Shoulder Dislocation Research Articles

High failure rate after conservative treatment for recurrent shoulder dislocation without subjective apprehension on physical examination.

The purpose of this study was to investigate the outcomes of conservative treatment for recurrent shoulder dislocation without subjective apprehension, despite the presence of a Bankart lesion or glenoid defect. A retrospective analysis was performed for 92 patients with recurrent shoulder dislocation treated with conservative treatment due to negative apprehension between 2009 and 2018. The failure of the conservative treatment was defined as a dislocation or subluxation episode or subjective feeling of instability based on a positive apprehension. The Kaplan-Meier method was used to estimate failure rates over time, and a receiver operating characteristic (ROC) curve was constructed to determine a cut-off value for a glenoid defect. The clinical outcomes were compared between patients who completed conservative treatment without recurrence of instability (Group A) and those who failed and subsequently underwent surgical treatment (Group B) using shoulder functional scores and sports/recreation activity level. This retrospective study included 61 of 92 eligible patients with recurrent shoulder dislocation. Among the 61 patients, conservative treatment failed in 46 (75.4%) over the 2-year study period. The cut-off value for a glenoid defect was 14.4%. The association between glenoid defect size (≥ 14.4% or as a continuous variable) and survival was statistically significant (p = 0.039 and p < 0.001, respectively). The mean glenoid defect size in Group B increased from 14.6 ± 3.0% to 17.3 ± 3.1% (p < 0.001), and clinical outcomes for Group A were inferior to those for Group B at the 24-month follow-up. Conservative treatment for recurrent shoulder dislocation in patients without subjective apprehension showed a high failure rate during the study period, especially if the glenoid defect was ≥ 14.4% in size. Despite clinical improvement in patients who completed conservative treatment without recurrence, functional outcome scores and sport/recreation activity levels were better in the patients who underwent arthroscopic Bankart repair. Therefore, for recurrent anterior shoulder instability, even without subjective apprehension, surgical treatment is warranted over conservative treatment. Level IV.

Chronic posterior dislocation of shoulder

PurposeChronic posterior dislocation of shoulder (PDS) is an uncommon injury and there are very few publications describing its different injury patterns and their treatment. This study was carried out to study the associated injuries in chronic PDS, which can help to classify and guide the treatment. MethodsWe retrospectively studied 16 chronic posterior dislocation of shoulder. CT scan was used to classify the injury based on the amount of bone loss in humeral head, malunion of greater tuberosity and malunion of proximal humerus metaphysis. Visual analogue score (VAS) for pain, university of California Los Angles (UCLA) shoulder score and American shoulder and elbow surgeon (ASES) shoulder score were recorded pre operatively and at an average of 27 months post operatively. Results– Type A1 injury was PDS with <50% humeral head bone loss with intact greater tuberosity (GT). It was managed by modified McLaughlin procedure (MMP). Type A2 injury was PDS with >50% bone loss with intact GT. It was managed by hemi-replacement (HRA). Type B1 injury was PDS with <50% bone loss with severe GT malunion. It was managed by MMP and corrective osteotomy of GT. Type B2 injury was PDS with >50% bone loss and severe GT malunion. It was managed by reverse shoulder arthroplasty (RSA). Type C1 injury was PDS with <50% bone loss and metaphyseal malunion. It was managed by MMP and osteotomy of proximal humeral metaphysis. Type C2 injury was PDS with >50% bone loss and metaphyseal malunion. It was managed by HRA. The VAS, UCLA score and ASES score improved significantly after the surgery in all cases. There was no recurrence of the instability ConclusionsWe concluded that chronic PDS could have fractures of tuberosities and/or proximal metaphysis in addition to bone loss in humeral head. The treatment is guided by all three factors-amount of bone loss in humeral head, malunion of GT and proximal humeral metaphysis. The proposed classification can help in choosing the optimum treatment out of joint salvage procedure, anatomic shoulder replacement and reverse shoulder arthroplasty

Glenoid bony morphology along long diameter is associated with the occurrence of recurrent anterior shoulder dislocation: a case-control study based on three-dimensional CT measurements.

The purpose of our study is to compare the anatomic parameters of proximal humerus, glenoid, and glenohumeral joint between patients with recurrent anterior shoulder dislocation (RASD) and patients without RASD with the assistance of three-dimensional (3D) CT scans. Sixty patients were included in the study and divided into group RASD and group control. 3D-CT models of shoulder joint for each included patient were reconstructed and multiple anatomic parameters were measured. There were no statistically significant differences between the two groups in morphological parameters of humerus and glenohumeral joints. Long diameter of glenoid was 3.50 ± 0.34cm for patients in group RASD and 3.31 ± 0.32cm in group control (p = 0.039). There was a statistically significant difference in the ratio of long to short diameter of glenoid (p < 0.001). Ratio of humeral head height to glenoid long diameter (Hhh/Gld) was 1.02 ± 0.07 in group RASD, significantly lower than 1.09 ± 0.08 in group control (p = 0.001). Longitudinal depth of glenoid was significantly higher in group RASD (p = 0.013). The glenoid morphology along long diameter is closely correlated with the stability of glenohumeral joint, including glenoid long diameter and glenoid longitudinal depth. It is especially noteworthy that the value of Hhh/Gld decreases in patients with RASD. The difference of Hhh/Gld between the two groups reminds us that the correlation of bony structure along long diameter between glenoid and humeral head plays an important role in RASD.

Posterior shoulder dislocation with associated reverse Hill–Sachs lesion: clinical outcome 10 years after joint-preserving surgery

IntroductionPosterior shoulder dislocation in association with reverse Hill–Sachs lesion is a rather rare injury. Few studies reporting results after joint-preserving surgery in these cases are available. This current study presents the clinical outcomes 10 years postoperatively.Materials and methodsIn a prospective case series, we operatively treated 12 consecutive patients (all males) after posterior shoulder dislocation with associated reverse Hill–Sachs lesion using joint-preserving techniques. Patients received surgery in a single center between January 2008 and December 2011. The joint-preserving surgical procedure was chosen depending on the defect size and bone quality. The following outcome-measures were analyzed: Constant-Score, DASH-Score, ROWE-Score, and SF-12. Results 1, 5, and 10 years postoperatively were compared.ResultsOut of 12 patients, ten patients (83.3%) were followed-up with a mean follow-up interval of 10.7 years (range 9.3–12.8). The mean patient age at the time of the last follow-up was 51 years (32–66). The outcome scores at the final follow-up were: Constant 92.5 (range 70.0–100), DASH 3.2 (0.0–10.8), ROWE 91.0 (85.0–100), and SF-12 87.8 (77.5–98.3). Clinical results had improved from 1 to 5 years postoperatively and showed a tendency for even further improvement after 10 years.ConclusionsJoint-preserving surgical therapy of posterior shoulder dislocation provides excellent results when the morphology of the reverse Hill–Sachs lesion is respected in surgical decision-making.Trial registration223/2012BO2, 02 August 2010.

Mountain Emergency Medicine Review, 1st edition

Mountain Emergency Medicine Review, 1st edition

Recurrent shoulder dislocation treated with Bristow Latarjet procedure: a case report

Introduction: The shoulder's glenohumeral joint is the most frequently dislocated joint because of its unstable structure. The recurrence rate of shoulder dislocation is high with most of them were anterior dislocations. Bristow-Latarjet (BL) procedure had been reported to provide good outcomes in restoring the joint's stability. The aim of this report is to describe a case of recurrent anterior shoulder dislocation treated with an open BL procedure. Case description: A 36-year-old patient came to our center with complaints of left shoulder pain after falling from a bicycle. Anterior apprehension and sulcus sign was positive on the physical examination and MRI showed anteroinferior labral detachment suggesting a Bankart lesion. This was a second episode of left anterior shoulder dislocation of this patient. An open BL procedure was conducted to this patient and good functionality and stability of the shoulder were obtained. The patient’s history, physical, and radiological examinations were in accordance with the diagnosis of recurrent anterior shoulder dislocation due to a Bankart lesion. Open BL procedure was done and its reported outcomes were also supported in several previous studies. Conclusion: Recurrent anterior shoulder dislocation is still a significant problem, especially in young individuals and athletes. The BL procedure is a good treatment choice in this patient whose instability was due to a Bankart lesion.

Can images crowdsourced from the internet be used to train generalizable joint dislocation deep learning algorithms?

Deep learning has the potential to automatically triage orthopedic emergencies, such as joint dislocations. However, due to the rarity of these injuries, collecting large numbers of images to train algorithms may be infeasible for many centers. We evaluated if the Internet could be used as a source of images to train convolutional neural networks (CNNs) for joint dislocations that would generalize well to real-world clinical cases. We collected datasets from online radiology repositories of 100 radiographs each (50 dislocated, 50 located) for four joints: native shoulder, elbow, hip, and total hip arthroplasty (THA). We trained a variety of CNN binary classifiers using both on-the-fly and static data augmentation to identify the various joint dislocations. The best-performing classifier for each joint was evaluated on an external test set of 100 corresponding radiographs (50 dislocations) from three hospitals. CNN performance was evaluated using area under the ROC curve (AUROC). To determine areas emphasized by the CNN for decision-making, class activation map (CAM) heatmaps were generated for test images. The best-performing CNNs for elbow, hip, shoulder, and THA dislocation achieved high AUROCs on both internal and external test sets (internal/external AUC): elbow (1.0/0.998), hip (0.993/0.880), shoulder (1.0/0.993), THA (1.0/0.950). Heatmaps demonstrated appropriate emphasis of joints for both located and dislocated joints. With modest numbers of images, radiographs from the Internet can be used to train clinically-generalizable CNNs for joint dislocations. Given the rarity of joint dislocations at many centers, online repositories may be a viable source for CNN-training data.

Conservative Care of a Patient with Initial Anterior Shoulder Dislocation Participating in an Intercollegiate Basketball: A Case Study

A 23 year-old male patient participating in intercollegiate basketball, suffered an acute shoulder dislocation. The patient was diagnosed with an anterior glenohumeral labral tear and was treated with an indirect approach to increase range of motion (ROM) and function while decreasing pain. Patient related outcome (PRO) measures were used along with clinician related outcome (CRO) measures to discharge the patient. The immediate changes in ROM and pain along with follow-up assessments of the DASH achieved MCD and MCID levels. As rehabilitation specialists, athletic trainers have the opportunity to provide quality care to patients and recognize the how the injury or condition effects the patient. The follow-up assessments support that the completed conservative indirect treatment for a patient with a glenohumeral anterior labral tear was as effective in this isolated case. The individual was able to return to basketball activities at the same level as prior to the diagnosis. The use of Primal Reflex Release Technique (PRRT) to restore allostatis in the central nervous was effective based on available outcomes for this patient. Then the continued re-education of pain-free functional movement patterns through Reflexive Neuromuscular Stabilization provided the patient the ability to maintain his functional gains. Clinically, the use of indirect treatments, like those used in this case, could be further researched to determine if they can be an effective treatment technique in patients following shoulder dislocation and subsequent glenohumeral anterior labral tear.

Primary traumatic shoulder dislocation associated with rotator cuff tear in the elderly.

Introduction and importanceThe shoulder is one of the most unstable joints of the body. Shoulder dislocation accounts for up to 60% of all major joint dislocations. This study reports two cases of primary traumatic shoulder dislocation and shows that in the elderly, primary traumatic shoulder dislocation is associated with a rotator cuff tear (RCT).Case presentationA case report and narrative review included two female patients, aged 63 and 100 years. Presenting symptoms were instability, pain, and restricted shoulder movement. Both were successfully treated by surgery. Arthroscopy was performed in the first patient and open reduction in the second patient.Clinical discussionIn the first case, we found synovitis around the rotator interval, long head of the biceps tendinitis, and tears of the subscapularis tendon, supraspinatus tendon, and subacromial bursitis. The anterior labrum was normal. In the second case, complete detachment of the infraspinatus tendon was found. In both cases, rotator cuff repair was performed. Primary traumatic shoulder dislocation in the elderly is often associated with rotator cuff injury. Therefore, a detailed evaluation and management of the rotator cuff injury is essential. Rotator cuff injuries cause loss of dynamic stabilization of the shoulder, leading to recurrent shoulder dislocation and chronic shoulder instability.ConclusionThe associated pathology of the primary traumatic shoulder dislocation in elderly are rotator cuff tear. The management of the rotator cuff tear in primary traumatic shoulder dislocation can prevent further shoulder instability events.

Satisfactory functional results and complication rates after anterior glenoid bone block reconstruction in recurrent shoulder dislocation: a mean 4-year follow-up comparative study

BackgroundAnterior recurrent instability of the glenohumeral joint is a common clinical problem among the young population. Glenoid reconstruction with bone graft has become the treatment of choice, particularly in significant deficiency (˃20%). This study aims to assess the functional results of glenoid reconstruction using Latarjet and iliac bone graft in the management of glenoid insufficiency associated with recurrent anterior dislocation of the glenohumeral joint. MethodsPatients suffering from anterior shoulder instability with glenoid defect >20% were included in this study between 2016 and 2021. The university of California at Los Angeles (UCLA) shoulder scale and Constant score were used to assess the functional improvement. Preoperative and final postoperative continuous outcomes were compared with a one-tailed paired t-test and the outcomes across groups were compared using a two-tailed independent t-test. A P-value of <0.05 was considered statistically significant for both tests. ResultsThis trial included 50 patients; twenty-five underwent mini-open Latarjet, and 25 underwent arthroscopic tricortical iliac crest bone grafting (ICBG). The mean follow-up durations were 50.1 ± 5.9 months for Laterjet and 51.6 ± 6.8 months for ICBG. Both techniques showed statistically significant improvement in the final UCLA (31.1 ± 2.1 in Laterjet and 30.2 ± 2.2 in ICBG) and Constant (90.2 ± 4.6 in Laterjet and 89 ± 5.01 in ICBG) scores. There was no statistically significant difference regarding mean age, sex, side of injury, mechanism of injury, follow-up period and clinical outcome between both surgical treatments. At the end of the study, both groups demonstrated statistically significant improvement in the range of motion (p ˂ 0.00001). Only one, non-adherent patient in Laterjet group had post-operative dislocation. In ICBG group, two patients had partial bone graft resorption, 3 graft site morbidities and 1 hardware prominence. ConclusionBoth Laterjet and iliac bone graft procedures had satisfactory functional results in reconstruction of glenoid defect >20% in unstable shoulders with a mean 4-year follow-up. No statistically significant difference was reported in the last postoperative Constant and UCLA scores between both techniques, but Latarjet procedure had fewer complications (4%) than ICBG (24%).Level of evidence: Prospective non-randomized comparative study; level II

Comparison of Rehabilitation Programs Following a Latarjet Procedure: A Level 3 Case Study

OBJECTIVE: Anterior shoulder dislocations cause chronic disability, often requiring surgery. Latarjet procedures are considered when the anterior glenoid fractures during shoulder dislocation. Latarjet procedures show positive outcomes with low dislocation recurrence rates, although rehabilitation guidelines are not well established. This Level-3 CASE report will compare two rehabilitation protocols. UNIQUENESS: Our patient’s progress was significantly delayed compared to Murphy et al.’s patient. Although they had similar strength and ROM deficits in week 2, our patient required an additional 15 weeks to make similar gains. Also, our patient did not begin aggressive overhead activity until 10 weeks after Murphy et al.’s patient. Murphy et al.’s patient returned to limited participation in week 8 and full participation in week 10, while our patient did not return to limited participation until week 16.

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 Following Tramadol Induced Seizure After Low Dose Consumption in a Healthy Adult

Tramadol is a synthetic analgesic used for the treatment of moderate to severe pain with a dual mechanism of action. Although Tramadol-induced seizures are reported in the literature, however, the incidence is rare with its use in therapeutic dosage. Bilateral symmetrical anterior dislocation following a seizure is an unusual complication. We present a rare case of bilateral symmetrical anterior shoulder dislocation following Tramadol-induced epileptiform reaction in an otherwise healthy adult male. The dislocations were diagnosed early and reduced immediately with a satisfactory outcome. An awareness of this entity and a high index of suspicion are required to make an early diagnosis and offer prompt treatment in order to avoid unpleasant complications.

Biomechanical Testing of Scapular Spine Autograft for Anterior Glenoid Bone Augmentation.

Background:Augmentation of anterior glenoid defects with bone graft can improve shoulder stability and reduce the risk of redislocation. Several characteristics of the scapular spine may make it a suitable harvest site, avoiding the disadvantages associated with other glenoid augmentation procedures.Purpose:To evaluate the capacity of scapular spine autograft to restore the stabilizing joint-reaction forces of the shoulder in simulated scenarios of bony anterior shoulder instability.Study Design:Controlled laboratory study.Methods:We obtained 6 matched pairs of fresh-frozen cadaveric shoulders. Skin, subcutaneous tissues, and non–rotator cuff muscles were removed from the specimens, leaving intact the rotator cuff musculature and shoulder capsule. A customized testing device was used to translate the humerus 1 cm anteriorly on the glenoid under 25 N of axial compression force. The peak joint-reaction force of the glenohumeral joint was then measured under 3 conditions: (1) specimen with intact glenoid, (2) specimen after a bone defect measuring 25% of the maximal width of the glenoid was made in the anteroinferior glenoid, and (3) specimen after size-matched glenoid augmentation with a scapular spine tricortical autograft. The primary outcome was the change in peak joint-reaction forces between the defect state and augmented state.Results:One matched pair was removed from final analysis secondary to anatomic concerns that undermined the accuracy of test results. Among the 10 remaining specimens, all showed a significant decrease in peak joint-reaction force after the glenoid defect was created compared with the intact state (P < .001). All remaining specimens showed an increase in peak joint-reaction force in the augmented state compared with the defect state (P < .001). On average, the augmented state restored 81% of the peak reaction force of the glenohumeral joint compared with the intact state, a nonsignificant difference (P = .07).Conclusion:The study findings indicated that autograft harvested from the scapular spine increased the bony restraint to anterior shoulder dislocation in shoulders with glenoid bone loss.Clinical Relevance:The scapular spine is an alternative for bony augmentation of glenoid defects in shoulder instability.

The introduction of the trauma triage clinic at a district general hospital: safety and efficacy during the first year of implementation.

Previously published work has shown that there are no missed injuries following the introduction of a trauma triage clinic (TTC). This study aimed to assess both the safety and efficacy of the TTC model in a district general hospital in the United Kingdom. We aimed to assess the rate of missed 'high-risk' injuries, including posterior shoulder dislocations, talar injuries, Lisfranc injuries and complex carpal instability. Data were collected retrospectively between November 2017 and October 2018 (inclusive). During this time, 3,721 patients were reviewed (mean age 38 years, SD 25.5, range 1-103 years). Case notes and x-rays were reviewed for all patients. Compliance was assessed against British Orthopaedic Association Standards for Trauma (BOAST 7) guidelines for fracture clinic services. The standard for adherence to guidelines was 100%. Thirty-two of 3,721 patients had a missed injury during the study period, and 66% of these injuries were high risk. TTC was effective in reducing the number of patients seen in the fracture clinic, with 23% of patients discharged directly from the TTC. Eighty-nine per cent of patients were reviewed in clinic within 72 hours of presentation, with a median time to review of 2 days. This study has shown that TTC is efficient in reducing the burden of patients seen in the fracture clinic, but it is not as safe as reported previously. Although the prevalence of missed injuries is low, hospitals introducing a TTC model should consider departmental processes to help accurately identify and triage high-risk injuries.

Long head of biceps transfer to augment Bankart repair in chronic anterior shoulder instability with and without subcritical bone loss: a biomechanical study.

Treating recurrent anterior shoulder instability in participants in collision sports, patients with capsulolabral defects, and patients with bipolar bone loss remains challenging. The study purpose was to investigate the effect of long head of the biceps transfer (LHBT) on load-to-dislocation biomechanics in a repetitive serial shoulder dislocation cadaveric model comparing LHBT with the Latarjet and Bankart procedures-the first-line treatment methods for chronic traumatic anterior shoulder instability with and without anterior glenoid bone loss, respectively. In this controlled laboratory study, 8 fresh-frozen cadaveric shoulders with different conditions were dislocated in sequence using a custom test frame. The muscle loading configuration simulated the arm in the apprehension position, and biceps loads of 20 N and 40 N were used for the static glenohumeral position analysis to evaluate the sling effect. Sequential experimental conditions consisted of the intact state, second and third dislocations, chronic instability, Bankart repair, first LHBT, subcritical glenoid bone loss, second LHBT, and Latarjet procedure. The pectoralis major and joint reaction loads to dislocation sequentially decreased with serial dislocations in all specimens, with the lowest value in the subcritical glenoid bone defect condition. In the setting of chronic instability, the pectoralis load to dislocation was significantly higher with the Bankart repair (P = .031) and LHBT (P < .001), at 71% and 85% of the intact value, respectively. Direct comparison of the pectoralis load to dislocation favored LHBT over Bankart repair (P = .015). In the subcritical defect scenario, LHBT did not significantly increase the load to dislocate, and the Latarjet procedure demonstrated a higher load to dislocate than LHBT (P < .001). All 3 surgical procedures tested significantly increased the angle of horizontal abduction at the time of dislocation and restored the glenohumeral position to closer to the intact state. Doubling the biceps load leveraged the sling effect, pulling the humeral head farther posterior-superiorly, but this was not enough to overcome the effect of a 20% subcritical glenoid bone defect. In a serial dislocation model, LHBT effectively stabilized the glenohumeral joint in a simulated chronic instability scenario, increasing the pectoralis major load-to-dislocate and glenohumeral joint reaction force components at the time of dislocation and restoring relative glenohumeral positioning to close to the intact state. The Latarjet procedure outperformed LHBT in stabilizing shoulders in the 20% subcritical glenoid bone defect condition.

Combined HAGL and Bankart Lesions in an Adolescent Athlete with Ligamentous Laxity and Recurrent Shoulder Dislocation

Combined HAGL and Bankart Lesions in an Adolescent Athlete with Ligamentous Laxity and Recurrent Shoulder Dislocation

Recurrent Heart Attacks in a Young Lady

24-year-old woman presented to our hospital with chest pain, new ECG changes and high troponin suggestive of non-ST Myocardial infarction, patient gave history of another two heart attacks at the age of 20 and 21, on both occasions, she was treated with angioplasty and no stenting. Her past medical history was significant for recurrent meniscal tear on both knees which was treated conservative, when patient was 15-year-old, she was diagnosed as carotid–cavernous fistula and Treated with endovascular therapy, her family history was noted for her sister having small bowel rupture at the age of 18 year, her brother had two strokes at the age of 18 and 19, patient also was known to have recurrent dislocation of right shoulder and delayed wound healing. Examination showed scattered bruising, blue sclera, hyperelasticty of skin over elbow joints, MRA of whole body showed aneurysm of both internal iliac vessels, coronary CT showed aneurysm in the left anterior descending and right coronary arteries, differential diagnosis was discussed with the patient who gave a consent for genetic study which came positive for COL3A1 and confirmed the diagnosis of Vascular Ehlers Donals Syndrome (formally called Ehlers Donals Syndrome type 4). Patient agreed for genetic counselling, and first-degree family agreed for genetic testing, in the article we will report the case and discuss the differential diagnosis.

Inferior shoulder dislocation with greater tuberosity avulsion fracture treated with Traction-Countertraction method in a rural hospital: A case report and literature review

Introduction. Inferior shoulder dislocation is considered a rare event. Although there is a seemingly low chance of occurrence, this condition should not be prematurely ruled out in the presence of acute shoulder pain. Case. A 45 years old woman complained of pain in her left shoulder and was unable to bring her arm lower than 90° after a car accident. The patient unintentionally put her left arm outstretched above her head to avoid head impact during the crash, causing hyperabduction of the shoulder. She experienced pain, numbness and could not move the ipsilateral hand. Her left arm was locked in hyperabduction (100°), and her elbow was extended. Close inspection showed a loss of left shoulder contour. On palpation, the humeral head was palpable in the axilla. Anteroposterior X-ray view confirmed inferior dislocation of the left shoulder with associated greater tuberosity fracture. A closed reduction under general anesthesia with the traction-counter traction technique was conducted as commonly used in rural settings. After perfect anatomical reduction was obtained and confirmed with X-ray, the patient was immobilized using an arm sling. The shoulder was immobilized for three weeks in adducted position to support soft tissue healing. Physiotherapy was started after three weeks. Conclusion. Inferior shoulder dislocation is a rare orthopedic pathology that should not be easily dismissed in post-traumatic shoulder pain. The mechanism of injury is characterized by downward force or lever mechanism on the hyperabducted arm. Orthopedic surgeons in rural areas could utilize the Traction-countertraction method.

Arthroscopic Technique for Distal Tibial Allograft Bone Augmentation With Suture Anchor Fixation for Anterior Shoulder Instability

Recurrent instability associated with glenoid bone loss is a commonly encountered problem after anterior shoulder dislocation. Surgical management with bony augmentation can be achieved with several allograft or autograft options. Fixation strategies also vary, including screw, suture button, or suture anchor fixation. Concerns exist regarding screw fixation because of the technical difficulty of a medial portal establishment, as well as the potential for graft osteolysis. Suture button fixation for osteochondral graft fixation has been previously described. However, no description of graft fixation using suture anchors exists. We describe an arthroscopic technique for glenoid augmentation using distal tibial allograft with suture anchor fixation.