1/3. The unstable shoulder: recurring subluxation.A review of operative repairs for recurring dislocation of the shoulder revealed that a significant proportion of these operations was being done for what could best be described as recurring subluxation of the shoulder. The presenting complaint was of the shoulder 'going out of joint', but no significant trauma was recalled, dislocation was never shown on the radiograph and none required manual reduction. The only physical finding was apprehension on external rotation of the shoulder in abduction. Radiographs were frequently normal and arthrography and cineradiography were not helpful in confirming anterior displacement. The most useful preoperative information was obtained by manipulation of the shoulder under general anaesthesia just before the surgical repair. In all instances anterior instability could be demonstrated. Of 99 Magnuson-Stack repairs drawn from the records of the Vancouver General Hospital in a 3-year period, 34 proved to be examples of recurring subluxation. This high proportion of such patients contradicts the teaching in standard orthopaedic textbooks, but substantiates the warning of Rowe (1963) to beware of the patient whose shoulder 'dislocates' initially with little evidence of injury. It also substantiates Saha's concept (1971) of inherent shoulder instability as a contributor to the incidence of recurring dislocation.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/3. An irreducible superior dislocation of the glenohumeral joint.The clinical features of a superior dislocation of the glenohumeral joint are described. Reposition, even under general anaesthesia, cannot be achieved. Associated supraspinatus tear, acromioclavicular separation and the dislocated position of the humeral head can be clearly visualized.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
3/3. Simultaneous anterior dislocation of the shoulder and fracture of the ipsilateral humeral shaft. Two case reports.Two patients with anterior dislocation of the shoulder and ipsilateral fracture of the shaft of the humerus have been studied and the mechanism of their injuries has been documented. Closed reduction of the dislocations was performed under anaesthesia during surgery for humeral fixation with a dynamic compression plate. The fractures and dislocations healed without any problems at 6 to 9 months postoperatively. At recent follow-up, one patient had returned to work and regained normal mobility. The other patient had the sequelae of a brachial plexus injury. The literature on this subject is reviewed.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |