Glenohumeral Dislocation Research Articles

Posterior Stabilization and Reverse Hill-Sachs Remplissage Using Linked Knotless Anchors

Posterior glenohumeral dislocation can result in impaction fractures to the anteromedial humeral head, known as a reverse Hill-Sachs lesion. They may also cause damage to the posterior capsuloligamentous structures. This can lead to ongoing posterior instability and altered biomechanics resulting in early degenerative changes. Ongoing symptoms may result in challenges to a patient’s day-to-day and sporting activities. Early intervention to stabilize the shoulder may help avoid these. We present a reproducible technique for posterior stabilization using linked knotless anchors to perform a remplissage of the subscapularis into the reverse Hill-Sachs lesion defect that avoids the need for exposure of the subcoracoid bursa.

Open Latarjet reduces residual apprehension, redislocation and possibility of dislocation arthropathy compared to arthroscopic Bankart repair despite greater bipolar bone loss in anterior glenohumeral instability

BackgroundArthroscopic Bankart repair (ABR) and the open Latarjet (OL) procedure are the most frequently preferred methods in the treatment of anterior glenohumeral instability. The aim of this study was to compare patients who underwent ABR or OL due to anterior glenohumeral instability in terms of functional capacity, glenohumeral bone loss, residual apprehension, redislocation and dislocation arthropathy. MethodsA total of 56 patients who underwent ABR or OL due to anterior glenohumeral instability between January 2018 and December 2021 were evaluated retrospectively. There were 32 patients in the ABR group and 24 patients in the OL group. Patients’ demographic characteristics, number of preoperative dislocations, and return-to-work and follow-up periods were recorded. Glenoid bone loss, Hill-Sachs interval, and Hill-Sachs depth were measured from preoperative computed tomography sections. The ASES score, WOSI score, Rowe score, and joint range of motion were calculated. Patients were also asked about residual apprehension, postoperative redislocations, dislocation arthropathy and surgery satisfaction. ResultsThe mean age of the ABR group was 22.5±3.9 years (28 men, 4 women), while that of the OL group was 25.0±4.8 years (22 men, 2 women). The mean number of dislocations was 2.7±1.3 in the ABR and 10.9±5.5 in the OL (p=0.001). Higher values of glenoid bone loss (%) (ABR: 6±2; OL: 20±4), Hill-Sachs interval (mm) (ABR: 8±3; OL: 21±3), and Hill-Sachs depth (mm) (ABR: 5±2; OL: 8±2) were measured in the OL (p=0.001 for all), reflecting significantly more bone loss. Residual apprehension was detected in 10 patients in the ABR and 2 patients in the OL (p=0.007). While 4 patients in the ABR had a history of redislocation, no redislocation occurred in the OL (p=0.012). Dislocation arthropathy development was observed in 9 patients in the ABR and 4 patients in the OL (p=0.038) according to the modified Samilson and Prieto classification. External rotation in adduction and external rotation in 90° abduction were approximately 5° higher in the OL (p=0.011 and p=0.016, respectively). ConclusionThe ABR and OL methods both provide satisfactory outcomes in the treatment of anterior glenohumeral instability with appropriate indications. The OL procedure is preferred for patients with more dislocations and greater bipolar bone loss. Despite greater bipolar bone loss, the OL procedure provides lower rates of residual apprehension, redislocation and dislocation arthropathy. Additionally, due to the stability it provides, there is less loss in external rotation.

Comparison of the Latarjet Procedure and Iliac Crest Bone Graft Transfer in Bone Bankart Lesions in Recurrent Anterior Shoulder Dislocations.

There are various treatment modalities for bony Bankart lesions following glenohumeral joint dislocations. In this research, we aimed to compare the radiological and clinical results of patients who underwent the Latarjet procedure and iliac crest bone graft transfer. Clinical and radiological data of 15 patients were retrospectively evaluated. Inclusion criteria were a history of at least two dislocations, being between 18-65 years of age and having at least 10% glenoid bone loss. The exclusion criteria were defined as follows: patients who underwent only soft tissue procedures, patients who did not attend the follow-up, patients with other pathology in the upper extremity (fracture, cuff tear, etc.), and patients with a follow-up period of less than 12 months time. Nine patients underwent the Latarjet procedure and six underwent iliac crest bone graft transfer. Clinical evaluation, age, gender, body mass index, range of motion, Quick Disabilities of the Arm, Shoulder and Hand (QDASH) score, Constant score, and Visual Analogue Scale (VAS) score were evaluated. Radiographic evaluation was performed with preoperative and postoperative direct radiographs and computed tomography. Mann-Whitney U test, t-test, and Fisher exact tests were used for group comparisons. The mean age of the patients was 32.6 years and the mean follow-up period was 24.9 months. When the two groups were compared, no statistical difference was found in terms of age, gender, body mass index, range of motion, Constant score, VAS score, glenoid cartilage stepping, and bone defect (p>0.05). The operation time was longer in the iliac crest bone graft transfer group compared to the Latarjet group (p<0.05). Latarjet and iliac crest bone graft transfer can be used successfully in the treatment of bony Bankart in recurrent anterior shoulder dislocations. The operation time is longer in iliac crest bone graft transfer compared to the Latarjet procedure.

The association between the insurance provider and rates of surgical stabilization for the treatment of glenohumeral dislocation: A nationwide retrospective analysis

The association between the insurance provider and rates of surgical stabilization for the treatment of glenohumeral dislocation: A nationwide retrospective analysis

The “glass shoulder”: Patients’ lived experiences of a traumatic shoulder dislocation – A qualitative study

BackgroundAnterior shoulder dislocations have a high recurrence rate, often necessitating stabilizing surgery, with residual long-term fear of reinjury. ObjectivesTo explore patients’ experiences of anterior shoulder dislocations in relation to their lives, well-being, fear of reinjury, and future perspectives. DesignQualitative study. MethodsWe interviewed fourteen individuals (median age 27.5 yrs, range 21–40; two women) with traumatic anterior glenohumeral dislocation within 5 years, with or without past stabilizing surgery. We analysed data using Interpretive Description. ResultsWe constructed three main themes. (1) Downward wellness spiral: The injury shattered their lives, influencing their self-identity and -confidence. Sleep disturbances added to stress levels, loss, depression and grief. The re-injury risk could lead to social isolation. (2) Out of arm's reach: Recurrences led to frustration as the prior surgery and rehabilitation appeared to have been unsuccessful, having to start again. Support from healthcare providers and whānau/family was crucial to regain trust in the body. (3) Obligatory compromise: Over time, some individuals accepted the re-injury risk, learnt to heed warning signals, or compromised by avoiding specific social and recreational activities, changing their sports or to other roles in their preferred sport, and adapting work-related and daily tasks. ConclusionParticipants described in-depth socio-emotional responses following shoulder dislocations. Most participants described an ongoing interplay between fear and confidence in their shoulder. Healthcare provider support and professional relationship, on-going shoulder-related strengthening, and risk mitigation strategies were important to facilitate and maintain confidence and self-efficacy, and to re-consider and adjust the participant's goals when needed.

Assessment of shoulder joint derangements with magnetic resonance imaging in adult Nigerians.

Shoulder pain secondary to various aetiologies is a common musculoskeletal complaint worldwide, and Magnetic Resonance Imaging (MRI) is the most accurate imaging method for evaluating shoulder pain in all age groups. While the patterns of shoulder MRI abnormalities in various demographics have been reported, data on sub-Sahara African populations are still sparse. This study aims to describe the imaging features and spectrum of shoulder joint pathologies on MRI in adult Nigerians. This was a retrospective review of the shoulder MRI of 100 adult Nigerians (with and without trauma) from September 2020 to December 2021. Their clinical data and shoulder MRI findings were extracted and analysed. Statistical significance was set at P ≤ 0.05. There were 64 males and 36 females aged 18-82 years. Right shoulder MRI was done in 53 subjects (53%), while the left shoulder was studied in 47 (47%). Supraspinatus tendinopathy (73%), acromioclavicular joint arthropathy (68%), and subacromial-subdeltoid (SASD) bursitis (64%) were the most frequently detected pathologies. Other demonstrated derangements include glenohumeral joint effusion (24%), long head of biceps tendon sheath effusion (18%), labral abnormalities (16%), subcoracoid bursitis (4%), Hill Sach's deformity (3%), anterior glenohumeral dislocation (2%), fatty degeneration of the supraspinatus/infraspinatus muscles (2%), adhesive capsulitis (1%), and other bony abnormalities (contusion, erosion, subchondral cysts). There was no significant difference in the frequency of shoulder abnormalities between the male and female subjects. Acromioclavicular joint arthropathy, SASD bursitis, and rotator cuff disorders were the dominant pathologies in the participants' shoulders.

Biomechanical study of 3D-printed titanium alloy pad for repairing glenoid bone defect.

Background: The purpose of this study was to investigate the effect of 3D-printed technology to repair glenoid bone defect on shoulder joint stability. Methods: The shoulder joints of 25 male cadavers were tested. The 3D-printed glenoid pad was designed and fabricated. The specimens were divided into 5 groups. Group A: no bone defect and the structure of the glenoid labrum and joint capsule was intact; Group B: Anterior inferior bone defect of the shoulder glenoid; Group C: a pad with a width of 2mm was installed; Group D: a pad with a width of 4mm was installed; Group E: a pad with a width of 6mm was installed. This study measured the distance the humeral head moved forward at the time of glenohumeral dislocation and the maximum load required to dislocate the shoulder. Results: The shoulder joint stability and humerus displacement was significantly lower in groups B and C compared with group A (p < .05). Compared with group A, the stability of the shoulder joint of group D was significantly improved (p < .05). However, there was no significant difference in humerus displacement between groups D and A (p > .05). In addition, compared with group A, shoulder joint stability was significantly increased and humerus displacement was significantly decreased in group E (p < .05). Conclusion: The 3D-printed technology can be used to make the shoulder glenoid pad to perfectly restore the geometric shape of the shoulder glenoid articular surface. Moreover, the 3D-printed pad is 2mm larger than the normal glenoid width to restore the initial stability of the shoulder joint.

PANORAMIC REVIEW OF MANAGEMENT, CONSERVATIVE TREATMENT AND SHOULDER REDUCTION TECHNIQUES

Introduction: The glenohumeral joint combines a wide range of motion and insufficient bony stabilization, making it susceptible to instability and dislocations. Glenohumeral dislocations are commonly attributed to contact sports, as well as bicycle accidents, falls and high impact trauma. Objective: to detail current information related to the incidence, clinical evaluation, imaging assessment, management, conservative treatment and shoulder reduction techniques of shoulder dislocations. Methodology: a total of 30 articles were analyzed in this review, including review and original articles, as well as clinical cases, of which 16 bibliographies were used because the other articles were not relevant for this study. The sources of information were PubMed, Google Scholar and Cochrane; the terms used to search for information in Spanish, Portuguese and English were: shoulder dislocation, glenohumeral dislocation, shoulder reduction maneuvers, shoulder reduction techniques. Results: The shoulder joint is frequently correlated to dislocations, showing up to 45% of all dislocations. Inferior as well as superior dislocations are rare. Chronic glenohumeral dislocations are infrequent injuries accounting for less than 2%. Anterior glenohumeral dislocations account for about 90% of shoulder dislocations. Approximately 50% to 79% of posterior glenohumeral dislocations are overlooked. Conclusions: As the epidemiology indicates, there is a high incidence of shoulder dislocations, so it is important to recognize the importance of adequate clinical assessment, diagnosis and knowledge of reduction maneuvers for the management of glenohumeral dislocations. There are several types of maneuvers that can be used for reduction of a dislocated shoulder, these maneuvers can be chosen according to the case of the affected individual, in addition to the preference and experience of the person who is going to perform the reduction maneuver. Imaging tests play an important role both at diagnosis and post-reduction to confirm reduction. KEY WORDS: shoulder, dislocation, techniques, reduction, conservative.

Demographics and Outcomes of Glenohumeral Dislocations in Individuals With Elevated Body Mass Index.

No specific study has investigated the characteristics and outcomes of anterior shoulder dislocations in morbidly obese individuals. The purpose of this study was to describe shoulder dislocations in patients with body mass index (BMI) greater than 40. A retrospective review was conducted to identify patients aged 18 years and older with a BMI ≥40 who presented with a shoulder dislocation in a single institution from 2000 to 2020. Dislocation patterns, associated injuries, treatment modalities, and associated complications were recorded. A significant increase was noted in the number of patients with BMI greater than 40 presenting per year (r2 = -0.831, P < 0.01) over the past 20 years. A significant increase was noted in the average BMI per year in this population (r2 = 0.504, P = 0.028). Fifteen patients (19.5%) experienced at least one recurrent dislocation episode. Ten patients had a Bankart lesion that was associated with an elevated BMI (P = 0.04). Nine patients (11.7%) sustained an associated neurologic injury (no association with BMI). Over time, there has been an increase in shoulder dislocations in morbidly obese individuals in the United States, alongside an overall increase in the average BMI of patients who present with shoulder dislocations.

A rare case of bilateral antero-internal shoulder dislocation: A case study and review of the literature

Introduction: Although anterior dislocations of the glenohumeral joint are the most frequent type of dislocation, bilateral forms are very rare [1] dominated by the posterior variant. We report a new case of bilateral anterior dislocation of the glenohumeral joints and discuss the mechanism and treatment. Case report: This concerns a 55-year-old patient, who presented to the emergency room with closed trauma to both shoulders in undetermined circumstances. The patient reported a disturbance of consciousness followed by a post-critical coma and generalized tonic-clonic seizures according to witnesses. Clinical examination revealed total functional impotence of the upper limbs, with the following findings: filling of the delto-pectoral groove, bilateral external axe strike, oedema of both shoulders. X-rays of both shoulders revealed bilateral anterior glenohumeral dislocation, with a nondisplaced fracture of the left great tuberosity. Discussion: Bilateral shoulder dislocation is a rare occurrence typically associated with specific etiologies such as epileptic seizures, electrical or neuromuscular disorders, or traumatic events. This report presents a case of bilateral shoulder dislocation in a patient with no history of ligament hyperlaxity, categorized under Brown's classification as traumatic origin. Despite the rarity of this presentation, similar unusual mechanisms of shoulder dislocation have been reported in the literature, including cases where each shoulder dislocated due to different mechanisms.

Shoulder injuries in Brazilian professional football players: epidemiological analysis of 3828 games

ObjectivesFootball is a globally played sport that poses potential risks for musculoskeletal injuries. Upper-limb injuries have a lower incidence rate than lower-limb injuries but can still cause absenteeism and performance impairment in football players. This descriptive epidemiological study aimed to evaluate and compare the epidemiological data on shoulder injuries among professional football players in two major Brazilian football championships. MethodsData were collected throughout the championships, and club physicians medically evaluated each player during official games using two online forms. The collected information included the player's age and position, injury diagnosis, laterality, location on the field where the injury occurred, playing time, imaging examinations performed, need for surgical treatment, time to return to play (TRP), and recurrence of the injury. The incidence of injuries was evaluated using the Federation Internationale de Football Association (FIFA) incidence formula. ResultsA total of 107 shoulder injuries were recorded (4.3% of all injuries), with a FIFA incidence of 0.847. Glenohumeral dislocations (GHDs) and acromioclavicular dislocations (ACDs) accounted for 37.38% and 35.51% of all shoulder injuries, respectively. Goalkeepers and defenders presented, respectively, a 2.15 and 1.57 times increased risk of suffering shoulder injuries, while attackers presented a 0.63 times decreased risk. Injury recurrence was observed in 14.95% of cases, with GHDs and ACDs showing recurrence rates of 35.00% and 5.26%, respectively. Surgery was performed in 9.35% of cases, with GHDs representing 50% of all surgeries. The average TRP was 22.37 days, with severe and major injuries accounting for 11.21% and 10.28% of all injuries, respectively. Goalkeepers had the highest average TRP of 36.15 days. Recurring injuries had a higher average TRP of 33.44 days compared to nonrecurring injuries, which had an average TRP of 20.43 days. Surgically treated injuries had the highest average TRP of 112.5 days. ConclusionShoulder injuries in the professional football scenario are of great concern due to the high recurrence rate and need for surgical treatment, which will lead to a long TRP. These findings emphasize the need to implement prevention protocols and effective treatments to reduce the consequences of such injuries, which are usually underestimated in this sport. Level of evidenceIII.

Mechanisms of shoulder trauma: Current concepts.

Acute traumatic injuries to the glenohumeral articulation are common. The types of injuries depend on age, muscle strength, bone density, and biomechanics of the traumatic event. Understanding the different mechanisms of trauma and how they affect the functional anatomical structures of the shoulder joint is crucial for the treatment of these lesions. Therefore, when clinicians have knowledge of these mechanisms they can accurately diagnose and treat shoulder pathology and predict distinct injury patterns. Here, we have described the fundamentals of the mechanisms of injury of the glenohumeral dislocation, dislocation with fracture of the humeral head, and the proximal humerus fracture. We have focused on common injury mechanisms and the correlation with radiological diagnostics. Radiological and laboratory findings of distinct types of injury were also discussed.

Anterior shoulder dislocation with avulsion fracture of the greater tuberosity results in reliable good outcomes after closed reduction

BackgroundAvulsion of the greater tuberosity (GT) due to traumatic anterior shoulder dislocation (ASD) is a commonly observed fracture pattern. After closed reduction of the dislocated humerus, the greater tuberosity typically reduces itself into its anatomic position enabling the patient to undergo conservative treatment. The aim of this study was to retrospectively review a consecutive series of patients with conservatively treated GT avulsion fractures after closed reduction of an ASD and analyze radiographic outcome, shoulder function and glenohumeral stability and the conversion rate to surgical treatment. Material and methodsAll patients who underwent closed reduction of a GT avulsion fracture after ASD with the primary intention of conservative treatment between 2017 and 2022 were included. Complications (i.e. conversion to surgical treatment), shoulder function assessed with the American Shoulder and Elbow Surgeons (ASES) score and subjective shoulder value (SSV), instability assessed with the Western Ontario Shoulder Instability (WOSI) score, radiological impingement (greater tuberosity index = GTI and impingement index = II) and GT fracture pattern were assessed as outcome measurements. ResultsA total of 29 patients (mean age 44 years, 27% female) with a mean follow-up of 32.6 (range, 8-96) months were enrolled. Seven patients (24%) underwent surgery due to secondary displacement (n=4, 14%) or impingement symptoms (n=3, 10%). All patients who underwent secondary surgery showed a multifragmentary fracture pattern of the GT. Shoulder stiffness (n=7) and neuropraxia of the axillary nerve (n=3) were observed temporarily and resolved during the follow-up period. The ASES and SSV of the conservatively treated patients at the last follow-up was 89.2±19.1 respectively 86±18.2%. No recurrent glenohumeral dislocation was documented. The mean WOSI score at last follow-up was 8(0-71). The mean GTI decreased from 1.2±0.1 after ASD to 1.1±0.1 at the last follow-up (p=0.002). The mean II decreased from 0.6±0.5 after ASD to 0.4±0.3 at the last follow-up (p=0.110). ConclusionThe greater tuberosity avulsion fragment reduces typically into a close to anatomic position after closed reduction and the greater tuberosity index even improves with further conservative treatment over time. Close radiological follow-up is necessary to rule out secondary displacement which occurs typically in a multifragmentary fracture pattern. Patients without the need for surgery showed good clinical outcomes without recurrence of glenohumeral instability.

Traumatic avulsion of the subscapularis tendon in adolescents: Return to sport after surgical repair

IntroductionTraumatic complete rotator cuff tears are rare in the pediatric population. These injuries might be a result of shoulder dislocation or direct trauma experienced during contact sports (i.e., rugby, judo). The purpose of this study was to identify the epidemiologic and clinical characteristics of these injuries and assess the medium- and long-term outcomes following surgery, with return to sport as the primary endpoint. Materials and methodsAn electronic questionnaire was sent to all surgeons who were members of the French Shoulder and Elbow Society (SOFEC) and/or the French Society of Arthroscopy (SFA), asking if they ever had to surgically treat a traumatic complete tear of 1 or more rotator cuff tendons in a child or adolescent. Ninety (38.6%) of the 233 surgeons members of the SOFEC and/or the SFA responded to our questionnaire. We then contacted the 15 surgeons who answered affirmatively to collect the complete medical records of their patient(s). ResultsWe reviewed the records of 17 children and adolescents who underwent surgery for a traumatic complete rotator cuff tear. The mean age at surgery was 15.2 years (range, 12–17). Glenohumeral dislocation during contact sports (n=7/17) was a frequent mechanism of injury (41%). All of these cases involved at least the subscapularis muscle with an avulsed bony insertion. The injury involved other rotator cuff tendons in 29% of cases (5/17). The bone and tendon repair was either performed as open surgery (n=5/17) or arthroscopically (n=12/17). At a median follow-up of 24 months and a mean follow-up of 50 months, 82.4% of patients had returned to sport at their preinjury level. Three patients presented neurologic complications resulting from the traumatic event, but only 1 of them required nerve grafting with a favorable outcome. We also reported 3 cases of nonunion of the lesser tuberosity that required revision surgery with good outcomes. Only 1 patient out of all those with at least 1 episode of dislocation presented a recurrent anterior shoulder instability that required a bone block-type procedure 7 years after the initial surgery. ConclusionTraumatic complete rotator cuff tears are rare in children and adolescents. They often occur during contact sports. These types of injuries are diagnosed by clinical examination and confirmed by cross-sectional imaging, ideally magnetic resonance imaging. Tendon injuries mainly involve the subscapularis but can also affect other cuff tendons. Return to preinjury activity levels after surgical management was possible in more than 80% of cases. Level of evidenceIV.

Functional Outcome Of Bristow-Latarjet Procedure In Post-Traumatic Recurrent Anterior Shoulder Instability.

Due to its lack of bony support, the shoulder joint has the broadest range of motion out of all the joints in the body. Instead, one of the joints that dislocate most frequently is the shoulder joint. Multiple pathologic abnormalities, including the traumatic separation of the anterior-inferior capsule-labral complex from the glenoid rim, are caused by repeated anterior glenohumeral dislocation. The objective of the study is to ascertain the Bristow-LATARJET procedure's efficacy in situations of recurrent post-traumatic anterior shoulder instability. From 31 January 2020 to 31 July 2020, a descriptive case series was undertaken in the orthopaedic surgery department of the Lahore General Hospital. For this study, 71 patients who met the inclusion and exclusion criteria were recruited, and all interventions were conducted while the patients were lying in a beach chair while under general anaesthesia. The Delto-pectoral incision surgical technique was applied. For 12 weeks, all patients underwent clinical follow-up, and the results were documented. There were 50(70.4%) males and 21(29.6%) females in this study & the mean age of the patients were 34.64±10.73. There were 37(52.1%) patients among them the outcome of treatment (Rowe Scale at 12th week) was excellent, among 21(29.6%) it was good, among 8(11.3%) it was fair and among 5 (7.0%) it was poor. There was a significant association between the outcome of treatment (Rowe scale at 12th week) and age groups (p-value: 0.000). The Bristow-LATARJET procedure is deemed to be a very productive, safe, and problem-free procedure for curing post-traumatic reoccurring traumatic anterior shoulder instability.

CLINICAL OUTCOMES FOLLOWING GLENOHUMERAL DISLOCATION WITH GREATER TUBEROSITY FRACTURE

A fracture of the tuberosity is associated with 16% of anterior glenohumeral dislocations. Manipulation of these injuries in the emergency department is safe with less than 1% risk of fracture propagation. However, there is a risk of associated neurological injury, recurrent instability and displacement of the greater tuberosity fragment. The risks and outcomes of these complications have not previously been reported. The purpose of this study was to establish the incidence and outcome of complications associated with this pattern of injury.We reviewed 339 consecutive glenohumeral dislocations with associated greater tuberosity fractures from a prospective trauma database. Documentation and radiographs were studied and the incidence of neurovascular compromise, greater tuberosity fragment migration and intervention and recurrent instability recorded.The mean age was 61 years (range, 18–96) with a female preponderance (140:199 male:female). At presentation 24% (n=78) patients had a nerve injury, with axillary nerve being most common (n=43, 55%). Of those patients with nerve injuries 15 (19%) did not resolve. Greater tuberosity displacement &gt;5mm was observed in 36% (n=123) of patients with 40 undergoing acute surgery, the remainder did not due to comorbidities or patient choice. Persistent displacement after reduction accounted for 60 cases, later displacement within 6 weeks occurred in 63 patients. Recurrent instability occurred in 4 (1%) patients. Patient reported outcomes were poor with average EQ5D being 0.73, QDASH score of 16 and Oxford Shoulder Score of 41.Anterior glenohumeral dislocation with associated greater tuberosity fracture is common with poor long term patient reported outcomes. Our results demonstrate there is a high rate of neurological deficits at presentation with the majority resolving spontaneously. Recurrent instability is rare. Late tuberosity fragment displacement occurs in 18% of patients and regular follow-up for 6 weeks is recommended to detect this.

GLENOHUMERAL DISLOCATION, ANATOMICAL DESCRIPTION, EPIDEMIOLOGY, MECHANISMS OF ACTION, CLASSIFICATION, CLINICAL PRESENTATION, IMAGING PRESENTATION, TREATMENT AND COMPLICATIONS

Introduction: Acute shoulder injuries that are common here include acromioclavicular joint injuries, clavicle fractures, glenohumeral dislocations, proximal humerus fractures and rotator cuff tears. Glenohumeral dislocations are frequently attributed to contact sports, as well as bicycle accidents, falls and high-impact trauma. Patients present several specific characteristics that will depend on the type of dislocation. Objective: to detail the current information related to glenohumeral dislocation, in addition to its description, epidemiology, classification, clinical evaluation, imaging presentation, treatment and complications of the different types of glenohumeral dislocation. Methodology: a total of 32 articles were analyzed in this review, including review and original articles, as well as clinical cases, of which 20 bibliographies were used because the other articles were not relevant for this study. The sources of information were PubMed, Google Scholar and Cochrane; the terms used to search for information in Spanish, Portuguese and English were: glenohumeral dislocation, shoulder pain, upper limb dislocation, shoulder reduction, shoulder dislocation. Results: Shoulder dislocations are usually anterior. In recurrent anterior dislocation, most recurrences occur in the first 2 years and mostly in males. Age at the time of initial dislocation has the greatest influence; incidence is not related to the duration or type of immobilization. The approximate recurrence rate in all age zones is 50%, however it increases to 89% in 14 to 20 year olds. Conclusions: The shoulder joint is frequently associated with dislocations, accounting for a large percentage of all dislocations, with anterior shoulder dislocations being more common. Anatomical, clinical and imaging knowledge play an important role in the diagnosis, allowing a better classification of the type of dislocation, which has a better impact on the treatment. The immobilization and physiotherapeutic approach will vary depending on the pathology, the age of the patient, the existence of recurrence and other complications. KEY WORDS: glenohumeral dislocation, shoulder reduction, shoulder dislocation.

A Systematic Review of Screw and Suture Button Glenoid Augmentation Constructs.

Glenohumeral dislocations often lead to glenoid bone loss and recurrent instability, warranting bony augmentation. While numerous biomechanical studies have investigated fixation methods to secure a graft to the glenoid, a review of available constructs has yet to be performed. To synthesize the literature and compare the biomechanics of screw and suture button constructs for anterior glenoid bony augmentation. Systematic review. A systematic review was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. There were 2 independent reviewers who performed a literature search using the PubMed, Embase, and Google Scholar databases of studies published between 1950 and 2020. Studies were included that compared the biomechanical outcomes of fixation for the treatment of anterior shoulder instability with glenoid bone loss. Overall, 13 of the 363 studies screened met the inclusion criteria. The included studies measured the biomechanical strength of screws or suture buttons on a cadaveric or synthetic Latarjet construct. Screws and suture buttons were biomechanically similar, as both constructs exhibited comparable loads at failure and final displacement. Screw type (diameter, threading, or composition) did not significantly affect construct strength, and double-screw fixation was superior to single-screw fixation. Additionally, 2 screws augmented with a small plate had a higher load at failure than screws that were not augmented. Unicortical double-screw fixation was inferior to bicortical double-screw fixation, although construct strength did not significantly decrease if 1 of these screws was unicortical. Further, 2 screws inserted at 15° off axis experienced significantly higher graft displacement and lower ultimate failure loads than those inserted at 0° parallel to the glenoid. Suture buttons provided comparable strength to screws and offer an effective alternative to reduce screw-related complications. Augmentation with a small plate may clinically enhance construct strength and decrease complications through the dispersion of force loads over a greater surface area. Differences in screw type did not appear to alter construct strength, provided that screws were placed parallel to the articular surface and were bicortical.

The ‘Glass shoulder’: individuals’ perspectives of living with at traumatic glenohumeral dislocation – a qualitative study

The ‘Glass shoulder’: individuals’ perspectives of living with at traumatic glenohumeral dislocation – a qualitative study

Epidemiology of shoulder dislocations presenting to United States emergency departments: An updated ten-year study.

Glenohumeral dislocation is a common injury that may predispose patients to chronic pain and instability. However, there is a paucity of current data available regarding the epidemiological trends of this injury. To provide an updated, comparative assessment of the epidemiology of shoulder dislocations presenting to emergency departments in the United States. We also sought to analyze patient demographic risk factors and consumer products associated with dislocation events. Data were obtained from the national electronic injury surveillance system database for glenohumeral dislocations between 2012 and 2021. Incidence, age, sex, and injury characteristics were analyzed using weighted population statistics as well as incidence rates and 95% confidence intervals (CI). In total, an estimated 773039 shoulder dislocations (CI: 640598-905481) presented to emergency rooms across the United States during the study period. The annual incidence rate was 23.96 per 100000 persons and the average patient age at the time of injury was 37.1 years. Significantly more male patients sustained dislocations than female patients (537189, 69.5%, vs 235834, 30.5%, P < 0.001). With regard to associated consumer products, sports and recreation equipment were involved in the highest proportion of incidents (44.31%), followed by home structures and construction materials (21.22%), and home furnishings, fixtures, and accessories (21.21%). Regarding product sub-groups, stairs, ramps, landings, floors was cited in the greatest number of cases (131745). The national annual incidence rate of glenohumeral dislocations throughout the study period was approximately 23.92 per 100000 persons. Male adolescents sustained the highest proportion of dislocations, with a peak incidence in age group 15-20 years, predominantly secondary to participation in sporting and recreational activities. Conversely, women experienced a relatively consistent incidence of dislocation throughout their lifespan. After age 63, the incidence rate of dislocations in females was found to surpass that observed in males.