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Treatment of Irreducible Traumatic Anterior Shoulder Dislocation Caused by Subscapularis Tendon Interposition.

ABSTRACT: Irreducible shoulder dislocation is an uncommon event. When it does occur, blocks to reduction can include bone, labrum, rotator cuff musculature, or tendon. Concomitant rotator cuff tear at the time of initial dislocation is not an exclusive complication of anterior shoulder dislocation in the older population. Indeed, rotator cuff tear should not be excluded based solely on the patient's age. Rotator cuff interposition is not an uncommon complication after anterior dislocation of the shoulder. It should be suspected when there is incongruency of the joint and persistent subluxation on postreduction radiographs. If such incongruence or subluxation is seen, a computed tomographic (CT) or magnetic resonance imaging (MRI) scan must then be obtained to determine the nature of the interposed soft tissues. The key to treatment is early diagnosis and adequate imaging. Open reduction and repair of the rotator cuff should be performed. We present a technique for treating irreducible anterior shoulder dislocation caused by interposition of the subscapularis tendon. Both CT and MRI observations, along with intraoperative findings and surgical technique, are discussed.

SUBMITTER: Bayoumy MA

PROVIDER: S-EPMC5495691 | biostudies-other | 2017 Jun

REPOSITORIES: biostudies-other

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Treatment of Irreducible Traumatic Anterior Shoulder Dislocation Caused by Subscapularis Tendon Interposition.

Bayoumy Maysara Abdelhalim MA Said Hatem G HG Abdelkawi Ayman Farouk AF Fetih Tarek N TN

Arthroscopy techniques 20170612 3

Irreducible shoulder dislocation is an uncommon event. When it does occur, blocks to reduction can include bone, labrum, rotator cuff musculature, or tendon. Concomitant rotator cuff tear at the time of initial dislocation is not an exclusive complication of anterior shoulder dislocation in the older population. Indeed, rotator cuff tear should not be excluded based solely on the patient's age. Rotator cuff interposition is not an uncommon complication after anterior dislocation of the shoulder. ...[more]

PMID: 28706825

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Project description:ObjectiveTo assess the effects of an additional programme of physiotherapy in adults with a first-time traumatic shoulder dislocation compared with single session of advice, supporting materials, and option to self-refer to physiotherapy.DesignPragmatic, multicentre, randomised controlled trial (ARTISAN).Setting and participantsTrauma research teams at 41 UK NHS Trust sites screened adults with a first time traumatic anterior shoulder dislocation confirmed radiologically, being managed non-operatively. People were excluded if they presented with both shoulders dislocated, had a neurovascular complication, or were considered for surgical management.InterventionsOne session of advice, supporting materials, and option to self-refer to physiotherapy (n=240) was assessed against the same advice and supporting materials and an additional programme of physiotherapy (n=242). Analyses were on an intention-to-treat basis with secondary per protocol analyses.Main outcome measuresThe primary outcome was the Oxford shoulder instability score (a single composite measure of shoulder function), measured six months after treatment allocation. Secondary outcomes included the QuickDASH, EQ-5D-5L, and complications.Results482 participants were recruited from 40 sites in the UK. 354 (73%) participants completed the primary outcome score (n=180 allocated to advice only, n=174 allocated to advice and physiotherapy). Participants were mostly male (66%), with a mean age of 45 years. No significant difference was noted between advice compared with advice and a programme of physiotherapy at six months for the primary intention-to-treat adjusted analysis (between group difference favouring physiotherapy 1.5 (95% confidence interval -0.3 to 3.5)) or at earlier three month and six week timepoints. Complication profiles were similar across the two groups (P>0.05).ConclusionsAn additional programme of current physiotherapy is not superior to advice, supporting materials, and the option to self-refer to physiotherapy.Trial registrationCurrent Controlled Trials ISRCTN63184243.

Project description:BackgroundThere is an important gap in knowledge about the effectiveness of nonoperative treatment (exercise) for patients with traumatic primary and recurrent anterior shoulder dislocations (ASDs).Purpose/hypothesisThe purpose of this study was to assess the efficacy and safety of physical therapist-supervised, shoulder instability neuromuscular exercise (SINEX) versus self-managed, home-based, standard care shoulder exercise (HOMEX) in patients with traumatic ASDs. The hypothesis was that SINEX would have a larger effect and fewer adverse events compared with HOMEX.Study designRandomized controlled trial; Level of evidence, 2.MethodsA total of 56 participants with radiographically verified, trauma-initiated primary or recurrent ASDs and self-reported decreased shoulder function were randomized to 12 weeks of either SINEX or HOMEX. The SINEX program consisted of 7 exercises, individually progressing from basic (2 × 20 repetitions each day) to elite (2 × 10 repetitions, 3 times weekly). The HOMEX program included 5 shoulder exercises performed 3 times weekly (2 × 10 repetitions). The primary outcome was the Western Ontario Shoulder Instability Index (WOSI) score, ranging from 0 (best possible) to 2100. The between-group minimal clinically important difference at 12 weeks was 250 points. Secondary outcomes included WOSI subdomain scores, patient-reported ratings of kinesiophobia and pain, objective shoulder function, patient satisfaction, and number of adverse events.ResultsThe between-group mean difference in the WOSI total score at 12 weeks significantly favored SINEX over HOMEX (-228.1 [95% CI, -430.5 to -25.6]). SINEX was furthermore superior to HOMEX in most of the secondary outcomes (3/4 subdomains of the WOSI and pain level during the past 7 days as well as clinical signs of anterior shoulder instability). Also, although not statistically significant, less than half the proportion of the SINEX patients compared with the HOMEX patients (3/27 [11%] vs 6/24 [25%], respectively; P = .204) underwent or were referred for shoulder stabilizing surgery. Satisfaction with both exercise programs was high, and no serious adverse events were reported.ConclusionNeuromuscular shoulder exercise (SINEX) was superior to standard care exercise (HOMEX) in patients with traumatic ASDs. Further long-term follow-ups on treatment effects are needed.RegistrationNCT02371928 (ClinicalTrials.gov identifier).

Dataset Information

Treatment of Irreducible Traumatic Anterior Shoulder Dislocation Caused by Subscapularis Tendon Interposition.

Publications

Treatment of Irreducible Traumatic Anterior Shoulder Dislocation Caused by Subscapularis Tendon Interposition.

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