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Results Following a Modified Magnuson Procedure in Recurrent Dislocation of the Shoulder
Results Following a Modified Magnuson Procedure in Recurrent Dislocation of the Shoulder ANTHONY F. DEPALMA, M.D., F.A.C.S. CHARLES E. SILBERSTEIN, M.D.
FOR THE preparation of this discussion, 75 cases with a minimum postoperative period of three years were reviewed, the purpose being to present the results of a standard technique as performed on one service.
Age
Thirty-four of the 75 patients were students. The average follow-up period was 4.8 years; the shortest was three years, the longest was llY2 years. The average age was 22 years; the oldest patient was 64 and the youngest was 14 years of age. Twenty-nine of these patients were under 20 years of age. Twenty-one were between 20 and 29. Twenty-one were between 30 and 39 and four were over 40 years. Number of Dislocations
The average number of dislocations was 7.2. Where a patient was not certain of the number of dislocations but had had at least three, the number was considered as three. Twelve of these patients had recurrences when asleep. The right arm was involved in 36 patients, the left arm in 37 and two patients had bilateral involvement. Mechanism of the Initial Injury
The mechanism of injury was known in 67 cases. In 49 it occurred during some athletic endeavor, in seven as the result of a fall on the outstretched arm; in three it was associated with an automobile accident and in five it appeared spontaneously, no injury having occurred. X-ray Findings Prior to Operation
There was a demonstrable defect in the head of the humerus in 56.6 per cent of the cases. There was also some demonstrable reactive bone 1651
1652
ANTHONY
F.
DEPALMA, CHARLES
E.
SILBERSTEIN
formation along the inferior lip of the glenoid cavity in 56.6 per cent of the patients. One patient showed evidence of some degenerative changes throughout the entire joint and, in one, there was evidence of calcification in the long head of the biceps tendon. Redislocation occurred after an average interval of 22 months from the date of the initial injury. Five of these patients had had a previous operation and in all five a Nicola procedure had been done. Recurrences Following the Modified Magnuson Procedure
There were two recurrences, one of which was in an epileptic who had five dislocations. The other patient experienced one. Evaluation of the Procedure
SUBJECTIVE. All of the patients were satisfied with the results of the operation except the two who had recurrences. Seven were aware of some limitation when attempting to throw some object; the rest were unaware of any functional disability. OBJECTIVE. Comparing the ranges of motion with the opposite side, dorsiflexion and internal rotation were normal in all patients. One patient exhibited some limitation of elevation in the sagittal plane. All had normal abduction in the coronal plane. Examination of external rotation with the elbow at the side revealed no difference in 78 per cent of the patients, 2 per cent showed less than 11 degrees of limitation of motion, 16 per cent had limitation between 11 and 20 degrees, 2 per cent had limitation between 21 and 30 degrees, 1 per cent had limitation between 31 and 45 degrees and less than 1 per cent had limitation over 45 degrees. Examination of the shoulder girdle demonstrated slight tenderness over the bicipital groove on palpation in six of the patients and over the anterior joint capsule in five. Twenty-two of the patients showed some spreading of the scar and six gave definite evidence of limitation of external rotation power as compared with the opposite side. The follow-up x-ray examination on these patients revealed that, in 23 in whom staples had been used, 19 of the staples had fractured. Four patients showed moderate degenerative changes in the joint as a whole, and in one instance there was calcification in the subscapularis tendon. In conclusion, we have presented the data on the follow-up of 75 patients for an average of 4.8 years. It appears to us that the procedure we have utilized-a modified Magnuson operation-is an effective procedure in recurrent dislocation of the shoulder. If the patient with epilepsy is excluded, only one of the 74 remaining patients had a recurrence. The findings noted on objective and subjective examination of the patients further confirm that the operation is fulfilling its goal. In view of its simplicity and effectiveness, we believe it should supplant other operative procedures for this entity.
Results Following a Modified Magnuson Procedure
1653
REFERENCES 1. Bankart, A. S.: Recurrent or habitual dislocation of shoulder joint. Brit. M. J. 2: 1132-1133 (Dec. 15) 1923. 2. Bankart, A. S.: The pathology and treatment of recurrent dislocation of the shoulder joint. Brit. J. Surg. 26: 23-29 (July) 1938. 3. Bankart, A. S.: Operation for recurrent dislocation (subluxation) of sternoclavicular joint. Brit. J. Surg. 26: 320-323 (Oct.) 1938. 4. DePalma, A. F.: Surgery of Shoulder. Philadelphia, J. B. Lippincott Co., 1950. 5. Eyre-Brook, A. L.: Recurrent dislocation of shoulder; lesions discovered in 17 cases, surgery employed and intermediate report on result. J. Bone & Joint Surg. 30-B: 39-46 (Feb.) 1948. 6. Gallie, W. E. and LeMesurier, A. B.: Recurring dislocation of shoulder. J. Bone & Joint Surg. 30-B: 9-18 (Feb.) 1948. 7. Nicola, T.: Recurrent. anterior dislocations of shoulder; new operation. J. Bone & Joint Surg. 11: 128-132 (Jan.) 1929. 8. Osmond-Clarke, H.: Habitual dislocation of shoulder; Putti-Platt operation. J. Bone & Joint Surg. 30-B: 19-25 (Feb.) 1948. 9. Palmer, 1. and Widen, A.: Bone block method for recurrent dislocation of shoulder joint. J. Bone & Joint Surg. 30-B: 53-58 (Feb.) 1948.
248 South 21st Street Philadelphia 3, Pa.
FOR THE preparation of this discussion, 75 cases with a minimum postoperative period of three years were reviewed, the purpose being to present the results of a standard technique as performed on one service.
Age
Thirty-four of the 75 patients were students. The average follow-up period was 4.8 years; the shortest was three years, the longest was llY2 years. The average age was 22 years; the oldest patient was 64 and the youngest was 14 years of age. Twenty-nine of these patients were under 20 years of age. Twenty-one were between 20 and 29. Twenty-one were between 30 and 39 and four were over 40 years. Number of Dislocations
The average number of dislocations was 7.2. Where a patient was not certain of the number of dislocations but had had at least three, the number was considered as three. Twelve of these patients had recurrences when asleep. The right arm was involved in 36 patients, the left arm in 37 and two patients had bilateral involvement. Mechanism of the Initial Injury
The mechanism of injury was known in 67 cases. In 49 it occurred during some athletic endeavor, in seven as the result of a fall on the outstretched arm; in three it was associated with an automobile accident and in five it appeared spontaneously, no injury having occurred. X-ray Findings Prior to Operation
There was a demonstrable defect in the head of the humerus in 56.6 per cent of the cases. There was also some demonstrable reactive bone 1651
1652
ANTHONY
F.
DEPALMA, CHARLES
E.
SILBERSTEIN
formation along the inferior lip of the glenoid cavity in 56.6 per cent of the patients. One patient showed evidence of some degenerative changes throughout the entire joint and, in one, there was evidence of calcification in the long head of the biceps tendon. Redislocation occurred after an average interval of 22 months from the date of the initial injury. Five of these patients had had a previous operation and in all five a Nicola procedure had been done. Recurrences Following the Modified Magnuson Procedure
There were two recurrences, one of which was in an epileptic who had five dislocations. The other patient experienced one. Evaluation of the Procedure
SUBJECTIVE. All of the patients were satisfied with the results of the operation except the two who had recurrences. Seven were aware of some limitation when attempting to throw some object; the rest were unaware of any functional disability. OBJECTIVE. Comparing the ranges of motion with the opposite side, dorsiflexion and internal rotation were normal in all patients. One patient exhibited some limitation of elevation in the sagittal plane. All had normal abduction in the coronal plane. Examination of external rotation with the elbow at the side revealed no difference in 78 per cent of the patients, 2 per cent showed less than 11 degrees of limitation of motion, 16 per cent had limitation between 11 and 20 degrees, 2 per cent had limitation between 21 and 30 degrees, 1 per cent had limitation between 31 and 45 degrees and less than 1 per cent had limitation over 45 degrees. Examination of the shoulder girdle demonstrated slight tenderness over the bicipital groove on palpation in six of the patients and over the anterior joint capsule in five. Twenty-two of the patients showed some spreading of the scar and six gave definite evidence of limitation of external rotation power as compared with the opposite side. The follow-up x-ray examination on these patients revealed that, in 23 in whom staples had been used, 19 of the staples had fractured. Four patients showed moderate degenerative changes in the joint as a whole, and in one instance there was calcification in the subscapularis tendon. In conclusion, we have presented the data on the follow-up of 75 patients for an average of 4.8 years. It appears to us that the procedure we have utilized-a modified Magnuson operation-is an effective procedure in recurrent dislocation of the shoulder. If the patient with epilepsy is excluded, only one of the 74 remaining patients had a recurrence. The findings noted on objective and subjective examination of the patients further confirm that the operation is fulfilling its goal. In view of its simplicity and effectiveness, we believe it should supplant other operative procedures for this entity.
Results Following a Modified Magnuson Procedure
1653
REFERENCES 1. Bankart, A. S.: Recurrent or habitual dislocation of shoulder joint. Brit. M. J. 2: 1132-1133 (Dec. 15) 1923. 2. Bankart, A. S.: The pathology and treatment of recurrent dislocation of the shoulder joint. Brit. J. Surg. 26: 23-29 (July) 1938. 3. Bankart, A. S.: Operation for recurrent dislocation (subluxation) of sternoclavicular joint. Brit. J. Surg. 26: 320-323 (Oct.) 1938. 4. DePalma, A. F.: Surgery of Shoulder. Philadelphia, J. B. Lippincott Co., 1950. 5. Eyre-Brook, A. L.: Recurrent dislocation of shoulder; lesions discovered in 17 cases, surgery employed and intermediate report on result. J. Bone & Joint Surg. 30-B: 39-46 (Feb.) 1948. 6. Gallie, W. E. and LeMesurier, A. B.: Recurring dislocation of shoulder. J. Bone & Joint Surg. 30-B: 9-18 (Feb.) 1948. 7. Nicola, T.: Recurrent. anterior dislocations of shoulder; new operation. J. Bone & Joint Surg. 11: 128-132 (Jan.) 1929. 8. Osmond-Clarke, H.: Habitual dislocation of shoulder; Putti-Platt operation. J. Bone & Joint Surg. 30-B: 19-25 (Feb.) 1948. 9. Palmer, 1. and Widen, A.: Bone block method for recurrent dislocation of shoulder joint. J. Bone & Joint Surg. 30-B: 53-58 (Feb.) 1948.
248 South 21st Street Philadelphia 3, Pa.