Primary Traumatic Shoulder Dislocation Research Articles

Glenohumeral Pathologies following Primary Anterior Traumatic Shoulder Dislocation-Comparison of Magnetic Resonance Arthrography and Arthroscopy.

We assessed intraarticular injuries in patients after primary anterior traumatic shoulder dislocation by comparing magnetic resonance arthrography (MRA) results with concomitant arthroscopic findings. All patients with primary traumatic shoulder dislocation who underwent arthroscopic surgery between 2001 and 2020 with preoperative MRA were included in this study. MRA was retrospectively compared with arthroscopic findings. Postoperative shoulder function was prospectively assessed using the Disabilities of Arm, Shoulder and Hand score (quick DASH), the Oxford Shoulder Score (OSS), the Subjective Shoulder Value (SSV), as well as the rate of return to sports. A total of 74 patients were included in this study. A Hill-Sachs lesion was consistently found in the corresponding shoulders on MRA and arthroscopy in 35 cases (p = 0.007), a Bankart lesion in 37 shoulders (p = 0.004), and a superior labrum from anterior to posterior (SLAP) lesion in 55 cases (p = 0.581). Of all cases, 32 patients were available for a clinical and functional follow-up evaluation. A positive correlation was found between the level of sport practiced and the Oxford Shoulder Score (redislocation subset) (p = 0.032) and between the age at the time of surgery and the follow-up SSV (p = 0.036). Conversely, a negative correlation was observed between the age at the time of surgery and the Oxford Instability Score (redislocation subset) (p = 0.038). The results of this study show a good correlation between MRA and arthroscopy. Therefore, MRA is a valid tool for the detection of soft tissue pathologies after primary anterior traumatic shoulder dislocation and can aid in presurgical planning.

ОРГАНИЗАЦИОННЫЕ И ТЕХНОЛОГИЧЕСКИЕ ОСОБЕННОСТИ ПРИ ЛЕЧЕНИИ ПАЦИЕНТОВ С ВЫВИХОМ ПЛЕЧА (ОБЗОР ЛИТЕРАТУРЫ)

Introduction. Shoulder dislocation currently continues to be the most common among dislocations of all localizations - about 45%. Over the years of observation, this indicator has been decreasing in different countries. More than 50 methods of correcting shoulder dislocation have been described. Methods of correction and organizational features of the treatment of injured are the subject of discussions on scientific forums and on the pages of specialized magazines. The review is dedicated to the analysis of organizational and technological features shoulder dislocation. Results. The existing methods of correcting shoulder dislocation can be divided into three groups: lever; physiological methods based on muscle stretching (traction); methods involving pushing the head of the humerus into the joint cavity (push methods). Despite the many ways, the recurrence shoulder dislocation is noted in almost every second victim. Most often, relapse is stated by young patients. Many specialists note the shortcomings of the methods of correcting the primary traumatic shoulder dislocation as in terms of the choice of the method of correction, and in terms of the organization of the therapeutic and diagnostic process. Among the complications of shoulder dislocation reduction, instability of the shoulder joint, habitual dislocation, restriction of shoulder movement are most often verified. The review analyzes the main methods of conservative correction of shoulder dislocation, provides data on the frequency and structure of complications. Separately, information about anesthesia for the reduction of shoulder dislocation is noted. The features of treatment of injured with shoulder dislocation in outpatient conditions and during hospitalization are shown. Presented overview the literature allows you to orientate yourself in the state of the issue of conservative correction of shoulder dislocation today.

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.

ASSESSMENT OF CONDITION OF SOFT-TISSUE COMPONENTS OF SHOULDER JOINT AFTER PRIMARY TRAUMATIC SHOULDER DISLOCATION: DYNAMICS OF CHANGES AFTER 1, 3, 6 AND 12 MONTHS BASED ON ULTRASOUND, CT AND MRI

Abstract. Objective. Assess the condition of soft-woven components of the shoulder joint after primary traumatic shoulder dislocation based on ultrasound, CT and MRI in dynamics. Materials and methods. The article presents a review; therefore, theoretical methods were used during the study: analysis of literary sources, results of original studies, clinical cases. We analyzed treatment outcomes in dynamics - 1, 3, 6 and 12 months after treatment initiation. Results. A month after traumatic dislocation, primary regenerative processes begin in the tissues. Regardless of whether surgical or conservative treatment is performed, it is important to assess the condition of the shoulder joint and surrounding soft tissues. Follow-up in patients with traumatic dislocation lasted from 3 to 12 months after treatment, registered results were referred as medium- or long-term follow-up results. 3 months after treatment, scar changes in the joint capsule were clearly observed. The scar began to form 3-4 weeks after the onset of restorative treatment. 2 months since the treatment began, scars gradually compacted. At about 3 months, the formation of the articular lip begins which lasts up to 6 months. 12 months after the treatment, the pattern of dislocation of the shoulder joint is maximally leveled and the state of the tissues approaches the normal. Evaluation of long-term treatment results is an important prognostic feature that allows monitoring the course of the recovery period. The main importance was attached to the results of the examination using ultrasound, MRI and CT. Based on the analysis of integral indicators of these studies, the optimal method of diagnosis in different time periods and tracking changes in dynamics was determined.

RETHINKING OF THE METHOD OF CONSERVATIVE TREATMENT OF PRIMARY TRAUMATIC SHOULDER DISLOCATION

Тhe authors of the article studied the evolution of views on the treatment of primary traumatic shoulder dislocation. In two research groups, including 103 patients, an attempt was made to eliminate the shortcomings of the generally accepted method of conservative treatment of this pathology: after atraumatic dislocation reduction, immobilization was performed in a mass-produced sling, and from the first day after the injury, an individually selected course of physical therapy for the immobilized limb was started, in accordance with age and physical development. The proposed approach to treatment was a reinterpretation of all stages of the existing method of conservative treatment of primary traumatic shoulder dislocation and allowed to improve the subjective feelings of patients on the VASH scale, as well as indicators of objective evaluation of function on the Rowe scale. In the conditions of a trauma center in a large district of a multi-million city, screening ultrasound of the shoulder joint is promising for all patients who have suffered a primary traumatic dislocation of the shoulder immediately after the dislocation is set and three weeks after the injury. This study allows us to conduct additional diagnostics and identify a group of patients with specific injuries to the anatomical structures of the shoulder joint, which in the future may initiate the development of post-traumatic instability. The functional method of immobilization of the upper limb after reduction of traumatic primary shoulder dislocation effective and simple to implement, easy for the patient and allows the doctor to monitor the results obtained at each stage of treatment.

Functional outcome and tendon integrity of rotator cuff reconstruction after primary traumatic glenohumeral dislocation.

Rotator cuff tears (rct) subsequent to glenohumeral dislocation are relevant concomitant injuries, can lead to impaired shoulder function and increase risk of recurrent dislocation. The aim of this study was to determine the functional outcome, recurrent dislocation rate and tendon integrity after rotator cuff repair after primary traumatic shoulder dislocation. In this retrospective case series, 23 patients (age 56.4 years ± 6.3) who underwent a rotator cuff reconstruction after primary traumatic shoulder dislocation with confirmed combination of full-thickness RCT and Bankart lesion were enrolled after a minimum follow-up of 2years. Clinical outcome (age and gender adjusted Constant Murley Score (CMS), DASH, Rowe Score) (n = 23) and sonographic tendon integrity (n = 19) were studied. After a mean follow-up of 58 ± 32months, a CMS of 85.1% ± 14.7, DASH of 14.2 ± 20.5, and Rowe Score of 82.4 ± 15.2 indicated good functional outcome. In 4 of 19 patients (21.1%) a re-tear was found during sonographic evaluation. In 3 cases (13%), a revision was performed (2 × stiff shoulder, 1 × postoperative infection). One patient had a single traumatic re-dislocation (4.3%). Patients undergone reconstruction of the rotator cuff following a primary traumatic shoulder dislocation can achieve good functional results and a low rate of recurrent dislocation. Postoperative tendon integrity is comparable with known data about non traumatic tears.

Anterior shoulder dislocation and concomitant fracture of the greater tuberosity: Clinical and radiological results.

BackgroundRecurrence rates after primary traumatic shoulder dislocation are distinctly high. We hypothesized that concomitant isolated fractures of the greater tuberosity are associated with low rates of persistent instability but decreased range of motion.MethodsBetween 2007 and 2013, 66 consecutive shoulders in 64 patients were treated for primary shoulder dislocation combined with an isolated fracture of the greater tuberosity with either a nonsurgical (48 shoulders, 72.7%) or surgical (18 shoulders, 27.3%) treatment approach. In all, 55 cases (83.3%) were available for clinical follow-up examination after an average of 59.0 ± 20.7 months (range: 25–96 months) and of these, 48 (72.7%) patients consented to radiological evaluation to determine healing and position of the greater tuberosity.ResultsThe mean range of motion of the affected shoulder was significantly decreased by 9° of elevation (p = 0.016), 11° of abduction (p = 0.048), 9° of external rotation in 0° of abduction (p = 0.005), and 10° of external rotation in 90° of abduction (p = 0.001), compared with the unaffected shoulder. The mean WOSI score was 373 ± 486 points, the mean Constant and Murley score was 75.1 ± 19.4 points, and the mean Rowe score was 83 ± 20 points. Three cases (5.5%) of re-dislocation were reported among the cohort, all of them were due to a relevant trauma. Radiological evaluation revealed anatomically healed fragments in 31 shoulders (65%), dislocation of the fragment in ten shoulders (21%), impaction into the humeral head in four shoulders (8%), and absorption in three shoulders (6%).ConclusionA concomitant isolated fracture of the greater tuberosity leads to low recurrence rates along with a significant decrease in range of motion after primary traumatic anterior shoulder dislocation.

First-time anterior shoulder dislocations: should they be arthroscopically stabilised?

The glenohumeral joint is inherently unstable because the large humeral head articulates with the small shadow glenoid fossa. Traumatic anterior dislocation of the shoulder is a relatively common athletic injury, and the high frequency of recurrent instability in young athletes after shoulder dislocation is discouraging to both the patient and the treating physician. Management of primary traumatic shoulder dislocation remains controversial. Traditionally, treatment involves initial immobilisation for 4-6 weeks, followed by functional rehabilitation. However, in view of the high recurrence rates associated with this traditional approach, there has been an escalating interest in determining whether immediate surgical intervention can lower the rate of recurrent shoulder dislocation, improving the patient's quality of life. This review article aims to provide an overview of the nature and pathogenesis of first-time primary anterior shoulder dislocations, the widely accepted management modalities, and the efficacy of primary surgical intervention in first-time primary anterior shoulder dislocations.

Cross-cultural adaptation and validation of the German version of the Western Ontario shoulder instability index

The Western Ontario shoulder instability index (WOSI) is a disease-specific quality of life measurement tool with 21 items for patients with shoulder instability. Here, we report on translation and validation of the German version of the WOSI according to international guidelines. A total of 86 patients in three groups were included in this study. In group I, 24 patients underwent surgical stabilization of the shoulder. Preoperatively and at 12 months post-operatively the WOSI, Rowe score, UCLA, Constant score, and the SF-36 were evaluated. In group II, 25 patients were evaluated 2.6 +/- 1.2 years after sustaining a primary traumatic shoulder dislocation. Group III consisted of 37 healthy men and women with normal, healthy shoulders. Evaluation of Pearson's correlation coefficient between WOSI and Rowe score, UCLA, SF-36 and Constant score and for test-retest reliability was made. Moreover, Cronbach's alpha and floor, and ceiling effects were analyzed. Internal consistency was high (Cronbach's alpha 0.92).Test-retest reliability (Pearson correlation coefficient) was excellent (r = 0.92). The construct validity showed a significant correlation between the WOSI and the scores investigated. There were no floor or ceiling effects for the German WOSI score. The German translation of the WOSI is a valid and reliable tool, applicable to outcome studies on patients with shoulder instability.

Do Bankart lesions heal better in shoulders immobilized in external rotation?

Background and purpose Immobilization in external rotation (ER) for shoulder dislocation has been reported to improve the coaptation of Bankart lesions to the glenoid. We compared the position of the labrum in patients treated with immobilization in ER or internal rotation (IR). A secondary aim was to evaluate the rate of Bankart lesions.Patients and methods 55 patients with primary anterior shoulder dislocation, aged between 16 and 40 years, were randomized to immobilization in ER or IR. Computer tomography (CT) and magnetic resonance imaging (MRI) were performed shortly after the injury. After the immobilization, MRI arthrography was performed. We evaluated the rate of Bankart lesions and measured the separation and displacement of the labrum as well as the length of the detached part of the capsule on the glenoid neck.Results Immobilization in ER reduced the number of Bankart lesions (OR = 3.8, 95% CI: 1.1 –13; p = 0.04). Separation decreased to a larger extent in the ER group than in the IR group (mean difference 0.6 mm, 95% CI: 0.1 – 1.1, p = 0.03). Displacement of the labrum and the detached part of the capsule showed no significant differences between the groups.Interpretation Immobilization in ER results in improved coaptation of the labrum after primary traumatic shoulder dislocation.

Traumatic Shoulder Dislocation in Children and Adolescents

Shoulder dislocation is rarely seen in children. Very few studies in the literature have assessed traumatic glenohumeral joint dislocation in young patients. A retrospective multicenter review of cases with traumatic shoulder dislocation in children presenting over the last 5 years was performed. In all centers, the dislocated joint was reduced and X-ray was performed before and after reduction. Fractures or nerve injuries were excluded. Immobilization for 2 weeks followed. The overall recurrence rate after a first traumatic dislocation was 29 out of 54 (53.7%). It was important to differentiate between traumatic and atraumatic etiologies. The literature on traumatic shoulder dislocation in children of all ages was also reviewed. It can be concluded that after primary traumatic shoulder dislocation in children < 14 years, the management of choice is reduction, X-ray confirmation, immobilization, and clinical examination after a couple of weeks. The recurrence rate in children before the puberty is so low that a conservative treatment can be recommended. Because of the high recurrence rate (80–90%) in adolescents (≥ 14 years), arthroscopy and stabilization should be performed. In adolescents with primary traumatic shoulder dislocation, we therefore highly recommend reduction, X-ray, and clinical examination, followed by arthroscopy with refixation of the labral lesion and subsequent reduced functional treatment.

Diagnosis and therapeutic management following traumatic anterior shoulder dislocation according to extrinsic prognostic factors

We examined the importance of preoperative CT- and NMR-imaging concerning the detection of a bankart-lesion by a retrospective evaluation of 36 patients with primary traumatic or posttraumatic recurrent shoulder dislocations. Because of unfavourable extrinsic prognostic factors, we advised shoulder arthroscopy and surgical stabilization in all cases. Intraoperatively 35 of 36 patients (97%) presented a bankart-lesion. Preoperatively a bankart-lesion was detected in 32 cases (91%) by CT (n = 29) or NMR (n = 7). We could predict the probability of a bankart-lesion with a high reliability by clinical evaluation alone due to several risk-factors. All patients had at least 2 unfavourable prognostic factors. Under these circumstances we could assume a bankart-lesion with a probability of 97%. Therefore in our opinion preoperative CT or NMR is not advised as standard diagnostic procedure in patients with high-risk of recurrence according to extrinsic prognostic factors. We recommend preoperative CT or NMR when the estimation of prognostic factors concerning the risk of redislocation is doubtful and in case of difficult clinical and ultrasound examination regarding shoulder laxity or rotator cuff lesions.

Behandlungsergebnisse nach traumatischer Schulterluxation

In 80 patients with primary traumatic shoulder dislocation treated at the Heidelberg Orthopaedic University Hospital we had a follow-up examination. We wanted to know about age and sex of the patients, the number of redislocations in correlation to time and way of fixation. We had 70% male and 30% female patients with 97.5% of anterior dislocation. The minimum age was 16 and the maximum 87 years with an average of 44 years. 48 patients had a Desault bandage for 2 weeks and 32 had a shoulder-arm plaster cast for 3 weeks. There was no difference between both ways of fixation. We also could not see any better results after more than a 3 weeks' fixation. The most important fact for redislocation is the age and activity of the patients. A young man has a very high risk of redislocation within the first year.

Stellenwert der MR-Tomographie bei akuten Schulterluxationen

24 patients up to two weeks after primary traumatic shoulder dislocation were examined at 0.5 and 1.5 T. Surgical and/or arthroscopic correlation was available in 13, CT-arthrographic correlation in 16 patients. A joint effusion allowing sufficient evaluation of the capsulolabral complex was present in 21/24 (87.5%) cases. 11/14 patients with combined dislocated detachments of the glenoid labrum and capsular lesions were subsequently operated upon. Marrow edema of the humeral head was found in 16/19 Hill-Sachs lesions and in 4/5 fractures of the greater tuberosity. Two patients presented with a lesion of the long biceps tendon associated with rotator cuff tears and were also subsequently operated upon. MRI performed shortly after primary traumatic shoulder dislocation allows a comprehensive evaluation of the intraarticular lesions and decisively influences further therapy.