Acute Traumatic Shoulder Dislocation Research Articles

Frequency of recurrent dislocation after conservative management of acute traumatic shoulder dislocation

Dislocations of the shoulder are a serious and expensive issue. Younger males are more likely than older men to experience shoulder dislocations, with overall incidence rates ranging between 23.91 and 23.12 per 100,000 person/years. After initial closure reduction and sling immobilization of the traumatic anterior shoulder dislocation, this study will give us the most recent and accurate information about the severity of recurrence of dislocation. Aim: The goal is to determine the frequency of recurrent shoulder dislocation occurs following conservative treatment. Place and Duration: In the Orthopaedics Department, Khyber Teaching Hospital, Peshawar for six months duration from 28/6/2012 to 28/12/2018. Methods: A total of 172 patients were observed during this study. All patients had conservative treatment, which included manual shoulder reduction and three weeks of immobilization with a sling. In order to reduce bias, all treatments were carried out by a consultant orthopedic surgeon with at least seven years of experience, assisted by a senior postgraduate resident. To check for the recurrence of the dislocation, all patients were instructed to maintain regular follow-up for the following three months.

Assessment of Acute Lesions of the Biceps Pulley in Patients with Traumatic Shoulder Dislocation Using MR Imaging.

Background: Shoulder dislocations represent common injuries and are often combined with rotator cuff tears and potentially damage to the biceps pulley. Purpose: To assess the occurrence and type of biceps pulley lesions in patients after traumatic anterior shoulder dislocation using 3T MRI. Methods: Thirty-three consecutive patients were enrolled between June 2021 and March 2022 (14 women, mean age 48.0 ± 19 years). All patients underwent MR imaging at 3 T within one week. Images were analyzed for the presence and type of pulley tears, subluxation/dislocation of the LHBT, rotator cuff lesions, joint effusion, labral lesions, and osseous defects. Results: Seventeen patients (52%) with traumatic anterior shoulder dislocation demonstrated biceps pulley lesions. Of those, eleven patients (33%) showed a combined tear of the sGHL and CHL. All seventeen patients with lesions of the biceps pulley showed associated partial tearing of the rotator cuff, whereas three patients showed an additional subluxation of the LHBT. Patients with pulley lesions after dislocations were significantly older than those without (mean age 52 ± 12 years vs. 44 ± 14 years, p = 0.023). Conclusion: Our results suggest an increased awareness for lesions of the biceps pulley in acute traumatic shoulder dislocation, particularly in patients over 45 years.

Arthroscopic Acute Bony Bankart Repair in Lateral Decubitus

The optimal management of anterior shoulder instability continues to be a challenge. The presence of an anterior glenoid rim fracture in the context of a glenohumeral dislocation, also called “bony Bankart lesion,” can alter therapeutic behavior. Reduction and fixation of the bone fragment has been shown to greatly reduce the risk of recurrence once bone consolidation is achieved. However, there is no gold standard surgical technique. Stability of fixation and the healing of the bony fragment are still a concern, and there are no clinical studies comparing the different techniques to date. The aim of this report is to describe an arthroscopic double-point fragment fixation technique in lateral decubitus for the treatment of an acute traumatic shoulder dislocation with a bony Bankart lesion.

Pitch-side management of acute shoulder dislocations: a conceptual review

The shoulder, specifically the glenohumeral joint, by virtue of its anatomical characteristics and biomechanics confers a large range of movement, which ultimately results in a joint that is inherently prone...

A Systematic Approach To “Pitch-Side” Shoulder Relocation After An Acute Shoulder Dislocation Occurring During Sport

BACKGROUND & PURPOSE: The shoulder, specifically the glenohumeral joint, by virtue of its anatomical characteristics and biomechanics, confers a large range of movement, which ultimately results in a joint that is inherently prone to becoming unstable. The incidence of acute traumatic shoulder dislocation varies within the sporting environment and most commonly occurs following direct trauma; i.e. a fall onto an outstretched hand or a blow to the upper arm when the arm is oriented in an abducted and externally rotated position. Anterior dislocations account for nearly 90% of all shoulder dislocation. Whilst most are referred and managed in the Emergency department, pitch-side relocation by experienced clinicians does occur prior to referral. The aim of this study was to delineate a guideline specifically for the pitch-side management of this common injury. METHOD: A literature search of PubMed and Medline using the keywords: ‘pre-hospital’, ‘pitch-side’, ‘shoulder dislocation’ and ‘reduction’ or ‘relocation technique’ was performed, and the available literature reviewed and collated. We then reviewed articles focusing on reduction techniques for anteriorly dislocated shoulders with particular consideration on their applicability to a pitch-side setting. RESULTS: Whilst studies exist that compare and contrast examination and reduction techniques, most are based in an in-hospital, acute setting. To date, there is no standardized management protocol published for the initial management of an anterior dislocated shoulder in a pitch-side setting. This article addresses this discrepancy and proposes a structured, systematic approach to the pitch-side management of a shoulder dislocation. Furthermore, the article addresses factors to consider in a pitch-side setting, suitable techniques and post-reduction care. CONCLUSION: Whilst a systematic approach has been delineated in this article, we recommend those pitch-side medical practitioners who provide this form of support should have attended appropriate training and ensure adequate malpractice cover.

Retrospective Audit of Triage of Acute Traumatic Shoulder Dislocation by Emergency Nurses

Acute traumatic shoulder dislocation (ATSD) is a relatively common presentation to the emergency department. Research into nurse-led triage shows emergency nurses to be accurate at identifying patients with bony injuries and follow protocols to expedite appropriate care. The aim of this study was to assess the quality of triage decisions made by emergency nursing staff in cases of confirmed ATSD, in an emergency department in the United Kingdom. A retrospective audit was undertaken on patients with ATSD for 12 months (August 2006-August 2007). The nursing triage sheet and the clinical record forms were used to obtain data detailing the entire patient journey from arrival in the department to discharge. Emergency nurses were less likely to identify ATSD at triage than their physician colleagues during their initial clinical assessment (OR 0.06; 99% CI 0.014-0.272). Failure to identify ATSD at triage affected the efficiency of the remaining patient journey. A learning need for nursing staff in the initial assessment and identification of ATSD has been identified. The King's Mill Hospital's integrated care pathway for ATSD has been developed in response to the findings of this study, designed to aid diagnosis at triage and expedite patients through the stages of their ED journey. Significant areas for improvement have been identified in the initial assessment and management of patients with ATSD presenting at triage in the emergency department. The impact of the King's Mill Hospital's integrated care pathway on the quality of triage in ATSD requires further assessment.

Traumatic posterior shoulder dislocation: a case with modification of Gerber procedure for humeral head reconstruction at 10-year follow-up

We report a case of acute traumatic posterior shoulder dislocation in a 41-year-old patient, which we treated surgically by a modification of the procedure described by Gerber for humeral head reconstruction in such cases. The diagnosis was confirmed by CT scan, which also helped us to assess the size of the antero-medial humeral head defect or impaction secondary to the dislocation; the size of this defect being a determinant element for the indication. Because the shoulder was unstable after closed reduction and almost 50% of the humeral head was impacted, we carried out a surgical treatment using an original technique as mentioned above. Radiologic and surgical features of acute traumatic posterior shoulder dislocation are discussed with special emphasis on diagnosis, indications and surgical aspects of this rare lesion, which represent 2–4% of acute traumatic shoulder dislocations.

Prospective audit of emergency department transit times associated with entonox analgesia for reduction of the acute, traumatic dislocated shoulder

Aim: To establish current UK practice for the management of the acute traumatic shoulder dislocation with respect to analgesia and reduction manoeuvres. To compare the transit times of patients through an emergency department (ED) after the use of intravenous analgesia and/ or sedation compared to entonox +/− simple oral analgesia.Methods: A postal questionnaire was sent to 100 UK ED consultants to establish current practice. The treating clinicians were allowed to choose the method of analgesia provided to reduce the patient’s dislocated shoulder, provided the patient was happy with it. They administered either (1) traditional intravenous morphine and/or midazolam or (2) entonox +/− simple oral analgesia to facilitate reduction. A prospective audit was conducted to compare the transit times of the two groups of patients.Results: The postal questionnaire revealed that intravenous morphine and midazolam are widely used during reduction of the acute shoulder dislocation in the UK. The audit showed that this was associated with a significantly prolonged transit time through the ED, compared to entonox alone, (mean 77min versus 177min, respectively, p<0.001) without compromise in reduction success.Conclusion: Entonox +/− simple oral analgesia significantly decreases ED transit times as compared to IV morphine and/or midazolam for the reduction of the acute traumatic dislocated shoulder. Further studies should be done into patient pain scores and into the best combination of oral analgesia and entonox.