SEARCH · PubMed Health
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
An open dislocation of the shoulder is a very uncommon and serious injury. The sequelae of open glenohumeral dislocation include infection, avascular necrosis, and limited motion. The patient with such complications will have serious compromise in shoulder function, as illustrated in this case report and reference to another report in the literature.
In the past 6 years, three patients were treated for acute anterior shoulder dislocation which could not be reduced by closed means. Interposition of the labrium was found to be the cause for irreducibility in one patient. The obstructions to reduction in the other two cases were dislocation of the biceps tendon into the joint in one and interposition of the biceps tendon and the greater tuberosity into the joint in the other. The condition manifests in adults more than 40 years old. Redislocation or subluxation has not been observed.
OBJECTIVE: We report the first documented case of avulsion of the serratus anterior muscle. A young man had difficulty in abducting his arm the day after using a rowing ergometer. Examination showed a firm mass on his lateral thoracic wall. This became firm with protraction of the scapula. Avulsion was confirmed by magnetic resonance imaging (MRI) scanning. Rest and modified activities resulted in resolution of symptoms. DISCUSSION: This case highlights the role of serratus anterior in the rowing action and supports its implication in stress fractures of the ribs. An imbalance between rhomboids and serratus anterior is the proposed cause of such avulsion injury. CONCLUSIONS: Difficulty with abducting the arm may result from pathology outside the glenohumeral joint. Athletes should be advised to use care when starting any new exercise.
Explore the source record for details and available documents.
UNLABELLED: Treatment of radial head fractures may be complicated because of the presence of associated lesions. However, little is known about the frequency or relevance of associated lesions in different types of radial head fractures. We studied the demographics of radial head fractures focusing on associated lesions in 333 adults from 1997 to 2002. The mean age of the patients was 45 years (range, 18-82 years). Two hundred twenty-three (67%) patients had Mason Type 1 fractures, 46 patients had Mason Type 2 (14%) fractures, and 64 patients had Mason Type 3 (19%) fractures. One hundred eighteen of 333 patients (39%) had associated fractures or soft tissue injury. Fifty-three (16%) patients had coronoid fractures, and 45 patients (14%) had elbow dislocations. Two hundred thirty-five (71%) patients had nonoperative treatment, which failed in six (3%) patients. Sixty-six (20%) patients had open reduction and internal fixation, which failed in six (9%) patients. Resection was used in 20 (6%) patients, and radial head replacement was used in 31 (9%) patients, one of which was revised. The ligamentous injury required surgical repair or reconstruction in 44 patients. A concurrent coronoid fracture was the most common associated injury prompting referral to this tertiary medical center. LEVEL OF EVIDENCE: Diagnostic study, Level IV (case-control study). See the Guidelines for Authors for a complete description of levels of evidence.
Dislocation of the shoulder joint is common. The shoulder is affected in up to 60% of all major joint dislocations, one study citing an incidence of 1.7% in the general population. The most common form is anteroinferior dislocation. A variety of techniques to reduce shoulder dislocation has been described. The key to successful relocation is a thorough understanding of the anatomy of both the enlocated and the dislocated shoulder joint.
Isolated first rib fractures are uncommon. They are usually associated with severe blunt trauma, although other mechanisms have been suggested, these being (a) indirect trauma, (b) sudden contraction of the neck muscles, and (c) stress or fatigue fractures attributable to repeated pull of muscles. Two cases are reported of stress fracture of the first rib, who presented to the accident and emergency department.
Isolated axillary nerve injury is uncommon, particularly in children. The motor deficit of shoulder abduction may not recover spontaneously and can be a substantial handicap. Detection may be difficult initially, as the injury is masked by trauma such as head injury, and concomitant shoulder injury requiring immobilization. After mobilization, patients learn to partially compensate by using alternate muscles. There are few reports of surgical management of this nerve injury. Most concern predominantly adults, and the results are mixed with on average slightly greater than half having a good recovery (defined as grade 4-5 Medical Research Council muscle power). We present our experience with 4 pediatric patients who had axillary nerve injury. Three patients had an interposition nerve graft, and 1 patient underwent neurolysis. All patients recovered to grade 4-5 deltoid muscle power. Children with an axillary nerve injury which fails to recover spontaneously by 4-6 months should strongly be considered for surgical exploration.
We evaluated the factors influencing the recurrence rate after primary anterior traumatic shoulder dislocation, especially sports activity. A significant number of patients changed to athletic activities that produce less shoulder strain. The natural assumption would be that sports activity directly influences recurrence. However, age-adjusted logistic regression analysis revealed that the correlation between sports and recurrence rate was false. Our statistical findings also clearly showed that physical therapy and immobilization do not reduce the risk of recurrence. The only factor associated with recurrence was age between 21 and 30 years. Patients in this age group who participate in high-risk sports activities should undergo primary surgical stabilization because of the increased risk of recurrence.
Explore the source record for details and available documents.
Blunt subclavian artery trauma is an uncommon but challenging surgical problem. The purpose of this study was to retrospectively review the management of blunt subclavian artery injuries treated by the Trauma and Vascular Surgery Services at the East Tennessee State University-affiliated hospitals between 1992 and 1998. Six patients with seven blunt subclavian artery injuries were identified. Physical signs indicating blunt subclavian artery injury were pain or contusion around the shoulder joint; fractures of the clavicle, scapula, or ribs; periclavicular hematomas; and ipsilateral pulse or neurologic deficits. Seven subclavian artery injuries were treated-two arterial transections, two pseudoaneurysms, and three intimal dissections. Associated injuries included four clavicle fractures, one humerus fracture, one combined rib and scapular fractures, and two pneumothoraxes. Vascular surgical treatment included three primary arterial repairs, two saphenous vein interposition grafts, and one polytetrafluoroethylene (PTFE) graft. One patient was treated nonoperatively with anticoagulation. No deaths occurred. Morbidity occurred in two patients with chronic upper extremity neuropathy producing prolonged disability from pain and weakness; one patient had reflex sympathetic dystrophy, and the other had a brachial plexus injury. In conclusion, blunt subclavian artery trauma can be successfully managed with early use of arteriography and prompt surgical correction by a variety of vascular techniques. Vascular morbidity is usually low, but long-term disability because of chronic neuropathy may result from associated brachial plexus nerve injury despite a successful arterial repair.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Five patients with extensive traumatic shoulder and arm defects in whom successful repair with the latissimus dorsi island myocutaneous flap are presented. The ease and speed of elevation of the flap, its wide skin surface, large size, and long pedicle make it an ideal flap for reconstruction of such defects.