Anterior Glenohumeral Dislocation Research Articles

Biomechanical reposition techniques in anterior shoulder dislocation: a randomised multicentre clinical trial— the BRASD-trial protocol

IntroductionGlenohumeral (shoulder) dislocations are the most common large joint dislocations seen in the emergency department (ED). They cause pain, often severe, and require timely interventions to minimise discomfort and tissue...

Increased Glenoid Index is a Risk Factor for Pediatric Anterior Glenohumeral Dislocation: An MRI-Based Case-Control Study

Objectives:In the adult population, anterior glenohumeral instability has been associated with a tall and narrow glenoid morphology, assessed using glenoid index (GI). This morphological association has not been assessed in children and adolescents. This study was designed to examine the association of GI with anterior glenohumeral dislocation in patients 19 years old and younger using a case-control study design.Methods:An institutional radiology database was queried over a 10-year period to identify patients 19 years old and younger who underwent glenohumeral MRI arthrography and were diagnosed with anterior shoulder dislocation (cases) and those without dislocation and normal shoulder arthrogram studies (controls). Those with bony Bankart lesions were excluded. Glenoid index (glenoid height-to-width ratio) was measured by an attending pediatric musculoskeletal radiologist and a fellowship-trained attending orthopedic surgeon. Comparative analysis between the two groups was performed using Student’s t-test for each variable, followed by receiver-operating-characteristic (ROC) analysis to determine discriminative ability when statistically significant.Results:Thirty-three males and 22 females (mean age: 15.4±2.1 years old) meeting inclusion and exclusion criteria were identified. Mean glenoid index in the dislocator group was significantly greater than the control group (1.55±0.14 vs. 1.38±0.08, P<0.001). ROC analysis revealed adequate discrimination of glenoid index in predicting glenohumeral dislocation (area under the curve [AUC] = 0.88). A glenoid index ≥1.45 was 83% sensitive and 79% specific for predicting dislocation in the study cohort.Conclusion:Patients with anterior glenohumeral dislocation were noted to have increased glenoid index (taller and narrower glenoid morphology) than controls. Glenoid index may help identify patients at risk for primary or recurrent anterior glenohumeral instability events, and can help guide treatment and anticipatory guidance.

Operação de Bristow‐Latarjet modificada no tratamento na luxação glenoumeral anterior traumática recidivante

ObjectiveRetrospective case‐control study of authors experience in the modified Bristow‐Latarjet procedure for treatment of recurrent traumatic anterior glenohumeral dislocation with glenoid bone injury. MethodsSample with 102 recurrent glenohumeral dislocation cases submitted to modified Bristow‐Latarjet procedure. Indications included situations of recurrent traumatic anterior glenohumeral instability with more than two dislocation episodes and with glenoid bone attritional or fragmentary injuries, without possibility of reconstruction. Mean follow‐up time was 5.33±2.74 years (minimum 1; range 1‐13). ResultsThe mean Walch‐Duplay Score at the last evaluation was 91.23±11.46 (range 15‐100). The functional score of patients with glenoid bone loss greater than 20% did not show a significant difference in comparison with patients with glenoid bone loss lower than 20% (90 vs. 92, respectively). The functional score also did not show a significant difference between sports practice categories and between recreational and competitive practice, being excellent (greater than 90) in every category. There were no dislocation recurrences and the only complications were a case of persistent instability and a screw revision. Mild glenohumeral osteoarthrosis imaging signs were identified in 7.84% of the patients; however, their functional scores were not significantly different in comparison to other patients. ConclusionThe modified Bristow‐Latarjet procedure is a very effective procedure with few complications in the medium‐term, showing very satisfactory functional outcomes in the treatment of recurrent traumatic anterior glenohumeral dislocation associated with glenoid bone injury.

Axillary Artery Injury Following Closed Reduction of an Age-Indeterminate Anterior Glenohumeral Dislocation

Case study: This report details an axillary artery injury associated with an anterior glenohumeral dislocation. The patient was initially evaluated at an outside hospital where the vascular injury was not immediately identified, and then was subsequently transferred to our institution where he underwent bypass grafting without significant sequela. Conclusion: Although rare, clinicians should actively rule out vascular injuries when evaluating shoulder dislocations, especially in the elderly patient with a known history of atherosclerotic disease or those with evidence of chronic joint instability. Hard signs of vascular injury including diminished distal pulses are the hallmark of this complication, and should always prompt vascular consultation.

Axillary Artery Injury Following Closed Reduction of an Age-Indeterminate Anterior Glenohumeral Dislocation

Axillary Artery Injury Following Closed Reduction of an Age-Indeterminate Anterior Glenohumeral Dislocation

A comparative study of the Milch method and the Spaso method in the reduction of anterior dislocation of the shoulder

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The Milch and Spaso methods are used for reduction of anterior shoulder dislocation of the shoulder. This study was undertaken to compare the efficacy of these two methods&lt;span lang="EN-IN"&gt;.&lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Sixty patients with anterior glenohumeral dislocation were included in this study. 30 patients were reduced by each of the 2 methods and the efficacy and the pain experienced by the patient was studied.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Both methods were found to be equally efficacious. The pain felt by the patient was lower in the Milch method but this was not statistically significant&lt;span lang="EN-IN"&gt;. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Both the Milch and the Spaso methods are equally effective methods for reduction of anterior dislocation of the shoulder&lt;span lang="EN-IN"&gt;.&lt;/span&gt;&lt;/p&gt;

Reversed Shoulder Arthroplasty in a Patient with Fixed Anterior Glenohumeral DislocationReversed Shoulder Arthroplasty in a Patient with Fixed Anterior Glenohumeral Dislocation

An anterior glenohumeral dislocation is a serious condition which can lead to soft tissue damage and substantial defects of the humeral head and glenoid. Little is known about the results of shoulder arthroplasty for the treatment of fixed glenohumeral dislocation. We present a case of an fixed anterior glenohumeral dislocation that developed with no associated trauma in a humeral head with an ongoing avascular necrosis in 75 years old patient with Parkinson disease. The patient had severe pain and a pseudo paralysis of the right arm. Radiology revealed a bone loss of the posterior head. The patient was submitted to a reversed shoulder arthroplasty and at 1 year follow up is happy with no pain; the subjective outcome scores substantially increased and had fair gains in arm mobility with no evidence of instabilities or other complications. We believe, based on the literature, and on recent advances in the implants and surgical technique, that shoulder reverse arthroplasty will probably achieve better results than unconstrained shoulder implants in treating fixed anterior dislocations in geriatric patients.

Reduction of anterior glenohumeral dislocations: a new closed reduction technique

ABSTRACTObjective: A new closed reduction technique for anterior glenohumeral dislocations and tuberosity fracture dislocations is introduced.Methods: Forty-one consecutive patients with an acute anterior glenohumeral dislocation or tuberosity fracture dislocation underwent closed reduction by an orthopaedic surgeon employing this new method.Results: Closed reduction was successful in 88% of patients using the reduction maneuver. Associated fracture with glenohumeral dislocation did not influence the success rate of the reduction maneuver. An assistant was needed in 15% of cases. No complications related to the reduction maneuver were noted amongst the cohort.Conclusion: This novel reduction technique is safe demonstrating excellent success rates both for anterior shoulder dislocations and tuberosity fracture-dislocations.

Tomographic evaluation of Hill-Sachs lesions: is there a correlation between different methods of measurement?

Several methods are currently available to evaluate and quantify the glenoid or humeral bone loss; however, none is universally accepted, particularly in the case of Hill-Sachs (HS) lesions. To establish whether there is correlation among different methods of measuring HS lesions, and to investigate the correlation between glenoid bone loss and the various HS lesion measurements and to assess the inter-observer reliability of such measurements. We assessed computed tomography (CT) or arthro-CT scans taken from individuals with recurrent anterior glenohumeral dislocation. The scans were independently assessed by two examiners. The parameters assessed were as follows: HS lesion width and depth on the axial and coronal planes, articular arc loss on the axial plane, and percentage of glenoid bone loss on the sagittal plane. Scans from 50 shoulders were assessed. The percentage of articular arc loss and HS lesion width on the axial plane were the only measurements that exhibited strong correlation (r = 0.83; P < 0.001). The values of the correlation coefficient corresponding to HS lesion depth on the coronal plane were the lowest. Most of the measurements exhibited moderate correlation. The inter-examiner reliability was good relative to all measurements except for HS lesion width and depth on the coronal plane, for which it was moderate. The measurements of articular arc loss and HS lesion width on the axial plane exhibited strong correlation. The inter-examiner reliability relative to articular arc loss, HS lesion width and depth on the axial plane, and glenoid bone loss was good.

Reducing Shoulder by Vertical Traction: A One-Man Method for Shoulder Reduction

Fifty percent of joint dislocations reported to the emergency department are of shoulder joint. Various techniques are used to reduce the shoulder and Spaso technique is the least known to the orthopaedic residents which is a simple one-man vertical traction method of shoulder reduction. We evaluated the effectiveness of vertical traction method for anterior shoulder dislocation by orthopaedic residents. Sixty consecutive patients of anterior glenohumeral dislocation attending the emergency department of our hospital were taken up for the study. The reduction was done using Spaso technique. Right shoulder was dislocated in 40 patients and 31 patients had recurrent shoulder dislocation. In 55 patients, shoulder was reduced without the use of any anaesthesia. In patients where no anaesthesia was used, the time of traction ranged from 45 seconds to 5 minutes, while under anaesthesia the time of traction ranged from 1 to 4 minutes. Twenty-one patients had associated greater tuberosity fracture which did not affect the method of reduction and all of them were reducible. No complication was reported, and all the patients were satisfied with the method. In conclusion vertical traction method is a good technique for reducing anterior shoulder dislocation with an easy learning curve among the residents and no complication has been reported so far.

Bilateral Shoulder Combined with Unilateral Knee Dislocation After a Fall

A 54-year-old overweight woman presented to the emergency department (ED) complaining of severe pain and lack of movement in both shoulders and her left knee. Her medical history revealed that the episode began after slipping on the wet floor in the bathroom. The first dislocation of the knee joint occurred during the fall when she lost her balance, and the second occurred when she tried to use her arms to avoid hitting her head on the wet floor. There was no history of connective tissue disease, seizure, or prior dislocations. During clinical examination, there was no evidence of neurovascular deficit for upper extremities and left knee. Radiographs confirmed bilateral anterior glenohumeral dislocation combined with anterior left knee dislocation (Figure 1). Bilateral anterior shoulder dislocations are reported less often. A recent review of 70 patients demonstrated that the causes of anterior injuries were trauma (50%), muscle contractions (37%) due to seizures or electrocution, and atraumatic events (13%). Because of various etiologies, dislocation mechanisms are different. Lever effect is a type of dislocation mechanism that forces abduction and external rotation of the arm. With the greater tuberosity pressing against the acromion, the humeral head is forced anteriorly out of the glenohumeral joint (1, 2). The patient, in this case, had low-energy trauma as well as left knee dislocation. Complete dislocation of the knee causes devastating extremity injuries, particularly in the popliteal artery and peroneal nerve. The incidence of nerve and artery injury due to knee dislocation is 10%–40%. Even worse, when a vascular injury secondary to a traumatic knee dislocation cannot be repaired within 8 h, the amputation rate increases to nearly 85%. Therefore, vascular assessment should include examination of both the dorsalis pedis and posterior tibial pulses, ankle-brachial index measurement, and computerized tomography (CT) angiography or arteriography. The patient had no clinical signs of vascular and nerve injury at the time of admission and observation, so she did not urgently need further radiological study such as CT angiography (3, 4).

Recurrent Anterior Shoulder Instability With Combined Bone Loss

Background: Recurrent anterior glenohumeral dislocation in the setting of an engaging Hill-Sachs lesion is high. The Latarjet procedure has been well described for restoring glenohumeral stability in patients with >25% glenoid bone loss. However, the treatment for patients with combined humeral head and mild (<25%) glenoid bone loss remains unclear. Purpose/Hypothesis: This study reports on the outcomes of the modified Latarjet for patients with combined humeral and glenoid defects and compares the results for patients with ≤25% glenoid bone loss versus patients with >25% glenoid bone loss. The hypothesis was that the 2 groups would have equivalent subjective outcomes and recurrence rates. Study Design: Cohort Study; Level of evidence, 3. Methods: Modified Latarjet was performed in 40 patients with recurrent anterior shoulder instability, engaging Hill-Sachs by examination confirmed with arthroscopy, and ≤25% anterior glenoid bone loss (group A). A second group of 12 patients were identified to have >25% glenoid bone loss with an engaging Hill-Sachs lesion (group B). The mean follow-up time was 3.5 years. All patients were assessed for their risk of recurrence using the Instability Severity Index score and Beighton score and had preoperative 3-dimensional imaging to assess humeral and glenoid bone loss. Single Assessment Numeric Evaluation (SANE), Western Ontario Shoulder Instability Index (WOSI), recurrence rate, radiographs, range of motion, and dynamometer strength were used to assess outcomes. A multivariate analysis was performed. Results: Glenoid bone loss averaged 15% in group A compared with 34% in group B. Both groups had comparable WOSI scores (356 vs 475; P = .311). In multivariate analysis, the number of previous surgeries and Beighton score were directly correlated with WOSI score in Latarjet patients. The SANE score was better in group A (86 vs 77; P = .02). Group B experienced more loss of external rotation (9.2° vs 15.8°; P = .0001) and weaker thumbs-down abduction and external rotation strength (P < .032). Subscapularis, abduction, and external rotation strength averaged at least 75% of the contralateral shoulder in both groups. Graft resorption was similar in both groups (32% vs 33%; P < .999). The overall recurrent instability rate for the study, defined as any subsequent subluxations or dislocation, was 15%; recurrent instability rates (15% vs 17%; P > .999) were similar for both groups. The complication rate was 25% for both groups. Conclusion: The modified Latarjet procedure provides satisfactory outcomes for patients with combined bone loss, which is known to have high recurrence rates with traditional arthroscopic stabilization. Previous surgical stabilization procedures and the Beighton score adversely affect outcome after modified Latarjet. Furthermore, the number of previous surgeries and Beighton score can be used to predict WOSI score in Latarjet patients. Further study is needed to determine if these results hold true in the long term.

Analysis and countermeasures of iatrogenic fracture of proximal humerus following reduction of anterior glenohumeral dislocation

Analysis and countermeasures of iatrogenic fracture of proximal humerus following reduction of anterior glenohumeral dislocation

Shoulder Dislocation with Head and Shaft Fracture Ipsilateral

Accompanied shoulder dislocation of the proximal humerus fracture associated with ipsilateral shaft fracture is a rare injury described in literature collection and whose treatment protocol is not clearly established. Here we present the case of 63 years old male who suffered a fall after slipping in a pool and presented a humeral shaft fracture associated with ipsilateral anterior glenohumeral dislocation and fracture of the proximal humerus in three fragments with involvement of the anatomical neck. The patient underwent a closed reduction first attempt with the help of two needle percutaneous. Axillary artery was injured so had to undergo a second time for another intervention in which we made open reduction and osteosynthesis by proximal humerus long plate and hemiarthroplasty.

Ten-year follow-up of acute arthroscopic Bankart repair for initial anterior shoulder dislocation in young patients

IntroductionEarly treatment of initial anterior glenohumeral dislocation in young patients is controversial and the interest of surgery, and notably arthroscopic stabilization, has not been demonstrated. A prospective study was therefore performed to assess (1) short-to-medium-term recurrence rate, (2) functional outcome, and (3) and medium-term osteoarthritis rate. HypothesisEarly arthroscopic stabilization by anterior capsule-labrum reinsertion after initial anterior shoulder dislocation is associated with low recurrence rate. Materials and methodsTwenty-one patients with initial anterior dislocation were included between June 2002 and February 2004. All patients underwent arthroscopic Bankart repair within 30 days of dislocation. Patients were followed up prospectively, with clinical (Duplay and Constant scores) and radiological assessment (osteoarthritis). ResultsThere were 5 recurrent dislocations (25%); 2 patients reported sensations of subluxation: i.e., 7 failures (35%). Mean Walch-Duplay score at 10 years was 88±1 (range, 30–100) and mean Rowe score 86±22 (range, 35–100). There was significant internal rotation deficit of one vertebral level between operated and contralateral shoulder (P < 0.005). At 10 years, 3 shoulders (15%) showed Samilson grade 1 centered glenohumeral osteoarthritis. ConclusionEarly arthroscopic capsule-labrum reinsertion by the Bankart technique in the month following initial anterior dislocation of the shoulder in patients under 25 years of age provided a low recurrence rate (35%) compared to the literature, including dislocation (25%) and subluxation (10%). Functional outcome was satisfactory, and osteoarthritis rate was low (15% Samilson grade 1). Level of evidenceIV, prospective non-comparative study.

Prevalence of associated injuries after anterior shoulder dislocation: a prospective study

Anterior shoulder dislocation can be associated with many lesions such as Bankart lesions, rotator cuff tears (RCT), Hill-Sachs lesions or greater tuberosity fractures. It has been documented that early management of the associated injury affords better recovery of shoulder function. The aim of this study was to highlight the incidence of associated injuries after anterior shoulder dislocation. A total of 240 patients with traumatic anterior glenohumeral dislocations were subjected to complete history taking, neurovascular assessment and pre-reduction plain X-ray. An X-ray was taken immediately after reduction. Ultrasonography (US) and magnetic resonance imaging (MRI) were done within one week after reduction in all patients. Nerve conduction studies were ordered for any patient with suspected nerve injury. Associated lesions were reported in 144 (60%) patients. RCT was the most common injury (67 cases). It was isolated in 34 patients (14.15%), while it was combined with other lesions in 33 cases (13.75%). Axillary nerve injury was encountered in 38 patients, of them 8 (3.33%) were isolated and 30 (12.5%) were combined. Greater tuberosity fracture was found in 37 patients, of them 15 (6.25%) were combined with axillary nerve injury, and in the other 22 patients (9.17%) the fracture was isolated. All cases with Hill-Sachs and Bankart lesion were combined lesions with no isolated cases. There was a significant relation between the incidence of associated injuries and age, mechanism of injury and the affected side. Lesions associated with traumatic anterior glenohumeral dislocations are more frequent than expected. Thorough clinical examination and detailed imaging including US and MRI are mandatory to avoid a missed diagnosis.

Shoulder Instability in the Overhead Athlete

Objectives:Overhead athletes place extraordinary physiologic demands on the shoulder during athletic activity. Repetitive microtrauma can result in attenuation of important capsuloligamentous structures that are responsible for providing glenohumeral stability resulting in symptomatic instability. Surgical management can utilize either an arthroscopic or open approach to shoulder stabilization; however, there is a paucity of data to support a specific technique and guide surgical decision making in this unique patient population. The purpose of the present study was to determine functional outcomes, including return to play, range of motion (ROM), validated outcome scores and recurrent instability following arthroscopic and open shoulder stabilization in overhead athletes diagnosed with anterior instability.Methods:MEDLINE and the Cochrane Database of Systematic Reviews were searched. Eleven articles matched our selection criteria for randomized controlled trials in which a cohort of overhead athletes participating in sports including baseball, tennis, volleyball, and freestyle swimming, were surgically treated by capsular plication or Bankart repair through either an open or arthroscopic approach for anterior shoulder subluxation or dislocation. The studies were assessed for methodological quality and relevant data was extracted and further evaluated. Results of comparable groups of trials were pooled and mean differences as well as 95% confidence intervals were calculated for continuous outcomes. A grading schema was designed to assess return to play: return to the same level of play (Grade 1), diminished level of play (Grade 2), and failure to return to play (Grade 3).Results:In overhead athletes with anterior glenohumeral subluxation or dislocation, return to play was similar between arthroscopic and open approaches (Grade 1 = arthroscopic 72 ± 22.6%, open 68.7 ± 7.8%; Grade 2 = arthroscopic 24.2 ± 18.3%, open 34.5 ± 7.8%; Grade 3 = arthroscopic 7.2 ± 10.8%, open 8.3 ± 14.4%). Arthroscopic and open approaches demonstrated similar changes in post-operative ROM, as evaluated through degrees of external rotation (arthroscopic -3.6 ± 1.9o, open -3.9 ± 1.9o), forward flexion (arthroscopic -2 ± 1.4o in FF, open -2.7 ± 3.82o), abduction (arthroscopic -0.7o, open -4.6o) and internal rotation (arthroscopic -2.7o, open -2.5o). No significant difference in functional score outcomes existed between arthroscopic (UCLA 31.2 ± 2.7, Rowe 87.1 ± 10.3, Constant 80.9 ± 16.4) and open (UCLA 30.8 ± 0.6, Rowe 87.5 ± 6, Constant 77.2 ± 15.3) stabilization. Recurrent instability, defined as either recurrent subluxation or dislocation was significantly higher with arthroscopic (11.4 ± 2.8%) versus open (4 ± 1.4%) stabilization.Conclusion:Arthroscopic management of anterior glenohumeral microinstability and overt instability allows overhead athletes to return to the same level of play as open stabilization, with similar levels of post-operative ROM and comparable clinical outcomes as measured by validated outcome scores. The higher rate of recurrent instability in overhead athletes following arthroscopic stabilization is similar to current studies in other athletic cohorts (e.g. contact athletes) and warrants further investigation to determine the reasons for this observation.

Treatment And Results Of Combined Mild Bone Loss Instability With The Modified Laterjet

Objectives:Recurrent anterior glenohumeral dislocation in the setting of an engaging Hill-Sachs lesion is high. The Latarjet procedure has been well-described for restoring glenohumeral stability in patients with over 25% glenoid bone loss. However, the treatment for patients with combined humeral head and mild (<25%) glenoid bone loss remains unclear. We report on the outcomes of the modified Latarjet for this population.Methods:Modified Latarjet was performed in twenty three patients with recurrent anterior shoulder instability, engaging Hill-Sachs by exam confirmed with arthroscopy, and less than 25% anterior glenoid bone loss. The mean follow-up was 3.5 years. All patients were assessed for their risk of recurrence using the Instability Severity Index Score (ISIS), had pre-operative 3D imaging to assess humeral and glenoid bone loss. Single Assessment Numeric Evaluation (SANE), Western Ontario Shoulder Instability Index (WOSI), recurrence rate, radiographs, range of motion and dynamometer strength were used to assess outcomes.Results:Average pre-operative instability severity index score was 6.2 (range 4-9). Pre-operative glenoid bone loss averaged 15.1% (range 5-25%). The humeral defect averaged 40.4% in width and 13.7% in depth on axial computed tomography scan, with an average Hill-Sachs angle of 28°. The mean WOSI index was 457 of 2100 (range 0-1398). The mean SANE score was 81.2 (range 60-100). Five out of ten competitive athletes returned to play for at least one season. There were no recurrent dislocation and three patients had a single episode of recurrent subluxation. Loss of external rotation at the side averaged 8°, and there was no significant loss of abduction. Subscapularis, abduction and external rotation strength averaged greater than 85% of the contralateral shoulder. Fourteen patients on average had 1.4 (range 1-4) previous open or arthroscopic stabilization procedures prior to the Latarjet, nine others had Latarjet done primarily. WOSI scores correlated directly with number of previous surgery (r=0.81, p=0.02). Average WOSI score was 239 (range 0-510) in primary Latarjet, 495 (range 42-1024) in patients with one previous stabilization procedure, and 674 (range 192-1398) in patients with two or more previous stabilization procedures (ANOVA p<0.001). There were three deep infections, two graft fractures, two painful hardware, one broken screw with graft malunion, and one radiographic graft nonunion. All infections, malunion and nonunion occurred in patients with failed previous stabilization procedures. No long-term nerve palsies were found. Resorption of the graft at the superior screw was seen in 28% of patients.Conclusion:The modified Latarjet is a reasonable choice for the treatment of an engaging Hill-Sachs lesion with concomitant mild anterior glenoid bone loss in this very demanding group of patients. However, the complication rate is significant.

Nerve transfers for treatment of isolated axillary nerve injuries

Background The most common neurological defect in traumatic anterior glenohumeral dislocation is isolated axillary nerve palsy. Most recover spontaneously; however, some have persistent axillary neuropathy. An intact rotator cuff may compensate for an isolated axillary nerve injury; however, given the high rate of rotator cuff pathology with advancing age, patients with an axillary nerve injury are at risk for complete shoulder disability. Objective To review reconstruction of the axillary nerve to alleviate shoulder pain, augment shoulder stability, abduction and external rotation to alleviate sole reliance on the rotator cuff to move and stabilize the shoulder. Method A retrospective review of 10 patients with an isolated axillary nerve injury and an intact rotator cuff who underwent a triceps nerve branch to axillary nerve transfer was performed. Patient demographics, surgical technique, deltoid strength, donor-site morbidity, complications and time to surgery were evaluated. Result Ten male patients, mean age 38.3 years (range 18 to 66 years), underwent a triceps to axillary nerve transfer for isolated axillary nerve injury 7.4 months (range five to 12 months) post-traumatic shoulder dislocation. Deltoid function was British Medical Research Council grade 0/5 in all patients preoperatively and ≥3/5 deltoid strength in eight patients at final follow-up (14.8 months [range 12 to 25 months]). There were no complications and no donor-site morbidity. Conclusion A triceps to axillary nerve transfer for isolated axillary neuropathy following traumatic shoulder dislocation improved shoulder pain, stability and deltoid strength, and potentially preserves shoulder function with advancing age by alleviating sole reliance on the rotator cuff for shoulder abduction and external rotation.

Etiopathogenesis of Anterior Glenohumeral Dislocation in Professional Rugby Players

Introduction: The glenohumeral joint is the most frequently dislocated joint in the body. There are various types of dislocations, but the most common is anterior glenohumeral joint dislocation (95%). The injury mechanism is often forced abduction accompanied by external rotation of the arm. There are a series of injuries that make the shoulder more predisposed to the occurrence of this type of injury. Objective: Review the existing literature on the etiopathogenesis of anterior glenohumeral luxation/dislocation and the mechanisms that cause such injuries in Professional Rugby. Material and Methods: Retrieval and re-analysis of data was carried out performing a critical review of existing literature published over the last 5 years and available on PubMed using the following key-word search criteria: ﾓanterior shoulder dislocationﾔ, ﾓshoulder injuries in rugbyﾔ and ﾓshoulder injuriesﾔ. Development and literature review: Shoulder injuries are common in rugby players, but the mechanisms of injury are less understood. Glenohumeral luxation represents 14% of all shoulder injuries and 62% of the disorders occur during blocking the ball. In the majority of cases (71%), injury is sustained during a tackle. Horsley et al defines the primary mechanism of injury as direct tackling (56%), followed by falling onto the arm (10%). Acromioclavicular joint injuries were the most common, with shoulder dislocations and instability accounting for the most severe injuries and greatest periods of absence from matches and scheduled training. James Crichton et al found that dislocations of the glenohumeral joint were the most common injury in 67% of rugby players. These dislocations were accompanied by associated injuries. Contact was responsible for 97% of injuries, with tackling or being tackled accounting for 65%. Longo et al describe three mechanisms: abduction and external rotation, flexion and internal rotation and landing heavily on a flexed elbow. Heady et al describe the ﾓTry Scorerﾔ, ﾓTacklerﾔ and ﾓDirect Impactﾔ mechanisms. Conclusions: (1) Repeated direct impact (blocking of the ball and the tackle) is the leading cause of most shoulder injuries; (2) There are discrepancies in the existing literature on the order and frequency shoulder dislocations occur in these athletes, but there is consensus that it is a common injury, a severe injury and can be the cause of great instability; (3) In some instances, glenohumeral dislocations can be accompanied by other injuries; (4) There is similarity in the mechanisms of injury, but all do not completely coincide.