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Wright A, Ness B, Spontelli-Gisselman A, Gosselin D, Cleland J, Wassinger C. Risk Factors Associated with First Time and Recurrent Shoulder Instability: A Systematic Review. Int J Sports Phys Ther 2024; 19:522-534. [PMID: 38707855 PMCID: PMC11065770 DOI: 10.26603/001c.116278] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 02/29/2024] [Indexed: 05/07/2024] Open
Abstract
Background Shoulder instabilities constitute a large proportion of shoulder injuries and have a wide range of presentations. While evidence regarding glenohumeral dislocations and associated risk factors has been reported, less is known regarding the full spectrum of instabilities and their risk factors. Purpose The purpose of this systematic review was to identify modifiable risk factors to guide patient management decisions with regards to implementation of interventions to prevent or reduce the risk of shoulder instability. Study Design Systematic Review. Methods A systematic, computerized search of electronic databases (CINAHL, Cochrane, Embase, PubMed, SportDiscus, and Web of Science) was performed. Inclusion criteria were: (1) a diagnosis of shoulder instability (2) the statistical association of at least one risk factor was reported, (3) study designs appropriate for risk factors, (4) written in English, and (5) used an acceptable reference standard for diagnosed shoulder instability. Titles and abstracts were independently screened by at least two reviewers. All reviewers examined the quality studies using the Newcastle-Ottawa Scale (NOS). At least two reviewers independently extracted information and data regarding author, year, study population, study design, criterion standard, and strength of association statistics with risk factors. Results Male sex, participation in sport, hypermobility in males, and glenoid index demonstrated moderate to large risk associated with first time shoulder instability. Male sex, age \<30 years, and history of glenohumeral instability with concomitant injury demonstrated moderate to large risk associated with recurrent shoulder instability. Conclusion There may be an opportunity for patient education in particular populations as to their increased risk for suffering shoulder instability, particularly in young males who appear to be at increased risk for recurrent shoulder instability. Level of Evidence Level III.
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Affiliation(s)
- Alexis Wright
- Department of Rehabilitation SciencesTufts University
| | - Brandon Ness
- Department of Rehabilitation SciencesTufts University
| | | | - Dora Gosselin
- Pediatric Physical Therapy and Occupational TherapyDuke Health
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Yang K, Yamamoto N, Takahashi N, Kamijo H, Okamura K, Mihata T, Sugaya H, Funakoshi T, Atsushi A, Kawakami J, Aizawa T, Itoi E. Location and Size of the Reverse Hill-Sachs Lesion in Patients with Traumatic Posterior Shoulder Instability. J Shoulder Elbow Surg 2024:S1058-2746(24)00265-9. [PMID: 38642873 DOI: 10.1016/j.jse.2024.03.017] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 02/16/2024] [Accepted: 03/03/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND In patients with traumatic posterior shoulder instability, little is known about the precise location and size of the reverse Hill-Sachs lesion. METHODS Forty-nine shoulders of 47 patients with traumatic posterior instability were included in this study based on the following inclusion criteria: 1) a primary or recurrent traumatic posterior shoulder dislocation, and 2) the initial event was caused by trauma. Patients were excluded if they had: 1) no history of trauma, 2) prior shoulder surgery, 3) no CT examination, or 4) seizure cases. Three-dimensional images of the humerus reconstructed from CT images were reviewed using an image analysis software. The location and size of the reverse Hill-Sachs lesion were measured and described on a clock face on the humeral head. RESULTS The reverse Hill-Sachs lesion was observed in 25 of 49 shoulders (51%). The reverse Hill-Sachs lesions were located between 1:37 and 2:48. The depth of the reverse Hill-Sachs lesion (mean ± SD) was 5.8 ± 2.2 mm. The extent of the reverse Hill-Sachs lesion was 35° ± 12°. The average orientation of the reverse Hill-Sachs lesion, represented by an angle measured from the 12 o'clock position, was 64° ± 12° and pointing towards 2:09 on a clock face. Length and width of reverse Hill-Sachs lesions were 9.7 ± 4.7 mm, 11.1 ± 3.6 mm, respectively. CONCLUSION The reverse Hill-Sachs lesion was a semicircular compression fracture located on the anteromedial aspect of the humeral head. Compared with shoulders with anterior shoulder instability, the humeral defect was smaller and located more inferiorly in shoulders with posterior instability.
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Affiliation(s)
- Kaijia Yang
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Nobuyuki Yamamoto
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan.
| | | | | | | | - Teruhisa Mihata
- Department of Orthopaedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | | | - Tadanao Funakoshi
- Department of Orthopaedic Surgery, Keiyu Hospital, Tatebayashi, Japan
| | - Arino Atsushi
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Jun Kawakami
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Toshimi Aizawa
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Eiji Itoi
- Department of Orthopaedic Surgery, Tohoku Rosai Hospital, Sendai, Japan
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Rinaldi VG, Coliva F, Favero A, Alesi D, Caravelli S, Zaffagnini S, Marcheggiani Muccioli GM. From Diagnosis to Decision-Making: A Systematic Review of the Management of Reverse Hill-Sachs Lesions after Posterior Shoulder Dislocations. J Clin Med 2024; 13:2085. [PMID: 38610850 PMCID: PMC11012447 DOI: 10.3390/jcm13072085] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 03/26/2024] [Accepted: 03/27/2024] [Indexed: 04/14/2024] Open
Abstract
(1) Background: The aim of this study is to describe all of the possible surgical procedures that intend to treat the McLaughlin lesion (or Reverse Hill-Sachs) in posterior shoulder dislocation. (2) Methods: Google Scholar, Pubmed, and Embase were used as databases in our research. Studies reporting the results of posterior shoulder dislocations surgically treated with procedures addressing the humeral lesion were evaluated. The studies reporting results after fracture-dislocation and multidirectional instability were excluded. (3) Results: A total of 16 studies were included in our review for a total of 207 shoulders with a mean age of 41.7 years that were evaluated at a mean of 62.1 months. The Modified McLaughlin procedure and the Graft procedures were the most commonly performed. No statistically significant difference was found between the two at the evaluation of the clinical score. (4) Conclusions: Our review highlights the importance of a correct diagnosis and an accurate surgical treatment choice based on the surgeon's experience and on the patients' characteristics.
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Affiliation(s)
- Vito Gaetano Rinaldi
- II Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; (V.G.R.); (A.F.); (D.A.); (S.Z.); (G.M.M.M.)
| | - Federico Coliva
- II Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; (V.G.R.); (A.F.); (D.A.); (S.Z.); (G.M.M.M.)
| | - Antongiulio Favero
- II Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; (V.G.R.); (A.F.); (D.A.); (S.Z.); (G.M.M.M.)
| | - Domenico Alesi
- II Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; (V.G.R.); (A.F.); (D.A.); (S.Z.); (G.M.M.M.)
| | - Silvio Caravelli
- Bentivoglio Orthopaedic Unit, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy;
| | - Stefano Zaffagnini
- II Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; (V.G.R.); (A.F.); (D.A.); (S.Z.); (G.M.M.M.)
- Dipartimento di Scienze Biomediche e Neuromotorie DIBINEM, University of Bologna, Via San Vitale, 40125 Bologna, Italy
| | - Giulio Maria Marcheggiani Muccioli
- II Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; (V.G.R.); (A.F.); (D.A.); (S.Z.); (G.M.M.M.)
- Dipartimento di Scienze Biomediche e Neuromotorie DIBINEM, University of Bologna, Via San Vitale, 40125 Bologna, Italy
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Bereźniak M, Palczewski P, Łęgosz P. Posterior Dislocation of the Long Head of Biceps Tendon after Traumatic Anterior Shoulder Dislocation. J Belg Soc Radiol 2024; 108:23. [PMID: 38463536 PMCID: PMC10921971 DOI: 10.5334/jbsr.3515] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 02/15/2024] [Indexed: 03/12/2024] Open
Abstract
Teaching point: An irreducible anterior glenohumeral joint dislocation associated with a displaced fracture of greater tuberosity, a rotator cuff tear, or a coracoid process fracture should raise the suspicion of posterior long head of biceps tendon (LHBT) dislocation.
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Affiliation(s)
- Marlena Bereźniak
- 1st Department of Clinical Radiology, Medical University of Warsaw, Warsaw, Poland
| | - Piotr Palczewski
- 1st Department of Clinical Radiology, Medical University of Warsaw, Warsaw, Poland
| | - Paweł Łęgosz
- Department of Orthopaedics and Traumatology of the Locomotor System, Medical University of Warsaw, Warsaw, Poland
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Jain V, Gupta H, Mehta N, Joshi D, Kataria H. Retrospective Comparative Analysis of Clinical and Functional Outcome After Arthroscopic Bankart Repair using All-Suture Anchor and Metal Anchor. Malays Orthop J 2024; 18:11-18. [PMID: 38638665 PMCID: PMC11023345 DOI: 10.5704/moj.2403.002] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 05/19/2023] [Indexed: 04/20/2024] Open
Abstract
Introduction Both knotted all suture anchors and metal anchors are used for arthroscopic Bankart repair. We retrospectively evaluated and compared clinical and functional outcomes after arthroscopic Bankart repair using the knotted all-suture anchors and knotted metal anchors. Materials and methods In a retrospective cohort analysis, patients who underwent arthroscopic Bankart repair without any concomitant additional lesion repair using either all-suture anchors or metal anchors, between January 2015 and May 2018 were identified. Their pre- and post-operative functional and clinical outcomes were compared using Rowe and WOSI scores. The recurrence rate in the two groups was also compared. Results A total of 41 patients in all suture anchors group and 47 in the metal anchors group were identified as per inclusion and exclusion criteria. The demographic profile of both groups was comparable. There was no significant difference in clinical and functional outcome between the two suture anchor groups as per Rowe (pre-operative 40.13+6.51 vs 38.09+6.24 and post-operative 2 years 93.28+7.09 vs 92.55+9.2) and WOSI (pre-operative 943.05+216.64 vs 977.55+165.46 and post-operative 2 years 278.21+227.56 vs 270.94+186.25) scores. There was a significant improvement in both the groups between preoperative and post-operative ROWE and WOSI scores at 6 months and 2 years follow-up as compared to pre-operative scores (p<0.001). Re-dislocation rates were also comparable (4.8% vs 6.3%). Conclusion All-suture anchors showed comparable clinical and functional results as the metal anchors for arthroscopic Bankart repair at two-year follow-up.
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Affiliation(s)
- V Jain
- Sports Injury Centre, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, India
| | - H Gupta
- Sports Injury Centre, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, India
| | - N Mehta
- Sports Injury Centre, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, India
| | - D Joshi
- Sports Injury Centre, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, India
| | - H Kataria
- Sports Injury Centre, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, India
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Widmer LW, Lerch TD, Genthner A, Pozzi L, Geiger J, Frei HC. Fast treatment of anterior shoulder dislocations with two sedation-free methods: The Davos self-reduction method and Arlt method. Shoulder Elbow 2024; 16:38-45. [PMID: 38435044 PMCID: PMC10902407 DOI: 10.1177/17585732221145608] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 11/21/2022] [Accepted: 11/28/2022] [Indexed: 03/05/2024]
Abstract
Background Various reduction techniques exist to treat traumatic shoulder dislocation, but best management remains unclear. Aims To investigate the reduction rate of traumatic anteroinferior shoulder dislocations using two sedation-free techniques and success rates of subgroups. Methods A single-center study was performed analysing shoulder dislocations in a two-year period. Adult patients with anteroinferior shoulder dislocation were included. Two sedation-free reduction techniques were used: the Davos self-reduction technique and the Arlt-chair technique. Two attempts were performed before sedation. All patients gave informed consent to study participation. Results The investigated 106 patients (106 shoulder dislocations) had a mean age of 48 ± 18 years (74% male patients). The majority occurred during winter sports (76%). The overall success rate for both sedation-free reduction techniques was 82% (87 reduced shoulders, two attempts). A significantly increased success rate was found in patients without greater tuberosity fracture (86% without vs. 68% with fracture, p = 0.002) and for patients with repeated dislocation (93% vs. 80% for primary dislocation, p = 0.004). Time for reduction was 5 minutes (Davos technique) and 1 minute (Arlt-chair-technique). Associated injuries were mostly Hill Sachs lesions (78%). There was no major complication and no new-onset sensory deficit. Conclusion Davos and Arlt reduction techniques allowed sedation-free and fast treatment for anteroinferior shoulder dislocation during winter sports.
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Affiliation(s)
- Lukas Werner Widmer
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Till Dominic Lerch
- Department of Radiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Anna Genthner
- Department of Surgery, Hospital Davos, Davos Platz, Switzerland
| | - Lara Pozzi
- Department of Surgery, Hospital Davos, Davos Platz, Switzerland
| | - James Geiger
- Department of Surgery, Hospital Davos, Davos Platz, Switzerland
| | - Hans-Curd Frei
- Department of Surgery, Hospital Davos, Davos Platz, Switzerland
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7
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Berk AN, Ifarraguerri AM, Rao AJ, Dib AG, Hysong AA, Meade JD, Trofa DP, Fleischli JE, Schiffern SC, Hamid N, Saltzman BM. Outcomes of the Latarjet procedure in female patients: A case series and matched-pair analysis. Shoulder Elbow 2024; 16:76-84. [PMID: 38435033 PMCID: PMC10902412 DOI: 10.1177/17585732231217170] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 11/10/2023] [Accepted: 11/11/2023] [Indexed: 03/05/2024]
Abstract
Background The objective of this study was to retrospectively report on the outcomes of female patients undergoing the Latarjet procedure. Methods Female patients undergoing the Latarjet procedure with minimum 1 year follow-up were identified and contacted to obtain Numeric Pain Rating Scale (NPRS), Subjective Shoulder Value (SSV), and return to sport (RTS) data. Eligible females were then matched 1:1 with a male counterpart based on laterality and age (± 3 years), and outcomes compared. Results A total of 20 female patients with a mean follow-up of 73.8 months reported postoperative NPRS and SSV scores of 2.2 ± 2.3 and 69.3 ± 22.0, respectively. Of the nine athletes, 3 (33%) reported a successful RTS at a mean of 9 months. Four patients (20.0%) required reoperation at a mean of 27.1 months. The matched analysis demonstrated similar NPRS scores between male and female patients and a trend towards lower SSV scores and rates of RTS. Conclusion At mid-term follow-up female patients reported pain levels similar to female-specific literature reports, but overall low subjective shoulder function and RTS. Compared to propensity-matched males, females reported similar levels of pain, lower shoulder function, and lower rates of RTS, however, differences did not reach statistical significance. Level of Evidence IV, retrospective case series.
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Affiliation(s)
- Alexander N Berk
- OrthoCarolina – Sports Medicine Center, Charlotte, NC, USA
- OrthoCarolina Research Institute, Charlotte, NC, USA
- Atrium Health – Musculoskeletal Institute, Charlotte, NC, USA
| | - Anna M Ifarraguerri
- OrthoCarolina – Sports Medicine Center, Charlotte, NC, USA
- OrthoCarolina Research Institute, Charlotte, NC, USA
- Atrium Health – Musculoskeletal Institute, Charlotte, NC, USA
| | - Allison J Rao
- Department of Orthopedic Surgery, University of Minnesota Physicians, University of Minnesota, Minneapolis, MNN, USA
| | - Aseel G Dib
- OrthoCarolina Research Institute, Charlotte, NC, USA
- Atrium Health – Musculoskeletal Institute, Charlotte, NC, USA
| | - Alexander A Hysong
- OrthoCarolina Research Institute, Charlotte, NC, USA
- Atrium Health – Musculoskeletal Institute, Charlotte, NC, USA
| | - Joshua D Meade
- OrthoCarolina – Sports Medicine Center, Charlotte, NC, USA
- OrthoCarolina Research Institute, Charlotte, NC, USA
- Atrium Health – Musculoskeletal Institute, Charlotte, NC, USA
| | - David P Trofa
- Department of Orthopaedics, New York Presbyterian, Columbia University Medical Center, New York, NY, USA
| | - James E Fleischli
- OrthoCarolina – Sports Medicine Center, Charlotte, NC, USA
- OrthoCarolina Research Institute, Charlotte, NC, USA
- Atrium Health – Musculoskeletal Institute, Charlotte, NC, USA
| | - Shadley C Schiffern
- OrthoCarolina – Sports Medicine Center, Charlotte, NC, USA
- OrthoCarolina Research Institute, Charlotte, NC, USA
- Atrium Health – Musculoskeletal Institute, Charlotte, NC, USA
| | - Nady Hamid
- OrthoCarolina – Sports Medicine Center, Charlotte, NC, USA
- OrthoCarolina Research Institute, Charlotte, NC, USA
- Atrium Health – Musculoskeletal Institute, Charlotte, NC, USA
| | - Bryan M Saltzman
- OrthoCarolina – Sports Medicine Center, Charlotte, NC, USA
- OrthoCarolina Research Institute, Charlotte, NC, USA
- Atrium Health – Musculoskeletal Institute, Charlotte, NC, USA
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Rawal A, Eckers F, Lee OSH, Hochreiter B, Wang KK, Ek ET. Current Evidence Regarding Shoulder Instability in the Paediatric and Adolescent Population. J Clin Med 2024; 13:724. [PMID: 38337418 PMCID: PMC10856087 DOI: 10.3390/jcm13030724] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 01/18/2024] [Accepted: 01/24/2024] [Indexed: 02/12/2024] Open
Abstract
Paediatric and adolescent shoulder instability is caused by a unique combination of traumatic factors, ligamentous laxity, and pattern of muscle contractility. The multifactorial nature of its aetiology makes interpretation of the literature difficult as nomenclature is also highly variable. The purpose of this review is to summarize the existing literature and shed light on the nuances of paediatric and adolescent shoulder instability. The epidemiology, clinical features, imaging, and management of all forms of paediatric shoulder instability are presented. The main findings of this review are that structural abnormalities following a dislocation are uncommon in pre-pubertal paediatric patients. Young post-pubertal adolescents are at the highest risk of failure of non-operative management in the setting of traumatic instability with structural abnormality, and early stabilisation should be considered for these patients. Remplissage and the Latarjet procedure are safe treatment options for adolescents at high risk of recurrence, but the side-effect profile should be carefully considered. Patients who suffer from instability due to generalized ligamentous laxity benefit from a structured, long-term physiotherapy regimen, with surgery in the form of arthroscopic plication as a viable last resort. Those who suffer from a predominantly muscle patterning pathology do not benefit from surgery and require focus on regaining neuromuscular control.
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Affiliation(s)
- Aziz Rawal
- Melbourne Orthopaedic Group, Windsor, Melbourne, VIC 3181, Australia; (A.R.); (F.E.)
| | - Franziska Eckers
- Melbourne Orthopaedic Group, Windsor, Melbourne, VIC 3181, Australia; (A.R.); (F.E.)
- Orthopädie und Traumatologie, Universitätsspital Basel, 4031 Basel, Switzerland
| | - Olivia S. H. Lee
- Victorian Paediatric Rehabilitation Service, The Royal Children’s Hospital, Melbourne, VIC 3052, Australia;
| | - Bettina Hochreiter
- Melbourne Orthopaedic Group, Windsor, Melbourne, VIC 3181, Australia; (A.R.); (F.E.)
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, 8006 Zürich, Switzerland
| | - Kemble K. Wang
- Department of Orthopaedic Surgery, The Royal Children’s Hospital, Melbourne, VIC 3052, Australia;
| | - Eugene T. Ek
- Melbourne Orthopaedic Group, Windsor, Melbourne, VIC 3181, Australia; (A.R.); (F.E.)
- Department of Surgery, Monash University, Melbourne, VIC 3800, Australia
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Tan EK, Ahmad Hanif KA, Seri Masran SM, Che-Hamzah F. A Triad of Shoulder Injuries Following Cardioversion: A Case Report. Cureus 2024; 16:e52704. [PMID: 38384611 PMCID: PMC10879726 DOI: 10.7759/cureus.52704] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2024] [Indexed: 02/23/2024] Open
Abstract
Transthoracic defibrillation and cardioversion are commonly used techniques to resuscitate a patient during acute cardiac arrhythmic events. There are numerous complications associated with these procedures. We report a previously unreported complication where a patient suffered from a supraspinatus tear after cardioversion for ventricular tachycardia. There are numerous complications associated with these procedures. We report a previously unreported complication where a middle-aged Chinese patient with no previous trauma history suffered from a supraspinatus tear after cardioversion for ventricular tachycardia.
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Affiliation(s)
- Eng Kee Tan
- Orthopaedics, Ministry of Health Malaysia, Serdang, MYS
| | | | | | - Fahrudin Che-Hamzah
- Orthopedics and Traumatology, Hospital Pengajar Universiti Putra Malaysia, Serdang, MYS
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10
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Grossi J, Danahy P, Rosenthal OD, Ackerman GP. Management of a Failed Distal Tibial Allograft Procedure for Anterior Shoulder Instability in a Patient With Epilepsy: A Case Report. Cureus 2024; 16:e51477. [PMID: 38298280 PMCID: PMC10830132 DOI: 10.7759/cureus.51477] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/01/2024] [Indexed: 02/02/2024] Open
Abstract
Shoulder instability episodes are observed in high-energy injuries, such as seizures. In this case report, we highlight the management of a failed distal tibial allograft procedure for recurrent shoulder instability in a patient with a bony Bankart lesion and epilepsy. The patient was treated with an iliac crest autograft and a proximal humerus osteochondral allograft procedure. To our knowledge, the use of an iliac crest autograft for glenoid bone loss and a proximal humerus osteochondral allograft after several failed shoulder instability procedures in a patient with epilepsy has not been reported.
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Affiliation(s)
- John Grossi
- Osteopathic Medicine, Lake Erie College of Osteopathic Medicine, Bradenton, USA
| | - Paul Danahy
- Orthopaedic Surgery, Lake Erie College of Osteopathic Medicine, Bradenton, USA
| | - Oren D Rosenthal
- Anatomy, Lake Erie College of Osteopathic Medicine, Bradenton, USA
| | - George P Ackerman
- Orthopaedic Surgery, Optum Urgent Care - Glen Oaks, Lake Success, USA
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11
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Rasmussen AB, Thorninger R, Wæver D. Hemodynamic Instability After Axillary Artery Rupture Following Inferior Glenohumeral Joint Dislocation: A Case Report. Am J Case Rep 2023; 24:e942123. [PMID: 38127679 PMCID: PMC10750799 DOI: 10.12659/ajcr.942123] [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: 08/10/2023] [Revised: 11/22/2023] [Accepted: 11/14/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Inferior shoulder dislocation is a rare type of glenohumeral joint dislocation. A serious complication to shoulder dislocation is axillary artery injury, which should be taken into consideration early to avoid potentially permanent damage. Literature on artery injury following inferior shoulder dislocation is sparse. CASE REPORT We report the case of a 71-year-old man with a traumatic inferior shoulder dislocation due to a fall. The patient had a medical history of stroke, and thus had a daily intake of 10 mg Warfarin. Previously, he had reported 2 anterior shoulder dislocations. The shoulder reduction was conducted under general anaesthesia after reduction with intravenous morphine sedation. Six hours after reduction, the patient showed signs of hemodynamic instability and a CT scan with contrast showed a suspected axillary artery rupture with a large hematoma in the right axilla. The artery rupture was confirmed with an arteriogram. The patient was successfully treated with an endovascular stent. After 3 months, the patient had normal neurovascular status in the right upper extremity and was continuing rehabilitation of the shoulder. CONCLUSIONS This case emphasizes the importance of proper recognition and awareness of artery injury after inferior shoulder dislocation. The symptoms of artery rupture after inferior shoulder dislocation can be immediate or have a late onset. The diagnostic modalities of CT scan with contrast or arteriogram should be performed with a low threshold of suspicion after reduction. With symptoms such as enlarging hematoma in the axilla, diminished radial and ulnar pulse, sudden pain from the axilla, or signs of hemodynamic instability after reduction, diagnostic modalities should be considered.
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Affiliation(s)
| | - Rikke Thorninger
- Department of Orthopaedic Surgery, Regional Hospital Randers, Randers, Denmark
| | - Daniel Wæver
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark
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12
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Kawashima I, Iwahori Y, Ishizuka S, Oba H, Sakaguchi T, Watanabe A, Inoue M, Imagama S. Arthroscopic Bankart repair with peeling osteotomy of the anterior glenoid rim preserves glenoid morphology. J Shoulder Elbow Surg 2023; 32:2445-2452. [PMID: 37327987 DOI: 10.1016/j.jse.2023.05.011] [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: 02/04/2023] [Revised: 05/02/2023] [Accepted: 05/06/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND A decrease in the glenoid size after arthroscopic Bankart repair (ABR) was common in shoulders without osseous fragments compared with those with osseous fragments. For cases of chronic recurrent traumatic anterior glenohumeral instability without osseous fragments, we have performed ABR with peeling osteotomy of the anterior glenoid rim (ABRPO) to make an intentional osseous Bankart lesion. The aim of this study was to compare the glenoid morphology after ABRPO with it after simple ABR. METHODS The medical records of patients who underwent arthroscopic stabilization for chronic recurrent traumatic anterior glenohumeral instability were retrospectively reviewed. Patients with an osseous fragment, with revision surgery and without complete data were excluded. Patients were assigned to 1 of 2 groups: Group A, ABR without peeling osteotomy procedure or Group B, with ABRPO procedure. Computed tomography was performed preoperatively and 1 year after surgery. The size of the glenoid bone loss was investigated by the assumed circle method. The following formula was used to calculate the decreased size of the glenoid: (Δ) = (postoperative size of the glenoid bone loss) - (preoperative size of the glenoid bone loss). The size of the glenoid 1 year after surgery was assessed to determine if it had decreased (Δ > 0%) or not decreased (Δ ≤ 0%) relative to the preoperative size. RESULTS This study evaluated 39 shoulders divided into 2 groups: 27 shoulders in Group A and 12 shoulders in Group B. In Group A, postoperative glenoid bone loss was significantly greater than preoperative glenoid bone loss (7.8 ± 6.2 vs. 5.5 ± 5.3, respectively, P = .02). In Group B, postoperative glenoid bone loss was significantly lower than preoperative glenoid bone loss (5.6 ± 5.4 vs. 8.7 ± 4.0, respectively, P = .02). The P value for the interaction of group (A or B) × time (preoperative or postoperative) was 0.001. The decreased size of the glenoid was significantly larger in Group A than in Group B (2.1 ± 4.2 vs. -3.1 ± 4.5, respectively, P = .001). The rate of shoulders in which the size of the glenoid decreased 1 year after surgery relative to the preoperative size was significantly higher in Group A than in Group B (63% [17/27] vs. 25% [3/2], respectively, P = .04). CONCLUSIONS The study showed that ABRPO preserved the glenoid size better than simple ABR without a peeling osteotomy procedure.
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Affiliation(s)
- Itaru Kawashima
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Yusuke Iwahori
- Sports Medicine and Joint Center, Asahi Hospital, Kasugai, Aichi, Japan
| | - Shinya Ishizuka
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.
| | - Hiroki Oba
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Takefumi Sakaguchi
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | | | - Masaki Inoue
- Department of Radiology, Asahi Hospital, Kasugai, Aichi, Japan
| | - Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
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Gawel RJ, Grill R, Bradley N, Luong J, Au AK. Ultrasound-Guided Peripheral Nerve Blocks for Shoulder Dislocation in the Emergency Department: A Systemic Review. J Emerg Med 2023; 65:e403-e413. [PMID: 37741738 DOI: 10.1016/j.jemermed.2023.05.021] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 05/26/2023] [Indexed: 09/25/2023]
Abstract
BACKGROUND Shoulder dislocations are among the most common orthopedic emergencies encountered in the emergency department (ED). Ultrasound-guided peripheral nerve blocks (USG-PNBs) are increasingly being used for acute pain management in the ED, but clinical evidence supporting their utility for shoulder dislocation is limited and often conflicting. OBJECTIVE The aim of this review was to summarize and evaluate the utility of USG-PNB for analgesia during closed reduction of dislocated shoulders in the ED. METHODS Adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic literature search of the PubMed, Scopus, and Cochrane databases was performed from database inception to September 2022. We included clinical studies examining USG-PNB for pain management of dislocated shoulders in the ED. Information collected from eligible studies included patient demographic characteristics, USG-PNB approach, alternate analgesia techniques, anesthetic regimens, clinical outcomes, and adverse events. RESULTS Five studies met inclusion criteria, all of which were randomized controlled trials comparing USG-PNB with procedural sedation and analgesia. Pooled patient satisfaction scores were similar for both analgesia methods (3.5 ± 0.6 vs. 3.9 ± 0.6 out of 5; p = 0.76). Patients managed with procedural sedation and analgesia achieved higher rates of overall shoulder reduction (100% vs. 67%; p < 0.001) and successful reduction on the first attempt (86% vs. 48%; p < 0.001). The USG-PNB groups in all but one study had shorter lengths of ED stay. Overall, USG-PNB was associated with a lower risk of adverse events and complications (3.9% vs. 24.9%; p < 0.001), especially adverse respiratory events (0% vs. 14.7%; p < 0.001). CONCLUSIONS USG-PNBs performed by adequately trained emergency physicians should be considered a safe and effective alternative for analgesia during closed reduction of dislocated shoulders in the ED, particularly in patients with cardiorespiratory comorbidities.
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Affiliation(s)
- Richard J Gawel
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania.
| | - Renee Grill
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Nathaniel Bradley
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jennifer Luong
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Arthur K Au
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania
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Anderson MJ, Confino JE, Mack CD, Herzog MM, Levine WN. Determining the True Incidence of Glenohumeral Instability Among Players in the National Football League: An Epidemiological Study of Non-Missed Time Shoulder Instability Injuries. Orthop J Sports Med 2023; 11:23259671231198025. [PMID: 37840903 PMCID: PMC10568991 DOI: 10.1177/23259671231198025] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 04/24/2023] [Indexed: 10/17/2023] Open
Abstract
Background Shoulder instability encompasses a spectrum of glenohumeral pathology ranging from subluxation to dislocation. While dislocation frequently leads to removal from play, athletes are often able to play through subluxation. Previous research on glenohumeral instability among athletes has largely focused on missed-time injuries, which has likely disproportionately excluded subluxation injuries and underestimated the overall incidence of shoulder instability. Purpose To describe the epidemiology of shoulder instability injuries resulting in no missed time beyond the date of injury (non-missed time injuries) among athletes in the National Football League (NFL). Study Design Descriptive epidemiology study. Methods The NFL's electronic medical record was retrospectively reviewed to identify non-missed time shoulder instability injuries during the 2015 through 2019 seasons. For each injury, player age, player position, shoulder laterality, instability type, instability direction, injury timing, injury setting, and injury mechanism were recorded. For injuries that occurred during games, incidence rates were calculated based on time during the season as well as player position. The influence of player position on instability direction was also investigated. Results Of the 546 shoulder instability injuries documented during the study period, 162 were non-missed time injuries. The majority of non-missed time injuries were subluxations (97.4%), occurred during games (70.7%), and resulted from a contact mechanism (91.2%). The overall incidence rate of game-related instability was 1.6 injuries per 100,000 player-plays and was highest during the postseason (3.5 per 100,000 player-plays). The greatest proportion of non-missed time injuries occurred in defensive secondary players (28.4%) and offensive linemen (19.8%), while kickers/punters and defensive secondary players had the highest game incidence rates (5.5 and 2.1 per 100,000 player-plays, respectively). In terms of direction, 54.3% of instability events were posterior, 31.9% anterior, 8.5% multidirectional, and 5.3% inferior. Instability events were most often anterior among linebackers and wide receivers (50% and 100%, respectively), while posterior instability was most common in defensive linemen (66.7%), defensive secondary players (58.6%), quarterbacks (100.0%), running backs (55.6%), and tight ends (75.0%). Conclusion The majority of non-missed time shoulder instability injuries (97.4%) were subluxations, which were likely excluded from or underreported in previous shoulder instability studies due to the inherent difficulty of detecting and diagnosing shoulder subluxation.
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Affiliation(s)
- Matthew J.J. Anderson
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Jamie E. Confino
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | | | | | - William N. Levine
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York, USA
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15
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Koutserimpas C, Piagkou M, Karaiskos I, Chronopoulos E, Arkoudis NA. Posterior Dislocation of the Shoulder: The Light-Bulb Sign. Cureus 2023; 15:e47800. [PMID: 38022099 PMCID: PMC10679799 DOI: 10.7759/cureus.47800] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2023] [Indexed: 12/01/2023] Open
Abstract
Posterior dislocation is a rather rare injury, often misdiagnosed. The current report offers valuable insights regarding the anatomical background of this clinical entity and emphasizes the 'light-bulb sign,' which can be observed in anterior-posterior shoulder X-rays when there is a posterior dislocation. It is crucial for healthcare professionals, including emergency department physicians, radiologists, general practitioners, orthopedic surgeons, and other relevant medical experts, to be well-acquainted with this sign and maintain a heightened awareness when encountering such cases. A 57-year-old male presented to the Emergency Department due to right shoulder pain immediately after an epileptic seizure. His arm was locked in internal rotation, while the initial X-rays, although did not reveal evident malalignment, showed the light-bulb sign. Further imaging with a computer tomography (CT) scan exhibited a large (50%) reverse Hill-Sachs defect. The patient was treated surgically with hemiarthroplasty. The light-bulb sign should be a red flag for physicians who evaluate these patients or these X-rays. The patient's history, such as epileptic seizures and examination, especially the locked arm in internal rotation, are of paramount importance for not misdiagnosing these cases.
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Affiliation(s)
| | - Maria Piagkou
- Anatomy/Oral Surgery, National and Kapodistrian University of Athens, Athens, GRC
| | - Ilias Karaiskos
- Orthopaedics and Traumatology, 251 Hellenic Air Force General Hospital, Athens, GRC
| | - Efstathios Chronopoulos
- Orthopaedic Surgery, National and Kapodistrian University of Athens, Athens, GRC
- Orthopaedic Surgery, Konstantopoulio General Hospital, Nea Ionia, GRC
| | - Nikolaos-Achilleas Arkoudis
- Radiology, Research Unit of Radiology and Medical Imaging, Medical School, National and Kapodistrian University of Athens, Athens, GRC
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16
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Kokkalis Z, Giannatos V, Papagiannis S, Kouzelis A, Panagopoulos A. Terrible Triad of the Shoulder: A Case Series and Literature Review. Cureus 2023; 15:e47699. [PMID: 38022223 PMCID: PMC10674095 DOI: 10.7759/cureus.47699] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2023] [Indexed: 12/01/2023] Open
Abstract
INTRODUCTION The shoulder terrible triad is an underdiagnosed injury pattern consisting of anterior shoulder dislocation, rotator cuff tear, and nerve injury from the brachial plexus in its original description. The purpose of this study is to raise awareness of the condition, suggest treatment strategies, and emphasize the difficulties in treating this condition. METHODS This case series of seven patients from the same institution. All patients underwent x-rays before and after the reduction of the dislocation, MRI to assess the musculoskeletal injuries, and EMG and clinical examination to assess the nerve lesions. Early arthroscopic repair was opted for the rotator cuff tears. A conservative approach was chosen for the nerve lesions. Active forward flexion and external rotation, Constant score, and Visual to Analogue Scale (VAS) were recorded pre- and post-operatively. RESULTS All the patients showed an improvement in function postoperatively. However, four of the seven patients did not recover fully. The mean Constant and VAS scores were improved from 15.2 +/- 2.8 (12 to 19) to 67 +/- 16.6 (44 to 86) and from 7.5 +/- 1 (6 to 9) to 2.3 +/- 0.8 (1 to 3), respectively. The patients were followed up for a mean time of 28.2 +/- 10.1 months (18 to 43 months). Time-to-surgery shorter than four weeks showed better results, but not statistically significant. CONCLUSIONS The diagnosis of the shoulder terrible triad requires a high level of suspicion. Early arthroscopic repair for the rotator cuff tears and waiting for the nerve recovery is suggested. Delayed time from injury to surgery might be related to worse outcomes, but higher-level research is needed in this direction.
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Affiliation(s)
- Zinon Kokkalis
- Orthopedics and Traumatology, University General Hospital of Patras, Patras, GRC
| | - Vasileios Giannatos
- Orthopedics and Traumatology, University General Hospital of Patras, Patras, GRC
| | - Spyridon Papagiannis
- Orthopedics and Traumatology, University General Hospital of Patras, Patras, GRC
| | - Antonis Kouzelis
- Orthopedics and Traumatology, University General Hospital of Patras, Patras, GRC
| | - Andreas Panagopoulos
- Orthopedics and Traumatology, University General Hospital of Patras, Patras, GRC
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Ninković S, Milankov V, Tošić M, Majkić M, Baljak B, Milinkov M, Obradović M. Segmental Humeral Head Reconstruction in Patients with Chronic Locked Posterior Shoulder Dislocation. Medicina (Kaunas) 2023; 59:1736. [PMID: 37893454 PMCID: PMC10608167 DOI: 10.3390/medicina59101736] [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: 08/20/2023] [Revised: 09/16/2023] [Accepted: 09/27/2023] [Indexed: 10/29/2023]
Abstract
Background and Objectives: The goal of this study was to evaluate the functional outcomes of patient treatment using an allograft after chronic locked posterior shoulder dislocation associated with a bony defect of the upper edge of the humerus that involves 25-50% of the articular surfaces. Materials and Methods: A total of 20 patients were included in this study. Electrocution was the cause of injury in eight patients; in ten patients, the cause was direct trauma; and in two patients, the cause of injury was a fall due to hypoglycemic coma. A standard deltoid pectoral approach was used and a fresh-frozen osteochondral allograft of the femoral condyle was applied. In evaluating the results, Constant's scoring scale was used. Results: The average value of Constant's point scale for the operated shoulder is 84.14 points. This result is good according to the average value of Constant's point scale. Conclusions: Patients with locked chronic posterior dislocation in combination with a bony defect of the humeral head that covers 25-50% of the articular surface, in our opinion, should be treated using bone allografts rather than non-anatomical reconstruction methods.
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Affiliation(s)
- Srđan Ninković
- Clinic for Orthopedic Surgery and Traumatology, Clinical Center of Vojvodina, 21000 Novi Sad, Serbia; (M.T.); (M.M.); (B.B.); (M.M.); (M.O.)
- Faculty of Medicine, Department of Surgery, University of Novi Sad, 21000 Novi Sad, Serbia;
| | - Vukadin Milankov
- Faculty of Medicine, Department of Surgery, University of Novi Sad, 21000 Novi Sad, Serbia;
- Institute for Children and Youth Health Care of Vojvodina, 21000 Novi Sad, Serbia
| | - Milan Tošić
- Clinic for Orthopedic Surgery and Traumatology, Clinical Center of Vojvodina, 21000 Novi Sad, Serbia; (M.T.); (M.M.); (B.B.); (M.M.); (M.O.)
| | - Milan Majkić
- Clinic for Orthopedic Surgery and Traumatology, Clinical Center of Vojvodina, 21000 Novi Sad, Serbia; (M.T.); (M.M.); (B.B.); (M.M.); (M.O.)
| | - Branko Baljak
- Clinic for Orthopedic Surgery and Traumatology, Clinical Center of Vojvodina, 21000 Novi Sad, Serbia; (M.T.); (M.M.); (B.B.); (M.M.); (M.O.)
| | - Milan Milinkov
- Clinic for Orthopedic Surgery and Traumatology, Clinical Center of Vojvodina, 21000 Novi Sad, Serbia; (M.T.); (M.M.); (B.B.); (M.M.); (M.O.)
| | - Mirko Obradović
- Clinic for Orthopedic Surgery and Traumatology, Clinical Center of Vojvodina, 21000 Novi Sad, Serbia; (M.T.); (M.M.); (B.B.); (M.M.); (M.O.)
- Faculty of Medicine, Department of Surgery, University of Novi Sad, 21000 Novi Sad, Serbia;
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Kosior M, Sibilska A, Piwnik M, Borowski A, Prusaczyk S, Rogers J, Struzik S, Kwapisz A. Time of Return to Work (RTW) May Not Correlate with Patient-Reported Outcomes Measurements (PROM) at Minimum One Year Post Arthroscopic Bankart Repair. J Clin Med 2023; 12:5794. [PMID: 37762735 PMCID: PMC10532194 DOI: 10.3390/jcm12185794] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/02/2023] [Accepted: 09/04/2023] [Indexed: 09/29/2023] Open
Abstract
It is widely recognized that work serves a dual role by not only ensuring financial independence but also functioning as a vital source of psychosocial well-being and contributing significantly to the attribution of meaning in life. The cost of work disability can be a multifactorial problem for both employers and workers; thus the inability to return to work (RTW) may have a destructive effect on mental health and confidence. Shoulder surgery is one of the conditions that inevitably impacts patients' ability to work. As current data focus on restoring range of motion, strength, and the patients' activity, to this day the data about RTW post shoulder surgery remain limited. The purpose of this study was to evaluate the return-to-work time of patients treated with an arthroscopic Bankart repair and to evaluate if patient-reported outcomes (PROM) correlate with the incapacity to work after an arthroscopic Bankart repair. We performed a retrospective review by conducting a questionnaire with patients more than 12 months after surgery and we identified 31 patients who met the criteria for the study and were able to contact 17 of them. In this paper we demonstrated that on average among groups working physically and at the office we may expect patients who underwent arthroscopic Bankart repair to return to work within 7 weeks from the surgery, with office workers tending to return significantly faster with an average of 2.5 weeks (p = 0.0239).
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Affiliation(s)
- Mateusz Kosior
- Clinic of Orthopedics and Pediatric Orthopedics, Medical University of Lodz, 92-213 Lodz, Poland; (M.K.)
| | - Aleksandra Sibilska
- Department of Orthopaedics and Traumatology of the Musculoskeletal System, Infant Jesus Teaching Hospital, Medical University of Warsaw, 02-091 Warsaw, Poland (S.S.)
| | | | - Andrzej Borowski
- Clinic of Orthopedics and Pediatric Orthopedics, Medical University of Lodz, 92-213 Lodz, Poland; (M.K.)
| | - Szymon Prusaczyk
- Department of Orthopedics and Traumatology, Radomsko Community Hospital, 97-500 Radomsko, Poland
| | - Jason Rogers
- EmergeOrtho Triad Region, Greeensboro, NC 27408, USA;
| | - Sławomir Struzik
- Department of Orthopaedics and Traumatology of the Musculoskeletal System, Infant Jesus Teaching Hospital, Medical University of Warsaw, 02-091 Warsaw, Poland (S.S.)
| | - Adam Kwapisz
- Clinic of Orthopedics and Pediatric Orthopedics, Medical University of Lodz, 92-213 Lodz, Poland; (M.K.)
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Markowitz MI, Donato Z, Huntley S, Syros A, Rizzo MG, Boomsma SE. Compartment Syndrome Due to Reperfusion Injury from an Axillary Artery Occlusion: A Case Report and Review of the Literature. J Orthop Case Rep 2023; 13:106-110. [PMID: 37654762 PMCID: PMC10465739 DOI: 10.13107/jocr.2023.v13.i08.3836] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/13/2023] [Indexed: 09/02/2023] Open
Abstract
Introduction While commonly caused by traumatic injury and fracture, compartment syndrome can also result from reperfusion injury. Very few cases of prophylactic fasciotomy are mentioned when considering time to revascularization after prolonged vascular ischemia. We present a case of a patient who underwent multiple compartment prophylactic fasciotomies following reperfusion injury in the upper extremity. Case Report We report a 72-year-old male that suffered from an anterior shoulder dislocation after a ground-level fall. After reduction, pulses were not measurable, and angiography indicated an axillary artery occlusion. Immediately after operative reperfusion, compartments became tense. Orthopedic surgeons subsequently performed arm anterior, posterior, and forearm volar and mobile wad compartment fasciotomies, after 13 h of ischemia. The patient tolerated the procedure, and at the latest follow-up, was working to improve strength in the extremity. Conclusion Even when the circumstances of injury seem to be less traumatic as in this case of a ground-level fall, we document the importance of prompt recognition and intervention of suspected compartment syndrome following prolonged ischemia and revascularization of the upper extremity.
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Affiliation(s)
- Moses I Markowitz
- Department of Orthopaedic Surgery, University of Miami Miller, School of Medicine, Miami, Florida 33136, United States
| | - Zachary Donato
- Department of Orthopaedic Surgery, University of Miami Miller, School of Medicine, Miami, Florida 33136, United States
| | - Samuel Huntley
- Department of Orthopaedic Surgery, University of Miami Miller, School of Medicine, Miami, Florida 33136, United States
| | - Alina Syros
- Department of Orthopaedic Surgery, University of Miami Miller, School of Medicine, Miami, Florida 33136, United States
| | - Michael G Rizzo
- Department of Orthopaedic Surgery, University of Miami Miller, School of Medicine, Miami, Florida 33136, United States
| | - Shawn E Boomsma
- Department of Orthopaedic Surgery, University of Miami Miller, School of Medicine, Miami, Florida 33136, United States
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20
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Ferreira F, Branco R, Silva R, Areias M, Oliveira C, Silva N. Recurrent Anterior Shoulder Dislocation After Trauma with Coracoid Apophysis Fracture - A Rare Association. Rev Bras Ortop 2023; 58:e667-e671. [PMID: 37663181 PMCID: PMC10468248 DOI: 10.1055/s-0041-1724088] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 12/01/2020] [Indexed: 10/21/2022] Open
Abstract
Anterior dislocations represent about 96% of total shoulder dislocations, with recurrence/instability being more common in young patients. Injury of other shoulder structures is frequent, namely bony Bankart lesion. However, the association with coracoid apophysis fracture is very rare. The present article describes the clinical case of a 67-year-old man who presented to the emergency department with complaints of persistent omalgia, with acute episodes, beginning after a fall from his own height. The patient also presented history of shoulder trauma 3 months earlier, which was evaluated at another hospital. Shoulder anterior dislocation was observed radiographically, and the computed tomography (CT) confirmed bone erosion of the anteroinferior part of the glenoid (bone loss of about 50% of the anteroposterior diameter in the lower region of the glenoid), with almost complete resorption of the bony Bankart lesion (apparent in later analysis of the radiography of the initial traumatic episode). Connectedly, a transverse fracture of the coracoid apophysis (type II in the Ogawa classification) was diagnosed. The patient was submitted to surgical treatment, with anterior bone stop confection using the remnant of the fractured fragment of the coracoid supplemented by tricortical autologous iliac graft, fixed with cannulated screws (according to the Bristow-Latarjet and Eden-Hybinett techniques). In the postoperative follow-up, a good functional result was observed, with no new episodes of dislocation and no significant pain complaints. A rare association of shoulder lesions is described, and the challenge of their treatment is highlighted, given the late diagnosis, as in the case presented.
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Affiliation(s)
- Filomena Ferreira
- Estagiários de Ortopedia e Traumatologia, Departamento de Ortopedia e Traumatologia, Unidade Local de Saúde Alto Minho, Viana do Castelo, Portugal
| | - Ricardo Branco
- Estagiários de Ortopedia e Traumatologia, Departamento de Ortopedia e Traumatologia, Unidade Local de Saúde Alto Minho, Viana do Castelo, Portugal
| | - Rómulo Silva
- Estagiários de Ortopedia e Traumatologia, Departamento de Ortopedia e Traumatologia, Unidade Local de Saúde Alto Minho, Viana do Castelo, Portugal
| | - Margarida Areias
- Estagiários de Ortopedia e Traumatologia, Departamento de Ortopedia e Traumatologia, Unidade Local de Saúde Alto Minho, Viana do Castelo, Portugal
| | - Carolina Oliveira
- Estagiários de Ortopedia e Traumatologia, Departamento de Ortopedia e Traumatologia, Unidade Local de Saúde Alto Minho, Viana do Castelo, Portugal
| | - Norberto Silva
- Estagiários de Ortopedia e Traumatologia, Departamento de Ortopedia e Traumatologia, Unidade Local de Saúde Alto Minho, Viana do Castelo, Portugal
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Tam YH, Abu Awwad D. A pictorial presentation and the clinical use of the modified trauma axial (MTA) shoulder x-ray view. J Med Radiat Sci 2023; 70:192-198. [PMID: 36941026 PMCID: PMC10258643 DOI: 10.1002/jmrs.670] [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: 08/05/2022] [Accepted: 03/02/2023] [Indexed: 03/23/2023] Open
Abstract
Anteroposterior (AP) and lateral shoulder projections are routinely performed as part of a post-reduction shoulder x-ray series in the emergency department (ED). Research has shown that these projections alone are insufficient to demonstrate post-dislocation injuries, particularly Hill-Sachs and Bankart lesions. These concomitant pathologies are best demonstrated on axial shoulder projections but are difficult to obtain in trauma patients with limited range of motion. The diagnostic quality and the pathology demonstrated by different projections is crucial so that doctors and other ED staff can triage patients appropriately, radiologists can report on the presence or absence of post-dislocation shoulder injuries, and the orthopaedic team can plan for follow-up or treatment. Different modified axial views were reported to improve the post-dislocation pathology sensitivity in the shoulder series. However, all of these shoulder axial views require patient movement. The modified trauma axial (MTA) is an alternative projection that is suitable for trauma patients that does not depend on patient movement. This paper presents several cases where the MTA shoulder projection had clinical importance when used as part of the post-reduction shoulder series in the ED or radiology department.
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Affiliation(s)
- Yat Hang Tam
- Concord Repatriation General Hospital Radiology DepartmentSydneyNSWAustralia
| | - Dania Abu Awwad
- Concord Repatriation General Hospital Radiology DepartmentSydneyNSWAustralia
- Discipline of Medical Imaging Science, Faculty of Medicine and HealthThe University of SydneyCamperdownNSWAustralia
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22
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Eibel A, Reddy RP, Hughes JD, Smith C, Popchak A, West R, Musahl V, Lesniak B, Lin A. Traumatic rotator cuff tears with concomitant shoulder dislocation: tear characteristics and postsurgical outcomes. J Shoulder Elbow Surg 2023; 32:842-9. [PMID: 36307054 DOI: 10.1016/j.jse.2022.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 09/19/2022] [Accepted: 09/28/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Arthroscopic rotator cuff repair has been shown to have favorable outcomes following traumatic rotator cuff tear with concomitant shoulder dislocation. The aim of this study was to compare outcomes and tear characteristics between patients who underwent arthroscopic rotator cuff repair following traumatic tear with shoulder dislocation to those without dislocation. METHODS A retrospective review of 226 consecutive patients with traumatic rotator cuff tears who underwent arthroscopic repair between 2013 and 2017 with a minimum of 1-year follow-up was performed. Patients with traumatic dislocations and concomitant rotator cuff tears were placed in the Dislocation & Tear cohort (DT cohort) and were matched 1:2 with a second cohort sustaining traumatic cuff tears without dislocation (T cohort). Primary outcomes were injury characteristics including tendon involvement and atrophy and tear size and thickness. Secondary outcomes were postoperative strength and range of motion (ROM) in forward flexion (FF), external rotation (ER), and internal rotation (IR); patient-reported outcomes including Subjective Shoulder Value, visual analog scale, and American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form; complications including repair failure (defined as symptomatic retear confirmed on postoperative magnetic resonance imaging), infection, adhesive capsulitis, and impingement; and rates of revision surgery. RESULTS There were 18 patients in the DT Cohort and 36 patients in the T Cohort with no significant differences in time to final follow-up (50.4 ± 24.5 months vs. 49.0 ± 30.4 months, P = .73). The DT cohort displayed a larger mean tear size (34 ± 12 mm vs. 19 ± 12 mm, P = .01) and had greater infraspinatus involvement (78% vs. 36%, P = .004) and subscapularis involvement (72% vs. 39%, P = .02) than the T cohort. With regard to strength, postoperative ER strength was less likely to be 5/5 in the DT Cohort (53% vs. 94% of patients with 5/5 strength, P = .002) compared with the T cohort. With regard to ROM, the DT cohort had significantly lower preoperative FF (90° ± 55° vs. 149° ± 33°, P < .001), ER (36 ± 21° vs. 52° ± 14°, P = .02), and IR (5.4 ± 2.1 vs. 7.5 ± 1.2, P = .002) compared with the T cohort but had similar FF, ER, and IR outcomes postoperatively. There were no differences between the groups for complications and postoperative patient-reported outcomes. CONCLUSION Traumatic rotator cuff tears with concomitant dislocations are associated with larger tear size and greater infraspinatus and subscapularis involvement than traumatic tears without dislocation. Arthroscopic repair of this injury is associated with lower preoperative ROM in FF, ER, and IR, as well as lower postoperative ER strength compared with traumatic tears without dislocation. Nonetheless, excellent patient-reported outcomes can be achieved following arthroscopic repair similar to patients without dislocation.
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23
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Hettrich CM, Magnuson JA, Baumgarten KM, Brophy RH, Kattan M, Bishop JY, Bollier MJ, Bravman JT, Cvetanovich GL, Dunn WR, Feeley BT, Frank RM, Kuhn JE, Lansdown DA, Benjamin Ma C, Marx RG, McCarty EC, Neviaser AS, Ortiz SF, Seidl AJ, Smith MV, Wright RW, Zhang AL, Cronin KJ, Wolf BR. Predictors of Bone Loss in Anterior Glenohumeral Instability. Am J Sports Med 2023; 51:1286-1294. [PMID: 36939180 DOI: 10.1177/03635465231160286] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
BACKGROUND Anterior shoulder instability can result in bone loss of both the anterior glenoid and the posterior humerus. Bone loss has been shown to lead to increased failure postoperatively and may necessitate more complex surgical procedures, resulting in worse clinical outcomes and posttraumatic arthritis. HYPOTHESIS/PURPOSE The purpose of this study was to investigate predictors of glenoid and humeral head bone loss in patients undergoing surgery for anterior shoulder instability. It was hypothesized that male sex, contact sport participation, traumatic dislocation, and higher number of instability events would be associated with greater bone loss. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS A total of 892 patients with anterior shoulder instability were prospectively enrolled in the Multicenter Orthopaedic Outcomes Network (MOON) Shoulder Instability cohort. The presence and amount of anterior glenoid bone loss and accompanying Hill-Sachs lesions were quantified. Descriptive information and injury history were used to construct proportional odds models for the presence of any bone defect, for defects >10% of the anterior glenoid or humeral head, and for combined bony defects. RESULTS Anterior glenoid bone loss and Hill-Sachs lesions were present in 185 (20.7%) and 470 (52.7%) patients, respectively. Having an increased number of dislocations was associated with bone loss in all models. Increasing age, male sex, and non-White race were associated with anterior glenoid bone defects and Hill-Sachs lesions. Contact sport participation was associated with anterior glenoid bone loss, and Shoulder Actitvity Scale with glenoid bone loss >10%. A positive apprehension test was associated with Hill-Sachs lesions. Combined lesions were present in 19.4% of patients, and for every additional shoulder dislocation, the odds of having a combined lesion was 95% higher. CONCLUSION An increasing number of preoperative shoulder dislocations is the factor most strongly associated with glenoid bone loss, Hill-Sachs lesions, and combined lesions. Early surgical stabilization before recurrence of instability may be the most effective method for preventing progression to clinically significant bone loss. Patients should be made aware of the expected course of shoulder instability, especially in athletes at high risk for recurrence and osseous defects, which may complicate care and worsen outcomes. REGISTRATION NCT02075775 (ClinicalTrials.gov identifier).
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Affiliation(s)
- Carolyn M Hettrich
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | | | - Robert H Brophy
- Department of Orthopedics, Washington University Saint Louis, St. Louis, Missouri, USA
| | - Michael Kattan
- Cleveland Clinic Department of Quantitative Health Sciences, Cleveland, Ohio, USA
| | | | - Julie Y Bishop
- The Ohio State University Sports Medicine Center, Columbus, Ohio, USA
| | | | - Jonathan T Bravman
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | | | - Warren R Dunn
- Fondren Orthopedic Group, Orthopedic Surgery, Houston, Texas, USA
| | - Brian T Feeley
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Rachel M Frank
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - John E Kuhn
- Department of Orthopaedic Surgery and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Drew A Lansdown
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - C Benjamin Ma
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Robert G Marx
- Department of Sports Medicine, Hospital for Special Surgery, New York, New York, USA
| | - Eric C McCarty
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | | | - Shannon F Ortiz
- University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Adam J Seidl
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Matthew V Smith
- Department of Orthopedics, Washington University Saint Louis, St. Louis, Missouri, USA
| | - Rick W Wright
- Department of Orthopaedic Surgery and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Alan L Zhang
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | | | - Brian R Wolf
- University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.,Investigation performed at multicenter facilities and the primary site is at University of Iowa, Iowa City, Iowa, USA
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24
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Sahu D, Shah D, Shetty G. Coracoid graft resorption after the Latarjet procedure does not depend on the preoperative glenoid defect. J Shoulder Elbow Surg 2023; 32:e94-e105. [PMID: 36252784 DOI: 10.1016/j.jse.2022.09.013] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 09/08/2022] [Accepted: 09/20/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND The primary purpose was to compare coracoid graft resorption after the Latarjet procedure in patients without preoperative glenoid bone loss vs. those with more than critical glenoid loss. The secondary purposes were to compare the functional outcomes and to investigate the association of graft position, angle of the screws, preoperative glenoid defect, age at surgery, and smoking status with graft resorption. METHODS Sixty consecutive patients with recurrent anterior instability were treated by the Latarjet procedure as the index procedure, irrespective of the glenoid bone loss between 2018 and 2021. Fifty-five patients were evaluated via computed tomography scans after a minimum of 1 year after surgery (range: 1-4 years). Twenty-five patients had no prior glenoid defect (No-defect group), 24 patients had preoperative glenoid defects ≥15% (Critical defect group), and 6 patients had glenoid defects between 5% and 15%. The No-defect group (n = 25) was compared with the Critical defect group (n = 24). Multivariate logistical regression was performed to evaluate the association of independent factors with the grade of resorption for all 55 patients in the cohort. RESULTS Major graft resorption at the level of the superior screw was observed in 72%-84% of patients in the No-defect group (n = 25) and in 75%-83% of patients in the Critical defect group (n = 24) (P = 1, P = 1; no significant difference). No to mild resorption at the level of the inferior screw was observed in 96% of patients in the No-defect group and 100% of patients in the Critical defect group (P = 1; no significant difference). Postoperative Rowe scores (100 [95-100] vs. 100 [95-100]; P = .8) and shoulder subjective value (87 [11] vs. 86 [9]; P = .9) were not significantly different between the 2 groups. None of the independent factors, including the corresponding screw angle, the mediolateral graft positioning, prior glenoid defect, age, and smoking status, were associated with graft resorption in multivariate logistical regression. CONCLUSIONS Graft resorption after the Latarjet procedure does not depend on the preoperative glenoid defect. The coracoid graft may be mostly resorbed around the superior screw but mildly or none at the level of the inferior screw, but this graft resorption is not dependent on the smoking status, age, prior glenoid defect, mediolateral graft positioning, and the angle of the screws.
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Affiliation(s)
- Dipit Sahu
- Department of Orthopaedics, Sir H.N. Reliance Foundation Hospital, Mumbai, Maharashtra, India; Mumbai Shoulder Institute, Mumbai, Maharashtra, India; Department of Orthopaedics, Jupiter Hospital, Thane, Maharashtra, India.
| | - Darshil Shah
- Sports Medicine Unit, Sportsmed, Mumbai, Maharashtra, India
| | - Gautam Shetty
- Knee and Orthopaedic Clinic, Mumbai, Maharashtra, India
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25
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Morgenstern J, Westafer L, Heitz C, Milne WK. Hot off the press: Sedation or analgesia methods for reduction of anterior shoulder dislocation. Acad Emerg Med 2023; 30:147-150. [PMID: 36441016 DOI: 10.1111/acem.14626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 11/09/2022] [Indexed: 11/29/2022]
Affiliation(s)
| | - Lauren Westafer
- University of Massachusetts Medical School-Baystate, Springfield, Massachusetts, USA
| | - Corey Heitz
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
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26
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Long B, Gottlieb M. Intra-articular lidocaine versus intravenous sedation for anterior shoulder dislocation reduction. Acad Emerg Med 2023; 30:151-153. [PMID: 36587375 DOI: 10.1111/acem.14653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 12/25/2022] [Accepted: 12/30/2022] [Indexed: 01/02/2023]
Affiliation(s)
- Brit Long
- Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, Texas, USA
| | - Michael Gottlieb
- Department of Emergency Medicine, Rush University Medical Center, Chicago, Illinois, USA
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27
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Shevate I, Salunkhe R, Kulkarni K, Janapamala K, Deshmukh A. A Case of Modified McLaughlin Procedure in Neglected Posterior Shoulder Fracture Dislocation. Cureus 2023; 15:e34356. [PMID: 36874667 PMCID: PMC9974937 DOI: 10.7759/cureus.34356] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2023] [Indexed: 01/31/2023] Open
Abstract
A Hill-Sachs lesion, a posterolateral bony defect of the proximal humerus, occurs when the humerus head collides with the anterior region of the glenoid during an anterior shoulder dislocation. A posteriorly dislocated shoulder may cause a reverse Hill-Sachs lesion, which is a deficiency on the anteromedial part of the humeral head due to impaction. Avascular necrosis could result from this lesion if detection and repair are not carried out. The subscapularis tendon is separated from the smaller tuberosity using an open technique in the original McLaughlin procedure, which was initially described in 1952. In neglected cases of patients undergoing surgery after three weeks, there is no commonly accepted standard of care. Glenohumeral joint stabilization and early and full functional recovery are the two objectives of the procedure. This case report describes a modified McLaughlin surgery where the subscapularis tendon and lesser tuberosity are transferred to the reverse Hill-Sachs defect for stability. The clinical significance of our case report is that it accentuates the role of early detection and appropriate management of reverse Hill-Sachs lesion, which is often overlooked and missed in a case of posterior shoulder dislocation. The use of the modified McLaughlin procedure not only covers the defect with a bone chunk and the subscapularis tendon transfer over the head of the humerus but the stable fixation with the anchor and cannulated cancellous screw helps in early rehabilitation of the shoulder joint.
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Affiliation(s)
- Ishan Shevate
- Orthopaedics, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, IND
| | - Rahul Salunkhe
- Orthopaedics, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, IND
| | - Ketan Kulkarni
- Orthopaedics, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, IND
| | - Kishore Janapamala
- Orthopaedics, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, IND
| | - Ashwin Deshmukh
- Orthopaedics, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, IND
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28
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Muacevic A, Adler JR, Rajak M, David V, Kumar R, Sarkar S. A Novel Technique to Reduce Anterior Shoulder Dislocation Without Anesthesia - A Prospective Analysis. Cureus 2023; 15:e33497. [PMID: 36756027 PMCID: PMC9903178 DOI: 10.7759/cureus.33497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2023] [Indexed: 01/09/2023] Open
Abstract
Background Shoulder dislocation is one of the most common injuries encountered in daily practice. Among shoulder dislocations, anterior shoulder dislocation is the most common variant. There are many techniques described to reduce a dislocated shoulder. Reduction of a dislocated shoulder joint may be performed under anesthesia or without anesthesia. In this study, we have evaluated the efficacy of Prakash's method in reducing anterior shoulder dislocations without anesthesia. Methodology This study is a prospective study that was conducted from March 2018 to February 2020 in the department of joint replacement and orthopedics in Tata Main Hospital, Jamshedpur. One hundred two shoulders fulfilling the inclusion criteria were included in this study, and observations were noted. Results The results were statistically analyzed, and it was found that this new method was successful in reducing 97.06% shoulders without any anesthesia. Out of the total 102 patients enrolled in this study, 17 (n=102, 16.67%) patients had left-sided shoulder dislocation, and 85 (n=102, 83.33%) patients had right-sided shoulder dislocation. In 91.18% (n=90 out of 102) of the patients, the reduction could be achieved on the first attempt. A second attempt was needed in 7.84% (n=8 out of 102). No complications were noted. Conclusion Prakash's method to reduce anterior shoulder dislocation is a simple technique to reduce dislocated shoulders. Through our study, we conclude that it is also an effective technique for reducing anteriorly dislocated shoulders. As there is no requirement of anesthesia, we recommend that orthopedic surgeons as well as emergency care providers should acquaint themselves with this technique.
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29
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Muacevic A, Adler JR, Nelson B, Tompkins MA. Open Glenoid Augmentation With Scapular Spine Autograft for Recurrent Shoulder Instability: A Report of Two Cases. Cureus 2023; 15:e33654. [PMID: 36788856 PMCID: PMC9918334 DOI: 10.7759/cureus.33654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2023] [Indexed: 01/13/2023] Open
Abstract
Optimal treatment for patients with significant glenoid bone loss after severe shoulder dislocation remains a topic of discussion, as there are many autograft and allograft techniques for glenoid augmentation. Several studies have identified scapular spine autograft to be a potential option for restoring glenohumeral stability, however, there is limited clinical data for this procedure. We present two cases in which patients suffered from anterior glenoid bone loss and recurrent shoulder instability who underwent open glenoid augmentation with scapular spine autograft. Both patients report a full return to activity with no functional limitations. Open glenoid augmentation with a scapular spine autograft is a viable option for patients with anterior glenoid bone loss and recurrent shoulder instability.
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30
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Ishikawa H, Smith KM, Wheelwright JC, Christensen GV, Henninger HB, Tashjian RZ, Chalmers PN. Rotator cuff muscle imbalance associates with shoulder instability direction. J Shoulder Elbow Surg 2023; 32:33-40. [PMID: 35961497 DOI: 10.1016/j.jse.2022.06.022] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 06/07/2022] [Accepted: 06/27/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Although muscle weakness and/or imbalance of the rotator cuff are thought to contribute to the development of shoulder instability, the association between muscular dysfunction and shoulder instability is not completely understood. The purpose of this study was to evaluate rotator cuff and deltoid muscle cross-sectional areas in different types of shoulder instability (anterior, posterior, and multidirectional instability [MDI]) and to determine the associations between muscular imbalance and shoulder instability direction. METHODS Preoperative magnetic resonance images of patients with shoulder instability who subsequently underwent arthroscopic glenohumeral labral repair or capsular plication were evaluated. Shoulder instability was classified into 3 categories by direction: (1) anterior, (2) posterior, and (3) MDI. The rotator cuff (supraspinatus, subscapularis, and infraspinatus + teres minor) and deltoid (anterior and posterior portions, and total) muscle areas were measured on T1 sagittal and axial slices, respectively. The ratios of the subscapularis to infraspinatus + teres minor area and the anterior deltoid to posterior deltoid area were calculated to quantify the transverse force couple imbalance. RESULTS A total of 189 patients were included, where each group consisted of 63 patients. The infraspinatus + teres minor muscle area was smaller than the subscapularis muscle area in the anterior instability group (P = .007). The subscapularis muscle area was smaller than the infraspinatus + teres minor muscle area in the posterior instability and MDI groups (P ≤ .003). The anterior deltoid muscle area was smaller than the posterior deltoid muscle area in all groups (P ≤ .001). The subscapularis-to-infraspinatus + teres minor area ratio in the anterior instability group (1.18 ± 0.40) was higher than that in the posterior instability and MDI groups (0.79 ± 0.31 and 0.93 ± 0.33, respectively; P < .001). There was no difference in the anterior deltoid-to-posterior deltoid area ratio among the 3 groups. CONCLUSION Patients with anterior instability have smaller muscle area of the posterior rotator cuff as compared with the anterior rotator cuff. In contrast, patients with posterior instability and MDI have smaller muscle area of the anterior rotator cuff as compared with the posterior rotator cuff. Thus, the direction of shoulder instability is associated with rotator cuff muscle area.
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Affiliation(s)
- Hiroaki Ishikawa
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA.
| | - Karch M Smith
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - J Cade Wheelwright
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Garrett V Christensen
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA, USA
| | - Heath B Henninger
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA; Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
| | - Robert Z Tashjian
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Peter N Chalmers
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
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31
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Ishikawa H, Henninger HB, Kawakami J, Zitnay JL, Yamamoto N, Tashjian RZ, Itoi E, Chalmers PN. A stabilizing role of the glenoid labrum: the suction cup effect. J Shoulder Elbow Surg 2022; 32:1095-1104. [PMID: 36586508 DOI: 10.1016/j.jse.2022.12.002] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 11/07/2022] [Accepted: 12/09/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND The glenoid labrum acts as a bumper, deepening glenoid concavity and amplifying the concavity-compression mechanism, and serves as the scapular attachment for glenohumeral ligaments. The role of the posterosuperior labrum in anteroinferior glenohumeral stability, and the role of the anterior labrum in posterior stability has been debated. The purpose of this study was to quantify the contribution of anteroinferior and posterosuperior labral tears to loss of glenohumeral stability in multiple directions. METHODS Fourteen fresh-frozen cadaveric shoulders were tested on a custom stability ratio measurement apparatus. The peak force that was required to translate the humeral head in anterior, anteroinferior, posterior, and posteroinferior directions was measured under 5 conditions: intact labrum (n = 14), anteroinferior labral tear (n = 7), posterosuperior labral tear (n = 7), combined labral tear (n = 14), and no labrum (n = 14). The stability ratio was defined as the peak translational force divided by the compressive force. Within force-translation curves, we defined the suction cup effect as the force required to release the negative pressure created by an intact labrum. RESULTS The suction cup effect was usually present with the intact labrum and always disappeared after removal of the labrum for anterior (100% vs. 0%) and posterior (86% vs. 0%) translations (P < .001). After creation of an anteroinferior labral tear, the stability ratio for posterior direction decreased (P < .001) and the suction cup effect disappeared (P < .001). After creation of a posterosuperior labral tear, stability ratios in the anterior and anteroinferior directions decreased (P ≤ .006) and the suction cup effect disappeared (P ≤ .015). The stability ratio for anterior and anteroinferior testing was more diminished by posterosuperior labral tears than anteroinferior labral tears, and the stability ratio for posterior testing was more diminished by anteroinferior labral tears than posterosuperior labral tears. CONCLUSION Anteroinferior labral tears decreased posterior stability and posterosuperior labral tears decreased anterior and anteroinferior stability, largely because of loss of the suction cup effect.
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Affiliation(s)
- Hiroaki Ishikawa
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA.
| | - Heath B Henninger
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA; Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA; Department of Mechanical Engineering, University of Utah, Salt Lake City, UT, USA
| | - Jun Kawakami
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Jared L Zitnay
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Nobuyuki Yamamoto
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Robert Z Tashjian
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Eiji Itoi
- Department of Orthopaedic Surgery, Tohoku Rosai Hospital, Sendai, Japan
| | - Peter N Chalmers
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
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32
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Saylık M, Gökkuş K. Bilateral locked posterior shoulder dislocation overlooked for 15 months treated with the modified McLaughlin procedure: A case report. Jt Dis Relat Surg 2022; 34:226-233. [PMID: 36700287 PMCID: PMC9903109 DOI: 10.52312/jdrs.2023.869] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 12/06/2022] [Indexed: 01/19/2023] Open
Abstract
Neglected bilateral posterior shoulder dislocation is a rare injury caused primarily by an epileptic seizure. The injury is usually associated with a reverse Hill-Sachs lesion in the anteromedial aspect of the humeral head. The modified McLaughlin technique may avoid instability and osteoarthritis when 20 to 40% of the articular surface is affected by reverse Hill-Sachs. In this article, we present the clinical results of a case overlooked in the literature for the longest time, i.e., for 15 months. A 46-year-old male patient was receiving treatment for epilepsy for five years. There was no fall or trauma in the four seizures he had during this time. The last seizure was 15 months ago. When the patient presented to our clinic, both shoulders were symmetrically deformed, the anterior shoulder contour disappeared (empty socket sign), and there was a loss of upper contour. The computed tomography (CT) scan revealed a posteriorly locked dislocation with a reverse Hill-Sachs lesion in 32% of the left shoulder and 36% of the right shoulder. We applied the modified McLaughlin procedure to the dominant right shoulder and, two months later, we used it to the left shoulder (with a graft taken from the anterior superior iliac spine). At one-year of follow-up, both shoulders were moderately functional: forward elevation left 70° and right 50°, abduction left 40° and right 60°, and internal rotation: the back of the hand could touch the fifth lumbar vertebra. Meanwhile, the patient did not suffer from recurrent dislocation. The pre- and postoperative Constant-Murley Scores for the right and left shoulder were 30/52 and 11/48, respectively. Although the operational outcomes using the modified McLaughlin technique were not ideal, with no recurrence, the patient seemed to be satisfied with this outcome. In conclusion, in neglected locked shoulder fracture-dislocations, the modified McLaughlin technique is a method that can respond to the pathophysiology by eliminating reverse Hill-Sachs lesion.
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Affiliation(s)
- Murat Saylık
- Department of Therapy and Rehabilitation, Mudanya University Vocational School, Bursa, Türkiye
| | - Kemal Gökkuş
- Başkent Üniversitesi Alanya Araştırma ve Uygulama Merkezi, Ortopedi ve Travmatoloji Kliniği, 07400 Alanya, Antalya, Türkiye.
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Wu F, Dhir R, Ng CY. Patterns of Nerve Injury and Recovery Rates of Infraclavicular Brachial Plexus Lesions Following Anterior Shoulder Dislocation. J Hand Surg Am 2022; 47:1227.e1-7. [PMID: 34774345 DOI: 10.1016/j.jhsa.2021.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 07/04/2021] [Accepted: 09/01/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE We reviewed our cases of infraclavicular brachial plexus injuries associated with anterior shoulder dislocation to determine patterns of injury, recovery rates, and factors associated with a poor motor outcome. METHODS This was a retrospective review of patients who had sustained a concomitant nerve injury following dislocation of the glenohumeral joint treated with closed manipulation. The data collected included patient demographics, injury factors, and patterns of neurological deficits. The Medical Research Council (MRC) grade for motor power was the primary outcome measure, where a grade of 4 or 5 was regarded as achieving good motor recovery. Univariate and multivariable analyses were used to identify factors associated with persistent motor weakness (MRC grades 0-3) at the final follow-up. RESULTS Between 2015 and 2019, 61 patients were assessed. There were 36 males and 25 females, with a median age of 64 years (interquartile range [IQR], 53-73 years). Four patterns of injury were identified: (1) isolated axillary nerve lesions; (2) single cord lesions; (3) combined lesions involving the medial and posterior cords; and (4) diffuse lesions affecting all 3 cords. Of 28 patients with isolated axillary nerve injuries, 22 recovered. All lateral cord injuries (11/11) and 20 of 24 posterior cord injuries recovered spontaneously. Recovery of hand intrinsic function from medial cord injuries had the worst outcome, with 14 of 27 patients not recovering beyond MRC grades 0 to 3. The median duration of dislocation before reduction was 6 hours (IQR, 3-12 hours). A multivariate analysis showed an association between the duration of shoulder dislocation and the likelihood of persistent motor weakness. CONCLUSIONS Shoulder dislocations with motor deficits should be regarded as orthopedic emergencies and reduced expediently. Persistent motor weakness may be associated with a prolonged duration of dislocation prior to glenohumeral relocation. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic IV.
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Muacevic A, Adler JR, Baiju D, Corbin RE, Deane DR, Kassie P. Chronic Bilateral Symmetric Anterior Shoulder Dislocation Secondary to Seizures in Chikungunya Encephalitis. Cureus 2022; 14:e32792. [PMID: 36694507 PMCID: PMC9857927 DOI: 10.7759/cureus.32792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2022] [Indexed: 12/24/2022] Open
Abstract
Bilateral shoulder dislocations are a rare occurrence and can be categorized as either symmetric (both humeral heads dislocate in the same direction) or asymmetric (wherein the humeral heads dislocate in different directions). Shoulder dislocations may be overlooked if they are the result of systemic injury; if diagnosed >21 days after occurring, they are considered chronic dislocations. We describe the case of a 31-year-old male who presented with an eight-week history of bilateral shoulder pain. His onset of pain coincided with a seizure secondary to Chikungunya encephalitis. Clinical and radiological examination demonstrated bilateral symmetric anterior shoulder dislocation with associated greater tuberosity fractures and extensive callus formation bilaterally. Open surgical management was performed first on the left shoulder via the deltopectoral approach. The callus was removed, the greater tuberosity fragment lifted off, reattached to the original position, and held in place with sutures and proximal humeral locking plates. The right shoulder was reduced six weeks after the left shoulder due to patient preference; the reduction utilized the same approach as with the left shoulder. Post-operatively the patient was immobilized, and physiotherapy commenced. He achieved a satisfactory range of motion four months post-operation. Physicians should be cognizant that shoulder pain after a convulsive seizure may signify shoulder dislocation. Thorough clinical and radiological examinations are warranted in such an instance. There exists no consensus on the treatment of chronic shoulder dislocations, but it is recommended that closed reduction only be attempted up to six weeks post-dislocation due to the high risk of iatrogenic fractures and neurovascular damage beyond this time.
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Yaari L, Ribenzaft SZ, Kittani M, Yassin M, Haviv B. Epidemiology of primary shoulder dislocations requiring surgery: A cohort study from a major trauma center during 7 years. J Orthop Surg (Hong Kong) 2022; 30:10225536221134032. [PMID: 36397651 DOI: 10.1177/10225536221134032] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
PURPOSE The epidemiology of shoulder instability in the general population is lacking. The aim of the current study was to determine the incidence rate of primary shoulder dislocations requiring surgical interventions in a major trauma center within a large maintenance organization. METHODS A retrospective cohort analysis of electronic health records database from 1 January 2014 and 31 December 2020 was conducted in major rural trauma center. This study included all patients aged 10 years or older with a primary shoulder dislocation that were treated with closed reduction in the emergency room department. An overall incidence density rates (IDR) (per 100,000 person-years) of primary shoulder dislocations and stabilization surgeries were determined for the entire cohort. The data was used to evaluate the age-specific and gender-specific epidemiology. RESULTS During the study period of 7 years there were 1,302 patients who underwent closed reduction after a primary shoulder dislocation (mean age 45 years). Of those, a total of 106 shoulder stabilization surgeries (8%) were performed. The IDR of primary shoulder dislocations was 179 per 100,000 person-years. The IDR of primary shoulder stabilizations was 15 per 100,000 person-years. The peak in number of dislocations was observed in the age groups of 20-29 years and over 60 years. In the age groups under 59 years dislocations were more common in men while in ages over 60 years dislocations were more common in women. The vast majority of shoulder stabilization surgeries were performed in young patients (age under 39 years). CONCLUSION The IDR of primary shoulder dislocations calculated from a major trauma center of the largest health maintenance organization in Israel was 179 per 100,000 person-years. Shoulder dislocations had bimodal age distribution. Overall, eight percent of the patients (mainly young) with shoulder dislocations underwent shoulder stabilization surgery during the study period.
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Affiliation(s)
- Lee Yaari
- Arthroscopy and Sports Injuries Unit, 36632Rabin Medical Center, Petach-Tikva, Israel.,Orthopedic Department, Sackler Faculty of Medicine, Tel Aviv University, Israel.,Orthopedic Department, 36632Rabin Medical Center, Petach-Tikva, Israel
| | - Shay Zion Ribenzaft
- Arthroscopy and Sports Injuries Unit, 36632Rabin Medical Center, Petach-Tikva, Israel.,Orthopedic Department, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Mohamed Kittani
- Arthroscopy and Sports Injuries Unit, 36632Rabin Medical Center, Petach-Tikva, Israel.,Orthopedic Department, Sackler Faculty of Medicine, Tel Aviv University, Israel.,Orthopedic Department, 36632Rabin Medical Center, Petach-Tikva, Israel
| | - Mustafa Yassin
- Arthroscopy and Sports Injuries Unit, 36632Rabin Medical Center, Petach-Tikva, Israel.,Orthopedic Department, Sackler Faculty of Medicine, Tel Aviv University, Israel.,Orthopedic Department, 36632Rabin Medical Center, Petach-Tikva, Israel
| | - Barak Haviv
- Arthroscopy and Sports Injuries Unit, 36632Rabin Medical Center, Petach-Tikva, Israel.,Orthopedic Department, Sackler Faculty of Medicine, Tel Aviv University, Israel.,Orthopedic Department, 36632Rabin Medical Center, Petach-Tikva, Israel
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36
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Brigham E, Olympia RP. School Nurses on the Front Lines of Healthcare: Emergencies Associated With Sport and Physical Activities (Part 4)-The Assessment of Pediatric Shoulder and Hip Injuries Utilizing the "SPASMS" Mnemonic. NASN Sch Nurse 2022; 37:318-323. [PMID: 35722957 DOI: 10.1177/1942602x221104204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Indexed: 05/31/2023]
Abstract
Sport participation is an important part of the development, both physically and mentally, of children and adolescents in the United States. Illness and injury associated with sport and physical activities may occur in the school setting. Although most sport-related illness and injury in students are considered minor emergencies, life-threatening illnesses or injuries may occur. It is important for the school nurse to recognize potential life-threatening emergencies associated with sport and physical activity, to initiate stabilization of the student with life-threatening symptoms, and to triage these students to an appropriate level of care (back to the classroom, home with their guardian with follow up at their primary healthcare provider's office, or directly to the closest emergency department [ED] via Emergency Medical Services [EMS]). This article specifically describes the initial assessment and management of shoulder and hip injuries in pediatric athletes.
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Affiliation(s)
- Elizabeth Brigham
- Professor, Departments of Emergency Medicine and Pediatrics, Penn State College of Medicine, Attending Pediatric Emergency Medicine physician, Penn State Hershey Medical Center Hershey, PA
| | - Robert P Olympia
- Professor, Departments of Emergency Medicine and Pediatrics, Penn State College of Medicine, Attending Pediatric Emergency Medicine physician, Penn State Hershey Medical Center Hershey, PA
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Hayashi M, Kano K, Kuroda N, Yamamoto N, Shiroshita A, Kataoka Y. Comparative efficacy of sedation or analgesia methods for reduction of anterior shoulder dislocation: A systematic review and network meta-analysis. Acad Emerg Med 2022; 29:1160-1171. [PMID: 35872652 DOI: 10.1111/acem.14568] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 07/13/2022] [Accepted: 07/20/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND We performed a network meta-analysis (NMA) to compare the efficacy and safety of intravenous sedation (IVS), intraarticular anesthetic injection (IAA), and peripheral nerve block (PNB) as sedation or analgesia methods for the reduction of anterior shoulder dislocation. METHODS We included randomized controlled trials (RCTs) comparing different sedation or analgesia methods for anterior shoulder dislocation reduction. The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, ICTRP, ClinicalTrials.gov, and Google Scholar databases were searched in October 2021. We conducted a random-effects NMA within a frequentist framework. We evaluated the confidence in each outcome using the CINeMA tool. RESULTS Sixteen RCTs (957 patients) were included. Regarding the primary outcomes, the three methods might result in little to no difference in the immediate success rate of reduction and patient satisfaction. The IAA method had a shorter emergency department length of stay than that of the IVS method (mean difference [MD] -107.88 min, 95% confidence interval [CI] -202.58 to -13.18). In the secondary outcomes, the IAA method had a lower pain score than that of the PNB method (standardized MD -1.83, 95% CI -3.64 to -0.02). The IAA and PNB methods might require a longer time for reduction than that of the IVS method (MD 5.3 min, 95% CI 2.4 to 10.36; MD 15.25, 95% CI 5.49 to 25.01). The three methods might result in little to no difference in the number of reduction attempts and total success rate of reduction. However, the confidence ratings for all treatment comparisons were very low. IAA and PNB had no adverse respiratory events. CONCLUSIONS The results of our NMA indicated that three sedation or analgesia methods (IVS, IAA, and PNB) might result in little to no difference in the success rate of reduction and patient satisfaction. IAA and PNB had no adverse respiratory events.
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Affiliation(s)
- Minoru Hayashi
- Department of Emergency Medicine, Fukui Prefectural Hospital, Fukui City, Fukui, Japan
| | - Kenichi Kano
- Department of Emergency Medicine, Fukui Prefectural Hospital, Fukui City, Fukui, Japan
| | - Naoto Kuroda
- Department of Pediatrics, Wayne State University, Detroit, Michigan, USA.,Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Japan.,Scientific Research Works Peer Support Group (SRWS-PSG), Osaka, Japan
| | - Norio Yamamoto
- Scientific Research Works Peer Support Group (SRWS-PSG), Osaka, Japan.,Department of Orthopedic Surgery, Miyamoto Orthopedic Hospital, Okayama, Okayama, Japan.,Department of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Akihiro Shiroshita
- Scientific Research Works Peer Support Group (SRWS-PSG), Osaka, Japan.,Department of Respiratory Medicine, Ichinomiyanishi Hospital, Ichinomiya, Aichi, Japan
| | - Yuki Kataoka
- Scientific Research Works Peer Support Group (SRWS-PSG), Osaka, Japan.,Department of Internal Medicine, Kyoto Min-Iren Asukai Hospital, Kyoto, Japan.,Section of Clinical Epidemiology, Department of Community Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.,Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine/Public Health, Kyoto, Japan
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Hassen GW, Bergmann-Dumont D, Duvvi A, Sudol S, Choy D, Yeo T, Viswanath A, Roffe E, Kim CL, Elnatour A, Arias MG, Kalantari H. The Use of a Suprascapular Nerve Block to Facilitate the Reduction of an Anterior Shoulder Dislocation: An Alternative for Elderly and Patients With Cardiopulmonary Comorbidities? J Emerg Med 2022; 63:265-271. [PMID: 36045024 DOI: 10.1016/j.jemermed.2022.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 11/11/2021] [Revised: 04/04/2022] [Accepted: 04/23/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Anterior shoulder dislocation is a common presentation to the emergency department (ED). Dislocations are spontaneous or traumatic. Generally, a reduction is performed under procedural sedation and analgesia (PSA). Other approaches include the use of intra-articular lidocaine or, in rare instances, nerve blocks. Here we discuss the case of a 66-year-old female patient who presented with left shoulder pain and limited range of motion after a fall. After discussing potential treatment options to reduce the dislocation, the patient agreed to a nerve block. DISCUSSION The dislocation was reduced successfully with a suprascapular nerve block (SSNB) without complications. The duration of the patient's ED stay was shorter than those who had received PSA. CONCLUSIONS SSNB could be an alternative method for shoulder dislocation reduction, particularly for patients who are obese, older, or have cardiopulmonary comorbidities.
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Affiliation(s)
- Getaw Worku Hassen
- Department of Emergency Medicine, New York Medical College (NYMC), Metropolitan Hospital Center, New York, New York
| | - Dahlia Bergmann-Dumont
- Department of Emergency Medicine, New York Medical College (NYMC), Metropolitan Hospital Center, New York, New York
| | - Anisha Duvvi
- Department of Emergency Medicine, New York Medical College (NYMC), Metropolitan Hospital Center, New York, New York
| | - Samantha Sudol
- Department of Emergency Medicine, New York Medical College (NYMC), Metropolitan Hospital Center, New York, New York
| | - Danny Choy
- Department of Emergency Medicine, New York Medical College (NYMC), Metropolitan Hospital Center, New York, New York
| | - Theresa Yeo
- Department of Emergency Medicine, New York Medical College (NYMC), Metropolitan Hospital Center, New York, New York
| | - Avinash Viswanath
- Department of Emergency Medicine, Harlem Hospital Center, New York, New York
| | - Estrella Roffe
- Department of Emergency Medicine, New York Medical College (NYMC), Metropolitan Hospital Center, New York, New York
| | - Cei Lim Kim
- Department of Emergency Medicine, New York Medical College (NYMC), Metropolitan Hospital Center, New York, New York
| | - Ali Elnatour
- Department of Emergency Medicine, New York Medical College (NYMC), Metropolitan Hospital Center, New York, New York
| | - Mauricio Gonzalez Arias
- Department of Emergency Medicine, New York Medical College (NYMC), Metropolitan Hospital Center, New York, New York
| | - Hossein Kalantari
- Department of Emergency Medicine, New York Medical College (NYMC), Metropolitan Hospital Center, New York, New York
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Ernat JJ, Rakowski DR, Hanson JA, Casp AJ, Lee S, Peebles AM, Horan MP, Provencher MT, Millett PJ. High rate of return to sport and excellent patient-reported outcomes after an open Latarjet procedure. J Shoulder Elbow Surg 2022; 31:1704-1712. [PMID: 35189371 DOI: 10.1016/j.jse.2022.01.139] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 01/12/2022] [Accepted: 01/16/2022] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS The purpose of this study was to report return to sport, patient-reported outcomes (PROs), subjective outcomes, and complications or failures in patients who underwent open Latarjet surgery. METHODS Patients who underwent open Latarjet surgery performed by 2 fellowship-trained surgeons between August 2006 and November 2018 were included. Prospectively collected data were reviewed. Recurrent instability and revision surgical procedures were recorded. Subjective outcomes included return to sport and fear of reinjury or activity modification as a result of patients' instability history. PROs included the American Shoulder and Elbow Surgeons (ASES) score, Short Form 12 Physical Component Summary score, Single Assessment Numeric Evaluation score, Quick Disabilities of the Arm, Shoulder and Hand score, and satisfaction. Age, sex, sports participation, pain, primary vs. revision surgery (prior failed arthroscopic or open Bankart repair), dislocation number, glenoid bone loss, glenoid track concept, and projected glenoid track were evaluated. Failure was defined as an ASES score <70, recurrent dislocation, or revision instability surgery. RESULTS A total of 126 shoulders (125 patients) met the inclusion criteria, with a mean age of 28.1 years (range, 15-57 years). Of 126 shoulders, 7 (5.5%) underwent additional procedures prior to final follow-up and were excluded from outcome analyses; failure occurred in 6 of these shoulders. Mean follow-up data at 3.7 years (range, 2-9.3 years) were attained in 86.6% of patients (103 of 119). All PROs significantly improved from preoperative baseline (ASES score, from 69.7 to 90.2; Single Assessment Numeric Evaluation score, from 55.8 to 85.9; and Quick Disabilities of the Arm, Shoulder and Hand score, from 28.4 to 10.5). PROs did not differ based on sex, sports participation type, dislocation with or without sports, primary vs. revision procedure, and preoperative dislocation number. No correlations existed between PROs and age, glenoid bone loss, or number of previous surgical procedures. On-track lesions (50 of 105, 47.6%) and projected on-track lesions (90 of 105, 85.7%) correlated with better patient satisfaction but not PROs. Despite not having recurrences, 63 of 99 patients (63.6%) reported activity modifications and 44 of 99 patients (44.4%) feared reinjury. These groups had statistically worse PROs, although the minimal clinically important difference was not met. Return to sport was reported by 97% of patients (86 of 89), with 74% (66 of 89) returning at the same level or slightly below the preinjury level. Revision stabilization surgery was required 6 of 126 cases (4.8%), and 6 of 103 shoulders (5.8%) had ASES scores <70. CONCLUSION The open Latarjet procedure led to significant improvements in all PROs, and overall, 97% of patients returned to sport. Fear of reinjury and activity modifications were common after open Latarjet procedures but did not appear to affect clinical outcomes. On-track and projected on-track measurements correlated with better patient satisfaction but not improved PROs.
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Affiliation(s)
- Justin J Ernat
- Steadman Philippon Research Institute, Vail, CO, USA; The Steadman Clinic, Vail, CO, USA; University of Utah Health, Salt Lake City, UT, USA
| | | | | | - Aaron J Casp
- Steadman Philippon Research Institute, Vail, CO, USA
| | - Simon Lee
- Steadman Philippon Research Institute, Vail, CO, USA
| | | | | | - Matthew T Provencher
- Steadman Philippon Research Institute, Vail, CO, USA; The Steadman Clinic, Vail, CO, USA
| | - Peter J Millett
- Steadman Philippon Research Institute, Vail, CO, USA; The Steadman Clinic, Vail, CO, USA.
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Yu M, Shalaby M, Luftig J, Cooper M, Farrow R. Ultrasound-Guided Retroclavicular Approach to the Infraclavicular Region (RAPTIR) Brachial Plexus Block for Anterior Shoulder Reduction. J Emerg Med 2022; 63:83-87. [PMID: 35934656 DOI: 10.1016/j.jemermed.2022.04.011] [Citation(s) in RCA: 2] [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: 11/25/2021] [Revised: 02/17/2022] [Accepted: 04/23/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Shoulder dislocations are a common presenting injury to the emergency department (ED), with anterior dislocations comprising the majority of these cases. Some patients may tolerate gentle manipulation and reduction, but many require analgesia of some type. Oral or parenteral pain medication is often used alone or in combination with procedural sedation if gentle manipulation fails to achieve reduction. Recently, this treatment algorithm has grown to include regional anesthesia as a mode of analgesia for reduction of shoulder dislocations in the form of brachial plexus blocks. It has been well described that the interscalene and supraclavicular approach to the brachial plexus can be used to assist in reduction of anterior shoulder dislocations; however, there has yet to be any published literature regarding the use of ultrasound-guided retroclavicular approach to the infraclavicular region (RAPTIR) brachial plexus blocks for shoulder reduction. CASE REPORT We describe three patients who presented to the ED with anterior shoulder dislocations. The RAPTIR block was performed, provided effective analgesia, and facilitated successful shoulder reduction in all three patients.Why Should an Emergency Physician Be Aware of This? The RAPTIR nerve block is a safe and effective option for analgesia in the patient with an anterior shoulder dislocation. It may have advantages over other brachial nerve blocks and avoids the risks and disadvantages of procedural sedation and opioids.
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Affiliation(s)
- Melissa Yu
- Department of Emergency Medicine, Crozer-Chester Medical Center, Upland, Pennsylvania
| | - Michael Shalaby
- Department of Emergency Medicine, Mount Sinai Medical Center, Miami Beach, Florida
| | - Josh Luftig
- Department of Emergency Medicine, Highland Hospital, Alameda Health System, Oakland, California
| | - Maxwell Cooper
- Department of Emergency Medicine, Crozer-Chester Medical Center, Upland, Pennsylvania
| | - Robert Farrow
- Department of Emergency Medicine, Mount Sinai Medical Center, Miami Beach, Florida
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Cohn MR, DeFroda SF, Huddleston HP, Williams BT, Singh H, Vadhera A, Garrigues GE, Nicholson GP, Yanke AB, Verma NN. Does native glenoid anatomy predispose to shoulder instability? An MRI analysis. J Shoulder Elbow Surg 2022; 31:S110-S116. [PMID: 35378313 DOI: 10.1016/j.jse.2022.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 03/07/2022] [Accepted: 03/14/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND It is unclear if native glenohumeral anatomic features predispose young patients to instability and if such anatomic risk factors differ between males and females. The purpose of this study was to compare glenoid and humeral head dimensions between patients with a documented instability event without bone loss to matched controls and to evaluate for sex-based differences across measurements. The authors hypothesized that a smaller glenoid width and glenoid surface area would be significant risk factors for instability, whereas humeral head width would not. METHODS A prospectively maintained database was queried for patients aged <21 years who underwent magnetic resonance imaging (MRI) for shoulder instability. Patients with prior shoulder surgery, bony Bankart, or glenoid or humeral bone loss were excluded. Patients were matched by sex and age to control patients who had no history of shoulder instability. Two blinded independent raters measured glenoid height, glenoid width, and humeral head width on sagittal MRI. Glenoid surface area, glenoid index (ratio of glenoid height to width), and glenohumeral mismatch ratio (ratio of humeral head width to glenoid width) were calculated. RESULTS A total of 107 instability patients and 107 controls were included (150 males and 64 females). Among the entire cohort, there were no differences in glenoid height, glenoid width, glenoid surface area, humeral head width, or glenoid index between patients with instability and controls. Overall, those with instability had a greater glenohumeral mismatch ratio (P = .029) compared with controls. When stratified by sex, female controls and instability patients showed no differences in any of the glenoid or humerus dimensions. However, males with instability had a smaller glenoid width by 3.5% (P = .017), smaller glenoid surface area by 5.2% (P = .015), and a greater glenohumeral mismatch ratio (P = .027) compared with controls. CONCLUSION Compared with controls, males with instability were found to have smaller glenoid width and surface area, and a glenoid width that was proportionally smaller relative to humeral width. In contrast, bony glenohumeral morphology did not appear to be a significant risk factor for instability among females. These sex-based differences suggest that anatomic factors may influence risk of instability for male and female patients differently.
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Affiliation(s)
- Matthew R Cohn
- Division of Sports Medicine and Shoulder Surgery, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Steven F DeFroda
- Division of Sports Medicine and Shoulder Surgery, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Hailey P Huddleston
- Division of Sports Medicine and Shoulder Surgery, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Brady T Williams
- Division of Sports Medicine and Shoulder Surgery, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Harsh Singh
- Division of Sports Medicine and Shoulder Surgery, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Amar Vadhera
- Division of Sports Medicine and Shoulder Surgery, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Grant E Garrigues
- Division of Sports Medicine and Shoulder Surgery, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Gregory P Nicholson
- Division of Sports Medicine and Shoulder Surgery, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Adam B Yanke
- Division of Sports Medicine and Shoulder Surgery, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Nikhil N Verma
- Division of Sports Medicine and Shoulder Surgery, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA.
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Coifman I, Brunner UH, Scheibel M. Dislocation Arthropathy of the Shoulder. J Clin Med 2022; 11:2019. [PMID: 35407627 DOI: 10.3390/jcm11072019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 03/28/2022] [Accepted: 04/02/2022] [Indexed: 12/04/2022] Open
Abstract
Glenohumeral osteoarthrosis (OA) may develop after primary, recurrent shoulder dislocation or instability surgery. The incidence is reported from 12 to 62%, depending on different risk factors. The risk of severe OA of the shoulder following dislocation is 10 to 20 times greater than the average population. Risk factors include the patient’s age at the first episode of instability or instability surgery, bony lesions, and rotator cuff tears. For mild stages of OA, arthroscopic removal of intraarticular material, arthroscopic debridement, or arthroscopic arthrolysis of an internal rotation contracture might be sufficient. For severe stages, mobilization of the internal rotation contracture and arthroplasty is indicated. With an intact rotator cuff and without a bone graft, results for anatomical shoulder arthroplasty are comparable to those following primary OA. With a bone graft at the glenoidal side, the risk for implant loosening is ten times greater. For the functional outcome, the quality of the rotator cuff is more predictive than the type of the previous surgery or the preoperative external rotation contracture. Reverse shoulder arthroplasty could be justified due to the higher rate of complications and revisions of non-constrained anatomic shoulder arthroplasties reported. Satisfactory clinical and radiological results have been published with mid to long term data now available.
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Patel HL, Babar SJ, Balasubramanian V, Lakshmi Kanthan SV, Ahmed A. Simultaneous Bilateral Anterior Glenohumeral Fracture Dislocation: A Case Report. Cureus 2022; 14:e24199. [PMID: 35602810 PMCID: PMC9117842 DOI: 10.7759/cureus.24199] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2022] [Indexed: 11/10/2022] Open
Abstract
Simultaneous anterior glenohumeral dislocations are rare in occurrence and difficult to diagnose and treat. Here, we present a case of a 33-year-old male with simultaneous anterior glenohumeral fracture dislocation after an episode of seizure. Closed reduction of both the shoulders was performed. Displaced greater tuberosity fracture fixation was done through deltoid splitting approach using cannulated cancellous screws. Fracture union was achieved at three months of follow-up with a good functional outcome. Early diagnosis and reduction provide a good functional outcome.
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Affiliation(s)
- Hardik L Patel
- Orthopedic Surgery, Sri Ramaswamy Memorial (SRM) Institute of Science and Technology, Chennai, IND
| | - Suraj J Babar
- Orthopedic Surgery, Sri Ramaswamy Memorial (SRM) Institute of Science and Technology, Chennai, IND
| | | | | | - Adnan Ahmed
- Orthopedics, Sri Ramaswamy Memorial (SRM) Medical College Hospital and Research Centre, Chengalpattu, IND
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44
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Fraser C, Pellatt R, Shirran M, McKay G, Smith M. Early reduction of acute anterior shoulder dislocations in a ski field setting. Emerg Med Australas 2022; 34:449-451. [PMID: 35297563 DOI: 10.1111/1742-6723.13959] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 02/09/2022] [Accepted: 02/11/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The present study describes the management of suspected shoulder dislocations in ski field clinics. METHODS Data were collected from two clinics in Queenstown, New Zealand. Suspected anterior shoulder dislocations, with no suspicion of significant fractures and without imaging, underwent attempted reduction. RESULTS Ninety percent (n = 49) of dislocations were successfully relocated. No short-term complications because of this procedure were observed. CONCLUSION This short report raises the possibility that early anterior shoulder reduction in a ski field clinic can be safe without imaging, in select cases. Prospective studies including patient centred data are recommended.
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Affiliation(s)
- Calum Fraser
- Medical Rescue Group, Gold Coast, Queensland, Australia
| | - Richard Pellatt
- Emergency Department, Gold Coast University Hospital, Gold Coast, Queensland, Australia.,LifeFlight Retrieval Medicine, Brisbane, Queensland, Australia.,Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia.,School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | - Mark Shirran
- Medical Rescue Group, Gold Coast, Queensland, Australia.,Emergency Department, Gold Coast University Hospital, Gold Coast, Queensland, Australia.,School of Medicine, Griffith University, Gold Coast, Queensland, Australia.,Queensland Ambulance Service, Brisbane, Queensland, Australia
| | - Glenn McKay
- Medical Rescue Group, Gold Coast, Queensland, Australia
| | - Michael Smith
- Medical Rescue Group, Gold Coast, Queensland, Australia.,Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
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45
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Scanaliato JP, Dunn JC, Fares AB, Czajkowski H, Parnes N. Outcomes of 270° Labral Repair for Combined Shoulder Instability in Active-Duty Military Patients: A Retrospective Study. Am J Sports Med 2022; 50:334-340. [PMID: 34898288 DOI: 10.1177/03635465211061602] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND There is a high prevalence of combined shoulder instability in military patients. Short-term outcomes after 270° labral repair are promising; however, there is a paucity of longer term outcome data in this high-demand group of patients. PURPOSE To report the midterm outcomes of active-duty military patients treated with 270° labral repair for combined shoulder instability. STUDY DESIGN Case series; Level of evidence, 4. METHODS All consecutive patients between January 2011 and January 2019 who underwent 270° labral repair by the senior surgeon with complete outcome scores were identified. All patients had experienced a shoulder dislocation after a traumatic event and had magnetic resonance imaging and intraoperative findings consistent with combined-type instability. A total of 52 patients met the inclusion criteria for the study, and all were active-duty servicemembers at the time of surgery. RESULTS The mean follow-up was 78.21 months (range, 24-117 months). There was a statistically significant increase in the mean American Shoulder and Elbow Surgeons score (from 44.92 to 89.31; P < .0001), Single Assessment Numeric Evaluation score (from 52.32 to 93.17; P < .0001), and Rowe instability score (from 46.63 to 91.35; P < .0001) from preoperatively to postoperatively. Mean pain decreased significantly as measured by the visual analog scale for pain (from 8.04 to 1.44; P < .0001). Range of motion in forward flexion (from 155.29° to 155.96°; P = .6793), external rotation (from 67.50° to 65.29°; P = .0623), and internal rotation (from T9.58 to T9.56; P = .9650) did not change significantly postoperatively. Outcomes did not differ significantly for patients who underwent surgery on their dominant shoulder versus those who underwent surgery on their nondominant shoulder, nor did outcomes vary with the type of anchor utilized (biocomposite vs all-suture). The overall rate of return to active duty was 92.31%. CONCLUSION Midterm outcomes in this population of active-duty patients undergoing 270° labral repair for combined shoulder instability demonstrated a statistically and clinically significant improvement in patient-reported outcome scores, a significant decrease in pain, and an overall rate of return to active duty of 92.31%.
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Affiliation(s)
| | - John C Dunn
- William Beaumont Army Medical Center, El Paso, Texas, USA
| | - Austin B Fares
- William Beaumont Army Medical Center, El Paso, Texas, USA
| | | | - Nata Parnes
- Carthage Area Hospital, Carthage, New York, USA.,Claxton-Hepburn Medical Center, Ogdensburg, New York, USA
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46
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Gottlieb M, Patel D, Marks A, Peksa GD. Ultrasound for the diagnosis of shoulder dislocation and reduction: A systematic review and meta-analysis. Acad Emerg Med 2022; 29:999-1007. [PMID: 35094451 DOI: 10.1111/acem.14454] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 12/27/2021] [Accepted: 01/20/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Shoulder dislocations are a common injury prompting presentation to the emergency department. Point-of-care ultrasound (POCUS) is a diagnostic tool for shoulder dislocations, which has the potential to reduce time to diagnosis and reduction, radiation exposure, and health care costs. This systematic review sought to evaluate the diagnostic accuracy of POCUS for diagnosing shoulder dislocations. METHODS We searched PubMed, Scopus, CINAHL, LILACS, the Cochrane databases, Google Scholar, and bibliographies of selected articles for all prospective and randomized controlled trials evaluating the diagnostic accuracy of POCUS for identifying shoulder dislocations. We dual-extracted data into a predefined worksheet and performed quality analysis using the QUADAS-2 tool. We performed a meta-analysis with subgroup analyses by technique and transducer type. As a secondary outcome, we assessed the diagnostic accuracy of identifying associated fractures. RESULTS Ten studies met our inclusion criteria, comprising 1,836 assessments with 636 dislocations (34.6%). Overall, POCUS was 100% (95% confidence interval [CI], 85.6%-100%) sensitive and 100% (95% CI, 79.4%-100%) specific for the diagnosis of shoulder dislocation with a LR+ of 11,254.8 (95% CI, 3.9-3.3e7) and a LR- of <0.1 (95% CI, < 0.1-0.2). When compared with the anterior/lateral technique, the posterior technique had greater sensitivity but no difference in specificity. There was no difference between transducer types. POCUS was also 96.8% (95% CI, 92.6%-98.7%) sensitive and 99.7% (95% CI, 92.5%-100%) specific for the diagnosis of associated fractures. CONCLUSIONS POCUS is a sensitive and specific tool for the rapid identification of shoulder dislocations and reductions, as well as for the detection of associated fractures. POCUS should be considered as an alternate diagnostic tool for the diagnosis and management of shoulder dislocations.
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Affiliation(s)
- Michael Gottlieb
- Department of Emergency Medicine Rush University Medical Center Chicago Illinois USA
| | - Daven Patel
- Department of Emergency Medicine Rush University Medical Center Chicago Illinois USA
| | - Amy Marks
- Department of Emergency Medicine Rush University Medical Center Chicago Illinois USA
| | - Gary D. Peksa
- Department of Emergency Medicine Rush University Medical Center Chicago Illinois USA
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Liang D, Liu H, Liang X, Qin Q, Long L, Huang Y, Lu W, Deng Z. Effect of Modified Arthroscopic Latarjet on Acromiohumeral Distance at 5-Year Follow-up. Orthop J Sports Med 2022; 9:23259671211063844. [PMID: 34988238 PMCID: PMC8721388 DOI: 10.1177/23259671211063844] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 09/16/2021] [Indexed: 11/17/2022] Open
Abstract
Background: It is unclear whether coracoacromial ligament release during the Latarjet procedure will increase superior translation of the shoulder joint. Purpose: To evaluate whether a modified suture button Latarjet procedure can decrease the acromiohumeral distance (AHD). Study Design: Case series; Level of evidence, 4. Methods: A retrospective analysis was conducted among 155 patients who underwent a modified suture button Latarjet procedure between 2013 and 2015. AHD was measured on bilateral computed tomography scans taken preoperatively and on scans of the affected shoulder taken on postoperative day 1 and postoperative month (POM) 6, POM 36, and POM 60. At each time point, we recorded pain on a visual analog scale (VAS) and objective shoulder function using the American Shoulder and Elbow Surgeons, Rowe, and Walch-Duplay scores. Preoperative and final follow-up VAS and functional scores were compared using the paired t test. Pairwise comparison of AHD values at each follow-up time point were compared with the preoperative intact side using the paired t test. Intra- and interobserver reproducibility of the AHD measurements was evaluated using the intraclass correlation coefficient. Results: A total of 104 patients who met the criteria completed the final follow-up, which occurred at 62.6 ± 2.4 months (mean ± SD). When compared with presurgery, the VAS and all functional scores improved significantly at the last follow-up (P < .001 for all). Intra- and interobserver intraclass correlation coefficients indicated good reliability for the ADH measurements. Preoperatively, there were no differences in AHD values between the intact and affected shoulders (7.8 ± 0.8 mm for both; P = .851). The AHD values at postoperative day 1 and POM 6, POM 36, and POM 60 were 9.6 ± 0.7 mm, 8.6 ± 0.9 mm, 8.0 ± 0.8 mm, and 7.9 ± 0.8 mm, respectively, all of which were larger than those of the preoperative intact side (P < .001 for all). Conclusion: The modified suture button Latarjet procedure not only offered satisfactory therapeutic effects but also did not decrease the AHD at 5-year follow-up.
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Affiliation(s)
- Daqiang Liang
- Department of Sports Medicine, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Haifeng Liu
- Department of Sports Medicine, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Xinzhi Liang
- Department of Sports Medicine, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Qihuang Qin
- Department of Sports Medicine, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Lujue Long
- Xiangya Stomatological Hospital & School of Stomatology, Central South University, Changsha, China
| | - Yong Huang
- Department of Sports Medicine, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Wei Lu
- Department of Sports Medicine, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Zhenhan Deng
- Department of Sports Medicine, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China.,Guangxi University of Chinese Medicine, Nanning, China
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Lu Y, Pareek A, Wilbur RR, Leland DP, Krych AJ, Camp CL. Understanding Anterior Shoulder Instability Through Machine Learning: New Models That Predict Recurrence, Progression to Surgery, and Development of Arthritis. Orthop J Sports Med 2021; 9:23259671211053326. [PMID: 34888391 PMCID: PMC8649098 DOI: 10.1177/23259671211053326] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 08/02/2021] [Indexed: 01/06/2023] Open
Abstract
Background Management of anterior shoulder instability (ASI) aims to reduce risk of future recurrence and prevent complications via nonoperative and surgical management. Machine learning may be able to reliably provide predictions to improve decision making for this condition. Purpose To develop and internally validate a machine-learning model to predict the following outcomes after ASI: (1) recurrent instability, (2) progression to surgery, and (3) the development of symptomatic osteoarthritis (OA) over long-term follow-up. Study Design Cohort study (prognosis); Level of evidence, 2. Methods An established geographic database of >500,000 patients was used to identify 654 patients aged <40 years with an initial diagnosis of ASI between 1994 and 2016; the mean follow-up was 11.1 years. Medical records were reviewed to obtain patient information, and models were generated to predict the outcomes of interest. Five candidate algorithms were trained in the development of each of the models, as well as an additional ensemble of the algorithms. Performance of the algorithms was assessed using discrimination, calibration, and decision curve analysis. Results Of the 654 included patients, 443 (67.7%) experienced multiple instability events, 228 (34.9%) underwent surgery, and 39 (5.9%) developed symptomatic OA. The ensemble gradient-boosted machines achieved the best performances based on discrimination (via area under the receiver operating characteristic curve [AUC]: AUCrecurrence = 0.86), AUCsurgery = 0.76, AUCOA = 0.78), calibration, decision curve analysis, and Brier score (Brierrecurrence = 0.138, Briersurgery = 0.185, BrierOA = 0.05). For demonstration purposes, models were integrated into a single web-based open-access application able to provide predictions and explanations for practitioners and researchers. Conclusion After identification of key features, including time from initial instability, age at initial instability, sports involvement, and radiographic findings, machine-learning models were developed that effectively and reliably predicted recurrent instability, progression to surgery, and the development of OA in patients with ASI. After careful external validation, these models can be incorporated into open-access digital applications to inform patients, clinicians, and researchers regarding quantifiable risks of relevant outcomes in the clinic.
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Affiliation(s)
- Yining Lu
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Ayoosh Pareek
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Ryan R Wilbur
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Devin P Leland
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Aaron J Krych
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Christopher L Camp
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
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49
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Longo UG, Papalia R, Ciapini G, De Salvatore S, Casciaro C, Ferrari E, Cosseddu F, Novi M, Piergentili I, Parchi P, Scaglione M, Denaro V. Instability Severity Index Score Does Not Predict the Risk of Shoulder Dislocation after a First Episode Treated Conservatively. Int J Environ Res Public Health 2021; 18:12026. [PMID: 34831778 DOI: 10.3390/ijerph182212026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 10/18/2021] [Accepted: 11/12/2021] [Indexed: 11/17/2022]
Abstract
The first purpose of this study was to verify the association between Instability Severity Index Score (ISIS) and Recurrent Shoulder Dislocation (RSD) after a first episode treated conservatively. The second aim is to identify the risk factors associated with RSD after a primary acute shoulder anterior dislocation treated conservatively. A total of 111 patients with first traumatic anterior shoulder dislocation treated at a single trauma centre between January 2014 and March 2016 were enrolled. The main predictive variables of risk factors and the ISIS score were calculated. Among the 85 patients included, 26 cases of RSD were observed (30.6%). Considering the whole population, no significant association between ISIS and RSD were reported. Regarding other risk factors, high-risk working activities and rotator cuff injury had a significantly higher RSD risk. Sex, dominant limb, familiar history, hyperlaxity, contact or overhead sports, competitive sport, post-reduction physiokinesitherapy, return to sports activity time, Hill-Sachs lesion, bony Bankart lesion and great tuberosity fracture did not seem to influence the risk of RSD. No correlation between ISIS score and RSD in patients treated conservatively after a first episode of shoulder dislocation were reported. The only risk factors with a significant association to RSD were high-risk working activities and rotator cuff injury.
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50
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Sharif W, Elubous KA, Sharif Z, AlRyalat SA, Al Hawamdeh HE, Abu-Rumaileh MA, Khanfar A, Al Bdour MD, Ababneh OH. Association Between Keratoconus and Shoulder Dislocation: A Cross-Sectional Study. Cureus 2021; 13:e19279. [PMID: 34754705 PMCID: PMC8570123 DOI: 10.7759/cureus.19279] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2021] [Indexed: 11/05/2022] Open
Abstract
Introduction Few studies have highlighted the correlation between shoulder dislocation and keratoconus (KC). This study aimed to examine the association between KC and shoulder dislocation using patients with KC and matched controls. Methods This cross-sectional study was conducted at Jordan University Hospital. We included patients diagnosed with KC from Jordan University Hospital's Ophthalmology Department between 2015 and 2018. We also included age- and sex-matched controls recruited randomly from fitness centers and shopping malls. All participants had complete ophthalmic and orthopedic assessments. KC was diagnosed by clinical examination followed by Pentacam (Scheimpflug Images, Oculyzer, WaveLight, Alcon, USA) confirmation. Results A total of 238 patients, with a mean age of 29.53 (±11.20) years, were included in this study. They were 144 (60.5%) men and 94 (39.5%) women. Moreover, 120 (50.4%) had KC while 118 (49.6%) did not have KC. Only 11 (4.6%) patients had previous shoulder dislocation. We did not find a significant difference in the frequency of shoulder dislocation between patients with and without KC (p = 0.512). Conclusion This study provides further evidence on the lack of association between shoulder dislocation and KC, an association that was presumed due to shared collagen characteristics.
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Affiliation(s)
- Walid Sharif
- Department of Ophthalmology, Jordan University Hospital/The University of Jordan, Amman, JOR
| | - Khaled A Elubous
- Department of Ophthalmology, Jordan University Hospital/The University of Jordan, Amman, JOR
| | - Zuhair Sharif
- Department of Ophthalmology, Jordan University Hospital/The University of Jordan, Amman, JOR
| | - Saif Aldeen AlRyalat
- Department of Ophthalmology, Jordan University Hospital/The University of Jordan, Amman, JOR
| | - Hashem E Al Hawamdeh
- Department of Orthopaedics, Jordan University Hospital/The University of Jordan, Amman, JOR
| | | | - Aws Khanfar
- Department of Orthopaedics, Jordan University Hospital/The University of Jordan, Amman, JOR
| | - Muawyah D Al Bdour
- Department of Ophthalmology, Jordan University Hospital/The University of Jordan, Amman, JOR
| | - Osama H Ababneh
- Department of Ophthalmology, Jordan University Hospital/The University of Jordan, Amman, JOR
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