Cases reported "Shoulder Dislocation"

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1/297. brachial plexus lesions complicating anterior fracture-dislocation of the shoulder joint.

    Four cases of brachial plexus lesions caused by anterior fracture-dislocation of the shoulder are reported. The incidence, mechanism of injury and prognosis are reviewed. ( info)

2/297. Bilateral anterior dislocation of the shoulders: a case report.

    A case of bilateral subcoracoid dislocation of the shoulder is described and the clinical presentation commented on. ( info)

3/297. Bilateral anterior shoulder fracture-dislocation. A case report and a review of the literature.

    We report an unusual case of bilateral anterior shoulder dislocation following trauma. Previously reported cases were either of bilateral dislocations or bilateral fracture dislocations. In our case the patient suffered bilateral anterior dislocation with a three part fracture dislocation on the right. A review of the literature is presented. ( info)

4/297. CT imaging and three-dimensional reconstructions of shoulders with anterior glenohumeral instability.

    Glenohumeral instability is a common occurrence following anterior dislocation of the shoulder joint, particularly in young men. The bony abnormalities encountered in patients with glenohumeral instability can be difficult to detect with conventional radiography, even with special views. The aim of our study was to evaluate the bony abnormalities associated with glenohumeral instability using CT imaging with 3-D reconstruction images. We scanned 11 patients with glenohumeral instability, one with bilateral symptoms; 10 were male, one female, and their ages ranged from 18-66 years. Contiguous 3 mm axial slices of the glenohumeral joint were taken at 2 mm intervals using a Siemens Somatom CT scanner. In the 12 shoulders imaged, we identified four main abnormalities. A humeral-head defect or Hill-Sachs deformity was seen in 83% cases, fractures of the anterior glenoid rim in 50%, periosteal new bone formation secondary to capsular stripping in 42%, and loose bone fragments in 25%. Manipulation of the 3-D images enabled the abnormalities to be well seen in all cases, giving a graphic visualization of the joint, and only two 3-D images were needed to demonstrate all the necessary information. We feel that CT is the imaging modality most likely to show all the bone abnormalities associated with glenohumeral instability. These bony changes may lead to the correct inference of soft tissue abnormalities making more invasive examinations such as arthrography unnecessary. ( info)

5/297. Arthroscopic treatment of acute traumatic anterior glenohumeral dislocation and greater tuberosity fracture.

    We present a case and a description of treatment of an anterior dislocation of the shoulder with a greater tuberosity fracture. Both the Bankart lesion and the tuberosity fracture were repaired using arthroscopic techniques. ( info)

6/297. An operative technique for recurrent shoulder dislocations in older patients.

    Recurrent anterior shoulder dislocation in the elderly is not as exceptional as it was once thought to be. That anterior shoulder dislocation in older patients is caused by a rotator cuff tear through the posterior mechanism is well accepted. However, in the subset of patients who have multiple recurrent or intractable dislocations develop, there may be combined pathologic conditions at work: large or massive rotator cuff tears together with anterior capsulolabral injuries such as a Bankart lesion or fracture of the glenoid rim. These patients have multiple recurrences because of disruption of both the anterior and the posterior stability mechanisms. We suggest a procedure that provides anterior stabilization with the capsular shift technique and that is supplemented by Bankart repair as necessary. The capsule transfer is performed superiorly and posteriorly to close the defect in the cuff. In this way a capsulodesis effect can be achieved that displaces the humeral head downward and produces active centering of the head in the course of abduction. Use of only the anterior capsule for the shift, and not the subscapularis tendon, does not compromise subscapularis function. Between 1990 and 1996, we used this technique to treat 16 patients older than 55 years of age with multiple recurrent anterior shoulder dislocation and massive rotator cuff tear. We report the results for the first 10 patients with a minimum follow-up of 2 years (range 2 to 7 years) and an average follow-up of 52 months. There were 7 excellent results, 2 good results, and 1 fair result according to the Rowe criteria. None of the patients had a recurrence of the dislocation. All the patients regained full or functional range of motion with stable shoulders, and most of them could perform activities of daily living without limitation. The average Constant score was 83%. This procedure appears to be successful in treating older patients with recurrent shoulder dislocation. ( info)

7/297. Asymptomatic chronic anterior posttraumatic dislocation in a young male patient.

    We report an unusual case of chronic anterior glenohumeral dislocation in a young active patient. The diagnosis was not made until 4 years after the initial injury occurred. X-ray evaluation and magnetic resonance imaging showed an anterior dislocated humeral head that was locked anteroinferior of the glenoid as a result of a large Hill-Sachs lesion. Passive and active range of motion was surprisingly normal, and the patient had no pain and no limitation in his activities of daily living. A chronic dislocation of the glenohumeral articulation has been defined as a joint that has been dislocated for at least several days. It is generally accepted that the longer the dislocation persists, the more the difficulties and complications of reduction increase. In most of the patients the persistence of an unreduced chronic dislocation is a very difficult problem. This condition is mostly seen in elderly patients and in those with limited general mental status. We report a case of a young male patient with only minor clinical symptoms. ( info)

8/297. Posterior shoulder dislocation: avoiding a missed diagnosis.

    Posterior shoulder dislocation is a relatively uncommon event, with an incidence of 1% to 4% of all shoulder dislocations. Because of the infrequency of this condition, the diagnosis is often missed, with significant consequences to the patient Injury in the athlete is usually from a direct blow or fall onto an outstretched arm. After such an injury, symptoms may be confused with a shoulder contusion or rotator cuff injury. Significant complications such as chronic posterior dislocation and degenerative disease of the shoulder can occur if the diagnosis is missed. A careful history and physical examination, complete radiographic evaluation, and a high level of suspicion are required to identify posterior shoulder dislocation. Treatment consists of prompt closed reduction, or operative repair if this is unsuccessful. ( info)

9/297. Luxatio erecta: a rarely seen, but often missed shoulder dislocation.

    Luxatio erecta is an uncommon disorder and presents in a unique, unusual manner. Luxatio erecta is often misdiagnosed as an anterior dislocation. The presentation is unmistakable and classic: the arm hyperabducted and locked above the head. Neurovascular injuries consist of neuropraxia of brachial plexus, radial and ulnar nerve. Vascular injuries are complicated by intimal tears, transections, and/or thrombosis of the axillary artery or vein. Reduction is done with the traction and countertraction maneuver. Once it is reduced the arm is then placed and maintained with a sling in adduction to the chest. Orthopedic referral is required because of the high incidence of rotator cuff injury. ( info)

10/297. The changes occurring after the Putti-Platt procedure using magnetic resonance imaging.

    The purpose of this study is to evaluate the magnetic resonance imaging (MRI) following Putti-Platt procedure for recurrent anterior dislocation of the shoulder. Six shoulders of six patients who had received Putti-Platt procedure were evaluated by the MRI before and after operation. After the Putti-Platt procedure the subscapularis tendon was thickened and an increased signal area on T2-weighted images were observed in four patients. The area of subscapularis tendons after operation was increased maximally 3.46-fold and the volume was increased on average 1.51-fold. The course of subscapularis muscle fiber before operation was described as a mild arc, but changed to a straight line after the procedure in five patients. The findings in this study suggest that the Putti-Platt procedure leads to a remarkable increase in strength of subscapularis tendon and an improvement of laxity of subscapularis muscle. In conclusion, there is a good possibility that this procedure will increase the stability of the glenohumeral joint and be a successful treatment for recurrent anterior dislocation of the shoulder. ( info)
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