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Anterior dislocation of the shoulder in the elderly
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169
J. Shoulder Elbow Surg. March/April 1996
Abstracts
ARTHROSCOPICALLY ASSISTED REPAIR OF ACUTE BANKART LESIONS IN ATHLETES.J.W. Uribe,M.D., K.S. Hechtman,
171
M.D., L.A. Vargas, M.D,, P.R. Lozman, M.D., E. W. Tjin.A-Tsoi, M.D., Division of Sports Medicine, Department of Orthopaedics and rehabUitation, University of Miami School of Medicine, Miam~ FL Acute traumatic anterior shoulder dislocations are associated with high recurrence rates in young individuals. Arthroscopically assisted stabilization of acute initial traumatic anterior dislocation was carried out in eleven young athletes. The average age was twenty years, with nine males and two females. The anterior acute Bar&art lesion was surgically repaired using the technique described by Caspari and Morgan. There were no surgical complications, All patients were able to return to return to their sport without restriction. One patient had a transient episode of instability eight months postoperatively associated with trauma, but no further sequelae. Using repair of Bar&art lesion provides a stable shoulder with minimal loss of function and low recurrence rate. Early intervention should be considered in young, highly competitive athletes.
1 70
ANTERIOR DISLOCATION OF THE SHOULDER IN THE ELDERLY. F. Postacchhii*, MD, & S. Gumina**, MD, *University of Modena; ** University "La Sapienza", Rome. ITALY. Few information is known abot~t recurre:~t dislocations of the shoulder in the elderly. Material and Methods, We mlalyzed the clinical records of all patients older than 60 years, who had been treated for a primary dislocation of the shoulder during the years 1988-1990. There were 121 patients, representing 24% of all subjects n'eated for a l~rimary dislocation of the shoulder, The group of study is represented by 104 patients. There were 85 females (82%) and 19 males (18%), aged 61 to 89 years (mean 73 ys). A concomitant fracture of the greater tuberosity had occun-ed in 13 patients (12.5%). The arm was immobilized in Desault for 2 to 4 weeks. The mean follow-up was 5.2 years. All patients were examined and 28 underwent MRI or arthrography. Results, A recun'ent dislocation occurred in 21 patients (20%), with pure dislocation. One recurrence occurred in 11 patients after a mean time of 21 months (range 0.3-3 ys) and two recurrences occurred in 5 patients with an interval of about one year (range, 0.9-1.2 ys) between the dislocations; 5 patients had numerous dislocations with a mean intelwal of 6.4 months between the recmTences. 68 patients with pure dislocation had a limited ROM and 60, including all those with recurrences of dislocation, had clinical evidence of a cuff tear. Imaging studies demonstrated a cuff tear in 22 out of 25 patients. Of the 13 patients with a fracture of the greater tuberosity, 11 had a limited ROM and one showed clinical signs of a cuff tear. In none of the 3 patients undergoing imaging studies there was evidence of a cuff tear. Conclusions. I/4 of the patients with a primary anterior shoulder dislocation m'e older than 60 years. 20% of elderly patients undergoing an anterior shoulder dislocation subsequently have one or more dislocations and 5% have frequent recurrences. An associated fracture of the greater tuberosity decreases considerably the risk of recmTences. More than 2/3 of our patients with no associated fracture, and all those with recurrences, showed evidence of a cuff tear.
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72
LUXATIO ERECTA OF THE S~OULDER. Y.NAKAGAWA, S.UMEGAKI, G.SAKURAI, J.OZAKI, K.NAKAGAKI, Dept. of Orthop. Surg, Haibara General Hospital, Nara, Japan. Luxatio erecta of the shoulder is rare type of glenohumeral dislocation. We report eleven cases. (Patients and Results) This study was composed of 7 females and 4 males and the average age was 67.5 years. Seven patients fell down with the arm hyperabducted overhead. One patient was injured by direct force applied to the shoulder from above. Three patients were injured in motorcycle accident. The clinical appearance was characteristic, with the arm elevated and fixed with the forearm resting on the head. The radiographic appearance was characteristic with the head of the humerus lying inferior to the glenoid fossa; the shaft of the humerus was directed upwards. Closed reduction of the dislocation succeeded in each case by traction-countertraction maneuver. Eight of 11 cases had complications; fracture of the proximal humerus (2 cases), chronic massiv~ rotator cuff tear (5 cases) and axillary nerve injury (I case). Tension band wiring were performed in two cases with associated fractures. Nine cases were treated conservatively. Five cases has returned to normal activity without problem. Three cases has regained a ful] range of motion of the shoulder with slight pain, Three cases has comElained of reduced range of motion. (Conclusion) Violent force is not always necessary to produce luxatio erecta of the shoulder, The position of the arm in a large measure influences its occurence, Especially, in the cases with chronic massive rotator cuff tear, luxatio erecta of the shoulder is produced by mild force. It is very important to examine the complications. Treatment appropriate for the complications produce good results.
TOPOGRAPHIC ANATOMY OF THE S U B C O R A C O A C R O M I A L SPACE.
If- De Santis, (i. Cerc'iello (*), (7. Gasparini, D. Rossetti (*) Depasmaentof Orthopedics~School of Medicine, University of Sassart (Italy) (*) Department of Orthopedics, Hospital Villa Betauia, Rome (Raly) The anatomical analytical knowledge of the subcoracoacromial space is widely acquired; to the contrary a functional vision of the reciprocal relations among each structure which constitutes it has not been faced yet. We intend to suggest, therefore, a topographic description of this region which allows us to better understand some appearances of the pathology of the rotator cuff tendons (correlating etiopathogenesis and site of the conflict) and to acquire the criteria of evaluation and evolution of the pathologic changes. From an anatomosurgical standpoint the subcoraeoacromial space is bounded by an osseous and ligamentons vault (acromJon, coracoacromial ligament and coracoid) and by the head of the humerus. In this space are contained the rotator cuff and the subcoracoacromial bursa, It is therefore evident that the tendons of the rotatory muscles, which must be considered the real content of the space, lie between two rigid structures. Anatomical variations of the vault (already described by Bigliaui and. Morrison and by Gerber) generate the basis for a conflict with the humeral head which develops in continual microtraumas oftae sob tissues contained in the space. The main interest for the orthopaedic surgeon is obviously focused on the pathology of the cuff and therefore, describing topographic relationship among the different struct~es, it has seamed useful to propose a subdivision in three sectors of the cuff based on criteria of pathology localization. We distinguish a preglenoid cuff(recognisable in the tendon of the subscapularis which could enter into conflict with the enracoid), a supraglenoid cuff(i, e. the tendon of the ~praspinatus which could enter into conflict with the acromion) and a retrogtenoid cuff"(which corresponds to the infraspinatus and teres minor tendons that don't enter directly into conflict with elements of die vault but could be involved at a further stage in the developmental phases of lesions that become massive).
169
J. Shoulder Elbow Surg. March/April 1996
Abstracts
ARTHROSCOPICALLY ASSISTED REPAIR OF ACUTE BANKART LESIONS IN ATHLETES.J.W. Uribe,M.D., K.S. Hechtman,
171
M.D., L.A. Vargas, M.D,, P.R. Lozman, M.D., E. W. Tjin.A-Tsoi, M.D., Division of Sports Medicine, Department of Orthopaedics and rehabUitation, University of Miami School of Medicine, Miam~ FL Acute traumatic anterior shoulder dislocations are associated with high recurrence rates in young individuals. Arthroscopically assisted stabilization of acute initial traumatic anterior dislocation was carried out in eleven young athletes. The average age was twenty years, with nine males and two females. The anterior acute Bar&art lesion was surgically repaired using the technique described by Caspari and Morgan. There were no surgical complications, All patients were able to return to return to their sport without restriction. One patient had a transient episode of instability eight months postoperatively associated with trauma, but no further sequelae. Using repair of Bar&art lesion provides a stable shoulder with minimal loss of function and low recurrence rate. Early intervention should be considered in young, highly competitive athletes.
1 70
ANTERIOR DISLOCATION OF THE SHOULDER IN THE ELDERLY. F. Postacchhii*, MD, & S. Gumina**, MD, *University of Modena; ** University "La Sapienza", Rome. ITALY. Few information is known abot~t recurre:~t dislocations of the shoulder in the elderly. Material and Methods, We mlalyzed the clinical records of all patients older than 60 years, who had been treated for a primary dislocation of the shoulder during the years 1988-1990. There were 121 patients, representing 24% of all subjects n'eated for a l~rimary dislocation of the shoulder, The group of study is represented by 104 patients. There were 85 females (82%) and 19 males (18%), aged 61 to 89 years (mean 73 ys). A concomitant fracture of the greater tuberosity had occun-ed in 13 patients (12.5%). The arm was immobilized in Desault for 2 to 4 weeks. The mean follow-up was 5.2 years. All patients were examined and 28 underwent MRI or arthrography. Results, A recun'ent dislocation occurred in 21 patients (20%), with pure dislocation. One recurrence occurred in 11 patients after a mean time of 21 months (range 0.3-3 ys) and two recurrences occurred in 5 patients with an interval of about one year (range, 0.9-1.2 ys) between the dislocations; 5 patients had numerous dislocations with a mean intelwal of 6.4 months between the recmTences. 68 patients with pure dislocation had a limited ROM and 60, including all those with recurrences of dislocation, had clinical evidence of a cuff tear. Imaging studies demonstrated a cuff tear in 22 out of 25 patients. Of the 13 patients with a fracture of the greater tuberosity, 11 had a limited ROM and one showed clinical signs of a cuff tear. In none of the 3 patients undergoing imaging studies there was evidence of a cuff tear. Conclusions. I/4 of the patients with a primary anterior shoulder dislocation m'e older than 60 years. 20% of elderly patients undergoing an anterior shoulder dislocation subsequently have one or more dislocations and 5% have frequent recurrences. An associated fracture of the greater tuberosity decreases considerably the risk of recmTences. More than 2/3 of our patients with no associated fracture, and all those with recurrences, showed evidence of a cuff tear.
l
72
LUXATIO ERECTA OF THE S~OULDER. Y.NAKAGAWA, S.UMEGAKI, G.SAKURAI, J.OZAKI, K.NAKAGAKI, Dept. of Orthop. Surg, Haibara General Hospital, Nara, Japan. Luxatio erecta of the shoulder is rare type of glenohumeral dislocation. We report eleven cases. (Patients and Results) This study was composed of 7 females and 4 males and the average age was 67.5 years. Seven patients fell down with the arm hyperabducted overhead. One patient was injured by direct force applied to the shoulder from above. Three patients were injured in motorcycle accident. The clinical appearance was characteristic, with the arm elevated and fixed with the forearm resting on the head. The radiographic appearance was characteristic with the head of the humerus lying inferior to the glenoid fossa; the shaft of the humerus was directed upwards. Closed reduction of the dislocation succeeded in each case by traction-countertraction maneuver. Eight of 11 cases had complications; fracture of the proximal humerus (2 cases), chronic massiv~ rotator cuff tear (5 cases) and axillary nerve injury (I case). Tension band wiring were performed in two cases with associated fractures. Nine cases were treated conservatively. Five cases has returned to normal activity without problem. Three cases has regained a ful] range of motion of the shoulder with slight pain, Three cases has comElained of reduced range of motion. (Conclusion) Violent force is not always necessary to produce luxatio erecta of the shoulder, The position of the arm in a large measure influences its occurence, Especially, in the cases with chronic massive rotator cuff tear, luxatio erecta of the shoulder is produced by mild force. It is very important to examine the complications. Treatment appropriate for the complications produce good results.
TOPOGRAPHIC ANATOMY OF THE S U B C O R A C O A C R O M I A L SPACE.
If- De Santis, (i. Cerc'iello (*), (7. Gasparini, D. Rossetti (*) Depasmaentof Orthopedics~School of Medicine, University of Sassart (Italy) (*) Department of Orthopedics, Hospital Villa Betauia, Rome (Raly) The anatomical analytical knowledge of the subcoracoacromial space is widely acquired; to the contrary a functional vision of the reciprocal relations among each structure which constitutes it has not been faced yet. We intend to suggest, therefore, a topographic description of this region which allows us to better understand some appearances of the pathology of the rotator cuff tendons (correlating etiopathogenesis and site of the conflict) and to acquire the criteria of evaluation and evolution of the pathologic changes. From an anatomosurgical standpoint the subcoraeoacromial space is bounded by an osseous and ligamentons vault (acromJon, coracoacromial ligament and coracoid) and by the head of the humerus. In this space are contained the rotator cuff and the subcoracoacromial bursa, It is therefore evident that the tendons of the rotatory muscles, which must be considered the real content of the space, lie between two rigid structures. Anatomical variations of the vault (already described by Bigliaui and. Morrison and by Gerber) generate the basis for a conflict with the humeral head which develops in continual microtraumas oftae sob tissues contained in the space. The main interest for the orthopaedic surgeon is obviously focused on the pathology of the cuff and therefore, describing topographic relationship among the different struct~es, it has seamed useful to propose a subdivision in three sectors of the cuff based on criteria of pathology localization. We distinguish a preglenoid cuff(recognisable in the tendon of the subscapularis which could enter into conflict with the enracoid), a supraglenoid cuff(i, e. the tendon of the ~praspinatus which could enter into conflict with the acromion) and a retrogtenoid cuff"(which corresponds to the infraspinatus and teres minor tendons that don't enter directly into conflict with elements of die vault but could be involved at a further stage in the developmental phases of lesions that become massive).