Arthroscopy: The Journal of Arthroscopic & Related Surgery
Primary traumatic anterior shoulder dislocation in patients 40 years of age and older
Abstract
During three consecutive ski seasons (1991 to 1994), 125 patients 40 years of age and older without previous shoulder injuries or surgery sustained a traumatic first-time anterior shoulder dislocation. At a minimum of 2 years' follow-up, patients were contacted to determine long-term outcome and to identify factors leading to prolonged morbidity or the need for surgical intervention. Fifty-two patients were available for interview. A modified Rowe shoulder score showed 32 excellent, nine good, eight fair, and three poor results. Eighteen (35%) rotator cuff tears were subsequently identified, with only 11 (61%) of these patients obtaining an excellent or good outcome (P = .011). Of the 11 patients with a fair or poor result, seven (64%) had a rotator cuff tear. Of the 12 patients with isolated cuff tears, 84% had an excellent or good result when treated surgically, compared with 50% when treated nonsurgically. Our findings indicate that recurrence is not a frequent complication of traumatic anterior shoulder dislocation in this age-group (4%). However, prolonged morbidity secondary to rotator cuff tear is more prevalent than in a younger population. We believe early diagnosis of rotator cuff pathology by either magnetic resonance imaging (MRI) or arthrogram with subsequent surgical repair can lead to faster restoration of function and a better outcome in these select individuals.
Arthroscopy 1998 Apr;14(3):289-94
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Surgical Intervention Following a First Traumatic Anterior Shoulder Dislocation Is Worthy of Consideration
2023, Arthroscopy - Journal of Arthroscopic and Related SurgeryUp to 60% of patients experience recurrence after a first traumatic anterior shoulder dislocation (FTASD), which is often defined as having experienced either dislocation or subluxation. Thus surgical intervention after FTASD is worthy of consideration and is guided by the number of patients who need to receive surgical intervention to prevent 1 redislocation (i.e., number needed to treat), (subjective) health benefit, complication risk, and costs. Operative intervention through arthroscopic stabilization can be successful in reducing recurrence risk in FTASD, as has been shown in multiple randomized controlled trials. Nevertheless, there is a large “gray area” for the indication of arthroscopic stabilization, and it is therefore heavily debated which patients should receive operative treatment. Previous trials showed widely varying redislocation rates in both the intervention and control group, meta-analysis shows 2% to 19% after operative and 20% to 75% after nonoperative treatment, and redislocation rates may not correlate with patient-reported outcomes. The literature is quite heterogeneous, and a major confounder is time to follow-up. Furthermore, there is insufficient standardization of reporting of outcomes and no consensus on definition of risk factors. As a result, surgery is a reasonable intervention for FTASD patients, but in which patients it best prevents redislocation requires additional refinement.
Skiing and snowboarding
2023, The Youth Athlete: A Practitioner's Guide to Providing Comprehensive Sports Medicine CareWinter sports continue to grow in popularity internationally and within the United States. A variety of musculoskeletal injuries occur in these sports, including both traumatic and overuse injuries. Injuries due to skiing and snowboarding continue to evolve with the advancement of technology, equipment, and further research into injury prevention. Other factors more unique to the winter sport athlete include environmental and altitude illness and return to snow rehabilitation programs. The sports medicine or team physician should take into consideration several factors associated with coverage of a winter sport, including weather and access to resources, including higher level of care when warranted.
Anteroinferior Glenoid Rim Fractures Are a Relatively Common Finding in Shoulder Instability Patients Aged 50 Years or Older but May Not Portend a Worse Prognosis
2022, Arthroscopy, Sports Medicine, and RehabilitationTo investigate the incidence of anteroinferior glenoid rim fractures (AGRFs) after anterior shoulder instability (ASI) in patients aged 50 years or older, identify risk factors for surgical intervention for AGRFs, compare initial treatment strategies, and compare clinical outcomes of patients with and without associated AGRFs.
An established geographic medical record system was used to identify patients aged 50 years or older with ASI between 1994 and 2016. Patients with radiographic evidence of AGRFs were identified and matched 1:1 to patients without AGRFs. Outcome measures included recurrent instability, recurrent pain events, conversion to arthroplasty, and osteoarthritis graded with the Samilson-Prieto classification for post-instability arthritis.
Overall, 177 patients were identified, with a mean follow-up period of 10.8 years. Of these patients, 41 (23.2%) had AGRFs and were matched to 41 control patients without AGRFs. The average age was 58.6 and 58.2 years for the AGRF and control groups, respectively. Rates of surgical intervention (27% vs 49%), recurrent instability (12% vs 20%), progression of osteoarthritis (34% vs 39%), and conversion to arthroplasty (2% vs 5%) were similar between AGRF patients and controls. For patients with AGRFs, increased bone fragment size (odds ratio, 1.1) and increased body mass index (odds ratio, 1.2) correlated with an increased risk of surgery. The cutoff value for an increased risk of surgery in patients with AGRFs was a fragment size 33% of the glenoid width or greater.
Of patients aged 50 years or older at presentation of ASI, 23.2% presented with an associated AGRF. A fragment size 33% of the glenoid width or greater and a higher patient body mass index were significant factors for surgical intervention; however, most patients did not require surgery and still showed acceptable clinical outcomes, and the most common reason for surgical intervention was a rotator cuff tear. Overall, the presence of an AGRF did not portend a worse prognosis as treatment strategies and long-term outcomes including recurrent instability, progression of osteoarthritis, and conversion to arthroplasty were similar to those in patients without AGRFs.
Level III, retrospective comparative study.
Superior capsular reconstruction for recurrent anterior shoulder dislocation with irreparable rotator cuff tear: a case report
2022, JSES Reviews, Reports, and TechniquesA 54-year-old man presented with apprehension of a repeat dislocation after a right shoulder dislocation, which was accompanied by restriction of shoulder function due to instability and pain of the right shoulder. Computed tomography showed that glenoid osseous defect was 20% of whole glenoid. Hill-Sachs lesion was greater than the glenoid track, which was called as Off-track lesion. Magnetic resonance imaging (MRI) showed a disruption of anterior band of inferior glenohumeral ligament complex and massive rotator cuff tear including supraspinatus and infraspinatus tendon tears. According to the Goutallier classification, the fatty infiltration of supraspinatus and infraspinatus were stage 1 and 3 in an oblique sagittal view of MRI. We treated an arthroscopic Bankart repair combined with superior capsular reconstruction (SCR) using fascia lata autograft. Two years postoperatively, there had been no recurrence of dislocation without pain. The range of motion had improved. The University of California, Los Angeles (UCLA) score was from 10 to 33 points and Japanese Orthopaedic Association (JOA) score was from 35 to 95 points. In conclusion, SCR using fascia lata autograft was a useful method to provide stabilize glenohumeral joint and to improve shoulder function in a patient with recurrent anterior shoulder instability with irreparable rotator cuff tear. SCR can provide not only reconstruction of muscle force couple but also the effect of remplissage to fill Hill-Sachs lesion with the graft.
Primary traumatic shoulder dislocation associated with rotator cuff tear in the elderly
2022, International Journal of Surgery Case ReportsCitation Excerpt :The identification of an associated injury will help to predict the recurrence of shoulder dislocation [10]. Meanwhile, the decision for surgery in elderly patients would also help the surgeon avoid prolonged immobilization morbidity [11]. This study reports our experience in two cases of primary traumatic shoulder dislocation in the elderly.
The shoulder is one of the most unstable joints of the body. Shoulder dislocation accounts for up to 60% of all major joint dislocations. This study reports two cases of primary traumatic shoulder dislocation and shows that in the elderly, primary traumatic shoulder dislocation is associated with a rotator cuff tear (RCT).
A case report and narrative review included two female patients, aged 63 and 100 years. Presenting symptoms were instability, pain, and restricted shoulder movement. Both were successfully treated by surgery. Arthroscopy was performed in the first patient and open reduction in the second patient.
In the first case, we found synovitis around the rotator interval, long head of the biceps tendinitis, and tears of the subscapularis tendon, supraspinatus tendon, and subacromial bursitis. The anterior labrum was normal. In the second case, complete detachment of the infraspinatus tendon was found. In both cases, rotator cuff repair was performed. Primary traumatic shoulder dislocation in the elderly is often associated with rotator cuff injury. Therefore, a detailed evaluation and management of the rotator cuff injury is essential. Rotator cuff injuries cause loss of dynamic stabilization of the shoulder, leading to recurrent shoulder dislocation and chronic shoulder instability.
The associated pathology of the primary traumatic shoulder dislocation in elderly are rotator cuff tear. The management of the rotator cuff tear in primary traumatic shoulder dislocation can prevent further shoulder instability events.
Recurrent anterior shoulder instability in patients 40–60 years old. Accompanying injuries and patient outcomes of arthroscopic repair
2021, Journal of Orthopaedic ScienceAccompanying injuries are frequently seen in middle aged patients with recurrent instability. The aim of this study was to elucidate the associated injuries, report patient outcomes of the following arthroscopic instability surgery regarding 40–60 years old patients with recurrent shoulder instability.
Patients that underwent arthroscopic instability surgery due to recurrent shoulder instability between February 2008 and November 2015, and which were 40–60 years old were included and evaluated retrospectively. Minimum follow-up duration was 24 months. Anterior-inferior labral injuries and accompanying pathologies such as rotator cuff tears and SLAP lesions were documented. Postoperative patient-reported outcome evaluation was made using Oxford Shoulder Instability Score.
Among 355 patients that underwent arthroscopic instability surgery, 88 patients which had pathology of recurrent instability were in the range of 40–60 years old. Patients who had previous shoulder surgery or fracture (n = 8) epileptic seizure history (n = 3), neurologic deficit (n = 2) were excluded from the study. 75 patients were included with a mean follow-up 69 ± 23 months (32–125). The percentage of middle-aged and elderly (40–60 years old) was 24.8% among recurrent shoulder instability patients. 44% had isolated Bankart lesion whereas 56% revealed multiple pathologies. Bankart + SLAP lesions were found in 32%, whereas Bankart + Rotator Cuff tears in 26.7% (13 isolated supraspinatus, 4 supraspinatus + subscapularis, 1 isolated subscapularis full-thickness and 2 partial-thickness supraspinatus tears). The mean Oxford Shoulder Instability Score was 38.4 ± 5.2 (26–48). The scores of patients which were treated with labrum and rotator cuff repair (median 42, range 30–48) were significantly better than the patients who were treated with isolated labrum repair (median 39, range 20–46) (p = 0.015). There was no difference regarding patients with or without SLAP repair (median 39 vs 39 and range 30–48 vs 20–48, respectively) (p = 0.702).
Arthroscopic repair of capsulolabral lesions is a safe and successful technique in 40–60 years old patients. Furthermore, the presence of repaired rotator cuff tears led to even superior results. Accompanying SLAP lesions did not affect the results.
Retrospective Case Series.
4, Retrospective Case Series.