Modified Boytchev procedure for treatment of recurrent anterior dislocation of shoulder

A Bilateral Symmetric Accessory Coracobrachialis Muscle Combined With an Interconnection of the Musculocutaneous Nerve With the Median Nerve

This report describes a bilateral symmetric accessory coracobrachialis muscle variant coexisting with a unilateral interconnection of the musculocutaneous nerve and the median nerve. An 80-year-old female cadaver was dissected. The bilateral coracobrachialis muscle variant consisted of three heads: two superficial heads and one deep head. One superficial head arose from the tip of the coracoid process, while the other originated from the short head tendon of the biceps brachii. The deep head of the coracobrachialis muscle emerged from the base of the coracoid process. The musculocutaneous nerve bilaterally coursed between the superficial and deep heads. On the right side, the three-headed coracobrachialis muscle coexisted with an ipsilateral interconnection of the musculocutaneous nerve and the median nerve, located at the lower third of the arm. While the presence of a unilateral three-headed coracobrachialis muscle is not rare (with a prevalence range of 0-22.2%), as well as the distal interconnection between the musculocutaneous nerve and the median nerve at the lower third of the arm (with a prevalence range of 1.8-53.6%), the coexistence of the current bilateral three-headed coracobrachialis muscle variant with the distal interconnection of the musculocutaneous and median nerves is quite unusual. A similar report underscores the finding of the bilateral coracobrachialis muscle variant.

Arthroscopic Bankart repair following traumatic recurrent shoulder dislocation: A prospective review of 30 cases

BACKGROUND

Literature on outcomes of arthroscopic Bankart repair at the intervening time intervals in traumatic recurrent dislocation of shoulder joint is limited.

STUDY DESIGN

Case series.

SUBJECTS AND METHODS

A prospective review of 30 shoulders, aged 20-40 years with clinically and magnetic resonance imaging established findings that were treated with primary arthroscopic Bankart repair and followed up for a minimum of 2 years. Outcomes were evaluated using Rowe score and University of California at Los Angeles (UCLA) scoring system.

RESULTS

The mean age was 26.40 years. All patients had definite trauma history. Average number of dislocation was 13.77 + 18.435 (range: 3-100). Time duration from first dislocation to surgery was an average of 4.80 + 3.576 years. The average size of the lesion was approximately 31% of the glenoid circumference. The number of suture anchors used for fixation did not correlate significantly with any of the scores. The mean Rowe and UCLA scores were 94.16 ± 9.7 and 33.83 ± 3.32, respectively, at final follow-up. The average duration of hospital stay was 7 days. Of the 30 patients, 2 (6.66%) had dislocation events post-operatively. Returns to pre-injury level were available for 27 (90%) of 30 patients. Multivariate analysis of independent Variables: age; side and number of dislocations, time to surgery, duration of surgery, size of lesion, number of anchors, and concurrent Hill-Sachs lesion, shown to have no significant relationship to outcomes.

CONCLUSION

Arthroscopic Bankart repair is an effective and safe technique for treating anterior glenohumeral instability in patients with recurrent traumatic shoulder dislocation.

Modified Boytchev procedure for recurrent anterior dislocation of shoulder

PURPOSE. To evaluate results of the modified Boytchev procedure for recurrent anterior dislocation of the shoulder in 60 patients. METHODS. Medical records of 45 men and 15 women aged 20 to 44 years who underwent the modified Boytchev procedure for recurrent anterior dislocation of the right (n=44) and left (n=16) shoulders were reviewed. The mean number of dislocations was 14. Outcome was evaluated using the Burkhead and Rockwood criteria. RESULTS. The mean follow-up period was 56 months. Outcome was excellent in 32 patients, good in 21, and fair in 7. None had poor outcome. The mean external rotation deficit at 0º and 90º of abduction improved from 14º to 7º (p=0.04) and 18º to 7º (p=0.03), respectively. Two patients had fragmentation of the coracoid process, which was fixed with non-absorbable suture. Two patients had traction injury to the musculocutaneous nerve, which recovered after 6 months. One patient had recurrent dislocation that ruled out the chance of revision surgery. CONCLUSION. The modified Boytchev procedure is a viable and simple treatment for recurrent anterior shoulder dislocation.