Shoulder Dislocation

BACKGROUND: The traditional treatment for primary anterior shoulder dislocations has been immobilization in a sling with the arm in a position of adduction and internal rotation. However, recent basic science and clinical data have suggested recurrent instability may be reduced with immobilization in external rotation after primary shoulder dislocation. QUESTIONS/PURPOSES: We performed a randomized controlled trial to compare the (1) frequency of recurrent instability and (2) disease-specific quality-of-life scores after treatment of first-time shoulder dislocation using either immobilization in external rotation or immobilization in internal rotation in a group of young patients...

BACKGROUND: Immobilization in external rotation is one of the treatment options for an initial dislocation of the shoulder. However, it remains unclear how long it takes for a Bankart lesion to heal. HYPOTHESIS: Protection of a healing Bankart lesion from stretching would promote the healing process and decrease the recurrence rate after an initial dislocation of the shoulder. STUDY DESIGN: Randomized controlled trial; Level of evidence, 2...

Shoulder dislocation is the most common large joint dislocation in the body. Recent advances in radiological imaging and shoulder surgery have shown the potential dangers of traditional reduction techniques such as the Kocher's and the Hippocratic methods, which are still advocated by many textbooks. Many non-specialists continue to use these techniques, unaware of their potential risks. This article reviews the clinical and radiographic presentation of dislocation; some common reduction techniques; their risks and success rate; analgesia methods to facilitate the reduction; and postreduction management...

The Hill-Sachs lesion is an osseous defect of the humeral head that is typically associated with anterior shoulder instability. The incidence of these lesions in the setting of glenohumeral instability is relatively high and approaches 100% in persons with recurrent anterior shoulder instability. Reverse Hill-Sachs lesion has been described in patients with posterior shoulder instability. Glenoid bone loss is typically associated with the Hill-Sachs lesion in patients with recurrent anterior shoulder instability...

No abstract text is available yet for this article.

BACKGROUND: An initial anterior dislocation of the shoulder becomes recurrent in 66% to 94% of young patients after immobilization of the shoulder in internal rotation. Magnetic resonance imaging and studies of cadavera have shown that coaptation of the Bankart lesion is better with the arm in external rotation than it is with the arm in internal rotation. Our aim was to determine the benefit of immobilization in external rotation in a randomized controlled trial. METHODS: One hundred and ninety-eight patients with an initial anterior dislocation of the shoulder were randomly assigned to be treated with immobilization in either internal rotation (ninety-four shoulders) or external rotation (104 shoulders) for three weeks...

We sought to determine whether post-reduction radiographs add clinically important information to what is seen on pre-reduction X-rays in Emergency Department (ED) patients with anterior shoulder dislocations. In this prospective, observational study, clinicians recorded preliminary pre-reduction and post-reduction X-ray readings on patients with shoulder dislocations. The films were subsequently reviewed by a blinded attending radiologist. Seventy-three patients presented to the ED with shoulder dislocations over an 18-month period; 55 of these patients had pre- and post-reduction X-rays and were included in the study...

Many terms have been used to describe what has been called idiopathic adhesive capsulitis of the shoulder. This pathology is defined as a self-limiting condition of unknown etiology. The natural history is 18-30 months even though a high-percentage of patient present impaired range of movement even at long-term follow-up. The diagnosis is mainly clinical and no significant changes are normally present at MRI or CT scan. Several treatment options have been tried over the years with different approaches and results...

Kocher described his method of reduction of anterior shoulder dislocation in German, which was misinterpreted. A new element of traction was added which causes considerable pain. We present our experience with the original method in reducing 12 anterior shoulder dislocations without using sedation or anaesthesia. The original method is gentle, painless and requires neither sedation nor anaesthesia. Patient reassurance and confidence is essential. The patient initiates the movements, the surgeon just guiding him through the manoeuvre...

The shoulder is the most commonly dislocated large joint presenting to American Emergency Departments (ED). Anterior dislocations account for the great majority of these dislocations. Most anterior shoulder dislocations can be reduced in the ED using a variety of reduction techniques. The traction-countertraction technique is quite familiar to most Emergency Physicians, however, many other effective methods of reduction have been described. No method has proven 100% successful, and occasionally multiple attempts using different techniques are required to effect reduction...

Forty-five patients with an anterior dislocation of the shoulder were randomised into one of two treatment groups and manipulation performed using Kocher's original method (without traction). A successful reduction was achieved in 80.9% of patients administered Entonox only and in 100% of patients sedated intravenously. No statistical significance was found in the pain scores between the two groups. The study shows that Kocher's original method is a reliable technique for reducing anterior dislocation of the shoulder and a successful outcome can be expected using nitrous oxide only, obviating the need for intravenous sedation and analgesia in the majority of patients...