Left Shoulder Dislocation Research Articles

Endovascular repair of a ruptured axillary artery during open reduction of the shoulder dislocation with humerus fracture

Abstract Axillary artery injury secondary to shoulder dislocation with humerus fracture is rare. Rupture of the axillary artery during open reduction is extremely rare. Here, we report about a rare case of a ruptured axillary artery during an open reduction for shoulder dislocation with humerus fracture. A 58-year-old man with left shoulder pain because of a fall after alcohol consumption was diagnosed as having left shoulder dislocation with a humerus fracture. He underwent open reduction surgery. During the procedure, bleeding was observed, and further examination through angiography revealed an ruptured axillary artery. To address this urgent situation, stent grafts were promptly deployed retrogradely from the brachial artery. The postoperative course was uneventful, except for brachial plexus palsy. In the emergent setting, endovascular repair is an efficient alternative to conventional open surgery for controlling bleeding when a ruptured axillary artery occur during open reduction for shoulder dislocation.

Successful Glenohumeral Shoulder Reduction With Combined Suprascapular and Axillary Nerve Block

Anterior glenohumeral dislocation is a common injury seen in the emergency department (ED) that sometimes requires procedural sedation for manual reduction. When compared with procedural sedation for dislocation reductions, peripheral nerve blocks provide similar patient satisfaction scores but have shorter ED length of stays. In this case report, we describe the first addition of an ultrasound-guided axillary nerve block to a suprascapular nerve block for reduction of an anterior shoulder dislocation in the ED. A 34-year-old man presented to the ED with an acute left shoulder dislocation. The patient was a fit rock climber with developed muscular build and tone. An attempt to reduce the shoulder with peripheral analgesia was unsuccessful. A combined suprascapular and axillary nerve block was performed with 0.5% bupivacaine, allowing appropriate relaxation of the patient's musculature while providing excellent pain control. The shoulder was then successfully reduced without procedural sedation. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Procedural sedation for reduction of anterior shoulder dislocations is time consuming, resource intensive, and can be risky in some populations. The addition of an axillary nerve block to a suprascapular nerve block allows for more complete muscle relaxation to successfully reduce a shoulder dislocation without procedural sedation.

AB185. SOH22ABS018. Alleged recurrent traumatic shoulder dislocation in a young male patient—diagnostic and management considerations

: Asher’s original description of Munchausen’s syndrome was characterised by pathological lying, feigning illness and wandering from hospital to hospital. Munchausen’s syndrome—orthopaedic variant has been rarely reported in the literature. A young male presented to a nearby hospital with a left shoulder dislocation after an alleged kickboxing injury. The patient reported worrying clinical findings including excruciating pain and absent sensation distally. Reduction was successful but his shoulder re-dislocated shortly after. His reported symptoms worsened and he was transferred to our institution. Imaging findings were not immediately concerning and he went to theatre the next day for an examination under anaesthetic. His shoulder was re-located easily and an immobiliser applied. Less than an hour later, the patient managed to re-dislocate his shoulder in recovery. He was subjected to another general anaesthetic and successful reduction. He absconded the following day after being declined multiple and increasing doses of opioid analgesia. He re-presented three weeks later with similar clinical findings but a different mechanism of injury. Further exploration of his collateral history revealed that he had been using a false identity. He had presented to all hospitals in our city within the previous 6 months. Once confronted, he did not return to these hospitals. He was also capable of self-relocating his shoulder. This case bore a striking resemblance to a case described by Warren in 2000 of a young lady with an apparently dislocated shoulder presenting to multiple city hospitals looking for analgesia and general anaesthetics. We wished to highlight the diagnostic and ethical challenges associated with these patients. They are vulnerable and so a high index of clinical suspicion is needed on the part of the surgeon to avoid unnecessary interventions. Effective communication between orthopaedic departments is a key recommendation from this case to mitigate risk of harm to these patients.

Bilateral Anterior Shoulder Dislocation Occurring Separately from the Same Injury: A Case Report

Bilateral anterior shoulder dislocation is a relatively rare condition. In a patient presenting with bilateral shoulder pain, a posteroanterior radiograph of the shoulders easily reveals the diagnosis. A 76-year-old woman presented to our emergency room with complaints of bilateral shoulder pain. She had fallen forward with both elbows hitting the ground and also hit her right shoulder. A posteroanterior radiograph revealed a right anterior shoulder dislocation with no remarkable changes noted on the left shoulder. The right shoulder dislocation was resolved, and she was sent home. Six hours later, she was brought back to our emergency room with left shoulder pain. A repeat posteroanterior radiograph of the left shoulder revealed left shoulder dislocation. Bilateral anterior shoulder dislocation occurring after 6 hours is an extremely rare condition. We report this case with a review of the literature.

Non-Anastomotic Complete ePTFE Axillobifemoral Bypass Disruption and Thrombosis Following Shoulder Dislocation.

Complete disruption of an expanded polytetrafluoroethylene (ePTFE) vascular graft is rare. This is a report of a case of a 70 year old man presenting with left shoulder dislocation, which was reduced immediately. Two weeks later, the patient presented with Rutherford 2b bilateral lower limb ischaemia related to the thrombosis of an ePTFE axillobifemoral bypass. The graft was implanted five years earlier for treatment of an aorto-enteric fistula secondary to an infected aortobifemoral bypass. A non-anastomotic pseudoaneurysm associated with complete disruption of the ePTFE graft was found. Systematic analysis of the explant showed that the rupture occurred at the level of a ringed external support and that ongoing tears also occurred on the posterior wall of the graft at the level of this external support. In conclusion, complete analysis of failure mechanisms even from an isolated report is mandatory.

Mclaughlin Procedure Treatment of Bilateral Sequential Posterior Dislocation Fracture of the Shoulder: A Case Report

Posterior dislocation of the shoulder is extremely rare condition. Common etiologic causes are extreme trauma, epilepsy and electroconvulsive therapy. Most cases are misdiagnosed due to inappropriate phisical examination and/or inadequate radiologic evaluation. In the literature several operation technics are described. Here we present a case with posterior dislocation of left shoulder after succesful treatment of right shoulder.

Neuro-orthopedic deformities managment: A multidisciplinary approach

Dystonic and dyskinetic syndromes produce musculotendinous retractions, subluxations and hip or shoulder dislocations. Most of the time, deep brain stimulation and pallidotomy cannot be used in secondary syndromes as they are in primitive forms. Drug treatments have frequent side effects. Very often these treatments are inadequate to prevent musculoskeletal deformities, which have an impact on pain, nursing, positioning and quality of life. We followed a 45-year-old man with a spastic tetraparesia and a generalised dystonic and dyskinetic syndrome residual of a cerebral anoxia due to a heart arrest. His initial treatment was oral baclofen, anticholinergics and secondary intratechal baclofen. His symptoms increased progressively: pain, communication and nursing difficulties, mispositioning, elbow crease mycosis, as a consequence of musculoskeletal deformities. The patient had triple flexion of his upper limbs, antero inferior irreducible left shoulder dislocation, bilateral flessum of the knees. Multidisciplinary management has been provided, initially surgical then medical. Surgery included rotator cuff desinsertion of the left shoulder, needle percutaneous tenotomies of left elbow flexors, biceps femoris and semitendinus and plaster cast immobilisation. The medical treatment included twice-daily bolus of intratechal baclofen with dose-increase, botulinum toxin injection (left semimembranosus, right shoulder retractor muscles), phenolyc neurolysis (bilateral ansa pectoralis, left musculocutaneous nerve), physiotherapy and occupational therapy. The pain relief allowed a progressive morphinic doses decrease. Both armchair and bed positioning have been improved. Dyskinetic movements disappeared and verbal communication became easier. Neuro-orthopedic deformities management in patients with dystonia and dyskinesia may allow a decrease of dyskinetic movements and improve their comfort. It consists of multidisciplinary medicosurgical approach with tenotomies in association with oral or intratechal baclofen, botulinum toxin, chemical neurolysis and rehabilitation.

Akciğerde Yağ Embolisine Bağlı Ölüm Olgu Sunumu

Yağ embolisi, genellikle ciddi travma veya cerrahi girişim sonrası kemik iliğinden ya da yumuşak dokulardan yağ damlacıklarının serbestleşip sistemik dolaşıma geçmesidir. Gençlerde daha çok uzun kemik kırıklarından sonra, yaşlılarda ise kalça kırığı sonrası gelişmektedir. Genellikle travmadan 24-48 saat sonra ortaya çıkan klinik tablo, hafif olabileceği gibi solunum yetmezliği ve ölüme kadar ilerleyebilir. Sunulan olgu; 84 yaşında kadın olup, araç dışı trafik kazası nedeni ile sol kolda ve sol pelvik bölgede ağrı yakınmalarıyla hastaneye başvurmuştur. Ortopedi konsültasyonunda; sol omuz çıkığı, sol humerus suprakondiler kırığı ve sol ramus pubis kırığı nedeniyle kapalı redüksiyon uygulanarak taburcu edilmiş ve kazadan yaklaşık üç saat sonra evinde öldüğü bildirilmiştir. Şüpheli ölüm olarak değerlendirilen adli olguya yapılan otopside; akciğer kesitlerinde yer yer köpüklü hemorajik özellikli sıvı çıkışı, sol omuz çıkığı, sol humerus suprakondiler kırığı ve sol ramus pubiste deplase kırık hattı görüldü. Postmortem histopatolojik incelemede; akciğerlerde interstisiyel kapiller lümenlerde evre IV yağ embolisi ve orta çaplı pulmoner damarlarda yaygın kemik iliği embolizasyonu tespit edildi. Olayın öyküsü, tıbbi belgelerin içeriği, otopsideki makroskopik ve histopatolojik inceleme verilerine göre, kişinin ölümünün araç dışı trafik kazası sonrası genel beden travmasına bağlı ekstremite kırıklarıyla birlikte akciğerde yağ embolisi sonucunda geliştiği belirlendi.Travma ile oluşan kemik kırıkları sonrası yağ embolisi oluşumunu önlemek için, kırıkların erken fiksasyonu ve immobilizasyonu önemlidir. Bu olgularının takip ve tedavisinde dikkatli olunması, tıbbi uygulama hatalarının önlenmesi yönünden de önem taşımaktadır. Ayrıca trafik kazası ile kemik kırıkları tespit edilen ve şüpheli ölüm olarak değerlendirilen olgularda otopsi ve postmortem histopatolojik incelemenin tanıyı belirlemede katkısı olduğu açıktır.Anahtar Kelimeler: Yağ embolisi, travma, adli tıp, otopsi, şüpheli ölüm.

Combined Posterior Osseous Bankart Lesion and Posterior Humeral Avulsion of the Glenohumeral Ligaments

The pathoanatomy of anterior shoulder dislocations has been well documented. Perthes1 described an anterior labral lesion as early as 1906, and Bankart2 wrote his classic article on recurrent anterior dislocations more than seventy years ago. Until recently, much less had been written about posterior shoulder instability; to our knowledge, the first case series was reported by Reeves3 in 1963. Recurrent posterior glenohumeral joint instability is far less common than anterior instability, accounting for approximately 2% to 10% of all cases of shoulder instability4. Pathoanatomic findings in patients with unidirectional posterior instability include a posterior Bankart lesion, posterior humeral avulsion of the glenohumeral ligament (PHAGL), and various combinations of the two5,6. In their article on humeral avulsion of the glenohumeral ligament (HAGL), Bui-Mansfield et al.7 defined the floating posterior inferior glenohumeral ligament (floating PIGHL) as a combined posterior Bankart lesion and PHAGL. Multiple cases of this lesion have been reported in the literature7-11. To our knowledge, there has been no reported case of the specific combination of a posterior osseous Bankart lesion and a PHAGL injury. We present a case of recurrent posterior instability associated with a combined PHAGL injury and posterior osseous Bankart lesion. We also describe four pathoanatomic subtypes of floating PIGHL lesions. The patient was informed that data concerning his case would be submitted for publication, and he provided consent. A twenty-three-year-old left-hand-dominant man fell while snowboarding three years prior to presentation and sustained a left shoulder dislocation. He was not certain about the direction of the dislocation. He was able to relocate the shoulder on the mountain with the help of friends and the ski patrol. Initially, he was managed nonoperatively with a sling and physical therapy as well as a progressive return …

Acute Posterior Shoulder Dislocation with Reverse Hill-Sachs Lesion of the Epiphyseal Humeral Head

Posterior dislocation of the shoulder is an unfrequent event that often occurs as a consequence of a direct trauma or epileptic crisis. Frequently the posterior dislocations are misunderstood, so they become chronic lesions. We reported a case of an acute posterior left shoulder dislocation with lesser tuberosity fracture and reverse Hill-Sachs lesions which involved more than 25% of the articular surface of the humeral head, in a 57-old-year man with right hemiparesis. We performed a synthesis of the lesser tuberosity with a screw, and we restored the shape of the humeral head with allograft. We achieved a good result that allows the patient to be able to do his previous activities of daily living.

소아에서 동측 상완골 외과적 경부 골절을 동반한 외상성 견관절 후방 탈구 - 증례 보고 -

Purpose: Traumatic posterior dislocation of the shoulder in a child is extremely rare, and posterior dislocation of the shoulder concomitant with ipsilateral humeral surgical neck fracture has not been reported in a child previously in Korea. Materials and Methods: The authors treated a 10-year-old with posterior dislocation of left shoulder and an ipsilateral humeral surgical neck fracture, that occurred during Taekwondo practice, by open reduction of the shoulder and pin fixation under general anesthesia. Results: A normal range of motion with complete union and good remodeling was achieved without redislocation or avascular necrosis of humeral head at 1 year after surgery. Conclusion: The authors report a successfully treated case of traumatic posterior dislocation of the shoulder with an ipsilateral humeral surgical neck fracture in child.

Transaortic migration of a Steinman wire from the shoulder

Orthopedic pins and wires are regularly used for the treatment of bone fractures and dislocations. Migration of these devices from the shoulder into the thoracic cavity is an uncommon but well-known complication. However, great vessels' injuries by a migrated wire are extremely rare. We report the case of a 78-year-old woman with a penetrating injury of the ascending thoracic aorta and the superior vena cava caused by migration of a Steinman wire that was used for percutaneous fixation of a left-shoulder dislocation 5 years earlier. There was no hemothorax, hemomediastinum, or hemopericardia, but hemoptysis was present. Such a case has not been previously described. The patient was treated by an emergency median sternotomy with a favorable outcome.

Adult onset tics after peripheral injury

We describe a case with adult onset motor tics after peripheral trauma. A 43-year-old man suffered a left shoulder dislocation during a motorcycle accident 21 years ago. Within 2 weeks after the injury, he noticed the gradual onset of involuntary jerking movements of his left shoulder, which was markedly exacerbated after second left shoulder injury 2 years later. The involuntary movements are phenomenologically identical to tics typically associated with Tourette syndrome (TS), but without the involvement of any other body part and without phonic tics or the typical TS co-morbidities, such as attention deficit or obsessive-compulsive disorder.

Shoulder Injury - Bicycling

HISTORY: A 13-year-old female sustained an injury to her left shoulder in a fall from her bicycle 6 days prior. Patient was seen initially in the emergency department where an anterior shoulder dislocation was diagnosed with additional finding of a small anterior fracture of her humeral head on x-ray. Closed reduction was performed under conscious sedation in the emergency department. She was placed in a sling and swathe with her arm in internal rotation. Patient presented with her father in the Sports Medicine Center to discuss further management and potential treatment options. PHYSICAL EXAMINATION: General - healthy appearing female in no acute distress. Neurovascular status is intact. Range of motion testing reveals abduction of left shoulder to 90 degrees, forward flexion to 80 degrees, and extension of 10 degrees. Pain is present with attempted external rotation. Patient in general is apprehensive to exam. DIFFERENTIAL DIAGNOSIS: Anterior shoulder dislocation with humeral head fracture with or without disruption of capsular labral complex. TESTS AND RESULTS X-rays reveal relocated humeral head, open growth plates. CT scan reveals fracture from the anterior surface of the epiphysis of the humeral head. Separated portion is comminuted. MRI demonstrates no evidence of a labral tear; MRI is positive for edema within inferior aspect of the subscapularis and infraspinatus muscles compatible with partial tear; and contusion and avulsion fracture at the greater tuberosity of the humeral head. FINAL DIAGNOSIS Primary anterior dislocation of left shoulder without Bankart lesion in a skeletally immature 13-year-old female. TREATMENT AND OUTCOME Discussion of risk for recurrent anterior dislocation and functional outcomes with operative versus non-operative intervention. Placed in external rotation brace for 4 weeks. Progressive increase in range of motion and strengthening with physical therapy. Fracture site with good approximation and doing well at 4 week follow-up.

Bilateral atraumatic dislocation of the shoulder.

A 69 year old woman was referred to the fracture clinic with a diagnosis of anterior dislocation of left shoulder. There was no history of acute injury. The patient had...

SHOULDER INJURY - FOOTBALL

302 HISTORY - A 19-year-old elite college football defensive lineman sustained a shoulder injury while tackling another player during a practice scrimmage. During the tackle another player fell on the back of his abducted left shoulder. He noted immediate pain and weakness in his shoulder. He denied paresthesias. He reported his symptoms to the athletic trainers and was taken out of the game. PHYSICAL EXAMINATION - Initial examination on the sidelines revealed no deformity of the shoulder. There was moderate tenderness in the posterior aspect of the left shoulder overlying the infraspinatus and trapezius muscles. Range of motion was limited in elevation and rotation secondary to pain. He was able to fire all muscle groups, but had weak deltoid, supraspinatus and external rotators. He denied any neck tenderness and he had normal sensation in the extremity. The affected arm was placed in an arm sling on the sidelines and ice was applied. His shoulder was re-examined after icing. There was still significant tenderness to palpation and pain with any attempted motion of the left shoulder. The pain progressively worsened and required narcotic analgesics. DIFFERENTIAL DIAGNOSIS: Anterior left shoulder dislocation Traumatic rotator cuff injury Scapular fracture Brachial plexus neuropraxia “stinger” TESTS AND RESULTS: RADIOGRAPHS: Left shoulder AP, True AP, and axillary: humeral head located normally on the glenoid an area of lucency at the neck of the scapula, that appears consistent with a vascular groove CT SCAN Left shoulder without contrast: (axial and coronal reconstruction in 5 mm increments) -Non-displaced vertical extra-articular fracture through the glenoid base of the left shoulder FINAL/WORKING DIAGNOSIS: Non-displaced left scapular glenoid base fracture TREATMENT: Immobilization in a shoulder immobilizer for 2 weeks Pendulum exercises and range of motion exercises 2 weeks after the injury. Rotator cuff and deltoid strengthening exercises for 3 and 4 weeks post injury. Cardiovascular workouts continued throughout rehabilitation Phased back to contact once near full strength achieved at 2 months post injury.