First-time Shoulder Research Articles

The Epidemiology of Pediatric Shoulder Dislocations in the United States.

Shoulder dislocations are the most common of all major joint dislocations and are a frequent cause of emergency department (ED) presentations. While the epidemiology of shoulder dislocations has been characterized in adults, it has not yet been done for children in the United States. The primary goal of this study was to calculate the incidence rate of pediatric shoulder dislocations in the United States. Secondary goals were to characterize the demographic information of children with shoulder dislocations as well as trends in management. The US Collaborative Network in TriNetX, a network of clinical data repositories containing patient data from over 100,000,000 unique individuals within the United States, was queried for patients younger than 18 years old diagnosed with shoulder dislocation from 2014 to 2024 using ICD codes. The demographic details were then extracted from the data set, and treatment approaches were determined by CPT coding. Over the past 10 years, there were 16,460 pediatric and adolescent patients diagnosed with a first-time shoulder dislocation in either an ED or ambulatory clinic. The overall incidence rate was 60.31 per 100,000 patients, while the incidence rate was 116.61 per 100,000 patients presenting in the ED and 33.95 per 100,000 patients presenting in ambulatory clinics that were under the age of 18 years. Most patients were male (73%), White (59%), and came from the southeastern region of the United States (36%). The most common treatment was a closed reduction (25%), followed by arthroscopic surgery (17%). The number of annual shoulder dislocations has increased over the past decade without an increase in the number of patients undergoing surgical treatment. There remains a high incidence rate of shoulder dislocations in the pediatric population of the United States. Despite evidence that early surgical treatment of shoulder dislocations offers improved outcomes, nonoperative treatment continues to be the most common modality without any increase in the percentage of patients undergoing surgical treatment. Level IV-descriptive epidemiological analysis.

Physiotherapy rehabilitation experiences of people with shoulder dislocation in ARTISAN study: a qualitative study

BackgroundAcute Rehabilitation following Traumatic anterior shoulder dISlocAtioN (ARTISAN) was a large trial comparing the clinical and cost-effectiveness of two rehabilitation interventions in adults with a first-time traumatic shoulder dislocation. Participants...

Shoulder dislocations in professional male football (soccer): A retrospective epidemiological analysis of the German Bundesliga from season 2012/2013 until 2022/2023.

Injuries exert a detrimental impact on the team performance in professional football. Shoulder dislocations are known for their severity and often cause substantial lay-off times. However, there is a notable gap in the general understanding regarding the frequency and convalescence of these events in professional football. Thus, the aims of this study were (1) to determine the incidence, (2) to evaluate return to competition (RTC) and redislocation events (RDEs) and (3) to identify relevant player-, match- and injury-related parameters. All shoulder dislocations within the highest three German football leagues (1.-3. Bundesliga) during the seasons 2012/2013 until 2022/2023 were identified. Player-, injury- and match-related data were obtained by performing a media analysis. Data were analysed using descriptive statistics. p Value was set at 0.05. A total of 90 first-time shoulder dislocations in 89 players with a median age of 25 years (interquartile range [IQR]: 23-28) were available for analysis. The incidence was 9.1 per 1000 Bundesliga matches played and increased over time. Forty-four (49%) shoulder dislocations were treated conservatively and 46 (51%) operatively. Median RTC was 24 days (IQR: 12-43) following conservative and 103 days (IQR: 85-135) following surgical treatment (p < 0.001). Twenty-two (24%) players suffered a redislocation, of whom 13 (59%) underwent initial conservative and nine (41%) initial surgical treatment (not significant [n.s.]). RDE following conservative treatment was after a median of 4 months (IQR: 2-22) and 7 months (IQR: 3-23) following surgical treatment (n.s.). The incidence of shoulder dislocation within professional football is increasing and currently amounts to 9.1 per 1000 matches played. A conservative treatment leads to a quicker RTC, while frequency and time to RDE were similar regardless of treatment. The increasing incidence of shoulder dislocations in professional football necessitates an analysis of relevant injury mechanisms and the implementation of specific preventive measures. Level III.

Advice only versus advice and a physiotherapy programme for acute traumatic anterior shoulder dislocation: the ARTISAN RCT.

The extra benefit of a programme of physiotherapy in addition to advice alone, following first-time traumatic shoulder dislocation, is uncertain. We compared the clinical and cost-effectiveness of a single session of advice with a single session of advice and a programme of physiotherapy. The primary objective was to quantify and draw inferences about observed differences in the Oxford Shoulder Instability Score between the trial treatment groups 6 months post randomisation, in adults with a first-time traumatic shoulder dislocation. A pragmatic, multicentre, superiority, randomised controlled trial with embedded qualitative study. Forty-one hospitals in the UK NHS. Adults with a radiologically confirmed first-time traumatic anterior shoulder dislocation, being managed non-operatively. People with neurovascular complications or bilateral dislocations, and those unable to adhere to trial procedures or unable to attend physiotherapy within 6 weeks of injury, or who had previously been randomised, were excluded. All participants received the same initial shoulder examination followed by advice to aid self-management, lasting up to 1 hour and administered by a physiotherapist (control). Participants randomised to receive an additional programme of physiotherapy were offered sessions lasting for up to 30 minutes, over a maximum duration of 4 months from the date of randomisation (intervention). The primary outcome measure was the Oxford Shoulder Instability Score. This is a self-completed outcome measure containing 12 questions (0-4 points each), with possible scores from 0 (worst function) to 48 (best function). Measurements were collected at 6 weeks, 3 months, 6 months and 12 months by postal questionnaire; 6 months was the primary outcome time point. The primary health outcome for economic evaluation was the quality-adjusted life-year, in accordance with National Institute of Health and Care Excellence guidelines. Between 14 November 2018 and 14 March 2022, 482 participants were randomised to advice (n = 240) or advice and a programme of physiotherapy (n = 242). Participants were 34% female, with a mean age of 45 years, and treatment arms were balanced at baseline. There was not a statistically significant difference in the primary outcome between advice only and advice plus a programme of physiotherapy at 6 months for the primary intention-to-treat adjusted analysis (favours physiotherapy: 1.5, 95% confidence interval -0.3 to 3.5) or at earlier 3-month and 6-week time points on the Oxford Shoulder Instability Score (0-48; higher scores indicate better function). The probability of physiotherapy being cost-effective at a willingness-to-pay threshold of £30,000 was 0.95. We found little difference in the primary outcome or other secondary outcomes. Advice with additional physiotherapy sessions was found likely to be cost-effective. However, small imprecise incremental costs and quality-adjusted life-years raise questions on whether it is the best use of scarce physiotherapy resources given current service demands. Loss to follow-up was 27%; however, the observed standard deviation was much smaller than anticipated. These changes in parameters reduced the number of participants required to observe the planned target difference of four points. Our post hoc sensitivity analysis, accounting for missing data, gives similar results. Further research should be directed towards optimising self-management strategies. This study is registered as ISRCTN63184243. This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 16/167/56) and is published in full in Health Technology Assessment; Vol. 28, No. 22. See the NIHR Funding and Awards website for further award information.

Acute rehabilitation following traumatic anterior shoulder dislocation (ARTISAN): pragmatic, multicentre, randomised controlled trial

ObjectiveTo assess the effects of an additional programme of physiotherapy in adults with a first-time traumatic shoulder dislocation compared with single session of advice, supporting materials, and option to self-refer...

SECEC Didier Patte Prize 2023: the ABC classification of posterior shoulder instability

BackgroundThe ABC classification has recently been proposed as a comprehensive classification system for posterior shoulder instability (PSI). The purpose of this study was to analyze the comprehensiveness as well as inter- and intra-rater reliability of the ABC classification. MethodsIn a prospective study all consecutive patients presenting with unidirectional PSI from June 2019 to June 2021 were included. No patients were excluded, leaving a consecutive series of 100 cases in 91 patients. All recorded clinical and imaging data was used to create anonymized clinical case vignettes, which were evaluated twice according to the ABC classification at the end of the recruitment period in random sequential order by four independent raters, two experienced shoulder surgeons and two orthopedic residents in order to analyze the comprehensiveness as well as inter- and intra-rater reliability of the ABC classification for posterior shoulder instability and to describe differences in characteristics among subtypes. Group A was defined as first-time singular posterior shoulder instability event less than 3 months in the past regardless of etiology and is further subdivided in Type 1 and Type 2 depending on the occurrence of a subluxation (A1) or dislocation (A2). Group B comprises recurrent dynamic PSI regardless of time since onset and is further subdivided by the cause of instability in functional (B1) and structural (B2) dynamic PSI. Group C includes chronic static PSI with posterior humeral decentering that can either be constitutional (C1) or acquired (C2). ResultsNone of the cases was deemed unsuitable to be classified based on the proposed system by the observers. After consensus agreement between the two experts 16 cases were attributed to group A (A1: 8, A2: 8), 64 to group B (B1: 33, B2: 31), and 20 to group C (C1: 11, C2: 9). The expert raters agreed in 99% and 96% of the cases on the classification subtypes during the first and second rating (ICC: 0.998 and ICC: 0.99). The intraobserver reliability was excellent for both raters. The beginners reached the same conclusion as the consensus agreement in 94% (ICC: 0.99) and 89% of the cases (ICC: 0.97) during the first round and 94% each (ICC: 0.97) during the second round. The intraobserver reliability was excellent for both beginners. Overall, discrepancies between raters were found between groups B1 and B2 (n=14), B2 and C2 (n=4), B1 and C1 (n=1), as well as A1 and B2 (n=1). In general, each subtype shows distinctive clinical and imaging characteristics that facilitate the diagnosis. ConclusionThe presented ABC classification for PSI is a comprehensive classification with a high reliability and reproducibility. However, a gradual transition and potential progression between the subtypes of PSI must be considered. The reliable distinction between different subtypes of PSI based on etiology and pathomechanism provides a standardized basis for future investigations on treatment recommendation.

Shoulder &amp; Elbow

The December 2023 Shoulder &amp; Elbow Roundup360 looks at: Clavicle fractures: is the evidence changing practice?; Humeral shaft fractures, and another meta-analysis…let’s wait for the trials now!; Hemiarthroplasty or total elbow arthroplasty for distal humeral fractures…what does the registry say?; What to do with a first-time shoulder dislocation?; Deprivation indices and minimal clinically important difference for patient-reported outcomes after arthroscopic rotator cuff repair; Prospective randomized clinical trial of arthroscopic repair versus debridement for partial subscapularis tears; Long-term follow-up following closed reduction and early movement for simple dislocation of the elbow; Sternoclavicular joint reconstruction for traumatic acute and chronic anterior and posterior instability.

Readability of Online Information on the Latarjet Procedure.

Introduction A common complication of first-time or recurrent shoulder dislocations is bone loss at the humeral head and glenoid. Recurrent shoulder instability is often a result of bony defects in the glenoid following shoulder dislocations. In the setting of glenoid bone loss, surgical interventions are generally required to restore stability. The Latarjet procedure is a challenging operation and, due to its complexity, may be associated with operative complications. It can be difficult to explain the procedure to patients in a manner that is easily comprehensible, which may lead to confusion or being overwhelmed with information. Hence, it is important that the information available to patients is easily accessible and perceivable to allow for adequate health literacy. Health literacy is defined as the ability to make health decisions in the context of everyday life. Methods The search engines Google and Bing were accessed on a single day in the month of July 2023, searching the terms "Latarjet surgery" and "Latarjet procedure." For each term on both search engines, the first three pages were evaluated, resulting in a total of 114 websites for review. Out of these, 25 websites met the inclusion criteria and underwent further in-depth analysis through the online readability software, WEB FX. This software generated a Flesch Reading Ease Score (FRES) and a Reading Grade Level (RGL) for each website. Results In our study, the mean FRES was 50.3 (SD ±12.5), categorizing the data as 'fairly difficult to read.' The mean RGL score was 8.12 (SD ±2.35), which exceeds the recommended target. Conclusion In conclusion, the results of this study have demonstrated that the material available on the Internet about the Latarjet procedure is above the recommended readability levels for the majority of the population. Our findings align with similar studies assessing the readability of online patient information. Based on these findings, physicians should provide patients with vetted information to facilitate a better understanding of the procedure, thereby enabling patients to make more informed decisions regarding their health.

Functional and Sport-Specific Outcome Following Traumatic First-Time Shoulder Dislocation and Arthroscopic Surgical Repair in Rock Climbers.

Traumatic shoulder dislocations rank among the most common shoulder injuries in climbers, with rising numbers over the last years. The objective of this study was to analyze the outcome following traumatic first-time shoulder dislocation and subsequent surgical treatment in this population. In a retrospective study, climbers who experienced a traumatic shoulder dislocation were treated with an arthroscopic repair of the labrum-ligament complex (LLC). The functional outcome was assessed with a standardized questionnaire and clinical examination, including the Constant Murley and Single Assessment Numeric Evaluation scores. The sport-specific outcome was analyzed using the Union Internationale des Associations d'Alpinisme (UIAA) scale of difficulty and a sport-specific outcome score. The functional and sport-specific outcome for 27 climbers (20 men; 7 women; 3 with bilateral injuries; age, 34±11 [17-61] y; data presented as mean±SD [range]) was assessed 53±29 (12-103) mo after surgery. The postoperative Constant Murley score was 95±8 (67-100) points. At follow-up, 93% (n=25) of patients had started climbing again. Twenty-one climbers (78%) reached a climbing level within the range of ±0.33 UIAA grades of their initial capability or even exceeded their preinjury grade. Only 7% (n=2) of the patients had a recurrent shoulder dislocation, leading to a secondary surgery, and, therefore, required ongoing postoperative treatment at the time of follow-up. Arthroscopic repair of the LLC following first-time traumatic shoulder dislocation in climbers shows a good outcome and a low recurrence rate. After surgery, most patients are able to regain a high level of rock-climbing ability.

Arthroscopic Bankart repair versus nonoperative management for first-time anterior shoulder instability: A cost-effectiveness analysis.

Arthroscopic Bankart repair (ABR) may be more effective than nonoperative management for patients with anterior shoulder instability following first-time dislocation. The purpose of the study was to determine the most cost-effective treatment strategy by evaluating the incremental cost-effectiveness ratio (ICER) for ABR versus nonoperative treatment. This cost-effectiveness study utilized a Markov decision chain and Monte Carlo simulation. Probabilities, health utility values, and outcome data regarding ABR and nonoperative management of first-time shoulder instability derived from level I/II evidence. Costs were tabulated from Centers for Medicaid & Medicare Services. Probabilistic sensitivity analysis was performed using >100,000 repetitions of the Monte Carlo simulation. A willingness-to-pay (WTP) threshold was set at $50,000. The expected cost for operative management higher than nonoperative management ($32,765 vs $29,343). However, ABR (5.48 quality-adjusted life years (QALYs)) was the more effective treatment strategy compared to nonoperative management (4.61 QALYs). The ICER for ABR was $3943. Probabilistic sensitivity analysis showed that ABR was the most cost-effective strategy in 100% of simulations. ABR is more cost-effective than nonoperative management for first-time anterior shoulder dislocation. The threshold analysis demonstrated that when accounting for WTP, ABR was found to be the more cost-effective strategy.

At long-term follow-up many first-time male traumatic shoulder dislocators remain symptomatic.

To assess the status at 13 to 17 years follow-up of a cohort of young male traumatic shoulder dislocators. Prospective cohort study. A prospective study of first-time young male traumatic shoulder dislocators, began in 2004. Subjects were evaluated by the apprehension test after completing rehabilitation 6 to 9 weeks post dislocation. Between March 2021 and July 2022, a telephone questionnaire was administered to ascertain their current shoulder status. Subjects were questioned about avoidance of activities of daily living and sport, participation in sports, current instability, and self-assessed shoulder function by the SANE score. 50/53 (94.3%) of the study subjects, mean age 20.4 years, completed a mean follow-up of 181.8 ± 12 months. The non-redislocation survival was 13% for those with a positive apprehension test and 49% for those with a negative test (p = 0.007). SANE scores were 64.3 ± 23.7 for those with a positive apprehension test and 83.7 ± 19.7 for those with a negative test (p = 0.001). In the year before the follow-up, 33.3% of those treated conservatively and 42.9% treated surgically experienced subluxation (p = 0.5). Fifty-seven percent of those who were treated conservatively and 56% of those who underwent surgery avoided some ADL or sports because of their shoulder. For young male first time traumatic shoulder dislocators a positive apprehension test after rehabilitation is associated with a high risk for reoccurrence and poorer long-term results. Most subjects were still dealing with shoulder symptoms at long-term follow-up.

Treatment of Sports Injuries in Orthopedic Surgery: Recent Advances

This article reviews the most recent advances in the literature regarding orthopedic surgery for sports injuries. For large-to-massive rotator cuff tears, non-surgical treatment yielded superior results at three months to surgical treatment, although surgical treatment provided better results over time. Arthroscopic partial repair without a posterior interval slide yielded superior results to complete arthroscopic rotator cuff repair with a posterior interval slide. Graft bridging yielded superior results to superior capsular reconstruction. In first-time shoulder dislocations, arthroscopic Bankart repair has yielded superior results to arthroscopic washout. In high-grade acromioclavicular separation, a single clavicle tunnel tendon graft construct is preferable to a double tunnel construct. In femoroacetabular impingement, patients treated with hip arthroscopy had superior short-term results to those treated with physiotherapy alone. The odds of needing anterior cruciate ligament (ACL) graft revision were 2.1-fold higher for patients using a hamstring autograft than those using a patellar bone-tendon-bone (BTB) autograft. The use of a patellar tendon graft reduced the risk of graft rupture. The return-to-sports rate was higher for patients who underwent surgery with a BTB autograft than those with an autograft hamstring. The combination of lateral extra-articular tenodesis and ACL reconstruction-ACLR (single-bundle hamstring autograft) decreased the risk of ACLR failure after two years of follow-up. In complete mid-substance ACL injuries, the bridge-enhanced ACL repair technique resulted in similar outcomes to autograft ACLR. Fresh-frozen allografts have been a good alternative to autografts in ACLR. In posterior medial meniscal root tears, root repair was associated with less arthritic progression than non-surgical treatment and partial meniscectomy. Medial patellofemoral ligament (MPFL) reconstruction has provided better results than MPFL repair in patellofemoral instability.

Athletic Identity and Shoulder Overuse Injury in Competitive Adolescent Tennis Players: The Smash Cohort Study.

ObjectivesOur primary aim was to determine if athletic identity is prospectively associated with shoulder overuse injuries. Secondly, we aimed to determine if athletic identity is prospectively associated with playing through pain and to describe how athletic identity relates to sex, age, playing level, weekly training load, and match volume.MethodsA cohort of 269 adolescent tennis players were followed over a period of 52 weeks. Cox regression was used to estimate the hazard rate ratio (HRR) of first-time shoulder overuse injury associated with every 10-unit increase on the Athletic Identity Measurement Scale (AIMS).ResultsThe adjusted HRR of shoulder overuse injury was 0.89 (95% CI: 0.36–2.20) and the odds ratio of playing through pain was 2.41 (95% CI: 0.74–8.96) for every 10 unit increase on AIMS. The level of athletic identity was higher among players at the national level than among players at the regional level and was weakly correlated to weekly hours of tennis matches, tennis training, and fitness training.ConclusionsOur results indicate that higher levels of athletic identity may be associated with a lower incidence of shoulder overuse injuries, and potentially with playing through pain, although these results are inconclusive due to wide confidence intervals.

Long-Term Effects of Immobilization in External Rotation after First-time Dislocation of the Shoulder: An 18-Year Follow-Up

Immobilization in external rotation after a first-time shoulder dislocation has been introduced to reduce the risk of recurrence compared to immobilization in internal rotation; however, its long-term effects remain unknown. This study aimed to determine the long-term effect of immobilization in external rotation after a first-time shoulder dislocation.

Long-term effect of immobilization in external rotation after first-time shoulder dislocation: an average 18-year follow-up.

Immobilization in external rotation (ER) after a first-time shoulder dislocation was introduced to reduce the risk of recurrence compared with immobilization in internal rotation (IR), but its efficacy remains controversial. The purpose of this study was to determine the long-term effect of immobilization in ER after a first-time shoulder dislocation. Between October 2000 and March 2004, 198 patients with a first-time anterior dislocation of the shoulder (average age 37) were randomly assigned to immobilization in ER (ER group = 104 shoulders) or IR (IR group = 94 shoulders) for 3 weeks. At an average 2-year follow-up, 159 patients (80.3%) were available for evaluation. In the current study, these 159 patients were further followed up and interviewed by telephone. The following items were evaluated: recurrent instability, apprehensive feeling, surgical intervention, limitation in the range of motion, return to sports, and the Single Assessment Numeric Evaluation (SANE) score. The average follow-up period was 18.2 years (range, 16-20 years). Fifty-six patients were available for follow-up with the follow-up rate of 35%. The number of recurrent patients was 6 of 27 (22%) in the ER group and 6 of 29 (21%) in the IR group (P = .889). The number of surgically stabilized patients was 3 of 27 (11%) in the ER group and 10 of 29 (34%) in the IR group (P = .038). In total, the recurrence rate was 33% (9 of 27) in the ER group and 55% (16 of 29) in the IR group (P = .100). Adding the surgical cases and those with the SANE score ≤70% as failure cases, the failure rate in the ER group (26%) was significantly lower than that in the IR group (52%) (P = .048). Among those who survived without surgical intervention, there were no significant differences in apprehensive feeling, return to sports, limited range of motion, and the SANE score between the groups. Immobilization in ER reduced the risk of surgical intervention compared with IR in the long term.

174 An Audit on First Time Shoulder Dislocations: Are We Following BESS Guidelines?

Abstract Aim Traumatic shoulder dislocations are the most common joint dislocation in the UK. They are often associated with concurrent injury to the joint and its stabilisers which can occasionally get missed. This can severely affect functional recovery and lead to chronic instability. Our aim was to assess adherence to the BESS guidelines for first time shoulder dislocations in a large acute general hospital. Method We conducted a retrospective review of all patients who attended the emergency department at Birmingham Heartlands Hospital between January and December 2019. A total of 20 patients were selected after verifying data received from the health informatics team. Patient notes, investigations and clinic letters were reviewed. Results The average age of our cohort was 50 with a male to female ratio of 13:7. The cohort was divided into three groups depending on their age i.e.,16–25, 25–40 and &amp;gt;40. Although 85% were seen in a fracture clinic only 25% were seen by a consultant. It was noted that among all three groups only 40% of appropriate imaging was requested. In addition, only 50% were correctly referred to a shoulder surgeon or shoulder clinic to assess shoulder function, however most patients were seen by a physiotherapist. Conclusions We found a large number of concomitant injuries in those investigated for a first-time dislocation. We have therefore designed a pathway to ensure that all patients with a first-time shoulder dislocation are followed up in fracture clinic and appropriate investigations ordered in a timely manner.

Conservative treatment of acute traumatic posterior shoulder dislocations (Type A) is a viable option especially in patients with centred joint, low gamma angle, and middle or old age

PurposePurpose of this study was to evaluate the mid- to long-term outcome after conservatively treated first-time posterior shoulder dislocations and to determine structural defects associated with failure.MethodsIn this multi-centric retrospective study, 29 shoulders in 28 patients with first-time acute posterior shoulder dislocation (Type A1 or A2 according to the ABC classification) and available cross-sectional imaging were included. Outcome scores as well as radiological and magnetic resonance imaging were obtained at a mean follow-up of 8.3 ± 2.7 years (minimum: 5 years). The association of structural defects with redislocation, need for secondary surgery, and inferior clinical outcomes were analysed.ResultsRedislocation occurred in six (21%) shoulders and nine shoulders (31%) underwent secondary surgery due to persistent symptoms. The posttraumatic posterior glenohumeral subluxation was higher in the redislocation group compared to the no redislocation group; however, statistical significance was not reached (61.9 ± 12.5% vs. 50.6 ± 6.4%). Furthermore, a higher adapted gamma angle was observed in the failed conservative treatment group versus the conservative treatment group, similarly without statistically significant difference (97.8° ± 7.2°, vs. 93.3° ± 9.7°). The adapted gamma angle was higher than 90° in all patients of failed conservative therapy and the redislocation group. An older age at the time of dislocation showed a significant correlation with better clinical outcomes (SSV: r = 0.543, p = 0.02; ROWE: r = 0.418, p = 0.035 and WOSI: r = 0.478, p = 0.045). Posterior glenohumeral subluxation after trauma correlated with a worse WOSI (r = − 0.59, p = 0.02) and follow-up posterior glenohumeral decentring (r = 0.68, p = 0.007). The gamma angle (r = 0.396, p = 0.039) and depth of the reverse Hill–Sachs lesion (r = 0.437, p = 0.023) correlated significantly with the grade of osteoarthritis at follow-up.ConclusionConservative treatment is a viable option in patients with an acute traumatic posterior shoulder dislocation with good outcome after mid- and long-term follow-up especially in patients with centred joint, low gamma angle, and middle or old age.Level of evidenceIV.

Evaluation of the Davos self-assisted technique for reduction of anterior glenohumeral dislocations: a comparative study with the traction/countertraction technique.

BackgroundFew studies have compared conventional and self-assisted shoulder reduction maneuvers. The goal of this study was to evaluate the results of self-assisted Davos vs. traction/countertraction (T/Ct) techniques in the treatment of acute anterior shoulder dislocations.MethodsThis was a single-center, prospective study carried out at a tertiary hospital emergency department. Patients aged 18-69 years old, with radiographic confirmation of anterior glenohumeral dislocations, were consecutively allocated to treatment groups. Recorded data included pain at admission (visual analog scale [VAS] score at admission), analgesia before reduction, maximum pain during reduction (maximum VAS score), demographic characteristics, lesion mechanism, laterality, prior dislocation, and immediate complications. The primary outcomes were reduction success rate and pain.ResultsEighty individuals were included (40/group). Regarding the success rate, no statistically significant differences were found between Davos or T/Ct (87.5% vs. 85%; P = .058). The maximum VAS score was significantly lower in Davos than that in T/Ct (4.18 ± 2.00 vs. 6.30 ± 2.13; P < .001). The effect of analgesia in the maximum VAS score was more evident among Davos patients, with significantly lower pain in the subgroup who were provided analgesia (3.63 ± 2.02 vs. 5.31 ± 2.01; P = .01).DiscussionDavos was as effective as T/Ct for reduction of acute anterior shoulder dislocations (highest reported success rate: 87.5%) and conditioned a less traumatic experience, with significantly lower pain during reduction (the maximum VAS score was more than 2 points lower in the Davos group; P < .001). Analgesia had a synergistic effect among patients submitted to the Davos technique, suggesting that T/Ct is inherently more painful.ConclusionThe Davos is a patient-controlled, atraumatic, and safe technique, allowing successful, gentle, and less painful glenohumeral reduction. These findings favor Davos as an easy-to-teach and effective first-line treatment for first-time and recurrent shoulder dislocations.

Greater tuberosity fractures are not a continuation of Hill-Sachs lesions, but do they have a similar etiology?

BackgroundIt is unclear whether greater tuberosity fractures (GTF) in the setting of a shoulder dislocation are due to an avulsion of the rotator cuff or a result of an extensive Hill-Sachs lesion (HSL). To explore whether these lesions have similar etiology, the primary aim of this study is to compare the postinjury morphology of the proximal humerus after GTF and HSL.MethodsComputed tomography scans of 19 patients with HSL and 18 patients with GTF after first-time shoulder dislocations were analyzed. We assessed the location by measuring height in relation to the highest point of the humerus and angles for the origin (most medial point of lesion), center, and endpoint (most lateral point of lesion) between GTF and HSL and the bicipital groove. For both GTF and HSL, we assessed whether infraspinatus and supraspinatus insertions were involved and whether they were off-track or on-track.ResultsMeasured from the bicipital groove, HSLs and GTFs have different origins (153˚ vs. 110˚; P < .0001, respectively), centers (125˚ vs. 60˚; P < .0001, respectively), and endpoints (92˚ vs. 37˚; P < .0001, respectively). HSLs had a higher position (0.76 cm vs. 1.71 cm; P < .0001), involved the supraspinatus footprint less often (16% vs. 72%; P = .0008), and were less likely to be off-track (31% vs. 94%; P = .0002). Half of the GTF were on the lateral side of the glenoid track and thus extra-capsular, versus 0% of HSL.ConclusionHSLs and GTFs have different anatomical characteristics and thus GTFs are likely to be distinct from extensive HSLs.

Arthroscopic Bankart Repair Versus Open Latarjet for First-Time Dislocators in Athletes.

Background:In athletes with a first-time shoulder dislocation, arthroscopic Bankart repair (ABR) and the open Latarjet procedure (OL) are the most commonly utilized surgical procedures to restore stability and allow them to return to play (RTP).Purpose:To compare the outcomes of ABR and OL in athletes with a first-time shoulder dislocation.Study Design:Cohort study; Level of evidence, 3.Methods:We performed a retrospective review of patients with first-time shoulder dislocation who underwent primary ABR and OL and had a minimum 24-month follow-up. Indications for OL over ABR in this population were those considered at high risk for recurrence, including patients with glenohumeral bone loss. Patients who underwent ABR were pair-matched in a 2:1 ratio with patients who underwent OL by age, sex, sport, and level of preoperative play. The rate, level, and timing of RTP, as well as the Shoulder Instability–Return to Sport after Injury (SIRSI) score were evaluated. Additionally, we compared recurrence, visual analog scale pain score, Subjective Shoulder Value, Rowe score, satisfaction, and whether patients would undergo the surgery again.Results:Overall, 80 athletes who underwent ABR and 40 who underwent OL were included, with a mean follow-up of 50.3 months. There was no significant difference between ABR and OL in rate of RTP, return to preinjury level, time to return, or recurrent dislocation rate. There were also no differences between ABR and OL in patient-reported outcome scores or patient satisfaction. When collision athletes were compared between ABR and OL, there were no differences in RTP, SIRSI score, or redislocation rate.Conclusion:ABR and OL resulted in excellent clinical outcomes, with high rates of RTP and low recurrence rates. Additionally, there were no differences between the procedures in athletes participating in collision sports.