Posttraumatic subluxation of the glenohumeral joint caused by interposition of the rotator cuff

Luxatio erecta of the humerus: the spectrum of injury of inferior shoulder dislocation and analysis of injury mechanisms

Erecta dislocation/inferior dislocation of the shoulder is considered an uncommon injury and the present knowledge stems from case reports or compilation of cases. We believe that there are reasons to believe that the injury is much more prevalent than previously stated. In this review, we discuss the mechanism of injury and based on the number of patients with unusual injury patterns at our hospitals and in the literature, the anatomical features of different variants of inferior dislocation are described. Only a few patients present with their arm still locked in abduction, and most patients with initial inferior dislocation are diagnosed with other types of dislocation or injury. Irreducible dislocation, with tissue blocking the glenoid appears to be a consequence typical of an initial inferior dislocation. Nerve and vascular injuries are overrepresented, as are humeral avulsion glenohumeral ligaments-injuries. The description of shoulder dislocations should ideally include the dislocation path and not only the final position of the humeral head.

Glenohumeral interposition of rotator cuff stumps: a rare complication of traumatic rotator cuff tear

The present report describes a case where typical findings of traumatic glenohumeral interposition of rotator cuff stumps were surgically confirmed. This condition is a rare complication of shoulder trauma. Generally, it occurs in high-energy trauma, frequently in association with glenohumeral joint dislocation. Radiography demonstrated increased joint space, internal rotation of the humerus and coracoid process fracture. In addition to the mentioned findings, magnetic resonance imaging showed massive rotator cuff tear with interposition of the supraspinatus, infraspinatus and subscapularis stumps within the glenohumeral joint. Surgical treatment was performed confirming the injury and the rotator cuff stumps interposition. It is important that radiologists and orthopedic surgeons become familiar with this entity which, because of its rarity, might be neglected in cases of shoulder trauma.

Arthroscopic repair for subacromial incarceration of a torn rotator cuff

Background/objective

Rotator cuff tears are common shoulder injuries. Various forms of rotator cuff tears are observed by arthroscopy. Inverted flap tears of the rotator cuff, however, also occur. The aim of the present study was to determine the preoperative characteristics of inverted torn cuffs and clinical outcomes after arthroscopic repair.

Methods

Seventeen patients (10 men, 7 women; mean age, 65.8 years; age range, 41–80 years) who underwent arthroscopic rotator cuff repair for an inverted flap tear participated in the study. The mean follow-up period was 31.8 months (range, 24–61 months). The preoperative history, radiographs, magnetic resonance images, tear pattern of the rotator cuff, preoperative and postoperative University of California Los Angeles (UCLA) rating scale, and postoperative repair integrity were assessed.

Results

Only two patients had acute episodes of aggravated shoulder pain. In radiographs, the anteroposterior view revealed a heel-type acromion in 8/17 (47.1%) patients with an inverted flap tear compared with 27/345 (7.8%) patients with ordinary retracted tears (p < 0.001). The supraspinatus tendon was incarcerated in all cases. The UCLA score increased from 11.9 ± 2.7 points to 32.5 ± 2.1 points postoperatively (p = 0.002). Postoperative magnetic resonance images at 12 months after surgery showed good repair integrity in all cases.

Conclusion

Arthroscopic reduction and repair are applicable for inverted flap tears of the rotator cuff. The findings of the present study indicated that patients with a heel-type acromion in the anteroposterior view of radiographs are at greater risk for inverted flap tears of the rotator cuff.

Pseudoparalysis of shoulder caused by glenohumeral interposition of rotator cuff tendon stumps: a rare complication of posterior shoulder dislocation

Magnetic resonance imaging (MRI) findings of a rare complication of posterior glenohumeral dislocation are described in two patients which led to shoulder dysfunction caused by interposition of rotator cuff tendon(s) into the glenohumeral joint. Both patients underwent successful surgical fixation and now have returned to normal shoulder function.

Incidence of associated injury in posterior shoulder dislocation: systematic review of the literature

OBJECTIVE

Posterior shoulder dislocations are rare and often missed. Classically associated with seizures, very little is known about the incidence and type of associated injuries. Unfortunately, the majority of the literature consists of incidental reports or small case series. Our goal was to increase the strength of available data by performing a systematic review.

DATA SOURCES

We searched EMBASE and PubMed for the terms "posterior shoulder dislocation." Our inclusion criteria were articles in either English or French with the words "posterior" and "dislocation" in the abstract or title. All reports of chronic cases or instability as well as those without patient information were excluded. Data regarding demographics, etiology, investigations, associated injuries, treatments, and outcomes were extracted. All data were analyzed by using SPSS 18.0 (IBM, Chicago, IL).

RESULTS

A total of 766 articles were found of which 108 were retained for analysis. A total of 475 patients (543 shoulders) were compiled. Seizures were reported in 34% of cases. A majority of dislocations (65%) had associated injuries. Fracture was most common followed by reverse Hill-Sachs and cuff tears. In the absence of fracture or reverse Hill-Sachs injury, the risk of cuff tear increased nearly fivefold (odds ratio, 4.6; P = 0.016).

CONCLUSION

Our results suggest the amount of associated injuries related to posterior shoulder dislocation is far greater than thought. We propose an investigation algorithm for acute posterior shoulder dislocations.

Occult interpositional rotator cuff - an extremely rare case of traumatic rotator cuff tear

Traumatic interposition of a rotator cuff tendon in the glenohumeral joint without recognizable glenohumeral dislocation is an unusual complication after shoulder trauma. Here we report the clinical and imaging presentations of a 17-year-old man with trapped rotator cuff tendons in the glenohumeral joint after a bicycle accident. The possible trauma mechanism is also discussed.

Glenohumeral interposition of a torn rotator cuff in a young motorcyclist

This report describes the rare case of a traumatic rotator cuff tear in a young patient which led to a pseudo-paralyzed shoulder by interposition of the tendon stump into the glenohumeral joint. The patient underwent an open rotator cuff repair and regained an almost normal shoulder function after 12 weeks. A review of the literature is presented.