Sex and Age-Specific Analysis of Basketball-Related Shoulder Dislocations in the United States: A National Injury Data Review.

HYPOTHESIS/PURPOSE: Basketball-related shoulder dislocations frequently present to emergency departments (EDs) in the US. This study aimed to identify the primary mechanisms, distributions, and trends of these injuries. METHODS: All data was extracted from the National Electronic Injury Surveillance System (NEISS), a public database representing approximately 100 US EDs. NEISS was queried for all basketball-related injuries and shoulder dislocations from January 1, 2013 to December 31, 2022. Clinical narratives were used to assign injury mechanisms and the presence of player contact. RESULTS: Between 2013 and 2022, 52,417 basketball-related shoulder dislocations were reported. 30.9% of all basketball-related shoulder injuries were dislocations, and 30.5% of all joint dislocations occurred at the shoulder. Basketball-related shoulder dislocations decreased significantly from 2013-2022 (p<.001). From 2019 to 2020, a 31.0% decrease was identified. The most common mechanism of shoulder dislocation was falling (36.9%). Males accounted for 92.5% of all shoulder dislocations. However, females were significantly more likely than males to dislocate their shoulders from player contact (15.5% of female dislocations v. 10.0% of male dislocations, p<.001). Only 0.2% of all dislocations resulted in hospitalization. 10.4% of dislocations resulted from contact with another player. Compared to other age groups, young adults (43.3%) and adolescents (42.7%) presented with the majority of shoulder dislocations. Children were more likely to dislocate their shoulder from sustaining a direct blow (25.5%), while all other age groups were more likely to have fallen. Children were also the most likely to sustain a dislocation involving player contact (23.9%). CONCLUSION: Basketball-related shoulder dislocations decreased significantly from 2013 to 2022. Females and children were significantly more likely to present with a dislocation by sustaining player contact. Across all demographics, teaching athletes how to break their falls safely may decrease rates of dislocation by minimizing impacts on a posteriorly outstretched arm.

Han's technique: a new reduction technique for acute anterior shoulder dislocation.

INTRODUCTION: Acute anterior shoulder dislocation (AASD) is the most common joint dislocation. Here, we introduced a new reduction technique for AASD, named "Han's technique" (or "Touch overhead technique"). METHODS: Patients diagnosed with AASD were treated with "Han's technique" in the orthopaedic department of our hospital from October 2018 to November 2020. An orthopedic surgeon performed the reduction maneuver without any anesthesia or sedation throughout the reduction process. The fundamental information and related data were recorded, including patients' age, sex, dislocation side, previous dislocations history, reduction time, number of attempts at reduction, success rate of the reduction, intensity of pain during reduction using the 10-point visual analogue scale score (VAS), any complications, with or without the fracture and neurovascular examination results. RESULTS: Forty-one patients with AASD were involved in our study. Thirty-nine cases (95%) were primary dislocation. Eleven patients (27%) were complicated with large tubercle fracture and one patient (2%) complicated with inferior glenoid fractures. All patients were successfully reduced by Han's technique with mean reduction time was 138 s. The pain score during the reduction operation is only1.83 ± 0.83 points. No neurovascular injury or iatrogenic fracture was found after reduction in all patients. CONCLUSIONS: Han's technique (or Touch overhead technique) is a simple, safe, effective, mild and easy to master which can be operated by one surgeon without anesthesia or sedation for AASD.

Which factors influence the ED length-of-stay after anterior shoulder dislocations: a retrospective chart review in 716 cases.

BACKGROUND: Anterior shoulder dislocations (ASD) are commonly seen in Emergency Departments (ED). ED overcrowding is increasingly burdening many healthcare systems. Little is known about factors influencing ED length-of-stay (LOS) for ASD. This study defines the factors influencing ED LOS for ASD patients. METHODS: Retrospective chart reviews were performed on all patients ≥12 years admitted with an anterior shoulder dislocation at two regional hospitals in the Netherlands between 2010 and 2016. The electronic patient records were reviewed for baseline patient characteristics, trauma mechanism, reduction methods, medication used, complications and the LOS at the ED. The main objective was determining factors influencing the LOS in patients with an anterior shoulder dislocation at the ED. RESULTS: During the study period, 716 ASD occurred in 574 patients, 374 (65.2%) in males. There were 389 (54.3%) primary ASD; the remainder (327, 45.7%) were recurrent. Median LOS was 92 min (IQR 66 min), with a significantly shorter LOS in those with recurrent dislocations (p < 0.001), younger age group (p < 0.03) and in patients who received no medications in the ED (p < 0.001). Traction-countertraction and leverage techniques were associated with a significant more use of ED medication compared to other techniques. Although the use of more medication might suggest the LOS would be longer for these techniques, we did not find a significant difference between different reduction techniques and LOS. CONCLUSION: To our knowledge this study is the largest of its kind, demonstrating ED LOS in ASD patients is influenced by age, the need for medication and dislocation history, primary versus recurrent. Notably, we found that biomechanical reduction techniques, which are not primarily traction-countertraction or leverage techniques, e.g. scapular manipulation and Cunningham, were associated with less ED medication use. Further research is needed to define how reduction methods influence ED medication use, patient satisfaction and ED throughput times.

The Elbow Technique: A Novel Reduction Technique for Anterior Shoulder Dislocations.

BACKGROUND: Anterior dislocation of the glenohumeral joint is a common upper extremity injury in orthopedic and emergency medicine. The aim of this study was to introduce a novel reduction technique, "elbow technique," for anterior shoulder dislocations. DISCUSSION: This study included 26 patients with anterior shoulder dislocation who were treated using the elbow technique in our hospital's emergency department between October 2014 and December 2015. One orthopedic physician performed the reduction maneuver and the vast majority of the patients were sedated. Patients who presented with posterior shoulder dislocation, remained dislocated for more than 7 days, who had Neer three or four parts proximal humerus fractures, and who had received previous shoulder surgery were excluded from this study. Twenty-one dislocations (80% of the patients) were primary. Six patients (23% of the dislocations) had associated fractures of the greater tuberosity. All of the patients were successfully reduced with the elbow technique. Mean time for reduction was 5 s (range 3-69 s). No iatrogenic fractures or neurovascular injuries were noted after the reductions. CONCLUSIONS: The elbow technique involves traction, leverage, pulsion, and can be performed by a single operator. The elbow technique is a safe, elegant, simple, effective, fast, and gentle reduction procedure for anterior shoulder dislocations in the emergency department.

Results of the Latarjet coracoid bone block procedure performed by mini invasive approach.

INTRODUCTION: The coracoid block technique described by Latarjet was modified by Patte and Walch in order to increase the glenoid surface. Saragaglia further modified this technique and described a minimally invasive approach which allows faster post-operative recovery. The aim of this study was to evaluate the medium-term functional and radiological results of this technique. METHODS: This is a single surgeon cohort of 40 shoulders in 38 patients (32 men, 6 women) with an average age of 34.5 years operated on between January and December 2014. The skin incision was 3 to 6 cm long allowing the bony block to be passed under the subscapularis tendon without sectioning it and to be placed in lying position. The bone block was fixed with a 6.5 cancellous screw or a 7.0 cannulated screw. RESULTS: At an average follow-up of 48 months, there were no recurrent dislocations. The average WOSI score was 42, the average Constant score was 95 corrected to 97% and the average SSV was 97. Visual analogue scores were 0 at rest and 0.6 with activity. The bone block healed in 92.5% of cases. It was flush with the edge of the glenoid in 84% of cases, lateralised in 10% and medialised in 6% of cases. Mean internal rotation power was 12 kg in the operated shoulder compared with 9 kg in the non-operated shoulder. CONCLUSION: The treatment of recurrent anterior shoulder instability by mini invasive Latarjet gives excellent medium-term functional results. The rate of recurrent dislocation in this series was zero and internal rotation power was well preserved. This is an excellent alternative to arthroscopic procedures which are yet to demonstrate their superiority over open surgery.

Hippocratic method for reduction of chronic locked anterior shoulder dislocations.

PURPOSE: Old shoulder dislocations are usually treated by a variety of surgical approaches. Closed reduction of chronic unreduced dislocation is less widely reported. This study was to evaluate the outcome of reduction of old anterior shoulder dislocations using the Hippocratic method. METHODS: Between January 2008 and July 2016, patients with unilateral old shoulder dislocations included 10 women and three men with an average age of 60.00 ± 2.83 years. Eight dislocations involved the right shoulder and five the left shoulder. The average delay between dislocation and treatment was 4.46 ± 0.97 weeks (ranging from 3 weeks to 6 weeks). One case also had a greater tuberosity fracture. No patients had distal nerve or artery dysfunction. The patients were all healthy prior to dislocation, i.e., no diabetes, hypertension, or heart disease, etc. Dislocations were diagnosed according to anteroposterior shoulder X­rays. Shoulder function was assessed using the Constant-Murley score. All manual reductions were conducted under general anesthesia using the Hippocratic method. RESULTS: All shoulder dislocations were successfully reduced with the Hippocratic method. The mean time of closed reduction was 31.46 ± 7.60 min and the mean hospitalization time was 2.77 ± 1.09 days. No neurovascular injury or humerus fractures were noted during hospitalization. The Constant-Murley scores before reduction and after reduction were 34.31 ± 7.25 and 60.92 ± 8.95, respectively. These scores were significantly higher after reduction compared with before reduction (P < 0.01). No recurrent dislocation was observed in any patients during the follow-up period. CONCLUSION: The closed reduction of old anterior shoulder dislocations using the Hippocratic method is not unfeasible and should be attempted in selected patients.

Effectiveness of the Cunningham technique for shoulder dislocation reduction and its role in providing analgesia and muscle relaxation as an adjunctive method.

BACKGROUND: Shoulder dislocation, particularly anterior dislocation, is a common orthopedic injury often presenting in emergency care settings, characterized by significant pain and muscle spasms. Prompt reduction is essential to alleviate symptoms and restore function. The Cunningham technique employs gentle pulling and massage motions targeted at the muscles and has emerged as a promising method for reducing anterior shoulder dislocations. However, its reported success rates vary widely across studies, and questions remain regarding its efficacy, particularly in cases of failure. This study aims to evaluate the effectiveness of the Cunningham technique for reducing anterior shoulder dislocations and its potential role in providing analgesia and muscle relaxation as an adjunctive method. METHODS: A retrospective study was conducted on patients presenting with acute anterior shoulder dislocation at a single center. Reduction using the Cunningham technique was performed initially, followed by the external rotation technique if unsuccessful. Procedural sedation and analgesia were administered if the reduction was still not achieved, and shoulder dislocation reduction was performed again through the external rotation method. The patients' VAS scores were recorded and evaluated the Cunningham technique's effectiveness in reduction and whether it increases the effectiveness of other techniques applied for reduction by lowering the VAS score, even in cases where it is not effective. RESULTS: A total of 61 patients were included in the study. The reduction was performed using the Cunningham technique in 34.4% (21/61) patients, the external rotation technique in 47.5% (29/61) patients, and the external rotation technique with PSA in 18% (11/61) patients. Significant differences were observed in the duration of hospital stay among the three techniques, with ER with PSA resulting in the longest stay. VAS scores showed significant improvements from initial presentation to post-reduction in all three groups. A significant decrease in pre-reduction VAS scores was observed during the transition from the Cunningham technique to other techniques. CONCLUSION: The Cunningham technique showed effectiveness in reducing anterior shoulder dislocations, providing analgesia, and muscle relaxation. It demonstrated favorable outcomes as an initial reduction technique, with the external rotation technique used as a subsequent option. Further studies comparing the success rates and complications of the Cunningham technique with other reduction methods are warranted to establish its role in clinical practice.

Use of Handheld Bedside Ultrasound to Confirm Successful Reduction of an Anterior Shoulder Dislocation.

We present the case of a 30-year-old male with anterior shoulder dislocation in which a bedside handheld ultrasound was used after sedation and a reduction procedure to confirm successful reduction. X-ray imaging as well as bedside ultrasound was performed before and after the reduction. The bedside handheld ultrasound demonstrated findings comparable to the X-ray results. X-ray imaging is used as a standard not only in the diagnosis of a dislocated shoulder but also to ensure successful reduction and to assess for any procedure-related fractures. An advantage of immediate bedside ultrasound is that immediate recognition by ultrasound of an unsuccessful reduction can allow the reduction process to continue while the patient is sedated, thus avoiding additional independent sedation procedures. The utilization of bedside ultrasonography in this manner may allow more expeditious and safer care for patients with shoulder dislocations.

A Locked Posterior Shoulder Dislocation: An Injury Not to Miss.

Locked posterior shoulder dislocations are dislocations that remain unreduced for more than three weeks. In most cases, they are associated with other injuries. We report the case of a 38-year-old male who presented with pain and total functional impotence due to a complex injury, including posterior glenohumeral dislocation, a reverse Hill-Sachs lesion, and a clavicle fracture. Because of the unsuccessful attempts at closed reduction, the patient underwent surgery. We performed the McLaughlin technique, which included the transfer of the subscapularis tendon to the reverse Hill-Sachs lesion, stabilized by bone anchors. At the last follow-up, the patient was doing well and had regained full range of motion with no recurrent dislocation. Clinicians should maintain clinical and radiological suspicion about this injury to timely manage this rare and dangerous injury.

Bristow-Latarjet Surgery: A Current Overview in Brazil.

Objective To provide a current overview of the Bristow-Latarjet surgery in Brazil. Materials and Methods This cross-sectional study was based on an electronic questionnaire with 26 items, which was sent to active members of the Brazilian Society of Shoulder and Elbow Surgery (Sociedade Brasileira de Cirurgia do Ombro e Cotovelo, SBCOC, in Portuguese). The questionnaire addressed training, surgical technique, complications, and postoperative management. Results We sent the questionnaire to 845 specialists from April 20 to May 12, 2021, and 310 of them answered i in full. During their specialization, most specialists participated in up to ten Bristow-Latarjet procedures. The most frequent complication was graft fracture, while the most common technical difficulty was screw positioning. In total, 50.6% and 73.9% reported having experienced intraoperative and postoperative complications respectively; 57.1% declared performing subscapularis suture; 99.7% indicated postoperative immobilization; and 61.9% considered graft consolidation fundamental. Conclusion Most specialists participated in up to ten Bristow-Latarjet procedures during the specialization, but 13.5% of them graduated without participating in the surgery. The most frequent complication was graft fracture. The most common technical difficulty was screw positioning. Most participants prefer postoperative immobilization since they believe graft consolidation is essential to resume the practiced of sports. The highest complication rate occurred with specialists who have obtained their titles 11 to 15 years ago. In Brazil, the Southeast region is the largest producer of specialists and has the highest concentration of these professionals.

Horizontal instability after acromioclavicular joint reduction using the two-hole technique is preferred over the loop technique: a single-blind randomized clinical trial.

BACKGROUND: Most acromioclavicular joint (ACJ) injuries are caused by direct trauma to the shoulders, and various methods and techniques are used to treat them; however, none of the options can be considered the gold standard. This study examines the horizontal stability of the ACJ after a complete dislocation was repaired using one of two Ethibond suture techniques, the loop technique and the two holes in the clavicle technique. METHODS: In this single-blind, randomized clinical trial, 104 patients diagnosed with complete ACJ dislocation type V were treated using Ethibond sutures with either the loop technique or the two holes in the clavicle technique. Horizontal changes in the ACJ were radiographically assessed in the lateral axial view, and shoulder function was evaluated by the Constant (CS) and Taft (TS) scores at intervals of 3, 6, and 12 months after surgery. RESULTS: The horizontal stability of the ACJ was better with the two-hole technique than the loop technique at all measurement times. CS and TS changes showed a significant upward trend over time with both techniques. The mean CS and TS at the final visit were 95.2 and 11.6 with the loop technique and 94.0 and 11.9 with the two-hole technique, respectively. The incidence of superficial infections caused by the subcutaneous pins was the same in the two groups. CONCLUSIONS: Due to the improved ACJ stability with the two-hole technique, it appears to be a more suitable option than the loop technique for AC joint reduction.

[Comparison of the efficacy between open and arthroscopic Latarjet procedure in the treatment of anterior shoulder instability:a Meta-analysis].

OBJECTIVE: To compare the clinical efficacy between open and arthroscopic Latarjet procedure in the treatment of anterior shoulder instability by using Meta-analysis. METHODS: Search PubMed, Medline, Embase, Cochrane, China National Knowledge Infrastructure(CNKI), Wanfang database, China Biological Literature system(CBM) and VIP database. Review all retrospective or prospective cohort studies and randomized controlled trials on open and arthroscopic Latarjet procedure for anterior shoulder instability. Binary variables (postoperative recurrence rate, incidence of intraoperative and postoperative complications) and continuousvariables [shoulder external rotation range of motion, Walch-Duplay score, Rowe score, WOSI score, postoperative visual analogue scale (VAS), postoperative anxiety degree and operation time] were selected for analysis. NOS bias risk assessment criteria (recommended by Cochrane collaboration Network) were used to evaluate the literature quality of retrospective or prospective cohort studies, and modified Jadad scale was used to evaluate the quality of randomized controlled trials. Literature screening, literature quality evaluation and data extraction were carried out independently by two observers. RevMan 5.3 software was used for Meta analysis. RESULTS: (1)A total of 9 studies were included, including 8 retrospective cohort studies and 1 prospective cohort study. A total of 956 patients were included in this study, including open Latarjet procedure(n=436) and arthroscopic Latarjet procedure(n=520). (2)The postoperative WOSI score in the open group was better than that of arthroscopic group (MD=93.74, 95%CI:26.00 to 161.49, P=0.007), and the α angle was smaller than arthroscopic group(MD=-6.44, 95%CI:-12.08 to 0.81, P=0.02). (3)The recurrence rate of open Latarjet group was lower than that of arthroscopic Latarjet group, but there was no significant difference between the two groups (OR=0.84, 95%CI:0.23 to 3.05, P=0.79). (4)There were no significant difference in shoulder external rotation, Walch-Duplay score, Rowe score, postoperative visual analogue score, postoperative anxiety degree and operation time between open and arthroscopic Latarjet group. CONCLUSION: The arthroscopic Latarjet stabilisation shows satisfactory and comparable results to open procedure, and the postoperative recurrence and complication rates are low in both group. Both open and arthroscopic Latarjet procedure are reliable surgical procedures in the treatment of anteriorly shoulder instability. Arthroscopic procedure has longer learning curve than open procedure, the doctors may either choose arthroscopic or open Latarjet procedure based on personal skills and preference, as well as the patient's condition. However, all the literatures included in this study are cohort studies with low level of evidence. The research lack randomized controlled trials, and small sample size is small. In the future, randomized controlled studies with large sample size and high level of evidence are still needed to determine the efficacy difference between the two.

MR arthrography of the shoulder; correlation with arthroscopy.

BACKGROUND: Shoulder dislocation is a common injury, particularly in the younger population. Common long-term sequelae include pain, recurrence, and shoulder arthritis. Immediate and correct diagnosis following shoulder dislocation is key to achieving optimum outcomes. Although magnetic resonance arthrography (MRA) is frequently used for diagnosing shoulder instabilities, arthroscopy is still considered the gold standard. PURPOSE: This study aims to compare the diagnostic value of arthroscopy and MRA of the shoulder joint. MATERIALS AND METHODS: This retrospective study estimates the sensitivity and specificity of MRA of the shoulder. Data from patients who had undergone shoulder MRA and subsequent arthroscopy during a 5-year period were retrospectively collected. Sensitivity and specificity were calculated using the arthroscopic findings as the gold standard. Moreover, diagnostic accuracy was estimated using McNemar's test. RESULTS: In total, 205 cases were included from which 372 pathological findings were uncovered during the arthroscopic procedures as opposed to 360 findings diagnosed from the MRA images. The glenoid labral tear was the most common finding reported by MRA and arthroscopy. For the detection of glenoid labral tears on MRA, the sensitivity was 0.955 but with eight missed lesions; the specificity was 0.679. Capsular tears, rotator cuff tears, and cartilage lesions proved the most difficult to correctly diagnose using MRA with sensitivities of 0.2, 0.346, and 0.366, respectively. CONCLUSIONS: With a sensitivity of 95%, MRA is a valuable diagnostic tool for assessing shoulder instabilities, particularly when diagnosing labral lesions, including bony and soft-tissue Bankart lesions. Sensitivities and specificities for other glenohumeral lesions are less convincing, however.

Serial Changes in Perianchor Cysts Following Arthroscopic Labral Repair Using All-Suture Anchors.

BACKGROUD: Changes in perianchor cysts around the all-suture anchors, which demonstrate distinguished features from the biocomposite anchors, have not been revealed sufficiently. The purpose of this study was to investigate serial changes of perianchor cysts according to the location of the inserted anchor in the glenoid in arthroscopic labral repair using all-suture anchors. METHODS: We enrolled 43 patients who underwent computed tomography (CT) immediately postoperatively and CT arthrogram (CTA) at 1 year or 2 years after arthroscopic labral repair using a 1.3-mm all-suture anchor for recurrent anterior shoulder dislocation with or without a superior labral tear from anterior to posterior and a posterior labral tear. The mean diameter and tissue density (HU) of perianchor cysts were measured depending on the location in the glenoid. Clinical outcomes, labral healing, and redislocation rate were evaluated at 2 years after surgery. RESULTS: On functional assessment, the mean American Shoulder and Elbow Surgeons score and Rowe score improved statistically significantly after surgery (from 47.9 ± 14.3 preoperatively to 90.1 ± 9.6 postoperatively and from 45.3 ± 12.4 preoperatively to 92.2 ± 10.1 postoperatively, respectively; p < 0.01). Postoperative redislocations were found in 2 patients (4.7%). In radiological evaluation, the mean diameter of perianchor cysts at postoperative 1 year (3.24 ± 0.65 mm) was significantly larger than the immediate postoperative diameter; however, there was no significant difference between postoperative 1 year and 2 years (3.23 ± 0.57 mm). Tissue density at the center of cysts demonstrated no significant difference between 1 and 2 year postoperatively (107.7 ± 29.8 HU [superior], 99.7 ± 31.7 HU [anteroinferior], and 105.1 ± 25.0 HU [posterior] vs. 109.1 ± 26.1 HU [superior], 106.4 ± 30.3 HU [anteroinferior], and 111.0 ± 32.9 HU [posterior]). The mean diameter of perianchor cysts in the anteroinferior position was largest compared with that in superior or posterior positions. CONCLUSIONS: Perianchor cysts associated with all-suture anchors enlarged significantly within 1 year after arthroscopic labral repair regardless of the insertion location in the glenoid. However, the size and tissue density of perianchor cysts were similar at postoperative 1 and 2 years, and satisfactory stability and clinical outcomes were obtained.

Shoulder dislocations among high school-aged and college-aged athletes in the United States: an epidemiologic analysis.

HYPOTHESIS/BACKGROUND: Shoulder dislocations are common orthopedic injuries due to the mobile nature of the glenohumeral joint. High school and collegiate athletes are at particularly high risk for sustaining a dislocation event. Despite the prevalence of these injuries, there is a paucity in the literature regarding incidence of sports-related shoulder dislocations and mechanism of injury within these populations. Therefore, the aim of the present study was to (1) determine the incidence rate of shoulder dislocations in high school-aged and collegiate-aged athletes presenting to emergency departments (EDs) in the United States; (2) to determine the most common sports associated with shoulder dislocations; and (3) to compare the current rates and risk factors for shoulder dislocation with previous trends. METHODS: The National Electronic Injury Surveillance System is a statistically validated injury surveillance system that collects data from ED visits as a representative probability sample of hospitals in the United States. We queried the National Electronic Injury Surveillance System for the years 2015-2019 to examine the following variables for sports-related shoulder dislocations: patient age (high school = 13-17 years of age; collegiate = 18-23 years of age), sex, year of admission, and sport type. Using a weighted multiplier, annual incidence rates were estimated based on the US Census estimates and injury rates were compared by sex and age group across the study period. RESULTS: From 2015 to 2019, there were a total of 1329 athletic-related shoulder dislocations that presented to participating EDs. Of these, 698 (52.5%) shoulder dislocations occurred in collegiate athletes, while 631 (47.5%) occurred in high school athletes. Using weighted and adjusted estimates automatically generated by the National Electronic Injury Surveillance System database, this translates to 89,511 total athletic-related shoulder dislocations across the United States (95% confidence interval lower bound 68,224; 95% confidence interval upper bound 110,798). Male athletes demonstrated a higher proportion of shoulder dislocations (87%) than female athletes (13%). The most common sport-specific mechanisms of traumatic shoulder dislocation were basketball (24.1%), football (21%), soccer (7.1%), baseball (7.1%), and weightlifting (3.3%). CONCLUSION: Sports-related shoulder dislocations are frequent in high school-aged and college-aged athletes presenting to the ED. Interventions to reduce incidence of injury should be sport-specific and focus on those participating in contact and noncontact sports. Male athletes have disproportionately higher rates of dislocation. These findings are consistent with the previous epidemiologic trends in the literature that have examined the incidence of shoulder dislocations in this population.

Incidence of Cutibacterium acnes in arthroscopic Bankart repair for traumatic anterior shoulder instability.

BACKGROUND: We evaluated the detection rate of Cutibacterium acnes (C. acnes) for patients who underwent arthroscopic Bankart repair for traumatic anterior shoulder instability. METHODS: Study subjects included 36 patients who underwent arthroscopic Bankart repair. Skin swabs prior to antisepsis, intraoperative synovial swabs of the glenohumeral joint (immediately after incision and prior to wound closure), and the suture of the suture anchor were cultured. Evaluation criteria included the detection rate of C. acnes in multiple regions of the body. RESULTS: Using a skin swab culture test, C. acnes was detected in 63 of 108 samples (58.3%). The bacterium was detected in 2 of 36 samples (5.5%) and 4 of 36 (11.1%) in the synovial swab culture of the glenohumeral joint immediately after surgical incision and immediately before wound closure, respectively. In the suture culture of the suture used in the arthroscopic Bankart repair, C. acnes was detected in 1 of 36 samples (2.8%). CONCLUSIONS: C. acnes was detected in patients undergoing surgeries for shoulder instability. The relationship between C. acnes and the pathological condition of shoulder instability remains unknown.

The Emergent Evaluation and Treatment of Shoulder, Clavicle, and Humerus Injuries.

Shoulder pain is a common presentation in the emergency department. The list of differential diagnoses is broad. This article summarizes common diagnoses of shoulder pain, including bony, infectious, and connective tissue pathologies and their proper treatment. It also reviews which shoulder pain conditions are emergency diagnoses and need immediate treatment and which diagnoses need conservative management and outpatient follow-up.

Traumatic Bilateral Luxatio Erecta from a Sliding Injury Down a Ladder; A Rare Case Report and Literature Review.

Bilateral inferior shoulder dislocations also known as luxatio erecta is an extremely rare injury that is commonly complicated with injuries to the humeral head, glenoid, clavicle, scapula, rotator cuff, capsule, ligaments, brachial plexus, axillary artery and vein.  Our patient is a 66-year-old man who presented with both upper extremities above his head in a fixed abducted position after sliding down a ladder approximately 6-meters. Initial radiographs revealed both humeral heads to be located below the glenoid fossa with each humeral shaft parallel to the scapular spines.  Computed tomography (CT) revealed a right Hill-Sachs compression fracture (posterolateral humeral head) with a bony Bankart fracture (anteroinferior glenoid) and an avulsion fracture of the left acromion. Successful closed reduction was obtained.  Upon follow up, bilateral rotator cuff tears were suspected and confirmed with magnetic resonance imaging (MRI).  Early recognition, treatment and follow-up is essential to minimize complications.

Effectiveness of the Cunningham technique for shoulder dislocation reduction and its role in providing analgesia and muscle relaxation as an adjunctive method

ABSTRACT Background: Shoulder dislocation, particularly anterior dislocation, is a common orthopedic injury often presenting in emergency care settings, characterized by significant pain and muscle spasms. Prompt reduction is essential to alleviate symptoms and restore function. The Cunningham technique employs gentle pulling and massage motions targeted at the muscles and has emerged as a promising method for reducing anterior shoulder dislocations. However, its reported success rates vary widely across studies, and questions remain regarding its efficacy, particularly in cases of failure. This study aims to evaluate the effectiveness of the Cunningham technique for reducing anterior shoulder dislocations and its potential role in providing analgesia and muscle relaxation as an adjunctive method. Methods: A retrospective study was conducted on patients presenting with acute anterior shoulder dislocation at a single center. Reduction using the Cunningham technique was performed initially, followed by the external rotation technique if unsuccessful. Procedural sedation and analgesia were administered if the reduction was still not achieved, and shoulder dislocation reduction was performed again through the external rotation method. The patients' VAS scores were recorded and evaluated the Cunningham technique's effectiveness in reduction and whether it increases the effectiveness of other techniques applied for reduction by lowering the VAS score, even in cases where it is not effective. Results: A total of 61 patients were included in the study. The reduction was performed using the Cunningham technique in 34.4% (21/61) patients, the external rotation technique in 47.5% (29/61) patients, and the external rotation technique with PSA in 18% (11/61) patients. Significant differences were observed in the duration of hospital stay among the three techniques, with ER with PSA resulting in the longest stay. VAS scores showed significant improvements from initial presentation to post-reduction in all three groups. A significant decrease in pre-reduction VAS scores was observed during the transition from the Cunningham technique to other techniques. Conclusion: The Cunningham technique showed effectiveness in reducing anterior shoulder dislocations, providing analgesia, and muscle relaxation. It demonstrated favorable outcomes as an initial reduction technique, with the external rotation technique used as a subsequent option. Further studies comparing the success rates and complications of the Cunningham technique with other reduction methods are warranted to establish its role in clinical practice.

Bristow-Latarjet Surgery: A Current Overview in Brazil / Cirurgia de Bristow-Latarjet: Um panorama atual do Brasil

Abstract Objective To provide a current overview of the Bristow-Latarjet surgery in Brazil. Materials and MethodsThis cross-sectional study was based on an electronic questionnaire with 26 items, which was sent to active members of the Brazilian Society of Shoulder and Elbow Surgery (Sociedade Brasileira de Cirurgia do Ombro e Cotovelo, SBCOC, in Portuguese). The questionnaire addressed training, surgical technique, complications, and postoperative management. Results We sent the questionnaire to 845 specialists from April 20 to May 12, 2021, and 310 of them answered i in full. During their specialization, most specialists participated in up to ten Bristow-Latarjet procedures. The most frequent complication was graft fracture, while the most common technical difficulty was screw positioning. In total, 50.6% and 73.9% reported having experienced intraoperative and postoperative complications respectively; 57.1% declared performing subscapularis suture; 99.7% indicated postoperative immobilization; and 61.9% considered graft consolidation fundamental. Conclusion Most specialists participated in up to ten Bristow-Latarjet procedures during the specialization, but 13.5% of them graduated without participating in the surgery. The most frequent complication was graft fracture. The most common technical difficulty was screw positioning. Most participants prefer postoperative immobilization since they believe graft consolidation is essential to resume the practiced of sports. The highest complication rate occurred with specialists who have obtained their titles 11 to 15 years ago. In Brazil, the Southeast region is the largest producer of specialists and has the highest concentration of these professionals.

Resumo Objetivo Traçar um panorama atual da cirurgia de Bristow-Latarjet no Brasil. Materiais e Métodos Estudo transversal no qual um questionário eletrônico com 26 perguntas sobre aspectos de formação, técnica cirúrgica, complicações e manejo pós-cirúrgico foi enviado a membros ativos da Sociedade Brasileira de Cirurgia do Ombro e Cotovelo (SBCOC). Resultados Entre 20 de abril e 12 de maio de 2021, o questionário foi enviado a 845 especialistas, e obteve-se 310 respostas completas. Durante a especialização, a maior parte dos especialistas participou de até dez procedimentos de Bristow-Latarjet. A complicação mais frequente foi a fratura do enxerto, e a dificuldade técnica, o posicionamento dos parafusos. Ao todo, 50,6% já tiveram complicações no intraoperatório; 73,9% já tiveram complicações no pós-operatório; 57,1% fazem a sutura do subescapular; 99,7% indicam a imobilização no pós-operatório; e 61,9% consideram a consolidação do enxerto fundamental. Conclusão A maior parte dos especialistas participou de até dez procedimentos de Bristow-Latarjet durante a especialização, mas 13,5% se formaram sem ter participado de nenhuma cirurgia. A complicação mais frequente foi a fratura do enxerto. A dificuldade técnica mais frequente foi o posicionamento dos parafusos. Imobilização no pós-operatório é a preferência da maioria dos participantes, que consideram fundamental a consolidação do enxerto para o retorno ao esporte. O maior número de complicações ocorreu com especialistas que obtiveram o título de 11 a 15 anos atrás. A região Sudeste é a maior formadora de especialistas e onde está concentrada a maior parte deles.