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PubMedDate not supplied

Magnetic resonance imaging evaluation of capsulolabral tears after traumatic primary anterior shoulder dislocation. A prospective comparison with arthroscopy of 25 cases.

The purpose of our study was to evaluate the use of static magnetic resonance imaging (MRI) as a preoperative diagnostic tool in young patients with a traumatic primary anterior shoulder dislocation. Twenty-five patients who had acute primary traumatic anterior shoulder dislocation were examined with MRI and arthroscopy. The patients (18 male and 7 female) were between 16 and 39 years old (mean age, 27 years). They had no previous shoulder dislocations. The dislocations were confirmed radiographically. Examination with MRI and arthroscopy was performed within 10 days after the trauma. The MRI evaluation was performed before the arthroscopic examination, and the images were interpreted by an experienced magnetic resonance radiologist. No information from the MRI examination was available to the orthopedic surgeons before arthroscopy. The standard of reference for comparison was arthroscopy. Subacute MRI evaluation identified 15 labral tears, 12 Hill-Sachs lesions, 1 total rotator cuff lesion, 1 partial joint side rotator cuff lesion, and 1 partial rupture of the biceps tendon. Arthroscopic examination revealed 22 labral tears, 15 Hill-Sachs lesions, 1 total rotator cuff lesion, 1 partial joint side rotator cuff tear, 1 partial rupture of the biceps tendon, and 1 osseous Bankart lesion. Anterior capsulolabral tears and Hill-Sachs lesions appeared with a high incidence after acute anterior primary shoulder dislocation. Conventional MRI was only moderately reliable in the preoperative evaluation of labral tears and Hill-Sachs lesions, and it failed to give an accurate, differentiated preoperative diagnosis of the capsulolabral lesions.

Adolescent↗
PubMed1998

[Conservative treatment after first traumatic shoulder dislocation].

Between January 1989 and March 1997, 175 patients with traumatic shoulder dislocation were treated by conservative means (median age 41 years, 39 F, 136 M). In 78 patients (17 F, 61 M) a clinical and radiological follow up (median 50 months, range 6-106) could be obtained. Additionally, a diagnostic ultrasound was carried out in all patients. The recurrence rate in the group younger than 30 years (G < 30; n = 35) was 86%; in the group older than 30 years (G > 30; n = 43) it was 21% (P < 0.05). Persisting neurological deficits were found in 6 patients (8%). According to the Rowe score, 16 patients (46%) of the G < 30 achieved excellent or good results, in the G > 30, 29 patients (67%). In 17% of cases, a glenohumeral arthrosis was diagnosed be radiological means. 18% had radiological signs of a previous fracture of the greater tuberosity. Hill-Sachs lesions were identified in 19% of cases. Rotator cuff tears were diagnosed in 9% by ultrasound. No relationship between the duration of immobilization and the recurrence rate was found (P = 0.95). The recurrence rate following primary shoulder dislocation depends primarily on the patients' age.

Adolescent↗
PubMed1984

New traction devices to aid reduction of shoulder dislocations.

A set of traction devices that aid in the reduction of shoulder dislocations is described and their use and efficiency are discussed. A series of 47 consecutive patients seen over a six-month period and diagnosed as having shoulder dislocations with no other major trauma composed the study population. After radiographic confirmation and premedication with analgesics and muscle relaxants, the devices were used. The traction- countertraction method was used initially. When this method was unsuccessful, the Stimson method was performed using an alternate traction strap. These devices were successful in 96% of the relocations attempted. No complications were encountered. The traction devices were found to be effective and easy to use.

Adolescent↗
PubMed2001

[Surgical therapy of traumatic shoulder dislocation. Are there evidence-based indications for arthroscopic Bankart operation?].

INTRODUCTION: For young athletic patients with a primary traumatic shoulder dislocation a surgical treatment is recommended. The operation of choice is the Bankart-Repair. QUESTION: Are there evidence-based indications for an arthroscopic Bankart repair. METHODS: Based on the criteria of the "Cochrane Collaboration" a systematic literature search was performed using medline (1966 to 9/2000). 172 publications were found with the key words "shoulder dislocation" and "Bankart". All relevant articles were ranked and analysed by the criteria of "evidence-based medicine". RESULTS: There are 12 prospective studies (evidence grade Ib/IIa) and another 28 retrospective studies (evidence grade III). For open Bankart-Repair a recurrence rate of 0 to 8% is reported (prospective/retrospective studies). For arthroscopic Bankart-Repair, 19 of 40 studies and 8 of 12 prospective studies, show a recurrence rate of < 10%; however in other studies (prospective/retrospective) an atraumatic recurrence rate of up to 38% is reported. The reasons for these differences in the recurrence rate are not obvious from the given data. In particular, there seems to be no correlation between the type of arthroscopic fixation technique and the recurrence rate. Concerning the postoperative range of shoulder motion, the reported data suggest that external rotation is less limited after arthroscopic than after open Bankart-Repair (arthroscopic: 5-12 degrees, open: 5-25 degrees). However, there is no evidence that patients are more likely to return to their previous level of sporting activities when operated on in an arthroscopic technique than in an open technique (arthroscopic: 42-100%, open: 72-94%). CONCLUSION: In the surgical treatment of a traumatic shoulder dislocation, the open Bankart-Repair remains the "gold standard". In reviewing the literature, arthroscopic Bankart-Repair has not been shown to be equal or superior to the open technique.

Arthroscopy↗
PubMedDate not supplied

Intraarticular lidocaine versus intravenous analgesic for reduction of acute anterior shoulder dislocations. A prospective randomized study.

We performed a prospective, randomized study to evaluate the use of injected lidocaine as an anesthetic for closed reduction of acute anterior shoulder dislocations. Thirty consecutive patients who presented at the emergency department with acute anterior shoulder dislocations were randomly placed in one of two groups. One group received an intraarticular injection of 20 ml of 1% lidocaine and the other group, intravenous injections of morphine sulfate and midazolam. The groups were compared regarding time of reduction maneuver, difficulty of reduction, subjective pain, complications, and total time spent in the emergency department. The lidocaine provided adequate anesthesia and secondary relief of muscle spasm in 15 of 15 (100%) patients. When compared with the intravenous sedation group, the lidocaine group showed no statistically significant difference in time for reduction maneuver, difficulty of reduction, or subjective pain. The lidocaine group had no complications and had a statistically significant shorter emergency department visit when compared with the intravenous sedation group (mean, 78 minutes versus 186 minutes; P = 0.004). Lidocaine provides excellent anesthesia for patients with uncomplicated anterior shoulder dislocations and can be very beneficial when sedation is contraindicated. Lidocaine injections also proved to be cost effective in our institution, reducing total costs by as much as 62%.

Acute Disease↗
PubMed1995

[Differential therapy of traumatically-induced persistent posterior shoulder dislocation. Review of the literature].

Three-hundred and twenty-nine cases of posterior dislocation of the shoulder documented in 300 articles published in the international literature are reviewed. They included 130 cases in which the duration of the dislocation was longer than 6 weeks and the dislocation could be classified as persistent primary dislocation. This group is the second largest group following that with acute primary dislocation. The mechanism of injury may be direct or indirect force: trauma, convulsions or electrocution are usually responsible for this type of dislocation, which often persists for longer than 6 weeks. Anatomically, 97.5% of dislocations are classified as subacromial. Posterior dislocation of the shoulder is commonly misdiagnosed on plain antero-posterior radiographs, and in over 50% of cases the diagnosis was missed on first examination. The typical signs of primary traumatic posterior dislocation of the shoulder are described. Management of persistent traumatic posterior dislocation of the shoulder depends on the size of the anterior Hill-Sachs lesion, the precipitating mechanism and the duration of dislocation. The results of 109 surgically and 24 conservatively treated dislocations of this type that have been published in the international literature are reviewed. Closed reduction is indicated in carefully selected cases with an anterior Hill-Sachs lesion under 15% of the size of humeral head (measured in the axillary view) that has been dislocation for less than 2 months. In most due to convulsions there was a distinct anterior Hill-Sachs lesion, which led to recurrence.(ABSTRACT TRUNCATED AT 250 WORDS)

Arthroplasty↗
PubMed1985

[Diagnosis and therapy of traumatic posterior shoulder dislocations].

In cases of dislocation of the shoulder the humeral head almost always dislocates anteriorly. Only rarely does the dislocation result in a posterior position of all or part of the humeral head. The diagnosis of posterior dislocation is not always as easy as the diagnosis of anterior dislocation and for this reason the injury is often missed. Cisternino et al. found that over 50% of patients with posterior dislocation of the shoulder were missed on initial examination. The longer the time between accident and treatment, the more difficult that treatment becomes and the harder it is to achieve a satisfactory functional result. Therefore it is vital to think of this injury in all cases of severe contusion of the shoulder and if there is the slightest suspicion of this injury, the patient must be aggressively investigated to establish the relationship between the humeral head and the glenoid.

Bone Plates↗
PubMed2002

Management of shoulder dislocation--are we doing enough to reduce the risk of recurrence?

Young patients with shoulder dislocation are at high risk of recurrence. Traditionally, management has been conservative, but rehabilitative programmes are successful in fewer than 20% of patients. Recent studies suggest that early surgical intervention (arthroscopic lavage or stabilisation) can significantly reduce recurrence in young patients with primary traumatic anterior dislocation. This study demonstrated that in our region, 21% of all patients presenting with shoulder dislocation had already suffered recurrence at 1 year; in the 15-22 years age group this figure was 43%. We propose to offer young patients presenting with primary traumatic anterior dislocations arthroscopic lavage within 10 days of injury. The extra surgical workload is manageable within our current trauma service arrangements, and we believe that this form of treatment would be acceptable to patients.

Adolescent↗
PubMed1998

[Treatment of shoulder dislocation and the prevention of its recurrence].

Shoulder dislocation is a frequent pathology with a high level of recurrences especially in young patients. One week immobilization in a Dessault dressing is sufficient if it is followed by free mobilization avoiding external rotation and abduction. A 6 weeks rehabilitation program seems to prevent recurrences.

Adolescent↗
PubMed1993

[Results of arthroscopic ventral limbus capsule refixation after primary traumatic shoulder dislocation].

The three-year results for arthroscopic refixation of the labrum-ligament-capsule complex after traumatic primary dislocation of the shoulder will be discussed. This prospective study included only patients with primary dislocations showing radiographic signs of anterior instability in the drawer test and no accompanying bony injuries. Twenty-six patients with an average age of 31 years and arthroscopic suture had been dismissed from postoperative treatment after an average 15 weeks showing a fully mobile and pain-free shoulder joint. At the time of follow-up the average results obtained with our own score were 94.1 points. 61.5% of the patients showed fully mobile shoulder joints and 84.6% reported full sporting capacity. Negative findings were obtained for all stability tests performed after 32 months. No recurrencies had occurred until the time of the follow-up. Compared to the reluxation rates described in the literature for traumatic primary shoulder dislocations in juvenile patients, our three-year results were highly positive and we will continue to use arthroscopy in the treatment of instable shoulder joints after traumatic primary dislocation in order to avoid recurrencies and associated sequelae.

Adult↗
PubMed1998

Posterior labrocapsular periosteal sleeve avulsion complicating locked posterior shoulder dislocation.

This case presents the imaging features of a posterior shoulder dislocation complicated by a rare but surgically relevant lesion of the posterior labrum. Due to the attachment of the posterior capsule to the posterior portion of the labrum, which in itself is attached to the posterior scapular periosteum, stripping of the labrum by the posterior capsule resulted in a posterior labrocapsular periosteal sleeve avulsion.

Adult↗
PubMed1990

Prognosis of primary anterior shoulder dislocation in young adults.

From 1982 to 1987, 194 patients with 196 primary traumatic anterior shoulder dislocations were treated in our hospital. One hundred and sixty-six patients with 168 shoulder dislocations (87%) were available for study at follow-up an average of 4 years after treatment. The most important prognostic factor in relation to recurrence was the age of the patient at the time of the primary dislocation. The highest recurrence rate was found in patients of 30 years and younger (64%). Athletes in this age group had no worse a prognosis as to recurrence than non-athletes. A fracture of the greater tuberosity improved the prognosis significantly (P less than 0.01). Neither the presence of a Hill-Sachs lesion nor the period of immobilization influenced the recurrence rate in patients aged 30 years and younger.

Adolescent↗
PubMedDate not supplied

Extensive shoulder capsule tearing as a main cause of recurrent anterior shoulder dislocation.

Anterior capsular and ligamentous injuries occur frequently at initial traumatic shoulder dislocation. However, these injuries have not been considered to be one of the main causes of recurrent anterior dislocation, which is believed to heal spontaneously. We evaluated five joints of five patients in which tears in the middle portion of the anterior capsule including the inferior glenohumeral ligament were considered to be the main cause of recurrent dislocation. History of present illness and physical and plain x-ray results were not specific. The only specific finding was a diverticulum-like expansion at the anteroinferior portion of the joint on arthrographic computed tomography. Treatment consisted of anatomic repair of the capsule and concurrent injuries. The outcome of the three cases in which at least 2 years had passed after surgery was excellent. The point of emphasis is that tears of the anterior capsule are one of the primary lesions in recurrent anterior dislocation.

Adult↗
PubMedDate not supplied

Anterior shoulder dislocation in adolescents.

Of 780 patients treated for primary anterior shoulder dislocations, 33 (4.2%) were aged 12 to 17 years at the time of the dislocation. We clinically evaluated 28 of these patients a mean of 7.1 years after the initial dislocation. All patients were radiographed, and 15 underwent magnetic resonance imaging or computed arthrotomography of the shoulder. The primary dislocation had been traumatic in 21 patients (75%) and atraumatic in 7 patients (25%). Recurrent dislocations had occurred in 24 cases (86%), the number of recurrences ranging from 1 to 30. In the group with traumatic primary dislocations, the rate of recurrences was 92% and the mean number of redislocations was 7 in the patients who had been 14 to 17 years of age at the time of the initial injury, whereas the corresponding figures were 33% and 0.3 in the patients who had been 13 years of age or less at the time of the initial injury. Imaging studies showed a Bankart lesion in 80% of cases; each of these patients had had a traumatic primary dislocation and was 14 to 17 years old at the time of injury. During the follow-up period, operative stabilizing procedures had been performed in 7 cases. At follow-up evaluations, all nonoperated patients showed clinical evidence of anterior or multidirectional instability of the involved shoulder; of the operated patients, each of those with traumatic primary dislocations reported no recurrences and had a satisfactory result, whereas both of the patients with atraumatic primary dislocations continued to have subluxation and/or dislocations of the operated shoulder. In the 14- to 17-year-old adolescents with traumatic primary dislocations in whom imaging studies show Bankart lesions, there is an indication for prophylactic stabilizing surgery at the time of the initial injury.

Adolescent↗