Comparison of Surgical Techniques Used in Treating Acromioclavicular Dislocation in Patients Participating in Sports: A Systematic Review

Introduction: The acromioclavicular joint is a superficial diarthrodial joint that surrounds the medial articular facet of the acromion and the distal portion of the clavicle. Due to its anatomy and biomechanics, it is highly susceptible to trauma and in young men who play contact sports, acromioclavicular dislocation is common. This article aimed to systematically review the literature and compare the surgical techniques used in the treatment of acromioclavicular dislocation in patients who practice sports. Methods: This systematic review was conducted according to the International Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. Eligible studies for this systematic review included articles in English or Spanish published between 2013 and 2023, which mention the occurrence of acromioclavicular dislocation during sports practices. Additionally, only studies that addressed the surgical treatment of acromion-clavicular dislocation and contained original data on the topic were included. Results: We found 144 eligible studies after searching the LILACS and PubMed databases. Based on the inclusion and exclusion criteria and the reviewers’ consensus, we selected four studies for the systematic review. 133 patients with AC joint displacement were evaluated. Mean Age: approximately 31.90 years. 81.92 of these injuries occurred during sports practice. Surgical Procedures Used: titanium plates fixation (49 patients), arthroscopy (24), single tunnel technique (30) and coracoid sling technique (30). The results of the visual analog scale and Constant-Murley scores varied between the techniques used. Twenty-two complications after surgical treatment were identified. Conclusion: A significant variability of operative techniques can be used in the surgical approach of acromioclavicular dislocation, such as arthroscopy, single tunnel, coracoid sling and titanium plates. Although it presented excellent functional results compared to the other three techniques evaluated by this review, using titanium plates is not the gold standard since other techniques not assessed by this work may be more effective.

Recent Traumatic Dislocations of the Shoulder in Adults: Epidemiological, Therapeutic and Evolutionary Aspects

Introduction: Shoulder dislocations represent about 50% of all joint dislocations. The objective was to describe the epidemiological, therapeutic and evolutionary aspects of traumatic shoulder dislocations in Bouaké. Methods: This retrospective and descriptive study was conducted between January 2017 and December 2019. It concerned patients over 15 years of age with a recent traumatic shoulder dislocation treated and followed in the department. The variables studied were epidemiological, therapeutic and evolutionary. The severity of the trauma was assessed according to the Injury Severity Score (ISS). Functional outcome was assessed according to the Constant score. Results: There were 49 patients (49 dislocations) out of 22,569 patients. The prevalence was 0.2%. The mean age was 32 years (17 - 62). There were 38 men (77.5%). The sex ratio was 3.4. Students predominated (n = 10;20.4%). The etiology was dominated by road traffic accidents (n = 19;38.8%). Anterior dislocation was the most common (n = 45;92%). The ISS score was minor (n = 46;93.8%). The mean time to reduction was 7 hours (4 - 16). Orthopaedic reduction using the Kocher technique predominated (n = 44;89.8%). The mean duration of external rotation immobilisation of the shoulder was 23 days (16 - 45). Recurrence occurred in 8 patients (21.6%). The functional outcome at a mean Constant follow-up of 15 months (8 - 20) was satisfactory (n = 44;89.8%). Conclusion: Traumatic dislocation of the shoulder represented 0.2%. Treatment was mainly orthopaedic. Recurrence was rare.

Epidemiology of shoulder dislocations presenting to United States emergency departments:An updated ten-year study

BACKGROUND Glenohumeral dislocation is a common injury that may predispose patients to chronic pain and instability.However,there is a paucity of current data available regarding the epidemiological trends of this injury.AIM To provide an updated,comparative assessment of the epidemiology of shoulder dislocations presenting to emergency departments in the United States.We also sought to analyze patient demographic risk factors and consumer products associated with dislocation events.METHODS Data were obtained from the national electronic injury surveillance system database for glenohumeral dislocations between 2012 and 2021.Incidence,age,sex,and injury characteristics were analyzed using weighted population statistics as well as incidence rates and 95%confidence intervals(CI).RESULTS In total,an estimated 773039 shoulder dislocations(CI:640598-905481)presented to emergency rooms across the United States during the study period.The annual incidence rate was 23.96 per 100000 persons and the average patient age at the time of injury was 37.1 years.Significantly more male patients sustained dislocations than female patients(537189,69.5%,vs 235834,30.5%,P<0.001).With regard to associated consumer products,sports and recreation equipment were involved in the highest proportion of incidents(44.31%),followed by home structures and construction materials(21.22%),and home furnishings,fixtures,and accessories(21.21%).Regarding product sub-groups,stairs,ramps,landings,floors was cited in the greatest number of cases(131745).CONCLUSION The national annual incidence rate of glenohumeral dislocations throughout the study period was approximately 23.92 per 100000 persons.Male adolescents sustained the highest proportion of dislocations,with a peak incidence in age group 15-20 years,predominantly secondary to participation in sporting and recreational activities.Conversely,women experienced a relatively consistent incidence of dislocation throughout their lifespan.After age 63,the incidence rate of dislocations in females was found to surpass that observed in males.

Locked Posterior Shoulder Dislocation with Impression Fracture Treated All Arthroscopically with the Use of an Allograft Bone Block: A Case Report

Background: Locked posterior shoulder dislocations are uncommon and possess many difficulties in diagnosis. They are often overlooked during the initial examination and delayed diagnosis adversely affects healing process. Apart from many open treatment options, there are reports of single attempts to treat such cases arthroscopically. Purpose: We present an original case of a posterior locked dislocation of the shoulder joint with a fracture of the lesser tuberosity followed by reverse Hill-Sachs fracture, treated in a novel fashion all-arthroscopically with the use of allogenic bone graft. Method: According to Constant Shoulder Score that tries to assess functional and subjective performance of the shoulder joint before the operation and after 12 months, we achieved a leap from 11 to 84. Results: The patient restored almost full range of motion and painless movement in activities of daily life as well as during sports. Conclusion: The use of an arthroscope reduces the invasiveness of the procedure, improves visualization of the joint and allows augmentation of the bone loss without performing an open approach. We believe that this is a promising method of treatment for selected cases of locked posterior shoulder dislocation.

Comparison of sedative effectiveness of thiopental versus midazolam in reduction of shoulder dislocation

BACKGROUND: Various sedative drugs have been proposed to control anxiety and agitation in shoulder dislocation, but none of them has been diagnosed as the best sedative and relaxant agent. The study aimed to compare the sedative effectiveness of thiopental versus midazolam in reduction of shoulder dislocation.METHODS: A randomized double-blind controlled trail was performed in 80 patients with shoulder dislocation recruited from the emergency department. Ten patients were excluded and 70 patients were enrolled in the study. Case group received intravenous thiopental 2 mg/kg+2 μg/kg fentanyl while control group received intravenous midazolam 0.1 mg/kg+2 μg/kg fentanyl. Number of times, patients and physician's satisfaction, difficulty of procedure, degree of muscle relaxation, time of sedation and complete recovery, number of patients with apnea episode, O2 saturation, patient's pain score and adverse events were all recorded.RESULTS: Muscular tone had significant difference between the two groups(P-value=0.014) and thiopental was more muscle relaxant than midazolam. Replacement of shoulder dislocation in thiopental group was easier than midazolam group(P-value=0.043). There was no need to use multiple methods of reduction in either group. Before drug infusion the mean±SD VAS scores were 8.37±2.21 in the midazolam group(A) and 8.94±1.78 in the thiopental group(B); mean difference 0.57, 95% CI= –0.38 to 1.52. After completion of the procedure, the mean±SD VAS scores in group(A) and(B) were 3.20±1.30 vs. 3.65±1.30; mean difference –0.45, 95% CI= –1.07 to 0.16.CONCLUSION: Thiopental might be more effective and relaxant than midazolam for reduction of shoulder dislocation.

Irreducible Traumatic Anterior Shoulder Dislocation Secondary to Both Subscapularis and Long Head of Biceps Tendon Interposition—A Case Report

An Irreducible dislocation of the shoulder is an uncommon event. When it does occur, blocks to reduction can include bone, labrum, rotator cuff musculature or tendon. Patients older than 40 at the time of initial dislocation are at increased risk of sustaining a concomitant rotator cuff tear. We present a case of an irreducible anterior shoulder dislocation due to interposition of both subscapularis tendon and a posteriorly dislocated long head of biceps. Both Computed Tomography (CT) and magnetic resonance imaging (MRI), along with intraoperative findings are discussed. Conclusion: We would advocate maintaining a low threshold for MR imaging post shoulder dislocation in the older population, when there is radiological or clinical concern regarding the integrity of the rotator cuff, and also to evaluate whether a concentric reduction of the shoulder joint has been achieved.

Inveterate Posterior Shoulder Dislocation Treated by Sub-Scapular Transfer, about One Case

Glena-humeral dislocation is rare. More than the half of those dislocations is unremarked because the diagnostic is not an emergency. A delayed diagnostic alters the functional prognostic and sometimes forces to do a complex surgery with complications whose success rate remains uncertain. We report a case of inveterate posterior shoulder dislocation on a 42-year-old adult occurred during a sport accident and treated by sub-scapulars transfer (modified Mac Laughlin’s technical). The aim of this article is to highlight this pathology to ameliorate its diagnostic rate indeed prognostic. Our diagnostic approach and injury, noticed during surgery and therapeutic propositions, are described at the light of literature data on this subject.

Complications of Surgical Treatment of Anterior Shoulder Dislocation:A Systematic Review

Introduction: shoulder joint has the greatest range of motion in the human body. The shoulder anatomy promotes high mobility and favors relative sacrifice of articular stability, making it susceptible and more prone to events of instability and dislocation. This review aimed at identifying main complications of surgical treatment of anterior shoulder dislocation. Methodology: This systematic review was conducted according to the International Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) guidelines. Studies which were eligible for this systematic review included: English or Spanish language, studies published from 2000, which mentioned surgical complications of anterior shoulder dislocation in their results, both in open and arthroscopic surgery. Included studies which were required to have at least 1 complication following surgical repair. Only studies from original data were included. Results: We found 228 potentially eligible studies for the survey. Through the inclusion and exclusion criteria and after consensus among reviewers, we chose 9 studies to compose the systematic review. Conclusion: Important information emerges: recurring instability, recurring dislocation, external rotation limitation and arthritis are main surgical complications of anterior shoulder dislocation.

Neurovascular complications due to the Hippocrates method for reducing anterior shoulder dislocations

In spite of the fact that the Hippocrates method hardly has been evaluated in a scientific manner and numerous associated iatrogenic complications have been reported, this method remains to be one of the most common techniques for reducing anterior shoulder dislocations. We report the case of a 69-year-old farmer under coumarin anticoagulant therapy who sustained acute first time anterior dislocation of his dominant right shoulder. By using the Hippocrates method with the patient under general anaesthesia, the brachial vein was injured and an increasing hematoma subsequently caused brachial plexus paresis by pressure. After surgery for decompression and vascular suturing, symptoms declined rapidly, but brachial plexus paresis still was not fully reversible after 3 mo of follow-up. The hazardousness of using the Hippocrates method can be explained by traction on the outstretched arm with force of the operator's body weight, direct trauma to the axillary region by the physician's heel, and the topographic relations of neurovascular structures and the dislocated humeral head. As there is a variety of alternative reduction techniques which have been evalu-ated scientifically and proofed to be safe, we strongly caution against the use of the Hippocrates method as a first line technique for reducing anterior shoulder dislocations, especially in elder patients with fragile vessels or under anticoagulant therapy, and recommend the scapular manipulation technique or the Milch technique, for example, as a first choice.

Open anterior glenohumeral dislocation with associated supraspinatus avulsion: A case report

BACKGROUND Open dislocation of the glenohumeral joint is a very rare complication with only six cases described in the literature. Most cases resulted in severe complications like avascular necrosis of the humeral head or septic arthritis with poor functional results. The "mandatory" treatment of choice is surgery, with accurate debridement and reconstruction of the damaged soft tissues. However, the results in these cases do not approach those seen in classical dislocations.CASE SUMMARY This case report is the first description of an anterior open glenohumeral dislocation without associated fractures, but with complete avulsion of the soft tissue envelope of the proximal humerus. Surgical treatment consisted of copious lavage with saline solution, meticulous debridement of the nonviable soft tissues,reduction of the dislocated humeral head and reconstruction of the soft tissue envelope of the humeral head. The selected surgical approach was an inferior extension of the wound at the level of the delto-pectoral groove, as the best choice to be able to perform an adequate debridement and capsulo-tendinous reinsertion. At 6 mo there were no clinical signs of instability of the glenohumeral joint, the functionality of the joint was restricted to 90o of anterior elevation,internal rotation to L2, with severe limitation of abduction(60o) and external rotation(0o) but without residual pain, with an Oxford shoulder Score of 28.CONCLUSION Thorough reconstruction of the soft tissues surrounding the shoulder joint and an early rehabilitation program are key points to a good functional result.

Bilateral dislocation of the long head of biceps tendon with intact rotator cuff tendon:A case report

BACKGROUND Dislocation of the long head of biceps tendon(LHBT)usually involves rotator cuff injury,and isolated dislocation with an intact rotator cuff is rare.Some cases of isolated dislocation have been reported.However,to the best of our knowledge,there has been no report of bilateral dislocation of the LHBT without rotator cuff pathology.CASE SUMMARY A 23-year-old male presented to our outpatient clinic with left side dominant pain in both shoulders.The patient had no history of trauma or overuse.The patient underwent intra-articular injection and physical therapy,but his symptoms aggravated.Based on preoperative imaging,the diagnosis was bilateral dislocation of the LHBT.Dysplasia of the bicipital groove was detected in both shoulders.Active dislocation of the biceps tendon over an intact subscapularis tendon was identified by diagnostic arthroscopy.Staged biceps tenodesis was performed and continuous passive motion therapy was administered immediately after surgery.The patient’s pain was resolved,and full functional recovery was achieved,and he was satisfied with the condition of his shoulders.CONCLUSION This study describes a rare case of bilateral dislocations of the LHBT without rotator cuff injury due to dysplasia of the bicipital groove.

Early rehabilitation of uncomplete dislocation of shoulder after stroke

Objective To investigate the clinical implications of early rehabilitative treatment for uncomplete dislocation of shoulder after stroke.Method 420 patients received the anti－ spasticity treatment of upper limb,protecting techniques and sling were also used for all patients.Result The recovery of uncomplete dislocation of shoulder after stroke was satisfying.Conclusion Early rehabilitative treatment was beneficial for the improvement of uncomplete dislocation of shoulder after stroke.

Combined bilateral asymmetric hip dislocation and anterior shoulder dislocation

BACKGROUND:Traumatic bilateral hip dislocation is a rare condition.Anterior shoulder dislocation combined with this condition is even a rare occurrence.A 57-year-old man had bilateral asymmetric hip dislocation with a posterior wall fracture of the left acetabulum associated with right shoulder anterior dislocation caused by falling down from a cherry tree.Traumatic hip dislocation and anterior shoulder dislocation represent a true orthopedic emergency.METHODS:Closed reduction was performed immediately for three of the dislocated joints.Posterior wall fracture of the left acetabulum was treated with open reduction and internal fixation by screws.Because of the severity of associated complications like aseptic necrosis or posttraumatic osteoarthritis,efforts were made to ensure prompt diagnosis,therapy and prognosis.RESULTS:The patient was successfully treated by open reduction and internal fixation of the left acetabulum,and discharged from the hospital.CONCLUSION:Traumatic asymmetric hip dislocation and anterior shoulder dislocation are an orthopedic emergency and early diagnosis with immediate reduction of the dislocation is the key determinants of excellent result of treatment.

Mechanisms of shoulder trauma: Current concepts

Acute traumatic injuries to the glenohumeral articulation are common.The types of injuries depend on age,muscle strength,bone density,and biomechanics of the traumatic event.Understanding the different mechanisms of trauma and how they affect the functional anatomical structures of the shoulder joint is crucial for the treatment of these lesions.Therefore,when clinicians have knowledge of these mechanisms they can accurately diagnose and treat shoulder pathology and predict distinct injury patterns.Here,we have described the fundamentals of the mechanisms of injury of the glenohumeral dislocation,dislocation with fracture of the humeral head,and the proximal humerus fracture.We have focused on common injury mechanisms and the correlation with radiological diagnostics.Radiological and laboratory findings of distinct types of injury were also discussed.

Reconstruction of Humeral Head Defect in Locked Posterior Dislocation Shoulder. A Case Series of Nine Patients

Locked posterior dislocation shoulder is uncommon and frequently missed injury. It account for 2% - 4% of all shoulder dislocations. It is commonly associated with osseous defects in humeral head articular surface known as reverse Hill-Sachs lesion. Numerous surgical procedures invented to repair this defect with variable outcomes but evidence based management strategies are lacking. Among these procedures are: transfer of lesser tuberosity or subscapularis tendon, rotational osteotomy of humerus, osteochondral grafts. Salvage procedure as hemiarthroplasty or total shoulder arthroplasty used in huge non-constructable defect or very old neglected dislocation. In our case series, we treated 9 cases (2 females) of locked posterior shoulder dislocation with antero-medial humeral head defects ranging between 30% - 50% of head size. Open reduction of dislocation followed by transfer of the lesser tuberosity together with subscapularis tendon for reconstruction of the humeral head defect. The transfer was fixed with Ethibond suture size 5-0 (Ethicon, Inc. Somerville, New Jersy). The mean follow-up period was 14.5 months (range, 12 - 25 months). Seven cases had no pain or restriction of activities of daily living. No patient had symptoms of instability of the shoulder. According to UCLA Shoulder rating scale, there were 3 cases rated excellent, 4 cases rated good, one case rated fair and one case rated poor. It is concluded that reconstruction of the humeral head defect provides good pain relief, stability and function for patients with a locked posterior dislocation where the defect involves between 30% - 50% of the articular surface circumference. Our technique is simple, cheap and there is no need for second operation for hardware removal.

Bilateral Anterior Shoulder Fracture-Dislocation: About a Case

Bilateral anterior dislocations of the shoulder are rare lesions. They are even rarer when combined with a bilateral fracture of major tubercles. We report the case of a 28-year-old patient admitted to trauma emergencies after trauma by falling from the top of a stool. Clinical and radiographic findings revealed bilateral anterior shoulder dislocation associated with bilateral fracture of major tubercles. The patient was treated orthopedically by a reduction of dislocations under General Anesthesia, immobilization of the shoulders for 6 weeks followed by reeducation. The functional result after 12 months was satisfactory with a UCLA score of 30 points.

Surgical interventions for anterior shoulder instability in rugby players: A systematic review

AIM: To systematically evaluate the evidence-based literature on surgical treatment interventions for elite rugby players with anterior shoulder instability. METHODS: We conducted a systematic review according to the PRISMA guidelines. A literature search was performed in PubM ed, EMBASE and Google Scholar using the following search terms: "rugby" and "shoulder" in combination with "instability" or "dislocation". All articles published from inception of the included data sources to January 1st 2014 that evaluated surgical treatment of elite rugby players with anterior shoulder instability were examined. RESULTS: Only five studies were found that met the eligibility criteria. A total of 379 shoulders in 376 elite rugby union and league players were included. All the studies were retrospective cohort or case series studies. The mean Coleman Methodological Score for the 5 studies was 47.4(poor). Owing to heterogeneity amongst the studies, quantitative synthesis was not possible, however a detailed qualitative synthesis is reported. The overall recurrence rate of instability after surgery was 8.7%, and the mean return to competitive play, where reported, was 13 mo.CONCLUSION: Arthroscopic stabilization has been performed successfully in acute anterior instability and there is a preference for open Latarjet-type procedures when instability is associated with osseous defects.

关节镜下“Chinese way”治疗老年肩关节脱位合并巨大肩袖撕裂的临床疗效

目的 评估“Chinese way”技术行上关节囊重建在关节镜下治疗老年肩关节脱位合并巨大肩袖撕裂的临床效果。方法 回顾性分析2019年5月至2022年1月在苏州大学附属第二医院收治的老年肩关节脱位后合并巨大肩袖撕裂的患者资料,纳入36例,男16例,女20例,年龄52~73岁,平均(62.3±4.7)岁,术中行肱二头肌长头腱转位,加强肩袖缝合。统计分析术前、术后的疼痛、肩关节活动度及肩关节功能评分,通过MR评估肩袖再撕裂率。结果 所有患者均获得随访,随访时间为17.6±4.5个月。末次随访时肩关节前屈、外展、体侧外旋、体侧内旋活动度较术前均有显著增加(P<0.05);末次随访VAS评分、ASES评分、Constant-Murley评分、UCLA评分较术前均有明显改善(P<0.05);无肩关节再次脱位发生,MR依据Sugaya标准提示5例(13.9%)肩袖再撕裂,UCLA评分优9例,良23例,差4例,优良率为88.9%。结论 关节镜下处理老年肩关节脱位合并巨大肩袖损伤时,采用“Chinese way”技术重建上关节囊,加强缝合肩袖组织,可有效避免肩袖再撕裂,解除肩关节疼痛,恢复肩关节功能并防止再次脱位。

手术治疗高龄肩关节多发骨折合并肩锁关节脱位1例

患者,男,80岁,车祸伤致左肩部疼痛活动受限半小时,于我院急诊行CT检查,显示左肩峰骨折、肩锁关节脱位、喙突基底部骨折、肩骨性Bankart损伤。入院排除其他手术禁忌证后,于2022年8月12日在全身麻醉下行左肩峰骨折钢板内固定+肩锁关节脱位钢板内固定+喙突基底部骨折空心钉内固定+肩骨性Bankart损伤带线锚钉内固定术。

带线锚钉重建喙锁韧带、肩锁韧带与锁骨钩钢板固定治疗肩锁关节脱位的疗效比较

目的比较带线锚钉重建喙锁韧带、肩锁韧带和锁骨钩钢板内固定两种术式治疗肩锁关节脱位的短期疗效差异。方法回顾性分析2018年1月至2023年6月广州市花都区人民医院手术治疗的59例RockwoodⅢ~Ⅴ型肩锁关节脱位患者的临床资料。患者根据手术方式的不同分入韧带重建组(使用带线锚钉重建喙锁韧带及肩锁韧带,n=27)和钢板内固定组(使用锁骨钩钢板固定,n=32)。比较两组患者的手术时间、术中出血量和住院时间,记录随访期间肩关节活动范围(ROM)、视觉模拟量表(VAS)评分和Constant-Merly评分,测量末次随访喙锁间距。结果患者获得6~26个月(平均11.3个月)随访。韧带重建组手术时间长于钢板内固定组(P<0.05);两组患者术中出血量、住院时间以及术后1、3个月VAS评分相近(P>0.05);韧带重建组患者术后6个月VAS评分,末次随访Constant-Merly总评分及肩关节活动范围、日常活动、疼痛程度3个分项评分均优于钢板内固定组(P<0.05),比较两组末次随访肩关节力量分项评分和喙锁间距,差异无统计学意义(P>0.05)。结论对于肩锁关节脱位患者,应用缝合锚钉重建喙锁韧带、肩锁韧带与锁骨钩钢板内固定两种术式均能获得良好疗效,其中韧带重建术式尽管手术时间相对较长,但在改善肩关节功能、提高生活质量等方面具有一定优势,同时可避免二次手术。