Long-Lever-Arm Manipulation Under Anesthesia With Resultant Traumatic Anterior Shoulder Dislocation.

The patient was a 61-year-old woman who underwent long-lever manipulation under anesthesia (MUA) for adhesive capsulitis. Two weeks following MUA, the constellation of clinical findings raised concern for possible adverse outcomes. Radiographs were obtained, as well as subsequent magnetic resonance imaging and computed tomography scans. Images revealed anterior shoulder dislocation with Bankart and Hill-Sachs lesions, and an anterior rotator cuff tear. J Orthop Sports Phys Ther 2016;46(8):707. doi:10.2519/jospt.2016.0412.

[Conservative therapy of acute locked posterior shoulder dislocation: clinical and radiological long-term results]. / Konservative Therapie der akuten verhakten posterioren Schultergelenkluxation: Klinische und radiologische Langzeitergebnisse.

BACKGROUND: Long-term results of conservative treatment of acute locked posterior shoulder dislocation with a reverse Hill-Sachs defect (Malgaigne lesion) <25% are rare. The aim of the present study was to evaluate the clinical and radiological results of patients after conservative treatment. MATERIAL AND METHODS: In this study 8 patients (8 male, average age 58.4 years) after non-operative treatment consisting of closed reduction and immobilization in 15° of external rotation were retrospectively clinically and radiologically examined (true anteroposterior, axillary and y view) The Constant score (CS), Rowe score (RS), Western Ontario shoulder instability index (WOSI) and the subjective shoulder value (SSV) were evaluated. RESULTS: After a mean follow-up of 5.4 years (range 5-7 years) no patient reported a redislocation or resubluxation or a persistent feeling of instability. None of the patients stated that they had to avoid certain movements or were limited in their everyday life. The clinical tests for posterior instability (jerk test/Kim test) were negative in all patients. The mean CS was 87.4 (range 42-98) points, the RS 96.4 (range 55-100) points, the WOSI 89.1% (range 41-100%) and the SSV 89.1% (range 50-98%). The radiological evaluation of the affected shoulder in true anteroposterior, axillary and y views showed signs of osteoarthritis (grade II according to Samilson and Prieto) in two cases. The humeral head was centered in all eight cases. CONCLUSIONS: Non-operative treatment of acute locked posterior shoulder dislocation demonstrated good to excellent clinical and radiological long-term results in this study. It represents the treatment of choice in patients with a reverse Hill-Sachs defect (Malgaigne lesion) < 25% and a duration of dislocation < 3 weeks.

Bilateral shoulder fracture dislocations and radiculopathies secondary to electrical injury (a case report).

INTRODUCTION: In this report a case of bilateral shoulder fracture dislocations and C5 radiculopathy developed after an electrical injury is presented. CASE: A 29 year-old male patient referred to our hospital with complaints of inability to raise his hands overhead starting 3 months ago after an electrical injury. The first physical examination revealed loss of strength (3/5) in deltoid muscles bilaterally, bilateral shoulder fracture dislocations and C5 radiculopathies. An open reduction and internal fixation (using K wire, cortical screw) procedure was applied for the right side in the Department of Orthopedics. Postoperatively active (A) and passive (P) ranges of motion (ROMs) were restricted extremely in the right and left shoulder respectively. Since applications of 15 sessions of electrical stimulation for deltoid muscle and physical treatment for both shoulders failed to achieve satisfactory ROMs, K wire extraction was instituted with resultant increase in the right shoulder A/P ROMs after 10 sessions of physical therapy postoperatively. At the last examination which was 18 months after the injury, ROMs of the right shoulder were increased, but not normal. CONCLUSION: It must be remembered that in electrical injury, fractures and dislocations might occur in affected sites without any evidence of trauma with associated neurologic complications, and that these cases must be promptly detected and managed without any delay.

Chronic shoulder dislocations.

Thirty-two patients with chronic dislocation of the shoulder were diagnosed over a 5-year period at King Edward VIII Hospital, Durban, South Africa. Thirty-one patients had an anterior subcoracoid dislocation. One patient had a chronic posterior dislocation. The duration of dislocation ranged from 6 days to 2 years. Six patients were epileptic, and it was an affliction of all ages. None of the patients had a vascular deficit, but 4 had neurologic damage on presentation. Closed manipulation was only successful in 1 patient. Ten patients' shoulders were left unreduced in the dislocated position. Twenty-one patients, including the patient with a single posterior dislocation, underwent open reduction. The author treated 10 patients with chronic anterior dislocations surgically. The coracoid was transferred to the glenoid, and acromiohumeral K-wire fixation was used for 4 weeks in this group. These 10 cases, as well as 5 cases left unreduced, were followed up for more than 2 years. The results were evaluated by the system proposed by Rowe and Zarins and showed that surgically treated patients fared better than those whose shoulders were left unreduced regardless of the duration of the dislocation or the age of the patient. This series differs from previous reports in several respects. All but one of the dislocations were anterior, the incidence of epilepsy was lower, and successful reduction by manipulation was rarely achieved. In all 10 cases in which the author performed the operation, the shoulder was successfully relocated without neurovascular complications. Dissection of the axillary vessels and nerves was never necessary.

[Nonoperative treatment of acute, grade III acromioclavicular dislocation in judo competing athletes]. / Nieoperacyjne leczenie ostrych zwichniec III stopnia stawu barkowo-obojczykowego u zawodników wyczynowo uprawiajacych judo.

Complete acromioclavicular separation is frequent injury during practice of judo. Fourteen athletes aged 17-33 (mean 23) were treated non-operatively. All patients received cryotherapy and Velpeau bandage for two weeks, intensive rehabilitation of the shoulder followed. The patients were reviewed after mean 4.5 years (range 3-7 years). A 100-point scale designed specifically for this study, inclusive of pain, function, strength, range of motion and return to preinjury level of sports activity was used for clinical assessment. Follow-up radiographs were compared to those taken immediately after injury but no correlation with clinical results has been found. Eight results were rated excellent (90-100 points), 5 results good (80-89 points) and one result was fair (70-79 points). Short period of immobilization and early rehabilitation seems to be efficient management in highly active individuals.

Shoulder subluxation in hemiplegia: effects of three different supports.

Shoulder subluxation in hemiplegia is a difficult problem to manage and it may be associated with pain and other complications. Measurements taken from x-rays have been used to obtain objective measures of shoulder subluxation, but have not been used to compare the effects of different shoulder supports. This study used x-ray measurements to evaluate different shoulder supports for subluxation in hemiplegia and to see if there was a significant difference between the Harris hemisling and the Bobath sling. The Harris hemisling gave good vertical correction of subluxation and compared closely to the uninvolved shoulder. The Bobath sling did not correct the subluxation as well, and the mean difference between the two slings was significant. The arm trough or lap board was less effective and tended to overcorrect. The Harris hemisling and arm trough or lap board had horizontal measurements similar to the uninvolved shoulders. The Bobath sling, however, distracted the glenohumeral joint horizontally and was more variable. The mean horizontal difference between the Harris hemisling and the Bobath sling was significant. These results support the effectiveness and specificity of shoulder support to decrease subluxation after hemiplegia.