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Maheshwer B, Halkiadakis P, Ina JG, Bafus BT, Lee A. Demographics and Outcomes of Glenohumeral Dislocations in Individuals With Elevated Body Mass Index. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202404000-00013. [PMID: 38603558 PMCID: PMC11003501 DOI: 10.5435/jaaosglobal-d-24-00021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 01/20/2024] [Indexed: 04/13/2024]
Abstract
INTRODUCTION No specific study has investigated the characteristics and outcomes of anterior shoulder dislocations in morbidly obese individuals. The purpose of this study was to describe shoulder dislocations in patients with body mass index (BMI) greater than 40. METHODS A retrospective review was conducted to identify patients aged 18 years and older with a BMI ≥40 who presented with a shoulder dislocation in a single institution from 2000 to 2020. Dislocation patterns, associated injuries, treatment modalities, and associated complications were recorded. RESULTS A significant increase was noted in the number of patients with BMI greater than 40 presenting per year (r2 = -0.831, P < 0.01) over the past 20 years. A significant increase was noted in the average BMI per year in this population (r2 = 0.504, P = 0.028). Fifteen patients (19.5%) experienced at least one recurrent dislocation episode. Ten patients had a Bankart lesion that was associated with an elevated BMI (P = 0.04). Nine patients (11.7%) sustained an associated neurologic injury (no association with BMI). CONCLUSIONS Over time, there has been an increase in shoulder dislocations in morbidly obese individuals in the United States, alongside an overall increase in the average BMI of patients who present with shoulder dislocations.
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Affiliation(s)
- Bhargavi Maheshwer
- From the University Hospitals Cleveland Medical Center (Dr. Maheshwer, and Dr. Ina); the Case Western Reserve University School of Medicine (Ms. Halkiadakis); the Veterans Affairs Medical Center (Dr. Bafus); and the MetroHealth Medical Center, Cleveland, OH (Dr. Bafus, and Dr. Lee)
| | - Penelope Halkiadakis
- From the University Hospitals Cleveland Medical Center (Dr. Maheshwer, and Dr. Ina); the Case Western Reserve University School of Medicine (Ms. Halkiadakis); the Veterans Affairs Medical Center (Dr. Bafus); and the MetroHealth Medical Center, Cleveland, OH (Dr. Bafus, and Dr. Lee)
| | - Jason G. Ina
- From the University Hospitals Cleveland Medical Center (Dr. Maheshwer, and Dr. Ina); the Case Western Reserve University School of Medicine (Ms. Halkiadakis); the Veterans Affairs Medical Center (Dr. Bafus); and the MetroHealth Medical Center, Cleveland, OH (Dr. Bafus, and Dr. Lee)
| | - Blaine T. Bafus
- From the University Hospitals Cleveland Medical Center (Dr. Maheshwer, and Dr. Ina); the Case Western Reserve University School of Medicine (Ms. Halkiadakis); the Veterans Affairs Medical Center (Dr. Bafus); and the MetroHealth Medical Center, Cleveland, OH (Dr. Bafus, and Dr. Lee)
| | - Adrienne Lee
- From the University Hospitals Cleveland Medical Center (Dr. Maheshwer, and Dr. Ina); the Case Western Reserve University School of Medicine (Ms. Halkiadakis); the Veterans Affairs Medical Center (Dr. Bafus); and the MetroHealth Medical Center, Cleveland, OH (Dr. Bafus, and Dr. Lee)
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Chen C, Ye T, Jiang J, He W, Xia J, Yang Y. Exploring temporal trends and burden of traumatic shoulder dislocation: a global perspective. Front Public Health 2024; 12:1346957. [PMID: 38487187 PMCID: PMC10937414 DOI: 10.3389/fpubh.2024.1346957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 02/14/2024] [Indexed: 03/17/2024] Open
Abstract
Objective To explore the geographical and temporal trends of traumatic shoulder dislocation, describe the association between the social and demographic factors and the health burden due to traumatic shoulder dislocation, and further investigate its causes. Methods Data on traumatic shoulder dislocation was collected from the Global Burden of Disease 2019, spanning the years 1990 to 2019. The epidemiology and disease burden were examined at global, regional, and national levels. Additionally, the age and gender patterns were analyzed, followed by an investigation into the primary causes. Lastly, the study studied the correlation between age-standardized rates and the socio-demographic index (SDI). Results Over a span of 30 years, both the crude and age-standardized rates of incidence and years lived with disability (YLDs) rates for all genders displayed a slight fluctuating downward trend. The incidence and YLDs rates in males were consistently higher than those in females. The study analyzed both incidence and YLDs rates of the global, regional, and national of traumatic shoulder dislocations from 1990 to 2019, as well as the temporal trends. Among males, the highest incidence rate was observed in young adulthood, while females exhibited the highest incidence rate in old age. This pattern was mirrored in the YLDs rate. Falls were identified as the main cause contributing to the disease burden related to traumatic shoulder dislocations. Moreover, a positive correlation was found between the age-standardized rates and SDI. Conclusion The disease burden of traumatic shoulder dislocation has not significantly decreased from 1990 to 2019. The incidence and YLD rates are associated with age, gender, and SDI. A thorough examination of the disease burden contributes to the efficient allocation and utilization of resources, as well as the development of targeted and effective intervention strategies.
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Affiliation(s)
- Cheng Chen
- Department of Orthopedics, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Tianbao Ye
- Department of Cardiology, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiantao Jiang
- Department of Orthopedic Surgery, Shaoxing Shangyu Traditional Chinese Medicine Hospital, Zhejiang, China
| | - Wenbao He
- Department of Orthopedics, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Jiang Xia
- Department of Orthopedics, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yunfeng Yang
- Department of Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Hardie CM, Jordan R, Forker O, Fort-Schaale A, Wade RG, Jones J, Bourke G. Prevalence and risk factors for nerve injury following shoulder dislocation. Musculoskelet Surg 2023; 107:345-350. [PMID: 36445531 PMCID: PMC10432320 DOI: 10.1007/s12306-022-00769-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 11/04/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The 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. METHODS A 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. RESULTS Of 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. CONCLUSIONS Shoulder 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.
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Affiliation(s)
- C M Hardie
- Leeds Institute for Medical Research, University of Leeds, Leeds, UK.
- Department of Plastic and Reconstructive Surgery, Leeds Teaching Hospitals Trust, Clarendon Wing, Leeds General Infimrary, Great George Street, Leeds, LS1 3EX, UK.
| | - R Jordan
- Faculty of Medicine and Health Sciences, University of Leeds, Leeds, UK
| | - O Forker
- Faculty of Medicine and Health Sciences, University of Leeds, Leeds, UK
| | - A Fort-Schaale
- Department of Plastic and Reconstructive Surgery, Leeds Teaching Hospitals Trust, Clarendon Wing, Leeds General Infimrary, Great George Street, Leeds, LS1 3EX, UK
| | - R G Wade
- Leeds Institute for Medical Research, University of Leeds, Leeds, UK
- Department of Plastic and Reconstructive Surgery, Leeds Teaching Hospitals Trust, Clarendon Wing, Leeds General Infimrary, Great George Street, Leeds, LS1 3EX, UK
| | - J Jones
- Department of Emergency Medicine, Leeds Teaching Hospitals Trust, Leeds, UK
| | - G Bourke
- Leeds Institute for Medical Research, University of Leeds, Leeds, UK
- Department of Plastic and Reconstructive Surgery, Leeds Teaching Hospitals Trust, Clarendon Wing, Leeds General Infimrary, Great George Street, Leeds, LS1 3EX, UK
- Department of Integrative Medical Biology, University of Umea, Umeå, Sweden
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Eren TK, Kaptan AY, Bircan R, Tosun MF, Kanatlı U. Lesion prevalence and patient outcome comparison between primary and recurrent anterior shoulder instability. J Shoulder Elbow Surg 2023; 32:1812-1818. [PMID: 37419438 DOI: 10.1016/j.jse.2023.05.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 05/07/2023] [Accepted: 05/21/2023] [Indexed: 07/09/2023]
Abstract
BACKGROUND The purpose of this study was to compare lesion prevalence and treatment outcomes in patients with primary and recurrent anterior shoulder instability. METHODS Patients who were admitted to the institution with a diagnosis of anterior shoulder instability and who underwent arthroscopic surgery between July 2006 and February 2020 were retrospectively evaluated. Minimum follow-up duration of the patients was 24 months. The recorded data and magnetic resonance imaging (MRI) of the patients were examined. Patients aged ≥40 years, with a history of shoulder region fracture, inflammatory arthritis, a history of epilepsy, multidirectional instability, nontraumatic dislocation, and off-track lesions were excluded from the study. Shoulder lesions were documented and patient outcome evaluation was made with the Oxford Shoulder Score (OSS) and visual analog scale (VAS). RESULTS A total of 340 patients were included in the study. The mean age of patients was 25.6 years (±6.49). The recurrent instability group had a significantly higher rate of anterior labroligamentous periosteal sleeve avulsion (ALPSA) lesions compared to the primary instability group (40.6% vs. 24.6% respectively) (P = .033). Twenty-five patients (43.9%) had superior labrum anterior and posterior (SLAP) lesions in the primary instability group and 81 patients (28.6%) had SLAP lesions in the recurrent instability group (P = .035). OSS increased for both primary (from 35 [16-44] to 46 [36-48]) (P = .001) and recurrent instability groups (from 33 [6-45] to 47 [19-48]) (P = .001). There was no significant difference between the groups regarding postoperative VAS and OSS scores (P > .05). CONCLUSIONS Successful results were obtained in patients younger than 40 years with both primary and recurrent anterior shoulder instability after arthroscopic treatment. ALPSA lesion prevalence was higher whereas SLAP lesion prevalence was lower in patients with recurrent instability. Although the postoperative OSS was comparable between the patient groups, the failure rate was higher in the recurrent instability patients.
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Affiliation(s)
- Toygun Kağan Eren
- Department of Orthopedics and Traumatology, Ankara Training and Research Hospital, Ankara, Turkey
| | - Ahmet Yiğit Kaptan
- Department of Orthopaedics & Traumatology, Harran University School of Medicine, Şanlıurfa, Turkey.
| | - Resul Bircan
- Department of Orthopedics and Traumatology, Mardin Training and Research Hospital, Mardin, Turkey
| | - Muhammed Furkan Tosun
- Department of Orthopedics and Traumatology, Gazi University Faculty of Medicine, Besevler, Ankara, Turkey
| | - Ulunay Kanatlı
- Department of Orthopedics and Traumatology, Gazi University Faculty of Medicine, Besevler, Ankara, Turkey
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Wahal N, Alabbasi A, Martetschläger F. [Injuries of the shoulder in winter sports]. Orthopadie (Heidelb) 2022; 51:896-902. [PMID: 36315290 DOI: 10.1007/s00132-022-04322-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/28/2022] [Indexed: 06/16/2023]
Abstract
Skiing as a sport has come a long way from the first competitive event in Norway in 1767 to about 200 million skiers today worldwide. With Germany alone recording around 8000 injuries annually, there is an increased need for awareness for winter-sport-related injuries and their management. According to the latest report by "Auswertungsstelle für Skiunfälle" (ASU, evaluation center for ski accidents), shoulder injuries alone account for more than 20% of injuries to all body regions (men 26.1% and women 13%). The most common injuries affecting the shoulder girdle are rotator cuff strains, glenohumeral dislocations, acromioclavicular dislocations and clavicle fractures. These injuries are primarily the result of four mechanisms: direct impact, axial load on an extended arm, resisted forced abduction of the arm, and external rotation forces resulting from a firmly planted ski pole in the grasp of a skier during a fall. In this article, we describe the three most common shoulder girdle injuries in winter sports along with their management and answer the most important questions for the athlete.
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Affiliation(s)
- N Wahal
- Deutsches Schulterzentrum in der ATOS Klinik München, Effnerstraße 38, 81925, München, Deutschland
| | - A Alabbasi
- Deutsches Schulterzentrum in der ATOS Klinik München, Effnerstraße 38, 81925, München, Deutschland
| | - F Martetschläger
- Deutsches Schulterzentrum in der ATOS Klinik München, Effnerstraße 38, 81925, München, Deutschland.
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Szyluk K, Niemiec P, Sieroń D, Lukoszek D, Gierek M, Lorek A, Christe A. Shoulder Dislocation Incidence and Risk Factors-Rural vs. Urban Populations of Poland. Int J Environ Res Public Health 2022; 19:ijerph191911857. [PMID: 36231157 PMCID: PMC9564760 DOI: 10.3390/ijerph191911857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 09/15/2022] [Accepted: 09/17/2022] [Indexed: 05/17/2023]
Abstract
(1) Background: The aim of this study was to analyze the incidence of shoulder dislocation and to estimate non-modifiable risk factors in rural and urban subgroups in Poland. (2) Methods: The study covered the entire Polish population, divided into urban and rural subgroups and observed between 1 January 2014 and 31 December 2014. The study population consisted of Polish patients with a diagnosis of shoulder dislocation (S43.0) in accordance with the International Statistical Classification of Diseases and Related Health Problems (ICD-10). Records were obtained from the public health care provider National Health Found (Narodowy Fundusz Zdrowia, NFZ). Based on these data, we assessed shoulder dislocation incidence and risk rates, stratifying the study sample by sex, age and place of residence (rural or urban) using the Central Statistical Office (GUS) personal territorial code (TERYT). (3) The incidence was 25.97/100,000 person-years in rural areas and 25.62/100,000 person-years in urban areas. We did not find significant differences in the incidence between the two subgroups. The highest incidence (75.12/100,000 person-years) and the highest risk for shoulder dislocation were found among subjects 80+ years old living in urban areas. Furthermore, men in the third decade of their life living in urban areas showed the highest risk (OR = 7.8, 95% CI; 6.44-9.45, p < 0.001). In both subgroups, the likelihood of shoulder dislocation was significantly lower for the female sex and among children ≤9 years old. However, girls living in rural areas presented with a significantly higher likelihood for dislocation compared with their peers living in urban environments. (4) Conclusions: No significant difference in the incidence rate of shoulder dislocation between Polish residents living in rural and urban areas emerged. The highest incidence was observed among female subjects 80+ years old living in urban environments. The highest risk was found among men in the third decade of their life living in urban areas. In addition, girls in the first decade of their life living in rural areas had more shoulder dislocations than girls living in urban environments. Shoulder dislocation is dominant in female subjects aged 70-79 living in rural areas and in females 80+ years old living in urban areas.
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Affiliation(s)
- Karol Szyluk
- Department of Physiotherapy, Faculty of Health Sciences in Katowice, Medical University of Silesia in Katowice, 40-752 Katowice, Poland
- District Hospital of Orthopaedics and Trauma Surgery, Bytomska 62 St., 41-940 Piekary Śląskie, Poland
- Correspondence:
| | - Paweł Niemiec
- Department of Biochemistry and Medical Genetics, Faculty of Health Sciences in Katowice, Medical University of Silesia in Katowice, 40-752 Katowice, Poland
| | - Dominik Sieroń
- Department of Radiology SLS, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010 Bern, Switzerland
| | - Dawid Lukoszek
- Dawid Lukoszek Physiotherapy Osteopathy, 42-690 Hanusek, Poland
| | - Marcin Gierek
- Center for Burns Treatment im. Dr Sakiel, ul. Jana Pawła II 2, 41-100 Siemianowice Śląskie, Poland
| | - Andrzej Lorek
- Department of Oncological Surgery, Prof. Kornel Gibiński Independent Public Central Clinical Hospital, Medical University of Silesia in Katowice, 40-514 Katowice, Poland
| | - Andreas Christe
- Department of Radiology SLS, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010 Bern, Switzerland
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Albright JA, Meghani O, Lemme NJ, Owens BD. Characterization of Shoulder Instability in Rhode Island: Incidence, Surgical Stabilization, and Recurrence. R I Med J (2013) 2022; 105:56-62. [PMID: 35617044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE To characterize shoulder instability within the state of Rhode Island from 2011 to 2019. METHODS The Rhode Island All-Payer Claims Database (APCD) was used to identify all patients that make an insurance claim related to a shoulder instability event. All patients in the APCD with an ICD-9 code of 718.31, 718.32, or 831.00 through 831.19 or an ICD-10 code of S43.001 through S43.086 or M24.41 through M25.319 between January 1, 2011 and December 31, 2019 were selected. Chi-square analysis was used to compare age- and sex-delimited subgroups; multivariate logistic regression was used to assess for factors influencing rates of surgical intervention and recurrent instability; and Kaplan-Meier failure and log-rank analyses was used to analyze variation in the time to surgery and recurrence between age-delimited subgroups. RESULTS The incidence of overall shoulder instability (subluxations and dislocations) in Rhode Island was 62.20 instability events (95% CI, 60.61-63.78) per 100,000 person-years. The incidence of dislocations and subluxations were 49.46 injuries (95% CI, 48.05-50.88) and 12.73 injuries (95% CI, 12.02-13.45) per 100,000 person-years, respectively. Bivariate analysis demonstrated that male patients had significantly increased rates of surgical stabilization (6.36% vs. 2.80%) and recurrent instability (16.30% vs. 9.85%) compared to their female counterparts. However, after controlling for age at the primary instability event and the type and directionality of the instability, the difference in recurrence rates between males and females is no longer statistically significant (p = 0.326). Contrary to sex, age maintained its significance with those patients aged 20 and younger and 21-40 years at significantly increased odds of surgical stabilization (3.12 and 1.99, respectively) and experiencing a recurrent instability event (3.96 and 2.77, respectively). CONCLUSION These data characterize the epidemiology of shoulder instability within the state of Rhode Island and demonstrate how increasing age at a primary instability event decreases the likelihood of both surgical stabilization and rates of recurrence.
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Affiliation(s)
- J Alex Albright
- Warren Alpert Medical School of Brown University, Providence, RI
| | - Ozair Meghani
- Department of Orthopaedics, Warren Alpert Medical School of Brown University, Providence, RI
| | - Nicholas J Lemme
- Department of Orthopaedics, Warren Alpert Medical School of Brown University, Providence, RI
| | - Brett D Owens
- Department of Orthopaedics, Warren Alpert Medical School of Brown University, Providence, RI
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Ahmad RG. Shoulder impingement: various risk factors for supraspinatus tendon tear: A case group study. Medicine (Baltimore) 2022; 101:e28575. [PMID: 35060519 PMCID: PMC8772690 DOI: 10.1097/md.0000000000028575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 12/22/2021] [Indexed: 01/05/2023] Open
Abstract
A total of 680 cases of monolateral shoulder pain and functional impairment were included, and Chi-Squared tests was incorporated to test for possible associations.No relation between impingement syndrome and potential risk factors was found, such as presence of down slopping (P = .083), presence of ossification acromiale (P = .102), presence of calcific tendinitis (P = .144), types of acromion (I [P = .600], II [P = .536], III [P = .633] and IV [P = .832]) and grade of acromioclavicular degenerative changes (mild [P = .077], moderate [P = .111], and severe [P = .700]). However, a significant relationship was uncovered between impingement syndrome and risk factors such as gender (X2 = 7.004, df = 1, P = .08) (where females were more prone), history of shoulder dislocation (X2 = 19.440, df = 1, P = .001), presence of supraspinatus tendon tear or tendinopathy (X2 = 69.344, df = 1, P = .001) and supraspinatus complete tear (X2 = 13.593, df = 1, P = .001). A significant relationship was found between the type of supraspinatus pathology and factors such as gender (female more prone) (X2 = 34.719, df = 3, P = .01), presence of down slopping (X2 = 57.765, df = 3, P = .01), history of shoulder dislocation (X2 = 148.880, df = 3, P = .001), type III of the acromion (X2 = 12.979, df = 3, P = .005), presence of acromioclavicular generative changes mild (X2 = 76.408, df = 3, P = .001) and moderate (X2 = 29.697, df = 3, P = .001), and acromiohumeral distance of ≤3 mm (X2 = 18.915, df = 3, P = .001), 3.1 to 6 mm (X2 = 13.212, df = 3, P = .004), and 9.1-12 mm (X2 = 15.066, df = 3, P = .002). Overall, the Magnetic Resonance Imaging results yielded high sensitivity for detecting full-thickness supraspinatus tears.Considering the findings, this study may help radiologists understand the salient risk factors and identify which factors are mainly responsible for supraspinatus tendon tears and the respective grade of tear (articular partial, bursal partial, complete, or tendinopathy).
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Mulvey JM, Carson IN, Palmer KA. Closed Reduction of Anterior Shoulder Dislocations Performed by Ski Patrollers in the Alpine Prehospital Environment: A Retrospective Review Demonstrating Efficacy in a Canadian Ski Resort. Wilderness Environ Med 2021; 32:441-449. [PMID: 34635430 DOI: 10.1016/j.wem.2021.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 06/28/2021] [Accepted: 07/14/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Shoulder dislocations are common ski hill injuries. Rapid reduction is known to improve outcomes; however, advanced providers are not always available to provide care to these patients. In 2017, nonmedical ski patrollers at Sunshine Village ski resort in Alberta, Canada, were trained to perform anterior shoulder dislocation (ASD) reductions. Program success was determined by a chart review after the 2020 ski season. METHODS This study retrospectively reviewed data on patients who presented to Sunshine Village ski patrol with a suspected ASD and who met the study inclusion criteria from November 2017 through March 2020. Data were collected from ski patrol electronic patient care records regarding general demographics, reduction technique used, analgesia administration, and reduction success rates. RESULTS Ninety-six cases were available for review after exclusions. Trained nonmedical ski patrollers successfully reduced 82 of these cases, resulting in an overall reduction success rate of 89%. Sixty-three (66%) of these patients had experienced first-time dislocations. Eighty-two (87%) patients were male, with a median age of 25 y. The most used technique was the Cunningham method (75%), and analgesia was administered to 70% of patients. CONCLUSIONS This retrospective study documents the results of a quality assurance review of the treatment of ASD at Sunshine Village ski resort. With a success rate of 89%, the evidence supports the conclusion that nonmedical ski patrollers can successfully perform ASD reductions. We believe training ski patrollers to reduce ASD improved patient care in our austere environment by providing early definitive treatment with a high success rate.
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Affiliation(s)
- Jamin M Mulvey
- Shock Trauma Air Rescue Service, Calgary, Canada; Section of Pediatric Anesthesia, Alberta Children's Hospital, University of Calgary, Calgary, Canada
| | - Ira N Carson
- University of Alberta, School of Medicine, Edmonton, Canada
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Mc Millan S, Fliegel B, Stark M, Ford E, Pontes M, Markowitz M. Recurrent Instability after Arthroscopic Glenoid Labral Repair with a Minimum of Three Points of Fixation: Do the Number of Anchors or Fixation Points Correlate to Outcomes? Surg Technol Int 2021; 38:433-439. [PMID: 33724436 DOI: 10.52198/21.sti.38.os1411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
INTRODUCTION The goal of this study was to evaluate the recurrence rate of instability following arthroscopic Bankart repairs in regard to the number and types of fixation utilized. A Bankart lesion is a tear in the anteroinferior capsulolabral complex within the shoulder, occurring in association with an anterior shoulder dislocation. These injuries can result in glenoid bone loss, decreased range of motion, and recurrent shoulder instability. Successful repair of these lesions has been reported in the literature with repair constructs that have three points of fixation. However, the definition of "one point of fixation" is yet to be fully elucidated. MATERIALS AND METHODS A consecutive series of arthroscopically repaired Bankart lesions were evaluated pertaining to the points of fixation required to achieve shoulder stability. This included the number, position, and types of anchors used. Patients consented to complete a series of surveys at a minimum of two years postoperatively. The primary outcome was to determine recurrent instability via the UCLA Shoulder Score, the ROWE Shoulder Instability Score, and the Oxford Shoulder Score. A secondary outcome included pain on a Visual Analog Scale (VAS). RESULTS There were 116 patients reviewed, 46 patients achieved three points of fixation in their surgical repair via two anchors and 70 patients achieved a similar fixation with three or more anchors. There was no significant difference in the mean age, gender, or body mass index (BMI). Patients receiving two anchors demonstrated recurrent instability 8.7% of the time (4 of 46 patients). Patients who received three or more anchors demonstrated recurrent instability 8.6% of the time (6 of 70 patients). Overall, there was no statistical significance between the number/types of anchors used. Between the two cohorts, there was no statistically significant difference found between VAS, ROWE, UCLA, and Oxford Scores. There was a significant difference in pain reported on the VAS scale with an average VAS score of 0.43 versus 2.5 in those without and with recurrent instability respectively. CONCLUSION Contention still exists surrounding the exact definition of "a point of fixation" in arthroscopic Bankart repairs. Three-point constructs can be created through a variety of combinations including anchors and sutures, ultimately achieving the goal of a stable shoulder.
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Affiliation(s)
- Sean Mc Millan
- Department of Orthopedics, Virtual Health Systems, Burlington, New Jersey
| | - Brian Fliegel
- Department of Orthopedics, Rowan School of Osteopathic Medicine, Stratford, New Jersey
| | - Michael Stark
- Department of Orthopedics, Rowan School of Osteopathic Medicine, Stratford, New Jersey
| | - Elizabeth Ford
- Department of Orthopedics, Inspira Health Network, Vineland, New Jersey
| | - Manuel Pontes
- Department of Orthopedics, Rowan School of Osteopathic Medicine, Stratford, New Jersey
| | - Michael Markowitz
- Department of Orthopedics, Rowan School of Osteopathic Medicine, Stratford, New Jersey
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Yow BG, Wade SM, Bedrin MD, Rue JPH, LeClere LE. The Incidence of Posterior and Combined AP Shoulder Instability Treatment with Surgical Stabilization Is Higher in an Active Military Population than in the General Population: Findings from the US Naval Academy. Clin Orthop Relat Res 2021; 479:704-708. [PMID: 33094964 PMCID: PMC8083805 DOI: 10.1097/corr.0000000000001530] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 09/18/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Anterior instability has consistently been shown to be the most common type of glenohumeral instability. Recent studies have demonstrated a higher percentage of posterior and combined (anterior and posterior) instability than had previously been reported; however, this work has not been replicated recently in a particularly young military population, which may be representative of an especially athletic or high-demand group. QUESTION/PURPOSE What proportion of arthroscopic shoulder stabilization procedures are performed to address isolated anterior instability, isolated posterior instability, and combined instability in a young, military population? METHODS Between August 2009 and January 2020, two sports medicine fellowship-trained surgeons performed arthroscopic shoulder surgery on 543 patients at a single institution. During that time, the indication to be treated with arthroscopic stabilization surgery was symptomatic glenohumeral instability, as diagnosed by the operative surgeon, that restricted patients from carrying out their military duties. Of those, 82% (443 of 543) could be evaluated in this retrospective study, while 18% (100 of 543) were excluded due to either incomplete data or because the procedure performed was not to address instability. No patient underwent an open stabilization procedure during this period. Of the 443 patients investigated, the mean age was 22 ± 4 years, and 88% (392 of 443 patients) were men. Instability type was characterized as isolated anterior, isolated posterior, or combined (anterior and posterior) according to the physician's diagnosis as listed in the patient's clinical records and operative reports after the particular capsulolabral pathology was identified and addressed. RESULTS Isolated anterior instability occurred in 47% of patients (210 of 443). Isolated posterior instability happened in 18% of patients (80 of 443), while combined anteroposterior instability occurred in 35% of patients (153 of 443). CONCLUSION Shoulder instability is common in the military population. Although anterior instability occurred most frequently, these findings demonstrate higher proportions of posterior and combined instability than have been previously reported. Surgeons should have a heightened suspicion for posterior and combined anteroposterior labral pathology when performing arthroscopic stabilization procedures to ensure that these instability patterns are recognized and treated appropriately. The current investigation examines a unique cohort of young and active individuals who are at particularly high risk for instability and whose findings may represent a good surrogate for other active populations that a surgeon may encounter.Level of Evidence Level III; therapeutic study.
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Affiliation(s)
- Bobby G Yow
- B. G. Yow, S. M. Wade, M. D. Bedrin, Department of Orthopaedic Surgery, Uniformed Services University-Walter Reed National Military Medical Center, Bethesda, MD, USA
- J. P. H. Rue, The Orthopaedic Specialty Hospital, Mercy Medical Center, Baltimore, MD, USA
- L. E. LeClere, Department of Orthopaedic Surgery, Naval Health Clinic Annapolis, United States Naval Academy, Annapolis, MD, USA
| | - Sean M Wade
- B. G. Yow, S. M. Wade, M. D. Bedrin, Department of Orthopaedic Surgery, Uniformed Services University-Walter Reed National Military Medical Center, Bethesda, MD, USA
- J. P. H. Rue, The Orthopaedic Specialty Hospital, Mercy Medical Center, Baltimore, MD, USA
- L. E. LeClere, Department of Orthopaedic Surgery, Naval Health Clinic Annapolis, United States Naval Academy, Annapolis, MD, USA
| | - Michael D Bedrin
- B. G. Yow, S. M. Wade, M. D. Bedrin, Department of Orthopaedic Surgery, Uniformed Services University-Walter Reed National Military Medical Center, Bethesda, MD, USA
- J. P. H. Rue, The Orthopaedic Specialty Hospital, Mercy Medical Center, Baltimore, MD, USA
- L. E. LeClere, Department of Orthopaedic Surgery, Naval Health Clinic Annapolis, United States Naval Academy, Annapolis, MD, USA
| | - John-Paul H Rue
- B. G. Yow, S. M. Wade, M. D. Bedrin, Department of Orthopaedic Surgery, Uniformed Services University-Walter Reed National Military Medical Center, Bethesda, MD, USA
- J. P. H. Rue, The Orthopaedic Specialty Hospital, Mercy Medical Center, Baltimore, MD, USA
- L. E. LeClere, Department of Orthopaedic Surgery, Naval Health Clinic Annapolis, United States Naval Academy, Annapolis, MD, USA
| | - Lance E LeClere
- B. G. Yow, S. M. Wade, M. D. Bedrin, Department of Orthopaedic Surgery, Uniformed Services University-Walter Reed National Military Medical Center, Bethesda, MD, USA
- J. P. H. Rue, The Orthopaedic Specialty Hospital, Mercy Medical Center, Baltimore, MD, USA
- L. E. LeClere, Department of Orthopaedic Surgery, Naval Health Clinic Annapolis, United States Naval Academy, Annapolis, MD, USA
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Gould HP. CORR Insights®: The Incidence of Posterior and Combined AP Shoulder Instability Treatment with Surgical Stabilization Is Higher in an Active Military Population than in the General Population: Findings from the US Naval Academy. Clin Orthop Relat Res 2021; 479:709-711. [PMID: 33177478 PMCID: PMC8083915 DOI: 10.1097/corr.0000000000001574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 10/20/2020] [Indexed: 01/31/2023]
Affiliation(s)
- Heath P Gould
- H. P. Gould, Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA
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Obhlídal M, Neoral P, Holibka R, Gallo J, Sigmund M, Kalina R. [Incidence, Morphology and Clinical Significance of Hill-Sachs Lesions in Shoulder Instability - CT Scan Evaluation of the Group of Patients]. Acta Chir Orthop Traumatol Cech 2021; 88:434-441. [PMID: 34998447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE OF THE STUDY Shoulder instability is often times accompanied by associated injuries caused by the humeral head displacement. These are primarily bone lesions on the head and socket of the glenohumeral joint. The purpose of this study was to evaluate the frequency, morphology and clinical significance of bone lesions in shoulder instabilities in a group of patients operated in our department for glenohumeral instability between 2012 and 2019. MATERIAL AND METHODS The ongoing evaluation included 373 patients with trauma and habitual instability who had undergone surgery in our department in the period from 2012 to 2019. All patients underwent a preoperative 3D CT scan of the shoulder joint. Subsequently, the morphology and clinical significance of individual bone lesions were evaluated based on the older Burkhart s concept of engaging/nonengaging lesions and the newer concept of glenoid track by Yamamoto and Di Giacomo of 2007, 2014 or 2020. RESULTS The frequency of Hill-Sachs lesion was 83.4% (311) in our group of patients. In nearly two thirds (211 cases) also a bone defect on glenoid was detected (59.3%). When comparing the basic types of instabilities, in the TUBS group the Hill-Sachs lesions were present up to twice as often as in the group with AMBRI instability. Clinically significant Hill-Sachs lesions according to the older concept of engaging/ nonengaging lesions of Burkhart were reported in 104 cases (34%). Clinically significant lesions according to the newer concept of Yamamoto and DiGiacomo (the so-called off-track lesions) were observed in 173 cases (55.6%). Classified as critical were the clinically insignificant lesions (the so-called on-track lesions), which by their location were near the glenoid track. These lesions were found in 80 patients. After adding up the significant (off-track) and critical on-track lesions, we arrived at 253 (81.4%) clinically significant lesions based on the updated Yamamoto concept. DISCUSSION The frequency of Hill-Sachs lesions and glenoid defects identified by us is close to the upper limit of the range described in literature (8 to 100%). Based on the recent study by Yamamoto, added to these defects were the so-called peripheral ontrack defects, the clinical significance of which is currently indisputable. The oldest classification into engaging/nonengaging lesions revealed only 34% of the significant lesions, but this concept does not evaluate the glenoid defect. The newer concept by Yamamoto/DiGiacomo resulted in detecting 55.6% of significant Hill-Sachs lesions. The latest modification of the glenoid track of 2020, which includes also the on-track lesions in the critical zone among the significant lesions, in our group of patients classified 81% of lesions as clinically significant. CONCLUSIONS Our study confirmed the very frequent occurrence of clinically significant Hill-Sachs lesions in shoulder instabilities. Therefore, for the sake of successful shoulder stabilisation surgery detailed preoperative planning with 3D CT of the shoulder joint and evaluation of the associated bone lesions are necessary. The highest detection of clinically significant lesions was achieved by the latest modification of the glenoid track concept. Future studies will have to prove the effect of this classification on the result of surgical treatment. Key words: shoulder instability, glenoid track; bone defects, Hill-Sachs lesion; bipolar lesions; 3D CT evaluation.
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Affiliation(s)
- M Obhlídal
- Ortopedická klinika Lékařské fakulty Univerzity Palackého v Olomouci a Fakultní nemocnice Olomouc
| | - P Neoral
- Ortopedická klinika Lékařské fakulty Univerzity Palackého v Olomouci a Fakultní nemocnice Olomouc
| | - R Holibka
- Ortopedická klinika Lékařské fakulty Univerzity Palackého v Olomouci a Fakultní nemocnice Olomouc
| | - J Gallo
- Ortopedická klinika Lékařské fakulty Univerzity Palackého v Olomouci a Fakultní nemocnice Olomouc
| | - M Sigmund
- Aplikační centrum BALUO, Fakulta tělesné kultury Univerzity Palackého v Olomouci
| | - R Kalina
- Ortopedická klinika Lékařské fakulty Univerzity Palackého v Olomouci a Fakultní nemocnice Olomouc
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Frank RM, Thon SG, Tokish JM, Cole BJ, McCarty EC, Romeo AA, Provencher CMT. Management of Shoulder Instability in 2020: What, When, and How. Instr Course Lect 2021; 70:3-22. [PMID: 33438901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Anterior glenohumeral instability remains a common clinical problem in the athletic and working patient populations, and further, recurrence rates following stabilization surgery continue to be problematic. Over the past 5 years, there have been substantial improvements in the understanding of anterior shoulder instability. To better counsel and treat patients, it is imperative for surgeons to have a comprehensive understanding of the epidemiology of shoulder instability, the anatomy of the glenohumeral joint particularly as it relates to glenoid and humeral head bone loss, surgical indications, and surgical techniques. These critical topics are summarized in an effort to provide a complete guide to managing anterior shoulder instability in 2020.
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Affiliation(s)
- Lukas Pe Verweij
- Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
- Academic Center for Evidence-based Sports medicine (ACES), Amsterdam UMC, Amsterdam, Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, Netherlands
| | - David N Baden
- Emergency Department, Diakonessenhuis, Utrecht, Netherlands
| | - Julia Mj van der Zande
- Department of Orthopaedic Surgery, Shoulder and Elbow unit, OLVG, Amsterdam, Netherlands
| | - Michel Pj van den Bekerom
- Department of Orthopaedic Surgery, Shoulder and Elbow unit, OLVG, Amsterdam, Netherlands
- Department of Human Movement Sciences, Faculty of Behavioural and Movement sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands
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Longo UG, Salvatore G, Locher J, Ruzzini L, Candela V, Berton A, Stelitano G, Schena E, Denaro V. Epidemiology of Paediatric Shoulder Dislocation: A Nationwide Study in Italy from 2001 to 2014. Int J Environ Res Public Health 2020; 17:E2834. [PMID: 32326066 PMCID: PMC7215533 DOI: 10.3390/ijerph17082834] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 04/15/2020] [Accepted: 04/17/2020] [Indexed: 01/06/2023]
Abstract
Limited knowledge is accessible concerning the tendencies of hospitalization for skeletally immature patients with episodes of shoulder dislocation. Our research aim was to evaluate annual hospitalizations for shoulder dislocation in paediatric patients in Italy from 2001 to 2014, on the basis of the official data source as hospitalization reports. The second purpose was to investigate geographical diversification in hospitalization for shoulder dislocation in regions of Italy. The last aim was to make statistical predictions of the number of shoulder dislocation hospitalization volumes and rates in skeletally immature patients based on data from 2001 to 2014. An examination of the National Hospital Discharge records (SDO) kept at the Italian Ministry of Health regarding the 14 years of our study (2001 through 2014) was conducted. These data are anonymous and include patient's age, gender, domicile, region and time of hospitalization, and the kind of reimbursement (public or private). In the 14-year study time, 344 hospitalizations for shoulder dislocation of patients aged 0-14 years took place in Italy. The male/female hospitalization ratio varied from a maximum of 3.0 (2001) to a minimum of 1.1 (2013), with a mean average ratio in the 2001-2014 timespan of 2.0. Almost half of the hospitalizations (49.1%) were performed in the South. The mean incidence of hospitalizations in Italy for shoulder dislocation in patients with less than 14 years was 0.3 for every 100,000 inhabitants in the same class of age. The most common treatment was a closed reduction (60.8%), followed by open stabilization (16.6%) and arthroscopic procedures (13.7%). The present registry study shows a low incidence of hospitalization for shoulder dislocation in young patients. The most common treatment for a shoulder dislocation in paediatric patients is a closed shoulder reduction. Regions from the south and the centre of Italy are marked by an inferior number of operations and a higher number of hospitalization for closed shoulder reduction.
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Affiliation(s)
- Umile Giuseppe Longo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (G.S.); (J.L.); (V.C.); (A.B.); (G.S.); (V.D.)
| | - Giuseppe Salvatore
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (G.S.); (J.L.); (V.C.); (A.B.); (G.S.); (V.D.)
| | - Joel Locher
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (G.S.); (J.L.); (V.C.); (A.B.); (G.S.); (V.D.)
| | - Laura Ruzzini
- Department of Orthopedics, Children’s Hospital Bambino Gesù, Via Torre di Palidoro, Palidoro, 00165 Rome, Italy;
| | - Vincenzo Candela
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (G.S.); (J.L.); (V.C.); (A.B.); (G.S.); (V.D.)
| | - Alessandra Berton
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (G.S.); (J.L.); (V.C.); (A.B.); (G.S.); (V.D.)
| | - Giovanna Stelitano
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (G.S.); (J.L.); (V.C.); (A.B.); (G.S.); (V.D.)
| | - Emiliano Schena
- Unit of Measurements and Biomedical Instrumentation, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Rome, Italy;
| | - Vincenzo Denaro
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (G.S.); (J.L.); (V.C.); (A.B.); (G.S.); (V.D.)
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Gutkowska O, Martynkiewicz J, Urban M, Gosk J. Brachial plexus injury after shoulder dislocation: a literature review. Neurosurg Rev 2020; 43:407-423. [PMID: 29961154 PMCID: PMC7186242 DOI: 10.1007/s10143-018-1001-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 05/17/2018] [Accepted: 06/21/2018] [Indexed: 12/01/2022]
Abstract
Brachial plexus injuries are among the rarest but at the same time the most severe complications of shoulder dislocation. The symptoms range from transient weakening or tingling sensation of the upper limb to total permanent paralysis of the limb associated with chronic pain and disability. Conflicting opinions exist as to whether these injuries should be treated operatively and if so when surgery should be performed. In this review, available literature dedicated to neurological complications of shoulder dislocation has been analysed and management algorithm has been proposed. Neurological complications were found in 5.4-55% of all dislocations, with the two most commonly affected patient groups being elderly women sustaining dislocation as a result of a simple fall and young men after high-energy injuries, often multitrauma victims. Infraclavicular part of the brachial plexus was most often affected. Neurapraxia or axonotmesis predominated, and complete nerve disruption was observed in less than 3% of the patients. Shoulder dislocation caused injury to multiple nerves more often than mononeuropathies. The axillary nerve was most commonly affected, both as a single nerve and in combination with other nerves. Older patient age, higher energy of the initial trauma and longer period from dislocation to its reduction have been postulated as risk factors. Brachial plexus injury resolved spontaneously in the majority of the patients. Operative treatment was required in 13-18% of the patients in different studies. Patients with suspected neurological complications require systematic control. Surgery should be performed within 3-6 months from the injury when no signs of recovery are present.
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Affiliation(s)
- Olga Gutkowska
- Department of Traumatology, Clinical Department of Traumatology and Hand Surgery, Wroclaw Medical University, ul. Borowska 213, 50-556 Wroclaw, Poland
| | - Jacek Martynkiewicz
- Department of Traumatology, Clinical Department of Traumatology and Hand Surgery, Wroclaw Medical University, ul. Borowska 213, 50-556 Wroclaw, Poland
| | - Maciej Urban
- Department of Traumatology, Clinical Department of Traumatology and Hand Surgery, Wroclaw Medical University, ul. Borowska 213, 50-556 Wroclaw, Poland
| | - Jerzy Gosk
- Department of Traumatology, Clinical Department of Traumatology and Hand Surgery, Wroclaw Medical University, ul. Borowska 213, 50-556 Wroclaw, Poland
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Abstract
BACKGROUND The Western Ontario Shoulder Instability index (WOSI) is a questionnaire designed to measure health-related quality of life in patients with shoulder instability. The aim of the current study was to translate the WOSI into Hebrew and assess its psychometric properties. METHODS The WOSI was translated into Hebrew according to World Health Organization guidelines. Twenty-five patients completed the WOSI and the Disabilities of Arm, Shoulder, and Hand (DASH) questionnaire 2 weeks and 2 months after surgical shoulder stabilization. Internal consistency (Cronbach's α), criterion validity (Pearson's correlation coefficient with DASH), responsiveness, and floor and ceiling effects were assessed. RESULTS Cronbach's α was 0.88-0.95 for total WOSI (range 0.68-0.95 for different sections). Strong correlation with DASH score (r = 0.76-0.84) indicated good criterion validity. Changes between baseline and follow-up for WOSI and DASH scores were moderately correlated (r = 0.68), suggesting moderate responsiveness. Some items demonstrated floor and ceiling effects, especially at baseline, but no floor or ceiling effects were observed for total WOSI or for the WOSI sections. CONCLUSIONS The results of the current study demonstrate that the Hebrew version of the WOSI is a valid instrument that can be used to assess disability in patients with shoulder instability. Additional studies are warranted to assess its psychometric properties among various subpopulations. TRIAL REGISTRATION The study was pre-registered at the ClinicalTrials.gov website, registration number NCT02978365 .
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Affiliation(s)
- Uri Gottlieb
- Israel Defense Forces, Medical Corps, Ramat-Gan, Israel.
- Department of Physical Therapy, Ariel University, 40700, Ariel, Israel.
| | - Shmuel Springer
- Department of Physical Therapy, Ariel University, 40700, Ariel, Israel
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Begly JP, Alaia MJ. First-Time Traumatic Anterior Shoulder Instability Management in the Young and Active Patient. Bull Hosp Jt Dis (2013) 2019; 77:21-32. [PMID: 30865861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Anterior instability of the glenohumeral joint is a common and functionally limiting shoulder condition, particularly in young and active patients. In this population, non-operative management has been increasingly demonstrated to be associated with recurrent instability and increased long-term morbidity. Surgical treatment options include both arthroscopic and open techniques. In appropriately indicated patients, surgical treatment of first-time anterior shoulder instability is a cost-effective and successful treatment option.
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Szyluk K, Jasiński A, Niemiec P, Mielnik M, Koczy B. Five-year prevalence of recurrent shoulder dislocation in the entire Polish population. Int Orthop 2017; 42:259-264. [PMID: 29197942 DOI: 10.1007/s00264-017-3701-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 11/21/2017] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to evaluate five-year prevalence of recurrent shoulder dislocation in the entire Polish population. METHODS The study involved the entire Polish population between 01 January 2010 and 31 December 2014. Demographic data were retrieved from the Central Statistical Office of Poland. Data on the number of shoulder joint dislocations were retrieved from the database of the National Health Fund. RESULTS We identified 32,253 Polish residents with shoulder instability. About 0.1% of Polish residents suffered from recurrent shoulder dislocation. Males suffered almost two times more often than females (66% and 34%, respectively), and male gender was recognized as a risk factor of instability (OR = 2.07, p <10-10). Females in their eighth decade of life had the highest risk of recurrent shoulder dislocation (OR = 3.33, p <10-10). In males the highest risk of recurrences was noted for the third decade of life (OR = 1.78, p <10-10). CONCLUSION The period prevalence rate of recurrent shoulder dislocation in Poland is 83.7 per 100,000 persons per five years. The rate of recurrent shoulder dislocation for the general Polish population is 0.1%. Males suffered from recurrent shoulder dislocation almost twice as frequently as females (OR = 2.07).
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Affiliation(s)
- Karol Szyluk
- District Hospital of Orthopaedics and Trauma Surgery, Bytomska 62 str, 41-940, Piekary Slaskie, Poland.
| | - Andrzej Jasiński
- District Hospital of Orthopaedics and Trauma Surgery, Bytomska 62 str, 41-940, Piekary Slaskie, Poland
| | - Pawel Niemiec
- School of Health Sciences in Katowice, Medical University of Silesia, Medykow 18 str, 40-752, Katowice, Poland
| | - Michal Mielnik
- District Hospital of Orthopaedics and Trauma Surgery, Bytomska 62 str, 41-940, Piekary Slaskie, Poland
| | - Bogdan Koczy
- District Hospital of Orthopaedics and Trauma Surgery, Bytomska 62 str, 41-940, Piekary Slaskie, Poland
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Shah A, Judge A, Delmestri A, Edwards K, Arden NK, Prieto-Alhambra D, Holt TA, Pinedo-Villanueva RA, Hopewell S, Lamb SE, Rangan A, Carr AJ, Collins GS, Rees JL. Incidence of shoulder dislocations in the UK, 1995-2015: a population-based cohort study. BMJ Open 2017; 7:e016112. [PMID: 29138197 PMCID: PMC5695490 DOI: 10.1136/bmjopen-2017-016112] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE This cohort study evaluates the unknown age-specific and gender-specific incidence of primary shoulder dislocations in the UK. SETTING UK primary care data from the Clinical Practice Research Datalink (CPRD) were used to identify patients aged 16-70 years with a shoulder dislocation during 1995-2015. Coding of primary shoulder dislocations was validated using the CPRD general practitioner questionnaire service. PARTICIPANTS A cohort of 16 763 patients with shoulder dislocation aged 16-70 years during 1995-2015 were identified. PRIMARY OUTCOME MEASURE Incidence rates per 100 000 person-years and 95% CIs were calculated. RESULTS Correct coding of shoulder dislocation within CPRD was 89% (95% CI 83% to 95%), and confirmation that the dislocation was a 'primary' was 76% (95% CI 67% to 85%). Seventy-two percent of shoulder dislocations occurred in men. The overall incidence rate in men was 40.4 per 100 000 person-years (95% CI 40.4 to 40.4), and in women was 15.5 per 100 000 person-years (95% CI 15.5 to 15.5). The highest incidence was observed in men aged 16-20 years (80.5 per 100 000 person-years; 95% CI 80.5 to 80.6). Incidence in women increased with age to a peak of 28.6 per 100 000 person-years among those aged 61-70 years. CONCLUSIONS This is the first time the incidence of shoulder dislocations has been studied using primary care data from a national database, and the first time the results for the UK have been produced. While most primary dislocations occurred in young men, an unexpected finding was that the incidence increased in women aged over 50 years, but not in men. The reasons for this are unknown. Further work is commissioned by the National Institute for Health Research to examine treatments and predictors for recurrent shoulder dislocation. STUDY REGISTRATION The design of this study was approved by the Independent Scientific Advisory Committee (15_260) for the Medicines & Healthcare products Regulatory Agency.
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Affiliation(s)
- Anjali Shah
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Andrew Judge
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Faculty of Medicine, University of Southampton, Southampton, UK
- Musculoskeletal Research Unit, University of Bristol, Bristol, UK
| | - Antonella Delmestri
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Katherine Edwards
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Nigel K Arden
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Daniel Prieto-Alhambra
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Tim A Holt
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Rafael A Pinedo-Villanueva
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Sally Hopewell
- Oxford Clinical Trials Research Unit, University of Oxford, Oxford, UK
| | - Sarah E Lamb
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Amar Rangan
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Orthopaedic Surgery, The James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
- Department of Health Sciences, University of York, York, UK
| | - Andrew J Carr
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Gary S Collins
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Jonathan L Rees
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Hovelius L, Rahme H. Primary anterior dislocation of the shoulder: long-term prognosis at the age of 40 years or younger. Knee Surg Sports Traumatol Arthrosc 2016; 24:330-42. [PMID: 26754859 DOI: 10.1007/s00167-015-3980-2] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 12/29/2015] [Indexed: 12/13/2022]
Abstract
PURPOSE We describe the long-term prognosis in 257 first-time anterior shoulder dislocations (255 patients, aged 12-40 years) registered at 27 Swedish emergency units between 1978 and 1979. METHODS Half the shoulders were immobilised for 3-4 weeks after repositioning. Follow-ups were performed after two (questionnaire), five (questionnaire), 10 (questionnaire and radiology) and 25 (questionnaire and radiology) years in 227 patients (229 shoulders). Twenty-eight patients died during the 25 years of observation. RESULTS Early movement or immobilisation after the primary dislocation resulted in the same long-term prognosis. Recurrences increased up to 10 years of follow-up, but, after 25 years, 29 % of the shoulders with ≥2 recurrences appeared to have stabilised over time. Arthropathy increased from 9 % moderate to severe and 11 % mild at 10 years, to 34 % moderate to severe and 27 % mild after 25 years. Alcoholics had a poorer prognosis with respect to dislocation arthropathy (P < 0.001). Age <25 years and/or bilateral instability represent a poorer prognosis, where stabilising surgery is necessary in every second shoulder. Fracture of the greater tuberosity means a good prognosis, and we have found no evidence that athletic activity, gender, a Hill-Sachs lesion and minor rim fractures had any prognostic impact. During the 25 years in which these patients were followed, 28/255 died (11 %), representing a mortality rate (SMR) that was more than double that of the general Swedish population (P < 0.001). CONCLUSION Almost half of all first-time dislocations at the age of <25 years will have stabilising surgery and two-thirds will develop different stages of arthropathy within 25 years.
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Affiliation(s)
- Lennart Hovelius
- Orthopedic Department, Gävle Hospital, Lasarettsvägen 1, SE-801 88, Gävle, Sweden.
| | - Hans Rahme
- Elisabethsjukhuset, Geijersgatan 10, SE-752 26, Uppsala, Sweden.
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Padegimas EM, Zmistowski BM, Restrepo C, Abboud JA, Lazarus MD, Ramsey ML, Williams GR, Namdari S. Instability After Reverse Total Shoulder Arthroplasty: Which Patients Dislocate? Am J Orthop (Belle Mead NJ) 2016; 45:E444-E450. [PMID: 28005111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Given the increasing use of reverse total shoulder arthroplasty (RTSA), it is important to study the complications associated with this procedure. We conducted a study of the incidence, predisposing factors, and treatment of RTSA dislocations. Using our institutional database, we retrospectively searched for RTSAs performed between September 27, 2010 and December 31, 2013 and identified postoperative dislocations. Four hundred eighty-seven patients underwent 510 RTSAs (393 primary, 117 revision). Fourteen patients had 15 dislocations (5 in primary RTSAs, 10 in revision RTSAs). Mean time from surgery to diagnosis was 58.2 days (range, 0-319 days). One dislocation occurred immediately after surgery, 2 after falls, 4 from low-energy mechanisms of injury, and 8 without known inciting events. Logistic regression analysis revealed revision RTSA (odds ratio [OR] = 7.515; P = .042) and higher body mass index (BMI) (OR = 1.09; P = .047) to be independent risk factors. The diagnosis of primary cuff tear arthropathy (CTA) was independently associated with a lower rate of dislocation (OR = 0.025; P = .008); dislocation occurred in only 1 (0.35%) of 285 patients with CTA. All dislocations were treated in the operating room; no dislocation was successfully treated with simple closed reduction in the clinic. Although dislocation after RTSA is uncommon, the risk is higher for patients with higher BMI and for revision patients. Patients may benefit from lifestyle modifications, preoperative counseling, intraoperative considerations, and rehabilitation modifications. Patients who undergo RTSA for primary CTA can be reassured that the likelihood of dislocation is low.
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Affiliation(s)
| | | | | | | | | | | | | | - Surena Namdari
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, Rothman Institute of Orthopedics, Thomas Jefferson University Hospital, Philadelphia, PA.
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Helfen T, Ockert B, Pozder P, Regauer M, Haasters F. Management of prehospital shoulder dislocation: feasibility and need of reduction. Eur J Trauma Emerg Surg 2015; 42:357-62. [PMID: 26156391 DOI: 10.1007/s00068-015-0545-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 05/31/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE Dislocation of the shoulder is rare in the prehospital setting. The medical specialities of the emergency physicians are heterogeneous, and the level of experience is different. Aim of this study was to evaluate the feasibility, sufficiency, and need of prehospital reduction. METHODS Over 12 months, 16 rescue stations in Germany and Austria documented cases. Points of examination were: incidence of reduction, influence of pathological findings, therapy and effectiveness of reduction. RESULTS We included 70 patients. A reduction was undertaken in n = 47 (66.6 %). In n = 70 (100 %) perfusion was without pathological finding after reduction, all n = 7 (10 %) neurological pathologies declined after reduction. There was no significance in total implementation of prehospital reduction between surgeons and anaesthetists. N = 63 (90 %) of all patients received an immobilisation of the shoulder. N = 68 (97 %) of all patients were transported to a hospital. Time to arrival in hospital was in n = 50 (71.4 %) ≤10 min, in n = 17 (24.2 %) ≤20 min and in n = 3 (4.4 %) ≤30 min. CONCLUSION Implementation of reduction is independent of pathological neurological or vascular findings. Knowledge and skill is enough to perform a reduction quiet effectively in all emergency physicians. No specific technique can be recommended for prehospital use, the importance of being skilled is more important than one method. Early reduction was performed most rapidly in surgeons, but as well in the recommended time by other medical disciplines. On documented timings to admission hospital waiver of reduction is doubt. Therefore, a reduction in the prehospital setting is possible, but not obligatory.
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Affiliation(s)
- T Helfen
- Department of Trauma Surgery, Ludwig-Maximilians-University (LMU) Campus Innenstadt, Nußbaumstr.20, 80336, Munich, Germany.
| | - B Ockert
- Department of Trauma Surgery, Ludwig-Maximilians-University (LMU) Campus Innenstadt, Nußbaumstr.20, 80336, Munich, Germany
| | - P Pozder
- Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - M Regauer
- Department of Trauma Surgery, Ludwig-Maximilians-University (LMU) Campus Innenstadt, Nußbaumstr.20, 80336, Munich, Germany
| | - F Haasters
- Department of Trauma Surgery, Ludwig-Maximilians-University (LMU) Campus Innenstadt, Nußbaumstr.20, 80336, Munich, Germany
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25
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Armed Forces Health Surveillance Center (AFHSC). Injuries associated with combat sports, active component, U.S. Armed Forces, 2010-2013. MSMR 2014; 21:16-8. [PMID: 24885879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The practice of combat sports creates a potential for training- and sports-related injuries among military members. During the 4-year surveillance period, there were 12,108 cases of injuries associated with combat sports among active component service members; the overall incidence rate was 21.0 per 10,000 person-years (p-yrs). The rates were higher among service members who were male, Hispanic, in the youngest age groups, in the Army, junior enlisted, and in combat-specific occupations. The rate among recruit/ trainees (779.4 per 10,000 p-yrs) was more than 165 times the rate among all other active component service members (non-recruits) (4.7 per 10,000 p-yrs). Sprains, strains, and contusions accounted for more than one-half of the primary (first-listed) diagnoses associated with combat sports cases. More serious conditions such as concussions/head injuries and skull/face fractures/intracranial injuries were reported among 3.9% and 2.1% of all cases and were more common among boxing-related cases. Hand/wrist fractures were also common among boxing cases. Wrestling had comparatively greater proportions of dislocations and open wounds. Although the combat sport training provides many physical and mental benefits to the individual, safety practices should be enforced to reduce the most frequent and serious injuries.
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26
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Heyworth BE, Kocher MS. Shoulder instability in the young athlete. Instr Course Lect 2013; 62:435-444. [PMID: 23395048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Shoulder instability is among the most common musculoskeletal injuries and overuse conditions in pediatric and adolescent athletes requiring orthopaedic care. Injury patterns in skeletally immature patients are unique to the developing musculoskeletal system and may be specific to the involved sport. It is helpful to have an outline of the basic diagnostic approaches and to review the literature that guides management principles in young athletes with shoulder instability.
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Affiliation(s)
- Benton E Heyworth
- Department of Orthopaedic Surgery, Children's Hospital Boston, Boston, MA, USA
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27
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Clark JC, Ritchie J, Song FS, Kissenberth MJ, Tolan SJ, Hart ND, Hawkins RJ. Complication rates, dislocation, pain, and postoperative range of motion after reverse shoulder arthroplasty in patients with and without repair of the subscapularis. J Shoulder Elbow Surg 2012; 21:36-41. [PMID: 21803609 DOI: 10.1016/j.jse.2011.04.009] [Citation(s) in RCA: 115] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2010] [Revised: 04/04/2011] [Accepted: 04/07/2011] [Indexed: 02/01/2023]
Abstract
BACKGROUND Despite improved results with reverse shoulder arthroplasty (RSA), questions still remain regarding certain technical aspects of the operation. One particular area of question is the effect of subscapularis repair on complication rates, dislocation, pain, and overall range of motion. Some authors suggest that when a deltopectoral approach is used, not repairing the subscapularis leads to a higher complication rate, especially for dislocation. MATERIALS AND METHODS From a reverse total shoulder arthroplasty database of 3 surgeons at 1 institution, we identified 55 patients who underwent RSA using the deltopectoral approach without subscapularis repair and 65 patients with subscapularis repair. RESULTS Complications were documented in 11 of 55 shoulders (20%) without subscapularis repair and in 13 of 65 shoulders (20%) with subscapularis repair. Dislocation occurred in 3 shoulders in the nonrepair group and in 2 shoulders in the repair group. These data indicate that nonrepair of the subscapularis did not have a significant effect on the risk of any complication, dislocation, infection, disassociation, or function. CONCLUSION Repairing the subscapularis has no appreciable effect on complication rate, dislocation events, or range of motion gains and pain relief.
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Affiliation(s)
- Jason C Clark
- Steadman Hawkins Clinic of the Carolinas, Greenville Hospital System, Greenville, SC, USA
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28
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Boyd J. Working with the teenaged athlete: A conversation with Joel Boyd, M.D. Interviewed by Carmen Peota and Megan Reams. Minn Med 2010; 93:22-25. [PMID: 21265414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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29
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Jiang CY. [Diagnosis and treatment of shoulder disease: current concepts and new thoughts]. Zhongguo Gu Shang 2009; 22:647-649. [PMID: 19817188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Chun-Yan Jiang
- Shoulder Service, Beijing Jishuitan Hospital, Beijing 100035, China
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30
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Taylor DC, Krasinski KL. Adolescent shoulder injuries: consensus and controversies. Instr Course Lect 2009; 58:281-292. [PMID: 19385542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Adolescent participation in sports is at an all-time high. Younger patients also are competing with a greater intensity level, frequently playing organized sports throughout the year. Players are putting greater demands on their shoulders, making them more prone to injuries. Because these players are in the process of skeletal development, certain considerations are needed for this patient population. There is controversy regarding the appropriate treatment of these adolescent athletes- including debate on injury prevention; nonsurgical treatment versus surgical treatment; overuse injuries; and return to play after shoulder fractures, dislocations, and instability. It is valuable to review evidence in the current literature regarding recommendations for the treatment of shoulder injuries in adolescent athletes.
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Affiliation(s)
- Dean C Taylor
- Division of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
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31
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Sperling JW, Galatz LM, Higgins LD, Levine WN, Ramsey ML, Dunn J. Avoidance and treatment of complications in shoulder arthroplasty. Instr Course Lect 2009; 58:459-472. [PMID: 19385555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Total shoulder replacement is well established as a treatment for a painful arthritic glenohumeral joint, typically leading to improved shoulder function and decreased pain. The frequency of revision surgery is increasing, as it is for hip and knee arthroplasty. The most common complications of shoulder arthroplasty can be avoided or successfully treated.
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Affiliation(s)
- John W Sperling
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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32
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Bhagat S, Bansal M, Sharma H, Jandhyala R, Amin P, Pandit J. A rare case of progressive bilateral congenital abduction contracture with shoulder dislocations treated with proximal deltoid release. Arch Orthop Trauma Surg 2008; 128:293-6. [PMID: 17285270 DOI: 10.1007/s00402-007-0291-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2006] [Indexed: 11/30/2022]
Abstract
The contracture of the deltoid muscle is an uncommon disorder. Amongst the various causes reported, post intramuscular injection and trauma leading to the fibrosis of the muscle are common. However, congenital cases are extremely rare. We report a case of congenital progressive bilateral abduction contracture left untreated for a long time leading to anteroinferior subluxation. A proximal release was performed with satisfactory outcome on both sides.
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Affiliation(s)
- S Bhagat
- Kettering General Hospital, 1/2 Mawsley Crescent, Kettering, Northants, UK.
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33
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Hausdorf J, Pietschmann M, Jansson V, Müller PE. [The dislocated shoulder prosthesis--an avoidable disaster?]. Orthopade 2007; 36:944, 946-9. [PMID: 17901945 DOI: 10.1007/s00132-007-1145-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Instability after shoulder arthroplasty is a common problem, even though complete dislocations are rare. A distinction can be made between vertical and horizontal instabilities. The most common type of vertical instability is superior migration of the humeral head caused by rotator cuff insufficiency; the shoulder prosthesis should be changed for an inverse prosthesis if the patient is symptomatic. Horizontal instabilities can certainly lead to acute dislocation, but it is far more common for them to result in eccentric loading of the glenoid and in turn to increased wear and loosening. When a prosthesis is first implanted it is essential to reproduce the original bony situation before the deformity caused by arthrosis, arthritis or fracture, as this is the only way to prevent instability. This requires careful preoperative planning including evaluation of CT or MRI scans so that during the operation it will be possible, for example, to reorientate an eccentrically torn glenoid using a bone graft or by eccentric reaming and restore the original torsion. At least as much importance attaches to the treatment of the soft tissue, meaning careful release and later closure of the rotator cuff and capsule complex, as to the bony situation. In the authors' own institution 190 prostheses were implanted between 2000 and 2006 and there were three dislocations (1.6%).
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Affiliation(s)
- J Hausdorf
- Klinik für Orthopädie der Ludwig-Maximilians-Universität München, München, Deutschland.
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34
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Owens BD, Duffey ML, Nelson BJ, DeBerardino TM, Taylor DC, Mountcastle SB. The incidence and characteristics of shoulder instability at the United States Military Academy. Am J Sports Med 2007; 35:1168-73. [PMID: 17581976 DOI: 10.1177/0363546506295179] [Citation(s) in RCA: 293] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The literature provides little information detailing the incidence of traumatic shoulder instability in young, healthy athletes. HYPOTHESIS Shoulder instability is common in young athletes. STUDY DESIGN Descriptive epidemiologic study. METHODS We prospectively captured all traumatic shoulder instability events at the United States Military Academy between September 1, 2004, and May 31, 2005. Throughout this period, all new traumatic shoulder instability events were evaluated with physical examination, plain radiographs, and magnetic resonance imaging. Instability events were classified according to direction, chronicity, and type (subluxation or dislocation). Subject demographics, mechanism of injury, and sport were evaluated. RESULTS Among 4141 students, 117 experienced new traumatic shoulder instability events during the study period; 11 experienced multiple events. The mean age of these 117 subjects was 20.0 years; 101 students were men (86.3%), and 16 were women (13.7%). The 1-year incidence proportion was 2.8%. The male incidence proportion was 2.9% and the female incidence proportion was 2.5%. Eighteen events were dislocations (15.4%), and 99 were subluxations (84.6%). Of the 99 subluxations, 45 (45.5%) were primary events, while 54 (54.5%) were recurrent. Of the 18 dislocations, 12 (66.7%) were primary events, while 6 (33.3%) were recurrent. The majority of the 117 events were anterior in nature (80.3%), while 12 (10.3%) were posterior, and 11 (9.4%) were multidirectional. Forty-four percent (43.6%) of the instability events experienced were as a result of contact injuries, while 41.0% were a result of noncontact injuries, including 9 subluxations caused by missed punches during boxing; information was unavailable for the remaining 15%. CONCLUSION Glenohumeral instability is a common injury in this population, with subluxations comprising 85% of instability events.
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Affiliation(s)
- Brett D Owens
- Orthopaedic Surgery Service, Keller Army Hospital, US Military Academy, West Point, NY 10996, USA.
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35
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Robinson CM, Akhtar A, Mitchell M, Beavis C. Complex posterior fracture-dislocation of the shoulder. Epidemiology, injury patterns, and results of operative treatment. J Bone Joint Surg Am 2007; 89:1454-66. [PMID: 17606784 DOI: 10.2106/jbjs.f.01214] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Complex posterior fracture-dislocations of the shoulder are rare and often associated with poor long-term function regardless of the choice of treatment. The purposes of this study were to evaluate the epidemiology and pathological anatomy of posterior fracture-dislocations of the shoulder and to assess the clinical and radiographic outcomes of a specific treatment protocol of open reduction and internal fixation. METHODS We studied the demographic details of a consecutive series of twenty-six patients (twenty-eight shoulders in nineteen men and seven women with a mean age of fifty-three years) who sustained acute posterior dislocation of the humeral head with an associated Neer two, three, or four-part fracture. We used age and gender-specific local census data to assess the incidence of injury in our local population. All patients were treated by open relocation of the humeral head, bone-grafting of humeral head defects if they were causing residual shoulder instability, and internal fixation of the fracture. We recorded the prevalence of fracture complications that were clinically and radiographically apparent and assessed the functional outcome using three validated scoring systems (the Short Form-36 general health measure, the Disabilities of the Arm, Shoulder and Hand score, and the Constant score). RESULTS The overall incidence of posterior fracture-dislocations was 0.6 per 100,000 population per year. The peak incidence was in middle-aged men, and most injuries were sustained during a seizure or a fall from a height. In all patients, there was a displaced primary fracture of the anatomic neck of the humerus, propagating from the area of an osteochondral fracture of the anterior aspect of the humeral head (a reverse Hill-Sachs lesion). We recognized three subtypes determined by the extent of the secondary fracture lines. At two years after surgery, the median Constant score was 83.5 points and the median Disabilities of the Arm, Shoulder and Hand score was 17.5 points. The eight components of the Short Form-36 score were not significantly different from those of age and sex-matched controls at two years. CONCLUSIONS Acute complex posterior fracture-dislocations of the shoulder are rare, but they occur in patients who are younger than the majority of other patients who sustain a proximal humeral fracture. The use of open reduction and internal fixation to treat these fractures is associated with a relatively low risk of postoperative complications, and the functional outcome is generally favorable.
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Affiliation(s)
- C Michael Robinson
- The Shoulder Injury Clinic, Edinburgh Orthopaedic Trauma Unit, Edinburgh, EH16 4SU, United Kingdom.
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Abstract
The objective of this study was to investigate the incidence, and the factors influencing the development, of complex regional pain syndrome-I in the upper extremity in hemiplegic patients within the first 28 weeks following a stroke. We followed up 82 stroke patients. All patients were evaluated at weeks 2, 6, 14 and 28 after suffering a stroke. Outcomes were assessed using passive range of motion of shoulder, presence of subluxation, Ashworth score, Motricity index arm score, Brunnstrom stages and depression score. The incidence of complex regional pain syndrome-I was 48.8% in the first 28 weeks. Significant correlation was found between complex regional pain syndrome-I and the presence of subluxation, Ashworth score, Motricity index arm score, Brunnstrom stage and depression score (r=0.259, P=0.019; r=0.271, P=0.014; r=-0.393, P<0.001; r=-0.385, P<0.001; r=0.293, P=0.008, respectively). In this study, there was a relationship between complex regional pain syndrome-I and subluxation, loss of range of motion, spasticity of shoulder muscles and muscle strength. In order to prevent the development of complex regional pain syndrome-I, exercises directed at increasing the range of motion for the glenohumeral joint, strengthening shoulder muscles and reduction of spasticity will establish the integrity of the shoulder joint.
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Affiliation(s)
- Hilal Kocabas
- Department of Physical Medicine and Rehabilitation, Selcuk University Meram Faculty of Medicine, Konya, Turkey
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37
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Antonio GE, Griffith JF, Yu AB, Yung PSH, Chan KM, Ahuja AT. First-time shoulder dislocation: High prevalence of labral injury and age-related differences revealed by MR arthrography. J Magn Reson Imaging 2007; 26:983-91. [PMID: 17896393 DOI: 10.1002/jmri.21092] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To evaluate abnormalities and age-related differences after first-time shoulder dislocation. MATERIALS AND METHODS MRA images of first-time dislocators were assessed for labral-ligamentous-capsular / rotator cuff abnormalities and analyzed the age-related differences (< and >/=30 years old). RESULTS Sixty-six patients (34 <30 years old vs. 32 >/=30 years; 51 males; all anterior dislocations) were imaged. Forty-eight patients (73%) showed anteroinferior labral avulsion, consisting of: 6% (4/34 vs. 0/32) Perthes; 23% (8/34 vs. 7/32) free ALPSA (anterior labrum periosteal sleeve avulsion) lesion); 6% (1/34 vs. 3/32) adherent ALPSA; 23% (9/34 vs. 6/32) Bankart; 14% (5/34 vs. 4/32) inferiorly displaced avulsed labrum; 2% (1/34 vs. 0/32) GLAD. Extensive labral detachment (extended above 3 o'clock position) was present in 31% (11/28 vs. 4/20). There were 14% (6/34 vs. 3/32) superior labrum anterior-posterior (SLAP) lesion; 27% (1/34 vs. 17/34) rotator cuff tendon tear; 71% (25/34 vs. 22/32) Hill-Sachs defect. Young patients were more likely to have extensive labral avulsions (P = 0.054), but less likely to have rotator cuff tears (P < 0.001). CONCLUSION A high prevalence and wide variety of labral avulsions after first-time shoulder dislocation, especially adherent ALPSA, inferiorly displaced avulsed labrum, or GLAD lesion, may influence treatment choice and outcome, suggesting a role for early MRA to assist in treatment triage.
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Affiliation(s)
- Gregory E Antonio
- Department of Diagnostic Radiology and Organ Imaging, Chinese University of Hong Kong
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38
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Abstract
There is a high incidence of reflex sympathetic dystrophy of the upper limbs in patients with hemiplegia, and its painful and functional consequences present a problem to specialists in physical medicine and rehabilitation. This study was designed to assess the role of several factors in the occurrence of reflex sympathetic dystrophy in patients with hemiplegia. Ninety-five consecutive stroke patients (63 male and 32 female, mean age 59+/-12 years) admitted to our hospital were evaluated. Of the study group, 29 patients (30.5%) were found to develop reflex sympathetic dystrophy. There were no significant differences between the hemiplegic patient groups with or without reflex sympathetic dystrophy regarding age, gender, etiology, side of involvement, disease duration and the presence of comorbidities. The recovery stages of hemiplegia, as shown by Brunnstrom functional classification, were significantly different between the two groups; patients in lower recovery stages tended to develop reflex sympathetic dystrophy more frequently (P<0.01). Additionally, the presence of flaccidity was also a significant factor in the development of reflex sympathetic dystrophy. Glenohumeral subluxation was present in 37 patients (38.9%) in our study group and the presence of this complication was related to the occurrence of reflex sympathetic dystrophy. The presence of glenohumeral subluxation was significantly higher in patients with reflex sympathetic dystrophy (21/29, 72.4%) when compared to the patients without reflex sympathetic dystrophy (16/66, 24.2%) (P<0.001). Also, hemiplegic patients with more severe shoulder subluxation were significantly more likely to develop reflex sympathetic dystrophy. These results suggest that lower recovery stages, reduced tonus and glenohumeral subluxation significantly contribute to the occurrence of reflex sympathetic dystrophy in the hemiplegic patient. We believe that preventive and treatment measures should consider these factors as they seem to have in common a higher risk of traumatizing the paralyzed upper limb and causing reflex sympathetic dystrophy.
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39
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Tan CK, Guisasola I, Machani B, Kemp G, Sinopidis C, Brownson P, Frostick S. Arthroscopic stabilization of the shoulder: a prospective randomized study of absorbable versus nonabsorbable suture anchors. Arthroscopy 2006; 22:716-20. [PMID: 16843806 DOI: 10.1016/j.arthro.2006.03.017] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2005] [Revised: 11/22/2005] [Accepted: 03/12/2006] [Indexed: 02/02/2023]
Abstract
PURPOSE The aim of this study was to evaluate, prospectively, outcomes following arthroscopic Bankart repair performed with 2 types of suture anchor--the G II (DePuy Mitek, Raynham, MA) nonabsorbable anchor and the Panalok (DePuy Mitek) absorbable anchor. METHODS Patients with a diagnosis of recurrent traumatic anterior instability of the shoulder who were seen in a single unit between April of 2000 and June of 2003 were considered for inclusion in the study. Patients were assessed preoperatively and postoperatively by means of a subjective, patient-related outcome measurement tool (Oxford Instability Score), a visual analogue scale for pain and instability (VAS Pain and VAS Instability), and a quality-of-life questionnaire (Short Form-12 [SF-12]). Length of follow-up was 1.5 to 5 years (mean, 2.6 y). The incidence of recurrent instability and the level of sporting ability were recorded. Patients were randomized to undergo surgical repair with nonabsorbable or absorbable anchors. RESULTS A total of 130 patients were included in this study, of whom 6 were lost to follow-up; therefore 124 patients (95%) completed the study. Both types of anchor were highly effective. No differences in rate of recurrence or in any of the scores were noted between the 2 groups. In all, 4 patients in the nonabsorbable group and 3 in the absorbable group experienced additional episodes of dislocation after a traumatic event. Rate of redislocation in the whole series was therefore 6%. In addition, 4 patients, all of them from the absorbable group (4%), described ongoing symptoms of instability but no true dislocations. In all, 85% of the patient group have returned to their previous level of sporting activity. CONCLUSIONS No differences in outcomes of arthroscopic Bankart repair were seen whether absorbable or nonabsorbable anchors were used. Both are highly effective, with a redislocation rate of 6%. LEVEL OF EVIDENCE Level I, therapeutic randomized controlled trial.
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Affiliation(s)
- Chin Khoon Tan
- Department of Trauma and Orthopaedics, University of Liverpool, Liverpool, England
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Strahovnik A, Fokter SK. Long-term results after open Bankart operation for anterior shoulder instability. A 3- to 16-year follow-up. Wien Klin Wochenschr 2006; 118 Suppl 2:58-61. [PMID: 16817046 DOI: 10.1007/s00508-006-0551-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The open Bankart procedure is still considered the gold standard for patients with recurrent posttraumatic anterior shoulder instability. The purpose of this retrospective study was to analyze long-term results after open Bankart procedure in 83 patients that were operated between 1987 and 2000 and to evaluate the rate of recurrent instability, level of function and range of motion. The mean follow-up time was 9 (3-16) years. The postoperative recurrence rate including subluxations was 12%. The mean Constant score was 77 and the mean Rowe score was 63. Average loss of external rotation in 90 degrees of abduction was 19 degrees . The results were disappointing in terms of stability and function. In the absence of longterm prospective studies on newer arthroscopic techniques, the decision on the reconstruction method must still be based on the surgeon's experience and the patient's choice.
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Affiliation(s)
- Andrej Strahovnik
- Department for Orthopedic Surgery and Sports Trauma, Celje General Hospital, Oblakova 5, 3000 Celje, Slovenia.
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Ozbaydar MU, Tekin C, Kocabaş R, Yalaman O. [Arthroscopic treatment of type 2 superior labrum anterior posterior lesions]. Acta Orthop Traumatol Turc 2006; 40:349-55. [PMID: 17220642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
OBJECTIVES We retrospectively evaluated patients who underwent arthroscopic repair for isolated type 2 superior labrum anterior posterior (SLAP) lesions. METHODS Isolated type 2 SLAP lesions were treated with arthroscopic repair with suture anchors in eight patients (5 males, 3 females; mean age 48.5 years; range 27 to 60 years) with shoulder pain unresponsive to conservative treatment. The mean duration of symptoms was 18.6 months (range 2 to 48 months). Initial diagnoses were based on patients' complaints and findings of physical examination and radiologic imaging, and were confirmed at diagnostic arthroscopy. Two suture anchors were used in six patients. Patients were evaluated with physical examination, radiographs, and the UCLA (University of California at Los Angeles) score. The mean follow-up was 30.8 months (range 14 to 48 months). RESULTS The mean preoperative and postoperative UCLA scores were 13.3 (range 10 to 18) and 30.8 (range 24 to 33), respectively (p<0.05). The results were good in seven patients (87.5%), and fair in one patient (12.5%). The mean preoperative active forward elevation was 136.3 degrees (range 90 degrees to 170 degrees), adduction-external rotation was 42.5 degrees (range 40 degrees to 60 degrees), and adduction-internal rotation was at T7 in three patients, and at L1 in five patients. At final follow-ups, the mean active forward flexion increased to 164.3 degrees (range 150 degrees to 170 degrees), adduction-external rotation was 40 degrees (range 30 degrees to 60 degrees), and adduction-internal rotation was at T7 in four patients, and at T12 in four patients. CONCLUSION The results of arthroscopic fixation of type 2 SLAP lesions with suture anchors are successful in the majority of patients, provided that an appropriate arthroscopic technique is performed to re-establish the stability of the biceps anchor.
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Mizuno N, Yoneda M, Hayashida K, Nakagawa S, Mae T, Izawa K. Recurrent anterior shoulder dislocation caused by a midsubstance complete capsular tear. J Bone Joint Surg Am 2005; 87:2717-2723. [PMID: 16322622 DOI: 10.2106/jbjs.e.00027] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND A midsubstance complete capsular tear is one of the well-known causes of anterior glenohumeral instability. However, its prevalence and clinical picture have not been well elucidated. The purpose of this study was to examine the prevalence of isolated complete capsular tears and to assess the clinical features as well as the results of surgical treatment of recurrent anterior glenohumeral instability caused by such tears. METHODS Three hundred and three shoulders underwent surgery to treat recurrent anterior glenohumeral instability at our institution during a five-year period. Twelve (4.0%) of these shoulders had an isolated complete capsular tear as the main pathological condition. Those twelve patients (nine male and three female) were the subjects of the present study. The average age at the time of the operation was twenty-five years. Patient age; the cause of the initial dislocation; the position of the arm at the initial dislocation; and the findings of the preoperative physical examination, of computed tomographic arthrography, and at surgery were assessed. Eleven patients underwent arthroscopic capsular repair, and one was treated with an open capsular repair. RESULTS The twelve patients either did not have a Hill-Sachs lesion or had a chondral indentation-type of Hill-Sachs lesion. When assessed with arthrography, the Hill-Sachs lesions were small compared with those in shoulders with an isolated Bankart lesion and, interestingly, they were quite similar in size to those seen with humeral avulsion of the inferior glenohumeral ligament. The average Rowe score for the twelve patients improved from 30.4 points preoperatively to 90.4 points at an average of thirty-one months postoperatively. CONCLUSIONS The prevalence of isolated complete capsular tears causing recurrent glenohumeral instability was 4.0% (twelve of 303). These tears were associated with either a small or no Hill-Sachs lesion. We believe that a complete capsular tear should be recognized as one of the essential lesions causing recurrent anterior shoulder dislocation. Arthroscopic examination and repair can provide effective treatment.
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Affiliation(s)
- Naoko Mizuno
- Shoulder and Sports Medicine Service, Osaka Kosei-nenkin Hospital, 4-2-78 Fukushima, Fukushima-ku, Osaka City, Osaka 530-0003, Japan.
| | - Minoru Yoneda
- Shoulder and Sports Medicine Service, Osaka Kosei-nenkin Hospital, 4-2-78 Fukushima, Fukushima-ku, Osaka City, Osaka 530-0003, Japan.
| | - Kenji Hayashida
- Department of Orthopaedic Surgery, Hoshigaoka Kosei-nenkin Hospital, 4-8-1 Hoshigaoka, Hirakata City, Osaka 573-8511, Japan
| | - Shigeto Nakagawa
- Department of Orthopaedic Surgery, Yukioka Hospital, 2-2-3 Ukita, Kita-ku, Osaka City, Osaka 530-0021, Japan
| | - Tatsuo Mae
- Shoulder and Sports Medicine Service, Osaka Kosei-nenkin Hospital, 4-2-78 Fukushima, Fukushima-ku, Osaka City, Osaka 530-0003, Japan.
| | - Kazutaka Izawa
- Department of Orthopaedic Surgery, Toneyama National Hospital, 5-1-1 Toneyama, Toyonaka City, Osaka 560-0045, Japan
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Abstract
PURPOSE Although the comparative efficacy of open and arthroscopic Bankart repair remains a matter of debate, little data exist on relative costs. We analyzed the patient outcomes, cost, and resource utilization of both procedures to determine if differences exist between open versus arthroscopic Bankart repair. TYPE OF STUDY Retrospective case-control study. METHODS We compared 22 patients who had open Bankart repair with 20 patients who had arthroscopic Bankart repair. Total operating times and all charges were obtained from records. Patients were evaluated using the American Shoulder and Elbow Surgeons (ASES) shoulder score, and any recurrence of dislocation was noted at minimum 24-month follow-up. RESULTS For arthroscopic Bankart repairs, operating times were shorter, but operating room equipment charges were greater. Overall charges were greater for open repairs as all open repair patients were admitted postoperatively. ASES shoulder scores were not significantly different between treatment groups. Four of 17 evaluable patients with open Bankart repair (including 1 shoulder in a patient who underwent bilateral repairs) had recurrent dislocation. One of the 18 evaluable patients with arthroscopic Bankart repair had recurrent dislocation. CONCLUSIONS Arthroscopic Bankart repair as same-day surgery has lower overall charges than open repair, although this difference would be negligible if all patients went home immediately after surgery. LEVEL OF EVIDENCE Level III, therapeutic, retrospective cohort study.
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Affiliation(s)
- Conrad Wang
- Department of Orthopaedics, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Hazmy CHW, Parwathi A. The epidemiology of shoulder dislocation in a state-hospital: a review of 106 cases. Med J Malaysia 2005; 60 Suppl C:17-21. [PMID: 16381277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
This retrospective study was conducted in a state hospital set-up and aimed at identifying the magnitude of shoulder dislocations and their demographic data, characteristics of the injury, mechanism and predisposing factors, and the instituted treatment. Patients with radiographic evidence of shoulder dislocation admitted to the hospital from January 1999 to December 2002 were included. Data were recorded from the case notes. There were 105 shoulder dislocations with male predomination in 77% cases and age ranged between 11 and 90 years (average 30.9 years). The right shoulder was affected in 68% of the cases. The contributing events were fall in 37% of cases, road traffic accident 23%, sports 17% and pathological conditions 13%. Anterior dislocation occurred in 96.2% of the cases. Posterior and inferior dislocations encountered in two patients for each type. Twelve dislocations were associated fracture of the greater tuberosity, two each with humeral neck fracture and cerebral injuries. First time dislocation occurred in 73.6% of the cases. The recurrences ranged between 2 to 6 times (average 3.4 times). Closed manipulative reduction and strapping was the definitive treatment in 92.4% of the cases and the remaining needed surgical reconstruction. Four patients had open reduction and internal fixation of the associated fractures while another four had arthroscopic Bankart's repair. In conclusion, shoulder dislocation represents the most common shoulder problems. It afflicted young adults of reproductive age (21-40 years) and participation in sports was a risk factor in men. Women over 40 years and fall were at risk to develop shoulder dislocation.
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Affiliation(s)
- C H Wan Hazmy
- Department of Orthopaedics and Traumatology, Seremban Hospital, Seremban, Negeri Sembilan, Malaysia
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Hazmy CHW, Parwathi A. Sports-related shoulder dislocations: a state-hospital experience. Med J Malaysia 2005; 60 Suppl C:22-5. [PMID: 16381278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
This retrospective study was conducted in a state hospital set-up and aimed at identifying the incidence of sports-related shoulder dislocations and their characteristics and the sports events involved. All patients with shoulder dislocation related to sporting activities admitted to the hospital from January 1999 to December 2002 were included in the study. There were 18 sports-related shoulder dislocations out of 106 all shoulder dislocations admitted during this 4-year period. The average age of the patients was 25.4 years. All but two were male. All were anterior dislocations. Recurrent dislocation constitutes 78% of the cases with an average of 3 times re-dislocation. Rugby and badminton were the major contributors to the injuries followed by volleyball, soccer and swimming. Conservative treatment was successfully instituted for 88% of the patients and 12% opted for surgical intervention.
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Affiliation(s)
- C H Wan Hazmy
- Department of Orthopaedics and Traumatology, Seremban Hospital, Seremban, Negeri Sembilan, Malaysia
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Lee DJK, Yeap JS, Fazir M, Muhd Borhan TA, Kareem BA. Audit on radiographs in anterior shoulder dislocations. Med J Malaysia 2005; 60:15-20. [PMID: 16250275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
The radiographs of 115 anterior shoulder dislocations (100 patients; 74 males, 26 female were reviewed to assess the radiographic views used in the management of this dislocation. Eighty-eight patients (88%) had only the anteroposterior (AP) view, 10 patients had 2 radiographic views taken and only 2 patients had three radiographic views. Hill-Sachs lesions were found in 18%, and glenoid rim fractures in 3% of the patients. A greater tuberosity fracture was found in 18% of the patients. Therefore, the current practice in the management of an acute anterior shoulder dislocation appears to be to perform a single view (AP) pre-reduction radiograph to confirm the diagnosis and a single view (AP) post reduction radiograph to confirm reduction after a close manipulative reduction has been performed. This practice is likely to result in an underestimate of associated Hill Sachs lesion and glenoid rim fractures, but not greater tuberosity fractures.
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Affiliation(s)
- D J K Lee
- Faculty of Medicine, Universiti Putra Malaysia, Jalan Masjid, 50586 Kuala Lumpur
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Abstract
This review summarizes the recent advances in glenohumeral subluxation (GHS) in hemiplegic patients and analyzes the reliability and validity of clinical evaluation and the effectiveness of different treatment approaches. GHS, a common complication of stroke, can be considered an important risk factor for shoulder pain and other problems. GHS is a complex phenomenon, and its pathomechanics are not yet fully understood. Radiographic measurements are considered the best method of quantifying GHS. Clinical evaluation can be useful as screening assessment. Functional electrical stimulation and strapping are effective in an acute stage of hemiplegia; some types of slings have been shown to be effective and may be used together with other strategies.
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Affiliation(s)
- Matteo Paci
- Department of Rehabilitation Medicine, Prato Hospital, Prato, Italy.
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Yeap JS, Lee DJK, Fazir M, Borhan TAM, Kareem BA. The epidemiology of shoulder dislocations in Malaysia. Med J Malaysia 2004; 59 Suppl F:19-23. [PMID: 15941156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
The case notes of 102 patients (117 shoulder dislocations) were reviewed retrospectively to improve the understanding of the epidemiology of this common injury. Eighty-one dislocations were primary and 36 dislocations were second or recurrent dislocations. The age distribution was characterized by a peak in male patients aged between 21-30 years. The mean age for males was 30.5 years and 47.7 years for females. The male:female ratio in first time dislocations was 5:2, while it was 5:1 in recurrent dislocations. Ninety-eight percent were anterior dislocations and 2% were posterior dislocations. Greater tuberosity fractures were found in 17 patients and almost half of these patients were aged between 41-50 years. The most common cause of first time dislocation was a direct blow or fall onto the shoulder, accounting for 42 patients (55%). The majority of these patients were aged 40 years and above. Next common cause was motor vehicle accident which occurred mostly in the younger age group. Dislocations due to sporting injuries accounted for only 5.3% of all first time dislocations. Nearly 97% were successfully reduced without a general anaesthesia. Seventy-seven percent of the patients had their shoulders immobilized after reduction, mostly with body strapping only. Fifteen patients (14.7%) were referred for physiotherapy for stiffness. Few operations were performed for recurrent dislocations but surgery does not appear to be well accepted as yet by our patients.
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Affiliation(s)
- J S Yeap
- Department of Orthopaedics, International Medical University, Seremban, Negeri Sembilan
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Abstract
OBJECTIVES To identify risk factors for fractures associated with an anterior shoulder dislocation treated in an emergency department (ED). METHODS A retrospective case-control study over five years of patients with an anterior shoulder dislocation was accomplished in a university-affiliated ED. Chart review identified possible predictors of fractures. Comparing the profile of patients having a clinically important fracture associated with their shoulder dislocation (cases) with those sustaining a noncomplicated dislocation (controls) provided the outcome measure. RESULTS A total of 334 patients were included in the study. Eighty-five (25.5%) had a clinically important fracture-dislocation, and the remaining 249 (74.5%) sustained a noncomplicated shoulder dislocation. Chi-square, logistic regression, and recursive partitioning analysis showed three significant factors for the presence of fracture-dislocation: 1) age 40 years or older, 2) a first episode of dislocation, and 3) mechanism of injury (i.e., a fall greater than one flight of stairs, a fight/assault episode, or a motor vehicle crash). A multiple logistic regression model estimated the significant adjusted odds ratios (and their 95% confidence intervals [95% CIs]) for each of the three factors: 5.18 (95% CI = 2.74 to 9.78), 4.23 (95% CI = 1.82 to 9.87), and 4.06 (95% CI = 1.95 to 8.48), respectively. A predictive model using any one of the three factors reached a sensitivity of 97.7% (95% CI = 91.8% to 99.4%), a specificity of 22.9% (95% CI = 18.1% to 28.5%), and a negative predictive value of 96.6% (95% CI = 88.3% to 99.6%). CONCLUSIONS Three risk factors predict clinically important fractures that are associated with shoulder dislocation: age, first episode, and mechanism of dislocation. A prospective validation may lead to standardized use of prereduction radiographs of the shoulder in the ED.
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Affiliation(s)
- Marcel Emond
- Trauma Research Unit, Centre Hospitalier Affilié Universitaire de Québec, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada.
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Abstract
BACKGROUND Glenoid dysplasia and posterior shoulder subluxation with resultant shoulder stiffness is a well-recognized complication in infants with neonatal brachial plexus palsy. It is generally considered to be the result of a slowly progressive glenohumeral deformation secondary to muscle imbalance, physeal trauma, or both. Recent publications about infantile posterior shoulder dislocation have suggested that the onset of dysplasia occurs at an earlier age than has been previously recognized. The prevalence of early dislocation in infants with this disorder has not been previously reported, to our knowledge. METHODS We studied 134 consecutive infants with neonatal brachial plexus palsy who were seen at our institution over a period of two years. All infants were examined at monthly intervals to assess neurological recovery and the status of the upper extremity until recovery occurred or a treatment plan was established. The type of brachial plexus involvement was classified. Specific clinical signs associated with subluxation and dislocation were recorded. These included asymmetry of skin folds of the axilla or the proximal aspect of the arm, apparent shortening of the humeral segment, a palpable asymmetric fullness in the posterior region of the shoulder, or a palpable click during shoulder manipulation. The infants who were identified as having these clinical signs were evaluated with ultrasonographic imaging studies. RESULTS Eleven (8%) of the 134 infants had a posterior shoulder dislocation. The mean age at the time of diagnosis was six months (range, three to ten months). There was no correlation between the occurrence of dislocation and the type of initial neurological deficit. A rapid loss of passive external rotation between monthly examinations indicated a posterior shoulder dislocation. CONCLUSIONS Posterior shoulder dislocation can occur earlier (before the age of one year) and more rapidly in infants with neonatal brachial plexus palsy than has been appreciated previously. As with developmental dysplasia of the hip, a high index of suspicion, recognition of clinical signs, and the use of ultrasonography will allow the diagnosis to be established. Following early diagnosis, attention should be focused on improving the stability and congruency of the shoulder joint.
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Affiliation(s)
- Didier Moukoko
- Texas Scottish Rite Hospital for Children, 2222 Welborn Street, Dallas, TX 75219, USA
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