Case Of Anterior Shoulder Dislocation Research Articles

Balloon humeroplasty reconstruction for acute Hill-Sachs injury: A technical note

Posterior Hill-Sachs humeral defects are present in 80% to 100% of cases of anterior shoulder dislocation and are a factor in recurrent instability. Several techniques have been described to fill the defect and avoid recurrence. We developed a percutaneous technique to fill the newly created defect in which a percutaneous balloon, analogous to the one used in vertebral kyphoplasty, is used to reduce the defect, which is then filled with calcium phosphate cement. One patient with an acute anterior dislocation of the shoulder with no previous history was treated using this method. Early imaging results showed adequate reduction of the defect and no cement resorption. The patient was followed for 12 months; he had normal function of the shoulder and no recurrent dislocation. Shoulder computed tomography (CT) arthrography with contrast after 3 months showed an intact capsule and no recurrence of the defect. While this technique is certainly in its infancy, we have demonstrated that emergency reduction of the defect in acute first occurrence anterior shoulder dislocation is feasible, helps to restore normal anatomy of the humeral head and leads to good clinical results. Whether it can improve clinical results and prevent recurrent shoulder dislocation remains to be evaluated.

FARES Method to Reduce Acute Anterior Shoulder Dislocation: A Case Series and an Efficacy Analysis

ObjectiveAnterior shoulder dislocation is a common large joint dislocation. There is no standard method for reduction. A new technique (FARES method) was introduced by a Greek group in late 2009.DesignCase series analysis.SettingAn emergency department.MethodsA survey was conducted from April to June 2010 in the emergency department primarily to collect data on the methods of reduction of anterior shoulder dislocation and their efficacies.ResultsNine cases of anterior shoulder dislocation were documented. All 9 cases were reduced successfully regardless of the reduction methods used. FARES method was found to be popular in the studying emergency department. Six out of the 9 cases were using the FARES method at their first attempt (the rest two case using Spaso; one using traction‐counter traction). No pre‐medication was needed in all FARES' cases. In all 6 cases using the FARES method, the shoulder could be reduced within 2 minutes.ConclusionsOur experience concords with overseas' in which the FARES method is efficacious and fast.

Ultrasound Diagnosis of Anterior Shoulder Dislocation

We describe the ultrasound evaluation technique and sonographic findings of a case of anterior shoulder dislocation. The sonographic features of anterior shoulder dislocation include: “sign of widening of subacromial space”, “sign of disappearance of humeral head”, “artery/vessel sign”, “humeral head below coracoid process sign” and “empty glenoid fossa sign”. It is a safe, real time, readily available, convenient, and well tolerated diagnostic technique. The time to confirming the diagnosis of anterior shoulder dislocation may be shortened and hence close reduction in a timely manner may be achieved. We suggest the use of high resolution ultrasound for confirmation of the diagnosis of anterior shoulder dislocation and relocation of the humeral head after close reduction. The potential of using ultrasonography to replace pre-reduction radiograph should be explored.

Chronic Unreduced Anterior Shoulder Dislocation

The uniqueness of anatomic structures and their variations provide the basis for forensic identification. During the identification process of 1991-1995 Croatian war victims, forensic pathologists and forensic anthropologists were faced with the problem of incomplete skeletal remains and insufficient premortem medical data. Here we present a case of anterior shoulder dislocation, which was a key confirmation in the identification of a war victim. In our case, anterior shoulder dislocation was not medically treated for 15 years, and the changes in the glenoid cavity and coracoid process indicated morphologic adaptation of anatomic structures to the new mechanical and physiological demands.

Prospective evaluation of a guideline for the selective elimination of pre-reduction radiographs in clinically obvious anterior shoulder dislocation

Research has demonstrated that experienced emergency physicians can identify a subgroup of patients with shoulder dislocation for whom pre-reduction radiographs do not alter patient management. Based on that research, a treatment guideline for the selective elimination of pre-reduction radiographs in clinically evident cases of anterior shoulder dislocation was developed and implemented. The primary objective of this study was to prospectively determine whether the treatment guideline safely eliminates unnecessary radiographs. We enrolled a convenience sample of patients who presented to our rural emergency department with possible shoulder dislocation between November 2000 and April 2001. Physicians scored their level of clinical diagnostic certainty on a 10-cm visual analogue scale prior to viewing pre-reduction radiographs (if obtained). Data were collected on clinical scoring and evaluation, compliance with the guideline, and outcomes. A total of 63 patients were enrolled, ranging in age from 17 to 79 years (mean = 33); 87.3% were male. Emergency physicians were certain of shoulder dislocation in 59 (93.7%) patients (95% CI, 84.5%-98.2%) and complied with the treatment guideline in 52 patients (82.5%). Most deviations from the treatment guideline involved the elimination of post-reduction radiographs (which the guideline recommends for all patients). The treatment guideline eliminated 56 (88.9%, 95% CI, 78.4%-95.4%) pre-reduction radiographs, as compared to the standard practice of obtaining pre-reduction films for all cases of suspected shoulder dislocation (p < 0.0001) Experienced emergency physicians are frequently certain of the diagnosis of anterior shoulder dislocation on clinical grounds alone and can comfortably and safely use this guideline for the selective elimination of pre-reduction radiographs. Compliance with the guideline substantially decreases pre-reduction radiographs. Validation of the guideline in other settings is warranted.

Reduction of anterior shoulder dislocation by external rotation

AbstractObjective: To examine the efficacy of external rotation as initial treatment for anterior shoulder dislocation.Design: Prospective uncontrolled study of the efficacy and adverse effects of external rotation when used as the initial technique to reduce anterior shoulder dislocation.Results: Ninety two cases of anterior shoulder dislocation were treated over an 18 month period. External rotation was used successfully to reduce the dislocation in 72 cases (78%). A further nine cases were reduced by external rotation with the aid of traction (total 88%). Six of eight cases complicated by fracture of a humeral tuberosity were reduced by external rotation. Twenty six reductions were achieved without the use of analgesia. Two cases of nerve palsy were seen, both associated with the use of traction.Conclusions: External rotation is a simple and safe method of reduction for anterior dislocations of the shoulder. The technique is recommended as the initial reduction technique for anterior shoulder dislocations. The use of traction should be discouraged.

Anterior dislocation of the shoulder with ipsilateral humerus shaft fracture

Anterior dislocation of the shoulder joint with ipsilateral humerus shaft fracture is a very rare injury. Until July 2006 only 18 cases have been reported in the literature. Here we report a case of Anterior Shoulder dislocation with greater tuberosity and shaft of humerus fracture. The patient was treated by Open reduction and internal fixation of the shaft fracture followed by closed reduction of the dislocation. A post-operative rehabilitation program was instituted for complete rehabilitation of the shoulder function.