Dislocation Of Glenohumeral Joint Research Articles

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.

Reverse shoulder arthroplasty versus hemiarthroplasty versus non-surgical treatment for older adults with acute 3- or 4-part fractures of the proximal humerus: study protocol for a randomised controlled trial (PROFHER-2: PROximal Fracture of Humerus Evaluation by Randomisation – Trial Number 2)

BackgroundProximal humerus fractures (PHF) are common and painful injuries, with the majority resulting from falls from a standing height. As with other fragility fractures, its age-specific incidence is increasing. Surgical treatment with hemiarthroplasty (HA) and reverse shoulder arthroplasty (RSA) have been increasingly used for displaced 3- and 4-part fractures despite a lack of good quality evidence as to whether one type of arthroplasty is superior to the other, and whether surgery is better than non-surgical management. The PROFHER-2 trial has been designed as a pragmatic, multicentre randomised trial to compare the clinical and cost-effectiveness of RSA vs HA vs Non-Surgical (NS) treatment in patients with 3- and 4-part PHF.MethodsAdults over 65 years of age presenting with acute radiographically confirmed 3- or 4-part fractures, with or without associated glenohumeral joint dislocation, who consent for trial participation will be recruited from around 40 National Health Service (NHS) Hospitals in the UK. Patients with polytrauma, open fractures, presence of axillary nerve palsy, pathological (other than osteoporotic) fractures, and those who are unable to adhere to trial procedures will be excluded. We will aim to recruit 380 participants (152 RSA, 152 HA, 76 NS) using 2:2:1 (HA:RSA:NS) randomisation for 3- or 4-part fractures without joint dislocation, and 1:1 (HA:RSA) randomisation for 3- or 4-part fracture dislocations. The primary outcome is the Oxford Shoulder Score at 24 months. Secondary outcomes include quality of life (EQ-5D-5L), pain, range of shoulder motion, fracture healing and implant position on X-rays, further procedures, and complications. Independent Trial Steering Committee and Data Monitoring Committee will oversee the trial conduct, including the reporting of adverse events and harms.DiscussionThe PROFHER-2 trial is designed to provide a robust answer to guide the treatment of patients aged 65 years or over who sustain 3- and 4-part proximal humeral fractures. The pragmatic design and recruitment from around 40 UK NHS hospitals will ensure immediate applicability and generalisability of the trial findings. The full trial results will be made available in a relevant open-access peer-reviewed journal.Trial registrationISRCTN76296703. Prospectively registered on 5th April 2018

Immobilization in External Rotation Versus Arthroscopic Stabilization After Primary Anterior Shoulder Dislocation: A Systematic Review of Level 1 and 2 Studies

Background: Arthroscopic stabilization has been established as a superior treatment option for primary glenohumeral instability when compared with immobilization in internal rotation. However, immobilization in external rotation (ER) has recently gained interest as a viable nonoperative treatment option for patients with shoulder instability. Purpose: To compare the rates of recurrent instability and subsequent surgery in patients undergoing treatment for primary anterior shoulder dislocation with arthroscopic stabilization versus immobilization in ER. Study Design: Systematic review; Level of evidence, 2. Methods: A systematic review was performed by searching PubMed, the Cochrane Library, and Embase to identify studies that’evaluated patients being treated for primary anterior glenohumeral dislocation with either arthroscopic stabilization or immobilization in ER. The search phrase used various combinations of the keywords/phrases “primary closed reduction,”“anterior shoulder dislocation,”“traumatic,”“primary,”“treatment,”“management,”“immobilization,”“external rotation,”“surgical,”“operative,”“nonoperative,” and “conservative.” Inclusion criteria included patients undergoing treatment for primary anterior glenohumeral joint dislocation with either immobilization in ER or arthroscopic stabilization. Rates of recurrent instability, subsequent stabilization surgery, return to sports, positive postintervention apprehension tests, and patient-reported outcomes were evaluated. Results: The 30 studies that met inclusion criteria included 760 patients undergoing arthroscopic stabilization (mean age, 23.1 years; mean follow-up time, 55.1 months) and 409 patients undergoing immobilization in ER (mean age, 29.8 years; mean follow-up time, 28.8 months). Overall, 8.8% of operative patients experienced recurrent instability at latest follow-up compared with 21.3% of patients who had undergone ER immobilization (P < .0001). Similarly, 5.7% of operative patients had undergone a subsequent stabilization procedure at latest follow-up compared with 11.3% of patients who had undergone ER immobilization (P = .0015). A higher rate of return to sports was found in the operative group (P < .05), but no other differences were found between groups. Conclusion: Patients undergoing arthroscopic treatment for primary anterior glenohumeral dislocation with arthroscopic stabilization can be expected to experience significantly lower rates of recurrent instability and subsequent stabilization procedures compared with patients undergoing ER immobilization.

Off-label use of reverse total shoulder arthroplasty: the American Academy of Orthopedic Surgeons Shoulder and Elbow Registry

HypothesisAfter the popularity of reverse total shoulder arthroplasty (rTSA) in Europe, the United States Food and Drug Administration (FDA) cleared the Delta rTSA system (DePuy Inc., Warsaw, IN, USA) for use in late 2003. The original FDA approved indications for rTSA in the United States were limited to a “Grossly rotator cuff deficient joint with severe arthropathy or a previous failed joint replacement with a grossly rotator cuff deficient joint.” Surgeons began to use rTSA for many off-label indications: osteoarthritis (OA) without rotator cuff tear (RCT), massive RCT without OA, proximal humerus fractures (PHFx), inflammatory arthritis (IA), and chronic glenohumeral joint dislocation (GHJD). Since 2006, The FDA has approved PHFx as an indication for some but not all reverse implants. The purpose of this study is to evaluate the trends in off-label rTSA use in the American Academy of Orthopaedic Surgeons Shoulder and Elbow Registry (AAOS-SER). MethodsAll rTSA procedures reported to the AAOS-SER from January 2015 to March 2021 were analyzed. Diagnoses associated with the use of rTSA including RCT arthropathy, OA without RCT, RCT without OA, PHFx, IA, and GHJD were evaluated, and trends were assessed over the data collection period. ResultsAt the time of data analysis the AAOS-SER contained 3850 cases of rTSA. Only 24.4% of rTSA surgeries were performed for original on-label use (RCT arthropathy). Off-label use of rTSA was seen in 75.6% of cases. When reviewing those rTSA done off-label, the majority (41.4%) were done for OA without RCT. Other off-label rTSA use included 15.1% for RCT without OA, 13% potentially off-label for PHFx, 4.6% for IA, and 1.6% for GHJD. Proportionally, off-label use is increasing over time while on-label use is decreasing. ConclusionIn the AAOS-SER, the majority of rTSA were performed for indications originally considered off-label by the FDA-a trend increasing over time. Some implant manufacturers have expanded indications for rTSA without providing clinical data to support changing FDA approved indications for use. The incremental expansion of indications for use without supportive data, a practice known as predicate creep, is occurring with rTSA. Performing rTSA for off-label indications may create liability risk for surgeons and implant manufacturers. Device manufacturers should formally expand indications of use for rTSA with the FDA to be consistent with published literature and trends.

Prevalence and risk factors for nerve injury following shoulder dislocation

BackgroundThe glenohumeral joint dislocation can be associated with major nerve injury. The reported prevalence and risk factors for major nerve injury are variable and this injury can have a severe and life-long impact on the patient. The objectives of this study were to analyse the prevalence of major nerve injury following shoulder dislocation and examine risk factors. Management and outcomes of nerve injury were explored.MethodsA 1 year retrospective cohort study of 243 consecutive adults who presented with a shoulder dislocation was performed. Data were collected on patient demographics, timings of investigations, treatment, follow-up, and nerve injury prevalence and management. The primary outcome measure was prevalence of nerve injury. Risk factors for this were analysed using appropriate tests with Stata SE15.1.ResultsOf 243 patients with shoulder dislocation, 14 (6%) had neurological deficit. Primary dislocation (p = 0.004) and older age (p = 0.02) were significantly associated with major nerve injury. Sex, time to successful reduction and force of injury were not associated with major nerve injury in this cohort. Patients with nerve injury made functional recovery to varying degrees. Recurrent shoulder dislocation was common accounting for 133/243 (55%) attendances.ConclusionsShoulder dislocation requires careful assessment and timely management in the ED. A 6% rate of nerve injury following shoulder dislocation was at the lower border of reported rates (5–55%), and primary dislocation and older age were identified as risk factors for nerve injury. We emphasise the importance of referring patients with suspected major nerve injury to specialist services.

Morphological characteristics and management of greater tuberosity fractures associated with anterior glenohumeral joint dislocation: A single centre 10-year retrospective review

IntroductionGreater tuberosity (GT) fractures associated with anterior gleno-humeral (GH) dislocations are unstable, with inadequate treatment leading to displacement, malunion, stiffness and functional disability. We explored its morphological characteristics to ultimately optimize their management. MethodsWe retrospectively reviewed all shoulder radiographs with GT fractures associated with anterior GH dislocations in a university hospital between December 1, 2009 and December 31, 2019. Special considerations were given to fracture morphology, presence and site of comminution, degree of displacement and need for surgical intervention. Results133 patients were identified. Most of the fracture-dislocations were multi-fragmentary (86.5%) and located antero- or postero-superiorly (68.7%). Superiorly comminuted GT fractures were twice as likely to displace compared to other sites of comminution (43% vs. 21%, p = 0.03), and require surgery (p = 0.03). Undisplaced comminuted GT fragments, particularly superior patterns, could undergo secondary migration if conservatively treated (p = 0.01). GT fractures fixed with interfragmentary screw suffered more secondary migration but those treated with double-row suture anchors (DRSA) did not on follow-up x-rays at two months. ConclusionGT fractures with anterior GH dislocations are frequently comminuted. Those with superiorly situated comminution should have a low threshold for surgical fixation, particularly with DRSA which can prevent secondary fragment migration.

Glenohumeral Joint Dislocation Classification: Literature Review and Suggestion for a New Subtype.

Glenohumeral joint (GHJ) dislocation is a relatively common injury. Anterior GHJ dislocations are divided into subcoracoid, subglenoid, subclavicular, and intrathoracic subtypes. The aim of this article is to review current GHJ dislocation classification and briefly discuss management of each type. Discrepancies and inaccuracies exist in regard to GHJ dislocation classification. We suggest adding a new subtype, "paraglenoid," to improve the current GHJ dislocation classification system. The paraglenoid subtype describes a portion of the subcoracoid anterior GHJ dislocation. GHJ dislocation is most often caused by force applied to the arm during a fall but also can be due to direct impact to the shoulder. Physical examination often reveals classic deformities, and thorough neurovascular examination is crucial. Radiographs should be used to confirm the diagnosis and assess for associated bony injuries. Numerous reduction techniques are described in the literature, with chosen method dependent on patient factors, provider experience, and GHJ dislocation type.

Expanding genotypic and phenotypic spectrums of LTBP3 variants in dental anomalies and short stature syndrome.

Mutations in LTBP3 are associated with Dental Anomalies and Short Stature syndrome (DASS; MIM 601216), which is characterized by hypoplastic type amelogenesis imperfecta, hypodontia, underdeveloped maxilla, short stature, brachyolmia, aneurysm and dissection of the thoracic aorta. Here we report a novel (p.Arg545ProfsTer22) and a recurrent (c.3107-2A > G) LTBP3 variants, in a Turkish family affected with DASS. The proband, who carried compound heterozygous variant c.3107-2A > G, p.Arg545ProfsTer22, was most severely affected with DASS. The proband's father, who carried the heterozygous variant c.3107-2A > G had short stature and prognathic mandible. The mother and brother of the proband carried the heterozygous variant p.Arg545ProfsTer22, but only the mother showed any DASS characteristics. The c.3107-2A > G and the p.Arg545ProfsTer22 variants are expected to result in abnormal LTPB3 protein, failure of TGFβ-LAP-LTBP3 complex formation, and subsequent disruption of TGFβ secretion and activation. This is the first report of heterozygous carriers of LTBP3 variants showing phenotypes. The new findings of DASS found in this family include taurodontism, single-rooted molars, abnormal dentin, calcified dental pulp blood vessels, prognathic mandible, failure of mandibular tooth eruption, interatrial septal aneurysm, secundum atrial septal defect, tricuspid valve prolapse, and a recurrent glenohumeral joint dislocation.

Glenohumeral joint dislocation is rare in children with proximal humeral fractures: a descriptive study and literature review

BackgroundGlenohumeral dislocation combined with fracture of the proximal humerus is extremely rare in children, and this study aims to investigate its incidence in the pediatric population and review the treatment strategy for this condition.MethodsBetween Jan 2014 and Jan 2019, 280 patients with unilateral proximal humeral fractures were retrospectively reviewed. Imaging and follow-up notes were reviewed for patients with a predilection for glenohumeral joint dislocation. Six (2.14%) patients between the ages of 5 and 10 years were confirmed as glenohumeral joint dislocation and included in the study. All these patients underwent closed reduction and external fixation under general anesthesia.ResultsOut of 280 patients with proximal humeral fractures, only 6 patients, including 4 males and 2 females, were confirmed as glenohumeral joint dislocation. ROM was normal compared with the contralateral shoulder in every patient at the last follow-up. There was no case of radiological abnormality, including avascular necrosis or devascularization of the humeral head.ConclusionsGlenohumeral dislocation is a rare entity associated with the proximal humerus fracture in children, with an overall incidence in our case series was 2.14%.Reduction and stabilization of such injury using an external fixator is a suitable choice for pediatric patients that failed closed reduction.

Inferior glenohumeral dislocation in an elderly.

Inferior dislocation of shoulder in an elderly is the least common form of shoulder dislocation. The mechanism of injury in elderly involves forceful hyperabduction of arm over the acromion repetitively, injuring the inferior glenoid labrum and subsequently allowing the head of humerus surpass the glenoid fossa inferiorly. The diagnostic procedure involves palpation of humeral head in axilla, confirming it with radiological diagnostic imaging. The management for elderly includes immobilization of the shoulder in sling with muscle relaxants and physiotherapy. An 80-year-old female patient, a known case of stage 5-Parkinson disease (Hoehn and Yahr scale) was observed with an inevitable bulge against the ribs along the right side with ecchymosis over the right shoulder joint. In the debilitating and deteriorating state of comorbidity, she had severe stiffness which made her bed dependent and wheelchair bound. Also, she was presenting hallucination or delusions making her mobility difficult for care-taker. The luxatio erecta/inferior glenohumeral joint dislocation occurred while shifting the patient from bed to wheelchair. The patient then underwent radiological diagnosis which demonstrated luxatio erecta with neurovascular injury owing to its close proximity to axillary artery and brachial plexus. Considering the age and Parkinson disease, the dislocation was managed by closed reduction and immobilization for 6-weeks. She was then prescribed physiotherapy wherein pain was subsided with cryotherapy; stiffness and restricted range of motion were regained with passive and active mobility exercises; and strength was restored by using progressive training for 6-weeks following 40-minutes per session for 5-days a week.

AKUT TRAVMATİK İLK KEZ ÖNE OMUZ ÇIKIĞININ GÜNCEL TEDAVİ UYGULAMALARINDA ORTOPEDİ VE ACİL TIP UZMANLARININ YAKLAŞIM FARKLILIKLARI

Objective&#x0D; Numerous techniques for the reduction of anterior&#x0D; glenohumeral joint dislocations have been described.&#x0D; However, there is no consensus on the best technique&#x0D; for reducing a dislocated glenohumeral joint. This&#x0D; study aimed to evaluate the approach of emergency&#x0D; specialists and orthopedic surgeons in the treatment&#x0D; of acute traumatic first-time anterior shoulder&#x0D; dislocation.&#x0D; Material and Methods&#x0D; Data used in this cross-sectional study were obtained&#x0D; through a web-based survey from the Turkish&#x0D; Orthopedics and Traumatology Association mail group&#x0D; and Emergency Medicine Physicians Association&#x0D; of Turkey mail group. All orthopedic surgeons&#x0D; and emergency medicine physicians who were&#x0D; registered in the database received an information&#x0D; mail regarding the aim of the questionnaire and a link&#x0D; to the online survey form (Google Forms, Alphabet&#x0D; Inc., Mountain View, CA). The survey consisted of 13&#x0D; questions, which are shown with their corresponding&#x0D; answer options. The current practices regarding the&#x0D; management of acute traumatic first-time anterior&#x0D; shoulder dislocation among orthopedic surgeons&#x0D; and emergency medicine physicians in Turkey were&#x0D; evaluated.&#x0D; Results&#x0D; A total of 152 orthopedic surgeons and 151 emergency&#x0D; physicians participated in this survey. The most&#x0D; common maneuvers used by emergency physicians&#x0D; to reduce shoulder dislocations were the Hippocrates&#x0D; technique (19.2%) and Cunningham technique&#x0D; (19.2%), while orthopedic surgeons preferred the&#x0D; Hippocrates technique (23.7%) and Kocher technique&#x0D; (29.6%). It was found that orthopedic surgeons&#x0D; preferred Kocher and Milch maneuvers more for&#x0D; shoulder joint dislocation reduction compared to&#x0D; emergency physicians (p &lt; 0.001 and p = 0.005,&#x0D; respectively). Both the pre- reduction and postreduction&#x0D; procedures showed variability between&#x0D; orthopedic surgeons and emergency physicians.&#x0D; Conclusion&#x0D; It would be more appropriate for the emergency&#x0D; physician and orthopedic surgeons to treat a&#x0D; patient with shoulder dislocation together as a team&#x0D; and beneficial to establish a national guideline for&#x0D; consensus.

Arthroscopy-Assisted Latarjet Procedure With Coracoid Exteriorization

The Latarjet procedure is a method for treating complicated glenohumeral joint dislocation that is often associated with a bone defect in the anterior glenoid. The Latarjet procedure addresses both soft-tissue and bone deficiencies by creating a biceps tendon sling and through bone reconstruction of the anterior glenoid defect. The arthroscopic Latarjet procedure provides good visual control in the structures and eliminates the need for an arthrotomy. We present an arthroscopy-assisted Latarjet technique where the coracoid is temporarily exteriorized to facilitate shaping and preparation for subsequent fixation to the glenoid. Coracoid debridement, anterior glenoid preparation, and the subscapular split are conducted arthroscopically. Cutting the coracoid process is also conducted under arthroscopic control, and the coracoid is exposed through the anteroinferior portal. Once the coracoid is openly shaped and the drill-holes are made, the coracoid is resituated and fixed to the glenoid edge in arthroscopic visual control. The purpose of this technique is to combine favorable elements of the open and arthroscopic procedures. Additionally, the instrumentation is simple, which makes the operation safe and practical to perform.

WITHDRAWN: Shoulder pseudoparalysis in a child after massive cuff tear interposed within the glenohumeral joint: a case report

<h2>Abstract</h2> We report an unusual case of a complete rotator cuff tendon avulsion with glenohumeral joint incarceration in skeletally-immature patient after significant trauma to the shoulder. Generally, it occurs in high-energy trauma, frequently in association with glenohumeral joint dislocation. Surgical treatment was performed confirming the injury and the rotator cuff interposition. It is important that orthopedic surgeons and radiologists become familiar with this entity which, because of its rarity, might be neglected in cases of shoulder trauma. Furthermore, this case documents the youngest patient ever to sustain such an injury in the orthopedic literature.

Fracture-subluxation of the shoulder in children: A case series and literature review

Glenohumeral dislocation in pediatric age is a rare injury. The proximal humerus fractures, on the other hand, are relatively common with the management ranging from conservative to operative fixation. Concomitant proximal humeral fracture and subluxation or dislocation of ipsilateral glenohumeral joint are the rarer events with very few reports available in the literature. We present a series of four pediatric cases (2 males and 2 females) of fracture dislocation of the shoulder with relevant details. All the cases suffered injuries following fall from tree and were managed by operative means in two while two were managed conservatively. Good functional outcome was noted in the mean follow-up of 10 months.

Although Surgical Techniques Differ, Similar Outcomes Can Be Obtained When Operating After Single Versus Multiple Anterior Shoulder Dislocations

PurposeTo compare the differences in preoperative pathology, surgical technique, and overall outcomes between patients treated surgically after a single anterior glenohumeral joint dislocation and those undergoing surgery after multiple dislocations.MethodsAn epidemiologic database was used to identify all patients younger than 40 years undergoing surgery for anterior shoulder instability between January 1, 1994, and July 31, 2016, in a defined geographic area. Patient medical records were reviewed to obtain demographic information, patient history, physical examination findings, imaging findings, clinical progression, surgical details, and outcomes. Comparative analysis was performed between patients who underwent surgery after a single dislocation and those who underwent surgery after multiple preoperative dislocations.ResultsThe study population consisted of 187 patients who had a single anterior shoulder dislocation (n = 55) or multiple anterior shoulder dislocations (n = 132) prior to surgery. The mean follow-up period was 103.3 months (range, 0.3-328.4 months). Demographic characteristics were not significantly different between groups. Although the presence of Hill-Sachs lesions on radiographs was more common in the multiple-dislocation group (42.1%) than in the single-dislocation group (18.8%, P = .005), there were no other significant differences in concomitant pathology between groups. Latarjet procedures were more commonly performed in the multiple-dislocation group (12.5% vs 2.1% in the single-dislocation group, P = .04). There were no other significant differences in surgical techniques and characteristics between groups. Rates of survival free from recurrent instability (P = .790), revision surgery (P = .726), and progression to symptomatic osteoarthritis (P = .588) were not significantly different between groups.ConclusionsAlthough patients with multiple dislocations prior to surgery were more likely to show radiographic evidence of Hill-Sachs lesions and undergo the Latarjet procedure than those who received surgery after a single dislocation, no significant differences in outcomes with respect to recurrent instability, revision surgery, or progression to symptomatic osteoarthritis were found between these 2 groups at long-term follow-up.Level of EvidenceLevel III, retrospective comparative study.

Endoscopic brachial plexus neurolysis in the management of infraclavicular nerve injuries due to glenohumeral dislocation

IntroductionInfraclavicular brachial plexus (BP) injury secondary to glenohumeral joint (GHJ) dislocation is a rather common complication, which may be accountable for long-lasting deficits. The purpose of this study was to assess the potential benefits of BP neurolysis in such presentation, using an endoscopic approach. Materials and methodsAll patients who underwent endoscopic BP neurolysis in the setting of infraclavicular BP palsy due to GHJ dislocation were included. Preoperative physical examination was conducted to classify the observed motor and sensitive deficits into nerves and/or cord lesions. Six weeks after the trauma, examination was repeated and endoscopic BP neurolysis was elected if no significant improvements were observed. If nerve ruptures and/or severe damages were identified during surgery, nerve reconstructions were conducted within a month; in other cases, follow-up examinations were conducted at 6 weeks, 3 and 6 months to assess the course of postoperative recovery. ResultsEleven patients were included, including 6 men and 5 women, with a mean age of 43 ± 23 years (16;73). Six patients had at least one cord involved, four patients had isolated axillary nerve palsy, and one patient had a complete BP palsy. In 7 patients with cord lesions and/or isolated axillary nerve palsy, at least grade-3 strength, according to the British Medical Research Council grading system, was noted in all affected muscles within 6 weeks following the neurolysis; after 3 months of follow-up, grade-4 strength was observed in all muscles, and all but patients but one had fully recovered within 6 months. In 3 patients with isolated axillary nerve palsy, complete nerve ruptures (n=2) and severe damages (n=1) were identified under scopic magnification; secondary nerve transfers were conducted to reanimate the axillary nerve, and all patients fully recovered within a year. In one patient with complete BP palsy, improvements started after 6 months of follow-up, and full recovery was yielded after 2 years. No intra- and/or postoperative complications were noted. ConclusionsAt the cost of minimal additional morbidity, endoscopic BP neurolysis appears to be a safe and reliable procedure to shorten recovery delays in most patients presenting with BP palsy due to GHJ dislocation.

New Reduction Technique for Traumatic Posterior Glenohumeral Joint Dislocations.

Traumatic posterior glenohumeral joint (GHJ) dislocation is a rare condition which can be missed if it is not suspected. Clinical presentation may be subtle, but limitation in range of motion in patient with acute trauma should warrant obtaining a thorough history, performing a comprehensive physical examination, and acquiring at least a 3-view plain radiography. Reduction can be achieved with a direct pressure to the posterior aspect of the humeral head.

Mechanisms of traumatic injury to the shoulder girdle in the Australian Football League

ObjectiveTo investigate mechanisms of shoulder girdle injuries and their impact on players from the Australian Football League (AFL). DesignRetrospective video analysis. MethodsTwo experienced sports physiotherapists (>10years) examined video footage of shoulder complex injuries that occurred in the 2015 premiership season. Information obtained from video footage included activity prior to injury; mechanism of injury; arm, head and neck position and point of body contact at the time of injury. Player demographics and injury characteristics were obtained from club and media data. ResultsThe most common mechanism of injury was lateral contact (34.6%) followed by hyperflexion/ abduction of the shoulder (19.2%). Glenohumeral joint (GHJ) dislocations and subluxations were the most frequent diagnosis for all mechanisms of injury, and occurred in a variety of shoulder positions. Over 80% of injuries occurred with the arm below 100° of shoulder flexion or abduction. The most common activity prior to injury was ‘ball in dispute’ (34.6%). Lateral contact injuries had the highest overall severity (two-thirds of players missed >3 games) and over 50% of shoulder injuries required surgery. Players missed on average 5.1 season games due to shoulder injury. ConclusionThe lateral contact mechanism was the most common and severe mechanism of shoulder injury. Improved understanding of shoulder girdle injury mechanisms can help guide the use of preventative strategies and injury management programs in elite AFL players.

The aetiology of posterior glenohumeral dislocations and occurrence of associated injuries: a systematic review.

The glenohumeral joint is the most frequently dislocated articulation, but possibly due to the lower prevalence of posterior shoulder dislocations, approximately 50% to 79% of posterior glenohumeral dislocations are missed at initial presentation. The aim of this study was to systematically evaluate the most recent evidence involving the aetiology of posterior glenohumeral dislocations, as well as the diagnosis and treatment. A systematic search was conducted using PubMed (MEDLINE), Web of Science, Embase, and Cochrane (January 1997 to September 2017), with references from articles also evaluated. Studies reporting patients who experienced an acute posterior glenohumeral joint subluxation and/or dislocation, as well as the aetiology of posterior glenohumeral dislocations, were included. A total of 54 studies met the inclusion criteria. In total, 182 patients were included in this analysis; study sizes ranged from one to 66 patients, with a mean age of 44.2 years (sd 13.7). There was a higher proportion of male patients. In all, 216 shoulders were included with 148 unilateral injuries and 34 bilateral. Seizures were implicated in 38% of patients (n = 69), with falls, road traffic accidents, electric shock, and iatrogenic reasons also described. Time to diagnosis varied across studies from immediate up to a delay of 25 years. Multiple associated injuries are described. This review provides an up-to-date insight into the aetiology of posterior shoulder dislocations. Our results showed that seizures were most commonly implicated. Overall, reduction was achieved via open means in the majority of shoulders. We also found that delayed diagnosis is common.

The Veil of Obscuration: Additional Radiographic Sign of Posterior Shoulder Dislocation.

To describe a new radiographic sign, "veil of obscuration", associated with posterior glenohumeral joint (shoulder) dislocations and determine its incidence and validity compared to other known classic radiographic signs. Four-year retrospective study identified 30 acute posterior shoulder dislocation patients. Radiographs reviewed in consensus by 2 musculoskeletal radiologists for the "veil of obscuration", seen on AP shoulder radiographs and representing a comminuted fracture of the lesser tuberosity projecting over the humeral head or glenohumeral joint. Incidence of this radiographic sign of posterior glenohumeral joint dislocation in addition to other previously described classic radiographic signs, and association with other fractures, surgery, and mechanism of injury were evaluated. Continuous data was analyzed with student t-test and categorical data with Chi-Square test. There were 20 right and 10 left posterior shoulder dislocations. Majority of injuries resulted from vehicle crash (44%). In most cases, reverse Hill-Sachs lesion (83%) and fixed internal rotation of the humeral head (76%) were present, followed by trough line (43%) and "veil of obscuration" (40%). Trough line was seen in significantly more major trauma and vehicle crashes (78% and 46%; P=0.015), while "veil of obscuration" was seen in more seizures (86%; P=0.037) and in all surgical patients. No significant difference in presence of other classic radiographic signs in regards to surgery. The newly described radiographic sign of posterior shoulder dislocations named the "veil of obscuration" has comparable incidence as other classic radiographic signs and may be useful in the recognition and diagnosis of these injuries.