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PubMed2005

Posterior shoulder dislocations and fracture-dislocations.

Posterior shoulder dislocations and fracture-dislocations are uncommon injuries that most often occur during seizures or as a result of high-energy trauma. Despite advances in imaging, they are frequently diagnosed late. Detection is facilitated by heightened clinical suspicion of the injury in high-risk individuals together with appropriate radiographic investigation. A wide variety of operative techniques, ranging from simple closed reduction to soft-tissue and bone stabilization procedures to prosthetic arthroplasty, are available to treat these injuries. Selection of the most appropriate treatment option is complex and multifactorial. Because of the rarity of these injuries, evidence-based treatment protocols are difficult to devise. Good functional outcomes are associated with early detection and treatment of isolated posterior dislocations that are associated with a small osseous defect and are stable following closed reduction. Poor prognostic factors include late diagnosis, a large anterior defect in the humeral head, deformity or arthrosis of the humeral head, an associated fracture of the proximal part of the humerus, and the need for an arthroplasty.

Humans↗
PubMed1988

Reduction of acute shoulder dislocations using the Eskimo technique: a study of 23 consecutive cases.

A new method of reduction of dislocated shoulders used by the Eskimos in Greenland is described. The method was tried as first attempt of reduction on 23 consecutive acute dislocations in the emergency room of a central Copenhagen hospital. The method was successful in 17 of the 23 (74%). Three dislocations required general anesthesia and two attempts were unsuccessful, but dislocations were reduced using other methods. The advantage of using the Eskimo method is: 1) it is simple and can be used by nonmedical personnel; 2) nontraumatic; and 3) needs no facilities.

Adolescent↗
PubMed1999

Current concepts in the treatment of anterior shoulder dislocations.

Anterior shoulder dislocations are commonly seen in emergency departments. With the recent proliferation of shoulder arthroscopy, the pathoanatomy has been better delineated. Arthroscopic series have confirmed the very high percentage of Bankart lesions (avulsions of the inferior glenohumeral ligament-labral complex), especially in younger patients. A high rate of recurrent dislocation in young patients has been noted in the literature with standard conservative treatment, consisting of immobilization with or without rehabilitation. This high recurrence rate is thought to be due to the Bankart lesion. Recently, investigations with the use of arthroscopic Bankart repairs have shown high success rates in preventing recurrences, with low surgical morbidity. A young, first-time, traumatic anterior dislocation patient should be referred for consideration of possible early arthroscopic Bankart repair, rather than automatically being treated conservatively with immobilization.

Age Factors↗
PubMedDate not supplied

The scapular manipulation technique for the reduction of acute anterior shoulder dislocations.

Anterior shoulder dislocations are a common occurrence in busy emergency departments. Numerous techniques for treating this problem have been reported. The majority of these techniques use traction and leverage of the humerus, often requiring considerable force and causing significant patient discomfort. We report a simple, relatively painless, and atraumatic method of shoulder reduction involving manipulation of the scapula as well as the humerus. This technique has been used in our emergency department with considerable success and no complications.

Humans↗
PubMed2004

Surgical versus non-surgical treatment for acute anterior shoulder dislocation.

BACKGROUND: Acute anterior shoulder dislocation is the commonest type of shoulder dislocation. Subsequently, the shoulder is less stable and more susceptible to re-dislocation, especially in active young adults. OBJECTIVES: We aimed to compare surgical versus non-surgical treatment for acute anterior dislocation of the shoulder. SEARCH STRATEGY: We searched the Cochrane Musculoskeletal Injuries Group specialised register (August 2003), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 3, 2003), MEDLINE (1966 to September week 3 2003), EMBASE (1988 to 2003 week 39), the National Research Register (UK) (Issue 3, 2003), conference proceedings and reference lists of articles. SELECTION CRITERIA: Randomised or quasi-randomised controlled trials comparing surgical with conservative interventions for treating acute anterior shoulder dislocation. DATA COLLECTION AND ANALYSIS: Selection of the included trials was by all three reviewers. Two reviewers independently assessed methodological quality and extracted data. Where appropriate, results of comparable studies were pooled. MAIN RESULTS: Five studies were included. These involved a total of 239 young (mainly aged around 22 years) active and mainly male people, all of whom had had a primary (first time) traumatic anterior shoulder dislocation. Methodological quality was variable, but notably there was insufficient information to judge whether allocation was effectively concealed in all five trials. Two trials, involving 115 participants, were only reported in conference abstracts.One trial involving military personnel reported that all had returned to active duty. Another trial reported similar numbers in the two intervention groups with reduced sports participation, and a third trial reported that significantly fewer people in the surgical group failed to attain previous levels of sports activity. Pooled results from all five trials showed that subsequent instability, either redislocation or subluxation, was statistically significantly less frequent in the surgical group (relative risk (RR) 0.20; 95%confidence interval (CI) 0.11 to 0.33). This result remained statistically significant (RR 0.32, 95%CI 0.17 to 0.59) for the three trials reported in full. Half (17/33) of the conservatively treated patients with shoulder instability in these three trials opted for subsequent surgery.Different, mainly patient-rated, functional assessment measures for the shoulder were recorded in the five trials. The results were more favourable, usually statistically significantly so, in the surgically treated group. Aside from a septic joint in a surgically treated patient, there were no other treatment complications reported. There was no information on shoulder pain, long-term complications such as osteoarthritis or on service utilisation and resource use. REVIEWER'S CONCLUSIONS: The limited evidence available supports primary surgery for young adults, usually male, engaged in highly demanding physical activities who have sustained their first acute traumatic shoulder dislocation. There is no evidence available to determine whether non-surgical treatment should not remain the prime treatment option for other categories of patient. Sufficiently powered, good quality and adequately reported randomised trials of good standard surgical treatment versus good standard conservative treatment for well-defined injuries are required; in particular, for patient categories at lower risk of activity-limiting recurrence. Long term surveillance of outcome, looking at shoulder disorders including osteoarthritis is also required. Reviews comparing different surgical interventions and different conservative interventions including rehabilitation are needed.

Adult↗
PubMed1994

Concomitant rotator cuff tear and brachial plexus injury in association with anterior shoulder dislocation: unhappy triad of the shoulder.

High incidences of nerve lesions or rotator cuff tears in association with shoulder dislocations have been reported. However, the simultaneous occurrence of these three lesions has only been reported once previously. This case is an example of a not so uncommon injury, which emphasizes the importance of looking for associated brachial plexus and rotator cuff lesions when examining a patient with shoulder dislocation.

Brachial Plexus↗
PubMedDate not supplied

Staple capsulorrhaphy for recurrent posterior shoulder dislocation.

Recurrent posterior shoulder dislocation or subluxation is uncommon but occurs occasionally in athletes. Ten patients were treated with a posterior shoulder staple capsulorrhaphy. A posterior Bankhart-type-lesion was found in all cases. Eight of the 10 patients had pain relief. The range of motion was usually maintained postoperatively, but no patient returned to his former throwing status. Four patients also had anterior instability. Three patients (30%) had postoperative recurrence of their posterior instability. The two "ligamentous lax" conditions in the series both recurred. The procedure should be supplemented in the "lax" individual. Complications in 4 patients included a painful staple, postoperative adhesions, and symptomatic ectopic bone formation in two patients. Recurrent posterior shoulder dislocation is not a definite indication for operative repair; patients must be carefully selected.

Adolescent↗
PubMed2006

Arthroscopic reduction and repair of a locked posterior shoulder dislocation.

Locked posterior shoulder dislocations are an uncommon but difficult problem for the orthopaedic clinician. Furthermore, they are often missed on initial presentation, resulting in significant delays in treatment. Traditional treatment has involved formal open reduction, most commonly from an anterior approach, followed by transfer of the lesser tuberosity or subscapularis tendon into the anterior humeral head defect. We present the case of a patient with locked posterior shoulder dislocation, who was treated with arthroscopically assisted reduction followed by arthroscopic posterior stabilization. Use of this technique allows the surgeon to reduce the dislocation without performing an open arthrotomy, thereby decreasing the patient's overall morbidity. Furthermore, an arthroscopic technique used for stabilization allows visualization of the entire glenohumeral joint and enables the surgeon to directly address posterior disease, rather than compensating for the defect with an anteriorly based transfer.

Adult↗
PubMed1995

Bilateral posterior shoulder dislocations.

Bilateral posterior shoulder dislocation is an uncommon complication of seizure activity. It may initially present in a manner that suggests other clinical entities. A case is reported of a man with blood pressure differences in his upper extremities after his first seizure who was found to have bilateral posterior dislocations of the shoulders.

Diagnosis, Differential↗
PubMed1989

[Bristow surgical treatment of shoulder dislocation].

14 shoulders with recurrent anterior dislocation were treated with a modified Bristow procedure and had a 38 to 66 months follow up after surgery. Postoperatively no patient had recurrent anterior dislocation. 4 patients had an average loss of external rotation of 10-15 degrees, one patient had a non-union of the transplanted coracoid. None of the patients was disappointed by the results.

Adolescent↗
PubMedDate not supplied

Anterior shoulder dislocations in sports.

Anterior shoulder dislocations, primary and recurrent, are among the most disabling injuries to the shoulder that can plague the athlete. The diagnosis is easily made by the following: the physical appearance of the shoulder; loss of capability by the athlete to internally and externally rotate the shoulder with the elbow at his side; by evaluating the mechanism of injury; and x-rays. Anterior shoulder dislocations should be reduced as soon as possible after diagnosis, to minimise the stretching effect on the neurovascular structures while the humeral head is dislocated. The reduction is not done to allow the athlete to return immediately to sport. Use of a simple traction method in the first 10 to 15 minutes following the injury will result in a successful reduction in the vast majority of dislocations. Reduction of the humeral head can be confirmed by the athlete regaining the capability to internally and externally rotate his shoulder with his elbow at his side. Following reduction, the athlete should begin a treatment regimen which includes a restrengthening programme emphasising the muscles of internal rotation and adduction plus rigid restrictions of activities until the goals of the rehabilitation programme are satisfied. The author's experience with this treatment regimen with athletes at the United States Naval Academy, has shown a decrease of the recurrence rate of primary anterior shoulder dislocations to 25% versus the 80% recurrence rate we have become familiar with from studies done which did not stress specific rehabilitation programmes. The athlete should also be instructed in a self-performed traction method for reduction should a redislocation occur, to minimise the stretching effect on the neurovascular structures and allow relief from discomfort. Surgery for primary and recurrent anterior dislocations should only be considered when the athlete fails to achieve the desired goals after participating in a specific, progressive, adequate rehabilitation programme.

Adolescent↗
PubMed1990

[Rare, bilateral posterior shoulder dislocation. A case report].

Posterior shoulder dislocation is a very rare injury, accounting for only 1-2% of all shoulder dislocations. It is very often misdiagnosed because its clinical symptoms are not characteristic and the X-ray pictures are often misinterpreted. In many cases this means delayed treatment and impaired shoulder function. The most common cause of posterior shoulder dislocation is an epileptic seizure. In approximately 50% of all cases a ventral impression fracture of the humeral head is diagnosed. This is known as the "reverse Hill-Sachs lesion". About 10% of all posterior shoulder dislocations are associated with fracture of the lesser tuberosity of the humerus. In this paper a case of bilateral posterior shoulder dislocation with bilateral fracture of the lesser tuberosity of the humerus is described. The luxations were caused by an epileptic seizure following chronic alcohol abuse. Following early commencement of an exercise programme excellent results were obtained, and no redislocations occurred.

Combined Modality Therapy↗
PubMed2004

Nerve injuries in anterior shoulder dislocations.

A retrospective study was conducted to determine the incidence of nerve injuries in anterior dislocations of the shoulder and to determine if a neurological examination is routinely performed in such cases. One hundred and fifteen shoulder dislocations in 100 patients (74 males, 26 females; mean age 35+/-18 years) were reviewed. Eighty-seven patients were examined for neurological injuries prior to reduction and 8 of these patients (9.2%) were found to have sustained neurological injuries. Following reduction, neurological examination was performed in 85 patients. Three patients who were not examined initially prior to reduction were subsequently found to have nerve injuries after reduction. Seven patients (7%) were not examined for neurological injury both before and after reduction of the dislocation. Eleven patients were found to have sustained nerve injuries in the final analysis. Axillary nerve injuries were the most common, occurring in 8 patients. In conclusion, nerve injuries are common in shoulder dislocations. The importance of performing and documenting the findings of neurological examination anterior shoulder dislocations needs to be reiterated.

Adolescent↗
PubMedDate not supplied

A prospective, randomized evaluation of arthroscopic stabilization versus nonoperative treatment in patients with acute, traumatic, first-time shoulder dislocations.

BACKGROUND: Nonoperative treatment of traumatic shoulder dislocations leads to a high rate of recurrent dislocations. HYPOTHESIS: Early arthroscopic treatment for shoulder dislocation will result in a lower recurrence rate than nonoperative treatment. STUDY DESIGN: Prospective, randomized clinical trial. METHODS: Two groups of patients were studied to compare nonoperative treatment with arthroscopic Bankart repair for acute, traumatic shoulder dislocations in young athletes. Fourteen nonoperatively treated patients underwent 4 weeks of immobilization followed by a supervised rehabilitation program. Ten operatively treated patients underwent arthroscopic Bankart repair with a bioabsorbable tack followed by the same rehabilitation protocol as the nonoperatively treated patients. The average follow-up was 36 months. RESULTS: Three patients were lost to follow-up. Twelve nonoperatively treated patients remained for follow-up. Nine of these (75%) developed recurrent instability. Six of the nine have required subsequent open Bankart repair for recurrent instability. Of the nine operatively treated patients available for follow-up, only one (11.1%) developed recurrent instability. CONCLUSIONS: Arthroscopic stabilization of traumatic, first-time anterior shoulder dislocations is an effective and safe treatment that significantly reduces the recurrence rate of shoulder dislocations in young athletes when compared with conventional, nonoperative treatment.

Accidental Falls↗
PubMed1989

The external rotation method for reduction of acute anterior shoulder dislocation.

Acute anterior shoulder dislocation is a common disorder confronting the emergency physician. Traditional methods of reduction are often technically difficult, time consuming, and painful to the patient. Furthermore, they frequently require more than one physician and occasionally exacerbate the injury. Conversely, the recently described method of reduction by external rotation is a reliable and safe method. A single physician performs the reduction rapidly and patients tolerate it well.

Emergencies↗
PubMed1982

Incidence of shoulder dislocation in Sweden.

Shoulder joint dislocations collected from a randomized population were investigated in Sweden, wherein nearly 50% of people with primary dislocations never visit hospitals nor are treated by a physician. Thus information obtained from surgically treated patients is of limited value because cases requiring operative repair represent only a small and selected percentage of the population. The incidence of shoulder dislocation in people from 18 to 70 years of age was at least 1.7% and was three times more common in males. Spontaneous healing of recurrent dislocations in a period of many years was not uncommon. Shoulder joint dislocation was more common among children than was generally appreciated, with the prognosis usually good. Recurrences of primary dislocations in people 15 to 25 years of age were not as frequent as was expected.

Adolescent↗
PubMed1997

[Ultrasound findings after shoulder dislocation].

AIM: Sonography of the shoulder is an effective method for detecting tears of the rotator cuff and bone lesions. The purpose of this study was to evaluate prospectively the sonographic findings after shoulder dislocation. METHODS: Sonography was performed on 208 patients with 210 shoulder dislocations, which were all verified by radiography. RESULTS: We diagnosed 62 rotator cuff lesions (29.5%), which were all in the group with traumatic shoulder dislocation. The incidence of tears in patients with first traumatic dislocation (n = 134) was 36.5%. 12 tears (21.8%) of the rotator cuff were noted in recurrent dislocations (n = 55). 23 fractures or bony avulsions of the greater tuberosity of the humerus (11%) and 168 Hill-Sachs lesions (80%) were seen. CONCLUSION: Sonographic examination of the shoulder revealed a significant amount of information that would remain undetected without the aid of expensive and/or invasive diagnostic tools.

Adolescent↗