese CK, Aigner R, Ruchholtz S, Frink M. Risk factors for secondary displacement in conservatively treated isolated greater tuberosity fractures: An analysis of 82 cases. Orthop Traumatol Surg Res 2019; 105:317-322. [PMID: 30635230 DOI: 10.1016/j.otsr.2018.06.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 06/02/2018] [Accepted: 06/29/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The optimal treatment of isolated fractures of the greater tuberosity is an important topic of current surgical research. While non-displaced fractures are amenable to conservative treatment, displacement of the fragment can result in rotator cuff malfunction and impingement. For the present study, risk factors predicting secondary fragment displacement were analyzed. HYPOTHESIS Certain risk factors determine a higher risk of secondary displacement in patients with greater tuberosity fractures. PATIENTS AND METHODS All patients diagnosed with a fracture of the greater tuberosity and initially treated non-surgically at our Level I trauma center between January 2008 and July 2015 were included in this retrospective analysis. Patients were grouped into: no secondary displacement (group 1) and secondary displacement at follow-up (group 2). The following risk factors were analyzed: age, gender, side of fracture, initial displacement, fragment/head ratio, fragment shape, dislocation, concomitant fractures and concomitant fractures to the same extremity. RESULTS 82 patients (42 male, 40 female) were eligible for further analyses. Median follow-up was 8.0±39.5 days. Patients with secondary displacement (group 2) were significantly older (group 1: 51.7±15.5, group 2: 68.3±14.3; p<0.001) and had significantly more shoulder dislocations (p=0.024), whereas gender (p=0.299), side of fracture (p=0.189) and fragment/head ratio (p=0.660) showed no significant different distribution between both groups. Finally, split-type fractures increased the risk of secondary displacement. DISCUSSION The present study identified age older than 65 years to be an important risk factor for secondary displacement in the conservative management of fractures of the greater tuberosity. Furthermore, fracture type and shoulder dislocations are factors associated with an increased relative risk for secondary displacement. LEVEL OF PROOF III, Retrospective comparative study.
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Affiliation(s)
- Benjamin Bockmann
- Department of Orthopaedics and Trauma Surgery, St. Josef Hospital, Ruhr University Bochum, 44791 Bochum, Germany
| | - Philipp Lechler
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, Location Marburg, Baldingerstraße, 35043 Marburg, Germany
| | - Christoph Kolja Boese
- Department of Orthopedic and Trauma Surgery, University Hospital of Cologne, Kerpener Straße 62, Cologne, Germany
| | - Rene Aigner
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, Location Marburg, Baldingerstraße, 35043 Marburg, Germany
| | - Steffen Ruchholtz
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, Location Marburg, Baldingerstraße, 35043 Marburg, Germany
| | - Michael Frink
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, Location Marburg, Baldingerstraße, 35043 Marburg, Germany.
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Ryu JH, Kang JR, Ryu RK. Arthroscopic Bankart Reconstruction with Minimal Bone Loss. OPER TECHN SPORT MED 2019. [DOI: 10.1053/j.otsm.2019.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Patel P, Brkljac M, Sonar U, Kumar S. Heterotopic ossification following anterior shoulder dislocation. BMJ Case Rep 2018; 2018:bcr-2018-226968. [PMID: 30413461 DOI: 10.1136/bcr-2018-226968] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Heterotopic ossification (HO) is the abnormal growth of extraskeletal bone. Joint involvement may result in chronic stiffness and pain causing considerable functional impairment and the inability to perform the activities of daily living. HO affecting the shoulder joint is rare and little is known about its clinical course or treatment. Here, we describe the first reported case of glenohumeral HO following anterior dislocation. This occurred in a 70-year-old man following a fall onto outstretched hand. Due to persistent stiffness and pain at 8 months from initial injury, he underwent plain radiographs and MRI scans that confirmed rotator cuff tear and HO. He was managed conservatively with physiotherapy and non-steroidal anti-inflammatory drugs. At 1-year follow-up, the patient maintains a good functional outcome.
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Affiliation(s)
- Preemal Patel
- Department of Trauma and Orthopaedics, Royal Lancaster Infirmary, Lancaster, UK
| | - Milos Brkljac
- Department of Trauma and Orthopaedics, Royal Lancaster Infirmary, Lancaster, UK
| | - Ulhas Sonar
- Department of Trauma and Orthopaedics, Royal Lancaster Infirmary, Lancaster, UK
| | - Shyam Kumar
- Department of Trauma and Orthopaedics, Royal Lancaster Infirmary, Lancaster, UK
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Lädermann A, Tirefort J, Zanchi D, Haller S, Charbonnier C, Hoffmeyer P, Cunningham G. Shoulder apprehension: A multifactorial approach. EFORT Open Rev 2018; 3:550-557. [PMID: 30662763 PMCID: PMC6335591 DOI: 10.1302/2058-5241.3.180007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Shoulder apprehension is related to changes in functional cerebral networks induced by dislocations, peripheral neuromuscular lesions and persistent mechanical glenohumeral instability consisting of micro-motion.All the damage to the osseous and soft-tissue stabilizers of the shoulder, as well as neurologic impairment persisting even after stabilization, must be properly identified in order to offer the best possible treatment to the patient.There is growing evidence supporting the use of a global multimodal approach, involving, on the one hand, shoulder 'reafferentation', including proprioception, mirror therapy and even cognitive behavioural approaches, and, on the other hand, surgical stabilization techniques and traditional physical therapy in order to minimize persistent micro-motion, which may help brain healing. This combined management could improve return to sport and avoid dislocation arthropathy in the long term. Cite this article: EFORT Open Rev 2018;3:550-557. DOI: 10.1302/2058-5241.3.180007.
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Affiliation(s)
- Alexandre Lädermann
- Division of Orthopaedics and Trauma Surgery, Department of Surgery, University Hospitals of Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Switzerland
| | - Jérome Tirefort
- Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Switzerland
| | - Davide Zanchi
- Department of Psychiatry (UPK), University of Basel, Switzerland
| | - Sven Haller
- Faculty of Medicine, University of Geneva, Switzerland.,Affidea Centre de Diagnostic Radiologique de Carouge CDRC, Geneva, Switzerland.,Department of Surgical Sciences, Uppsala University, Sweden.,Department of Neuroradiology, University Hospital Freiburg, Germany
| | - Caecilia Charbonnier
- Faculty of Medicine, University of Geneva, Switzerland.,Medical Research Department, Artanim Foundation, Geneva, Switzerland
| | - Pierre Hoffmeyer
- Division of Orthopaedics and Trauma Surgery, Department of Surgery, University Hospitals of Geneva, Switzerland
| | - Gregory Cunningham
- Division of Orthopaedics and Trauma Surgery, Department of Surgery, University Hospitals of Geneva, Switzerland
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41
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Said HG, El-Radi MA, Hassanein MY, Said GZ. Orthopaedic publications from Egypt in the last five years: a bibliometric report. INTERNATIONAL ORTHOPAEDICS 2018; 42:2507-2511. [DOI: 10.1007/s00264-018-4152-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Accepted: 09/06/2018] [Indexed: 12/11/2022]
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42
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Wang SI. Management of the First-time Traumatic Anterior Shoulder Dislocation. Clin Shoulder Elb 2018; 21:169-175. [PMID: 33330172 PMCID: PMC7726393 DOI: 10.5397/cise.2018.21.3.169] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 07/28/2018] [Accepted: 07/30/2018] [Indexed: 11/25/2022] Open
Abstract
Traumatic anterior dislocation of the shoulder is one of the most common directions of instability following a traumatic event. Although the incidence of shoulder dislocation is similar between young and elderly patients, most studies have traditionally focused on young patients due to relatively high rates of recurrent dislocations in this population. However, shoulder dislocations in older patients also require careful evaluation and treatment selection because they can lead to persistent pain and disability due to rotator cuff tears and nerve injuries. This article provides an overview of the nature and pathology of acute primary anterior shoulder dislocation, widely accepted management modalities, and differences in treatment for young and elderly patients.
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Affiliation(s)
- Sung Il Wang
- Department of Orthopaedic Surgery, Chonbuk National University Medical School, Research Insitute for Endocrine Sciences and Research Insitute of Clinical Medicine of Chonbuk National University-Biomedical Research Insitute of Chonbuk National University Hospital, Jeonju, Korea
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43
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Chamseddine AH, Haidar IM, El Hajj OM, Zein HK, Bazzal AM, Alasiry AA, Mansour NA, Abdallah AC. FARES method for reduction without medication of first episode of traumatic anterior shoulder dislocation. INTERNATIONAL ORTHOPAEDICS 2018; 43:1165-1170. [PMID: 30159802 DOI: 10.1007/s00264-018-4131-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 08/21/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of this study is to demonstrate the efficiency of (FARES) method for reduction of first-episode anterior shoulder dislocation, as well as its safety, reliability, and quick easy reproducibility by inexperienced physicians without any use of medications. METHODS This was a prospective study of 28 patients with first episode of anterior shoulder dislocation that underwent closed reduction using FARES method by junior orthopaedic residents without use of any analgesic, muscle relaxant, or anesthesia. Only two attempts of reduction were allowed for each patient. The time needed for reduction was recorded, and the patients were asked to grade their pain according to a visual analog scale from 0 to 10. RESULTS Reduction was achieved after one attempt in 21 patients (75%) and after two attempts in three additional patients (total 85.7%). The mean time needed for reduction was 62.66 seconds, and the mean visual analog scale for pain evaluation was 5.29. CONCLUSION FARES method is a fast, reliable, and safe method for reduction of a first episode of anterior shoulder dislocation and can be easily performed by inexperienced physicians and junior residents.
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Affiliation(s)
- Ali Hassan Chamseddine
- Division of Orthopaedics and Trauma Surgery, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon.
- Division of Orthopaedics and Trauma Surgery, Sahel General Hospital, University Medical Centre, Beirut, Lebanon.
| | - Ibrahim M Haidar
- Division of Orthopaedics and Trauma Surgery, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
- Division of Orthopaedics and Trauma Surgery, Sahel General Hospital, University Medical Centre, Beirut, Lebanon
| | - Oussama M El Hajj
- Division of Orthopaedics and Trauma Surgery, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
- Division of Orthopaedics and Trauma Surgery, Sahel General Hospital, University Medical Centre, Beirut, Lebanon
| | - Hadi K Zein
- Division of Orthopaedics and Trauma Surgery, Sahel General Hospital, University Medical Centre, Beirut, Lebanon
| | - Ali M Bazzal
- Division of Orthopaedics and Trauma Surgery, Sahel General Hospital, University Medical Centre, Beirut, Lebanon
| | - Abdullah A Alasiry
- Division of Orthopaedics and Trauma Surgery, Sahel General Hospital, University Medical Centre, Beirut, Lebanon
| | - Nader A Mansour
- Division of Orthopaedics and Trauma Surgery, Sahel General Hospital, University Medical Centre, Beirut, Lebanon
| | - Amer C Abdallah
- Division of Orthopaedics and Trauma Surgery, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
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44
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Merlini L, Yalizis M, Carrillon Y, Bothorel H, Saffarini M, Godenèche A. Hidden degloving rotator cuff tears secondary to glenohumeral dislocation. J Shoulder Elbow Surg 2018; 27:1456-1461. [PMID: 29555121 DOI: 10.1016/j.jse.2018.01.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 01/16/2018] [Accepted: 01/22/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND A rare form of rotator cuff tear (RCT) is observed secondary to glenohumeral dislocation, followed by immediate repositioning, as well as formation of scar tissue between tendons and tuberosities. Radiographic diagnosis of such "degloving" tears is problematic because they are obscured by scar tissue. We aimed to describe characteristics of degloving tears and report outcomes following their arthroscopic repair. METHODS Among 67 patients who underwent arthroscopic repair of RCTs secondary to shoulder dislocation, we identified 8 patients (12%) (7 anterior dislocations and 1 posterior dislocation), aged 54.5 years (range, 38-61 years), with typical characteristics of degloving tears. Preoperative imaging revealed massive 2- or 3-tendon tears in all patients (6 with a ruptured or dislocated long head of the biceps), evaluated preoperatively and at greater than 2 years, using the absolute and age- and gender-adjusted Constant scores, Subjective Shoulder Value, and Simple Shoulder Test score. RESULTS The absolute Constant score improved from 27 (range, 17-54) to 89 (range, 62-95). The age- and gender-adjusted Constant score improved from 31 (range, 24-57) to 97 (range, 83-100). The Simple Shoulder Test score improved from 2 (range, 0-4) to 12 (range, 9-12), while the Subjective Shoulder Value improved from 18 (range, 10-30) to 90 (range, 60-100). All patients were very satisfied (63%) or satisfied (37%). CONCLUSION We have described a particular form of RCT secondary to glenohumeral dislocation, resulting in degloving of the rotator cuff, followed by repositioning of tendons. The formation of scar tissue can obscure tendon tears on ultrasound, in which case further imaging is recommended to ascertain the diagnosis and avoid therapeutic delays.
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Affiliation(s)
- Lorenzo Merlini
- Centre Orthopédique Santy, Hôpital Privé Jean Marmoz, Lyon, France
| | | | | | | | | | - Arnaud Godenèche
- Centre Orthopédique Santy, Hôpital Privé Jean Marmoz, Lyon, France
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Kraeutler MJ, McCarty EC, Belk JW, Wolf BR, Hettrich CM, Ortiz SF, Bravman JT, Baumgarten KM, Bishop JY, Bollier MJ, Brophy RH, Carey JL, Carpenter JE, Cox CL, Feeley BT, Grant JA, Jones GL, Kuhn JE, Kelly JD, Ma CB, Marx RG, Miller BS, Sennett BJ, Smith MV, Wright RW, Zhang AL. Descriptive Epidemiology of the MOON Shoulder Instability Cohort. Am J Sports Med 2018; 46:1064-1069. [PMID: 29505730 DOI: 10.1177/0363546518755752] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Shoulder instability is a common diagnosis among patients undergoing shoulder surgery. PURPOSE To perform a descriptive analysis of patients undergoing surgery for shoulder instability through a large multicenter consortium. STUDY DESIGN Case series; Level of evidence, 4. METHODS All patients undergoing surgery for shoulder instability who were enrolled in the MOON Shoulder Instability Study were included. Baseline demographics included age, sex, body mass index, and race. Baseline patient-reported outcomes (PROs) included the American Shoulder and Elbow Surgeons (ASES) score, Shoulder Activity Score, Western Ontario Shoulder Instability Index (WOSI), 36-Item Health Survey (RAND-36), and Single Assessment Numeric Evaluation (SANE). The preoperative physician examination included active range of motion (ROM) and strength testing. Preoperative imaging assessments with plain radiography, magnetic resonance imaging (MRI), and computed tomography were also included and analyzed. RESULTS Twenty-six surgeons had enrolled 863 patients (709 male, 154 female) across 10 clinical sites. The mean age for the cohort was 24 years (range, 12-63 years). Male patients represented 82% of the cohort. The primary direction of instability was anterior for both male (74%) and female (73%) patients. Football (24%) and basketball (13%) were the most common sports in which the primary shoulder injury occurred. No clinically significant differences were found in preoperative ROM between the affected and unaffected sides for any measurement taken. Preoperative MRI scans were obtained in 798 patients (92%). An anterior labral tear was the most common injury found on preoperative MRI, seen in 66% of patients, followed by a Hill-Sachs lesion in 41%. Poor PRO scores were recorded preoperatively (mean: ASES, 72.4; WOSI, 43.3; SANE, 46.6). CONCLUSION The MOON Shoulder Instability Study has enrolled the largest cohort of patients undergoing shoulder stabilization to date. Anterior instability is most common among shoulder instability patients, and most patients undergoing shoulder stabilization are in their early 20s or younger. The results of this study provide important epidemiological information for patients undergoing shoulder stabilization surgery.
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Affiliation(s)
- Matthew J Kraeutler
- Investigation performed at CU Sports Medicine and Performance Center, Department of Orthopedics, University of Colorado School of Medicine, Boulder, Colorado, USA
| | - Eric C McCarty
- Investigation performed at CU Sports Medicine and Performance Center, Department of Orthopedics, University of Colorado School of Medicine, Boulder, Colorado, USA
| | - John W Belk
- Investigation performed at CU Sports Medicine and Performance Center, Department of Orthopedics, University of Colorado School of Medicine, Boulder, Colorado, USA
| | - Brian R Wolf
- Investigation performed at CU Sports Medicine and Performance Center, Department of Orthopedics, University of Colorado School of Medicine, Boulder, Colorado, USA
| | - Carolyn M Hettrich
- Investigation performed at CU Sports Medicine and Performance Center, Department of Orthopedics, University of Colorado School of Medicine, Boulder, Colorado, USA
| | - Shannon F Ortiz
- Investigation performed at CU Sports Medicine and Performance Center, Department of Orthopedics, University of Colorado School of Medicine, Boulder, Colorado, USA
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- Investigation performed at CU Sports Medicine and Performance Center, Department of Orthopedics, University of Colorado School of Medicine, Boulder, Colorado, USA
| | - Jonathan T Bravman
- Investigation performed at CU Sports Medicine and Performance Center, Department of Orthopedics, University of Colorado School of Medicine, Boulder, Colorado, USA
| | - Keith M Baumgarten
- Investigation performed at CU Sports Medicine and Performance Center, Department of Orthopedics, University of Colorado School of Medicine, Boulder, Colorado, USA
| | - Julie Y Bishop
- Investigation performed at CU Sports Medicine and Performance Center, Department of Orthopedics, University of Colorado School of Medicine, Boulder, Colorado, USA
| | - Matthew J Bollier
- Investigation performed at CU Sports Medicine and Performance Center, Department of Orthopedics, University of Colorado School of Medicine, Boulder, Colorado, USA
| | - Robert H Brophy
- Investigation performed at CU Sports Medicine and Performance Center, Department of Orthopedics, University of Colorado School of Medicine, Boulder, Colorado, USA
| | - James L Carey
- Investigation performed at CU Sports Medicine and Performance Center, Department of Orthopedics, University of Colorado School of Medicine, Boulder, Colorado, USA
| | - James E Carpenter
- Investigation performed at CU Sports Medicine and Performance Center, Department of Orthopedics, University of Colorado School of Medicine, Boulder, Colorado, USA
| | - Charlie L Cox
- Investigation performed at CU Sports Medicine and Performance Center, Department of Orthopedics, University of Colorado School of Medicine, Boulder, Colorado, USA
| | - Brian T Feeley
- Investigation performed at CU Sports Medicine and Performance Center, Department of Orthopedics, University of Colorado School of Medicine, Boulder, Colorado, USA
| | - John A Grant
- Investigation performed at CU Sports Medicine and Performance Center, Department of Orthopedics, University of Colorado School of Medicine, Boulder, Colorado, USA
| | - Grant L Jones
- Investigation performed at CU Sports Medicine and Performance Center, Department of Orthopedics, University of Colorado School of Medicine, Boulder, Colorado, USA
| | - John E Kuhn
- Investigation performed at CU Sports Medicine and Performance Center, Department of Orthopedics, University of Colorado School of Medicine, Boulder, Colorado, USA
| | - John D Kelly
- Investigation performed at CU Sports Medicine and Performance Center, Department of Orthopedics, University of Colorado School of Medicine, Boulder, Colorado, USA
| | - C Benjamin Ma
- Investigation performed at CU Sports Medicine and Performance Center, Department of Orthopedics, University of Colorado School of Medicine, Boulder, Colorado, USA
| | - Robert G Marx
- Investigation performed at CU Sports Medicine and Performance Center, Department of Orthopedics, University of Colorado School of Medicine, Boulder, Colorado, USA
| | - Bruce S Miller
- Investigation performed at CU Sports Medicine and Performance Center, Department of Orthopedics, University of Colorado School of Medicine, Boulder, Colorado, USA
| | - Brian J Sennett
- Investigation performed at CU Sports Medicine and Performance Center, Department of Orthopedics, University of Colorado School of Medicine, Boulder, Colorado, USA
| | - Matthew V Smith
- Investigation performed at CU Sports Medicine and Performance Center, Department of Orthopedics, University of Colorado School of Medicine, Boulder, Colorado, USA
| | - Rick W Wright
- Investigation performed at CU Sports Medicine and Performance Center, Department of Orthopedics, University of Colorado School of Medicine, Boulder, Colorado, USA
| | - Alan L Zhang
- Investigation performed at CU Sports Medicine and Performance Center, Department of Orthopedics, University of Colorado School of Medicine, Boulder, Colorado, USA
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Abstract
Axillary nerve injury is a well-recognized complication of glenohumeral dislocation. It is often a low-grade injury which progresses to full recovery without intervention. There is, however, a small number of patients who have received a higher-grade injury and are less likely to achieve a functional recovery without surgical exploration and reconstruction. Following a review of the literature and consideration of local practice in a regional peripheral nerve injury unit, an algorithm has been developed to help identification of those patients with more severe nerve injuries. Early identification of patients with high-grade injuries allows rapid referral to peripheral nerve injury centres, allowing specialist observation or intervention at an early stage in their injury, thus aiming to maximize potential for recovery. Cite this article: EFORT Open Rev 2018;3:70-77. DOI:10.1302/2058-5241.3.170003.
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Marcano-Fernández F, Balaguer-Castro M, Fillat-Gomà F, Ràfols-Perramon O, Torrens C, Torner P. Teaching Patients How to Reduce a Shoulder Dislocation: A Randomized Clinical Trial Comparing the Boss-Holzach-Matter Self-Assisted Technique and the Spaso Method. J Bone Joint Surg Am 2018; 100:375-380. [PMID: 29509614 PMCID: PMC5882288 DOI: 10.2106/jbjs.17.00687] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND There are many different techniques for reducing acute anterior dislocations of the shoulder, and their use depends on surgeon preference. The objective of this study was to compare the pain experienced by a patient performing a self-reduction technique with the pain felt during a reduction performed by a trained physician. METHODS The study was carried out at the emergency department of a tertiary referral center. Patients between 18 and 60 years of age with an acute anterior shoulder dislocation were randomly allocated into 2 groups. In 1 group the emergency doctor actively guided the reduction process with the Spaso technique (Sp group), and in the other group the patient used the Boss-Holzach-Matter (also known as Davos or Aronen) self-reduction technique (BHM group). The pain experienced by the patient during the reduction was recorded by means of a visual analogue scale (VAS) ranging from 0 to 10. Other recorded data included demographic characteristics, reduction time, and success rate. RESULTS Of 378 patients assessed for eligibility from May 2015 until February 2017, 197 did not meet the inclusion criteria, 58 met exclusion criteria, 22 declined to participate, and 41 withdrew before randomization. Sixty acute anterior shoulder dislocations were randomized into the Sp group (n = 30) or the BHM group (n = 30). The BHM group experienced significantly less pain during reduction than the Sp group (p = 0.047), with mean pain scores of 3.57 (standard deviation [SD] = 2.1]) and 5.26 (SD = 2.9), respectively. No significant difference between groups was found with respect to reduction time (105 seconds [range, 10 to 660 seconds] in the Sp group and 90 seconds [range, 5 to 600 seconds] in the BHM group; p = 0.6) or success rate (67% and 77%, respectively; p = 0.39). CONCLUSIONS The self-reduction technique results in less pain than, and is as efficient in achieving reduction of anterior shoulder dislocations as, the Spaso technique. These findings favor the use of the self-assisted method as an effective first-line treatment for shoulder dislocations seen in the emergency department as well as its use by patients with recurrent dislocation. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- F.A. Marcano-Fernández
- Orthopedic Department, Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain,E-mail address for F.A. Marcano-Fernández:
| | - Mariano Balaguer-Castro
- Orthopedic Department, Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain
| | - F. Fillat-Gomà
- Orthopedic Department, Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Ona Ràfols-Perramon
- Orthopedic Department, Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain
| | - C. Torrens
- Orthopedic Department, Hospital del Mar de Barcelona, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - P. Torner
- Orthopedic Department, Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain
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Analysis of Patient-Dependent and Trauma-Dependent Risk Factors for Persistent Brachial Plexus Injury after Shoulder Dislocation. BIOMED RESEARCH INTERNATIONAL 2018; 2018:4512137. [PMID: 29546059 PMCID: PMC5818932 DOI: 10.1155/2018/4512137] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 11/19/2017] [Accepted: 12/03/2017] [Indexed: 11/22/2022]
Abstract
Brachial plexus injuries (BPIs) caused by shoulder dislocation usually have a transient character and tend to resolve spontaneously. However, in some patients the symptoms can persist and require operative intervention. This work aims to determine the risk factors for persistent BPIs resulting from shoulder dislocation. The study comprised 73 patients (58 men, 15 women; mean age: 50 years) treated operatively between the years 2000 and 2016 for persistent BPIs resulting from shoulder dislocation. Patient age, gender, type of initial trauma, number of affected nerves, presence of accompanying injuries, and time interval from dislocation to its reduction were analysed. Elderly patients more often sustained multiple-nerve injuries, while single nerve injuries were more often observed in younger patients. Injury to a single nerve was diagnosed in 30% of the patients. Axillary nerve was most commonly affected. Fracture of the greater tuberosity of humerus coincided with total BPI in 50% of the cases. Longer unreduced period caused injury to multiple nerves. Analysis of our patient group against relevant literature revealed that persistent BPI after shoulder dislocation is more common in older patients. Injuries to ulnar and median nerves more often require operative intervention due to low potential for spontaneous recovery of these nerves.
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Abstract
RATIONALE Bilateral anterior shoulder dislocation is clinically rare and has been reported to be related to high-speed sports. PATIENT CONCERNS A 76-year-old woman presented with bilateral shoulders pain after traditional Chinese manipulation. DIAGNOSES She was diagnosed with bilateral anterior dislocations, and a closed reduction was immediately performed. INTERVENTION The patient was referred for rehabilitation 3 days later, and bilateral rotator cuff injuries were identified from musculoskeletal ultrasound. After 4 weeks of physical therapy, the patient's shoulder pain had reduced and the passive ROM was nearly full. OUTCOMES At 1-year follow-up, only mild intermittent shoulder pain was noted, and there was no limitation of shoulder ROM. LESSONS This case illustrates that patients with acute shoulder injuries who receive proper diagnosis and treatment can achieve good outcomes. Therefore, patients with musculoskeletal disorders should seek qualified specialists for accurate diagnosis and appropriate management.
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50
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Carpinteiro EP, Barros AA. Natural History of Anterior Shoulder Instability. Open Orthop J 2017; 11:909-918. [PMID: 28979599 PMCID: PMC5612030 DOI: 10.2174/1874325001711010909] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Revised: 10/28/2016] [Accepted: 10/28/2016] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The shoulder is the most complex joint in the body. The large freedom of motion in this joint is the main cause of instability. Instability varies in its degree, direction, etiology and volition and there is a large spectrum of conditions. METHODS Based on literature research and also in our own experience, we propose to elucidate the reader about the natural history of instability and its importance for the appropriate management of this pathology, by answering the following questions: What happens in the shoulder after the first dislocation? Which structures suffer damage? Who are the patients at higher risk of recurrence? How does the disease evolve without treatment? Will surgical treatment avoid future negative outcomes and prevent degenerative joint disease? Who should we treat and when? RESULTS 80% of anterior-inferior dislocations occur in young patients. Recurrent instability is common and multiple dislocations are the rule. Instability is influenced by a large number of variables, including age of onset, activity profile, number of episodes,delay between first episode and surgical treatment. CONCLUSION Understanding the disease and its natural evolution is determinant to decide the treatment in order to obtain the best outcome. It is crucial to identify the risk factors for recurrence. Delay in surgical treatment, when indicated, leads to worse results. Surgical technique should address the type and severity of both soft tissue and bone lesions, when present.
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Affiliation(s)
| | - Andre Aires Barros
- Hospital da Luz - Orthopaedics, av. lusiada 100 lisbon 1500-650, Portugal
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