Conservative Treatment of an Isolated Greater Tuberosity Fracture With Dislocation: Management of Post-Traumatic Subacromial Impingement Syndrome and a Mini-Review of the Literature.

This case report evaluates the effectiveness of conservative treatment for an isolated greater tuberosity fracture-dislocation, detailing the treatment process and addressing post-traumatic subacromial impingement syndrome with a mini-review of the literature. A 26-year-old male fell from a height, resulting in a self-reduced dislocated shoulder. Examination revealed extensive ecchymosis, pain, and limited motion in the right shoulder. Radiological assessments showed an isolated greater tuberosity fracture, partial tears of the supraspinatus and subscapularis muscles, a suspected ALPSA lesion, and periarticular effusion. Initial treatment included a shoulder sling, passive elbow and wrist exercises, and pendulum exercises starting in the second week. At six weeks, persistent pain prompted TENS therapy and advanced rehabilitation exercises. At three months, the patient continued to experience pain and restricted shoulder movement. An MRI ruled out labral pathology, and a shoulder ultrasound revealed post-traumatic subacromial bursitis, leading to a diagnosis of subacromial impingement. A diagnostic ultrasound-guided injection of prilocaine into the subacromial bursa significantly improved the range of motion and alleviated pain within one hour. Treatment recommendations included avoiding overhead activities, NSAIDs, and continued rehabilitation. By six months, the patient had achieved a pain-free range of motion of 180 degrees. This case demonstrates that conservative treatment and appropriate rehabilitation can effectively manage isolated greater tuberosity fractures and associated glenohumeral joint dislocations. Early diagnosis and suitable rehabilitation strategies for post-traumatic subacromial impingement syndrome positively influenced the patient's recovery. Given the patient's youth and swimming background, steroid injections were avoided due to potential complications, with successful recovery achieved through NSAIDs, overhead activity restriction, and rehabilitation.

Does immobilization position after arthroscopic rotator cuff repair impact work quality or comfort?

PURPOSE: The purpose of this study was to quantify subjective discomfort and decrease in working performance in patients submitted to arthroscopic rotator cuff repair. METHODS: We enrolled 101 asymptomatic administrative employees (mean age 55). Subjects were asked to write a text using Microsoft Word and to make a table using Microsoft Excel, with and without shoulder braces which kept the right shoulder in neutral (brace A) and internal rotation (brace B). Total time needed to complete the tests and number of mistakes committed were annotated. Furthermore, a questionnaire to assess the subjective and interpersonal discomfort caused by the braces was compiled. Data were submitted to statistical analysis. RESULTS: When any brace is worn, both times and mistakes are higher than those registered without brace (p < 0.02). Both times and mistakes are higher for brace B in comparison with brace A (p < 0.02). Subjects wearing brace B had a severe/very severe discomfort degree three times higher than that registered in subjects wearing brace A. Finally, 91 % of subjects preferred brace A to brace B. DISCUSSION: If the choice of the brace is not supported by biological or clinical advantages, we recommend to use the brace that keeps the arm at the side, since it ensures better working performance and lower discomfort. It also received the greatest satisfaction of the respondents. LEVEL OF EVIDENCE: IV.

Shoulder Subluxation in Hemiplegia: Comparison of Therapeutic Effects of Four Different Types of Slings

The purpose of this study is to compare the effectiveness of the Rolyan, hemisling, remodified Bobath, and the newly designed triangular Bobath slings. Sixteen patients with a shoulder subluxation were evaluated by the simple shoulder AP X-rays with and without slings. The hemisling was applied with the elbow flexed at 90 and 120 degrees. The radiologic evaluation for the detection of shoulder subluxation was done by measuring the vertical and horizontal displacement on a plain AP view. The mean value of vertical displacement without a sling application was 5.21 cm which was reduced to 4.30 cm by a triangular Bobath sling application and 4.32 cm by a hemisling application at 120degrees elbow flexion. These two slings significantly corrected the vertical displacement, but other were not. In nine of sixteen patients, the triangular Bobath sling was the best sling for the vertical correction. All slings except a hemisling increased the horizontal displacement even though it was not statistically significant. The triangular Bobath sling improved the discomfort of the axilla better than the remodified Bobath sling. The results support that the triangular Bobath sling was the best among 4 slings for the correction of shoulder subluxation, although a reduction in lateral displacement and an improvement in applicability need to be explored further.