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PubMed1980

[The painful frozen shoulder (author's transl)].

The painful frozen shoulder has many different causes. Most common among the patients in the hospital "Bergmannsheil" is the deterioration of a cervical syndrome through an accident. Stiffness is seen occasionally after injuries to the soft tissues of the shoulder, especially after dislocations or dislocated fractures of the shoulder. A few case reports are given to illustrate the origin and the treatment of the painful frozen shoulder. An effective therapy aims at the underlying cause. Physiotherapy is helpful to hasten the remobilization of the shoulder. A support for the arm is an important aid in the treatment of the painful frozen shoulder.

Adult↗
PubMed2000

[Mid-term outcome of postoperative infections of the shoulder].

Between 1 January 1986 and 31 December 1997, in the traumatology department of Nuremberg hospital, a total of 46 patients with postoperative infections of the shoulder were treated. The primary surgical procedure was carried out for various reasons. The diagnosis of infection was found on clinical parameters such as pain, redness, and swelling, in combination with laboratory parameters and diagnostic aspiration of joint fluid. The period between operation and infection ranged between 4 days and 9 months. The main question was whether a local infection or an infection of the glenohumeral joint, called empyema, was involved. Some cases required diagnostic aspiration. Macroscopic inspection of the fluid was helpful, as was cell counting and analysis of fluid pH [14]. The fluid was given to a gram preparation. In case of infection of the joint, diagnostic arthroscopy was performed with a saline lavage (10-15 l). Local synovectomy was carried out when local synovitis was found. Similar to the therapy of the knee, antibiotic collagen (Sulmycin-Implant) (no PMMA chains as former) was applied. We compared patients who were operated as usual, i.e., by great incision and open wound-drain (group 1, 21 patients), with patients who were operated arthroscopically assisted (group 2, 25 patients). We saw an earlier reconvalescence in the second group. Of the 46 patients, 25 were followed-up for an average of 4 years. The results were rated according to the Constant score. The mean total score of 25 patients was 61 points (range 43-78 points). Positive intra-articular bacterial culture was an important prognostic factor; inspite of an arthroscopical procedure, results were not as good as without joint infection. Generally, the arthroscopic procedure with application of the Sulmycin Implant leads to better results than the open procedure with application of PMMA chains.

Arthroscopy↗
PubMed1996

Hill-Sachs lesion: sonographic detection.

OBJECTIVE: To determine the value of ultrasonography (US) in the detection of Hill-Sachs lesion of the humerus in comparison with double-contrast computed tomographic arthrography (CTA) and with arthroscopy. DESIGN AND PATIENTS: US and CTA were performed on 92 patients, 86 of whom subsequently underwent arthroscopy. The findings of US, CTA and arthroscopy in these 86 patients in the diagnosis of Hill-Sachs lesion were analyzed. RESULTS AND CONCLUSIONS: In the detection of Hill-Sachs lesion US showed a sensitivity of 91% (21 of 23), a specificity of 95% (60 of 63) and an accuracy of 94% (81 of 86) when compared with CTA, and a sensitivity of 94% (18 of 19), specificity of 91% (61 of 67) and accuracy of 91% (79 of 86) when compared with arthroscopy. In only 2% (2 of 86) of patients was there reduced visualization because of restriction of movement. Hill-Sachs lesion and its relationship to the humeral head can be reliably diagnosed with US.

Adult↗
PubMed1992

Operative management of lesions of the axillary nerve, isolated or combined with other nerve lesions.

Sixty-six surgically treated lesions of the axillary nerve were reviewed and 57 were followed up over 1 year. Patients were divided into 4 groups: isolated axillary nerve lesions (n = 23), axillary and suprascapular nerve lesions (n = 15), axillary and infraclavicular nerve/plexus lesions (n = 26), and axillary nerve lesions and lower root avulsions (n = 2). Of 34 patients operated upon within 6 months after the trauma, 24 (71%) recovered a force of M4 or M5. Of 17 patients operated upon within 1 year, 10 (59%) had M4 or M5. Of 6 patients operated upon after 1 year, only one had M4. Good shoulder function was only regained when the spinati muscles had recovered good force.

Adolescent↗
PubMed2006

Arthroscopic fixation of the subscapularis tendon in the reverse Hill-Sachs lesion for traumatic unidirectional posterior dislocation of the shoulder.

Posterior unidirectional instability of the shoulder following trauma is frequently associated with a cartilage-bone defect on the anterior joint surface of the humeral head. This defect can catch on the posterior joint surface during internal rotation of the arm, which causes redislocation of the humeral head in a posterior direction, thus increasing joint destruction. We describe a new arthroscopic surgical technique in which the subscapularis tendon is mobilized and attached to the defect using nonabsorbable or bioabsorbable suture anchors. In an manner analogous to open surgery with arthrotomy and transposition of the subscapularis tendon insertion into the defect, this arthroscopic technique fills up the defect, blocks extension during internal rotation of the arm, and safely avoids redislocation of the humeral head in a dorsal direction. The arthroscopic technique we describe is easy and safe to perform. Complicated tightening of the posterior joint capsule is no longer necessary following acute injury.

Arthroscopy↗
PubMed2005

Recurrent bilateral dislocation of the shoulders due to nocturnal hypoglycemia: a case report.

A 20-year-old male was admitted to emergency room with convulsion. He had insulin-dependent diabetes mellitus for 8 years. He had suffered nocturnal hypoglycemia after strenuous exercise without additional calories. After recovery, the patient complained of bilateral anterior shoulder dislocation. Patient's history revealed another episode of bilateral shoulder dislocations after an hypoglycemic convulsion 3 years ago.

Adult↗