1/12. Posterior shoulder dislocation: avoiding a missed diagnosis.Posterior shoulder dislocation is a relatively uncommon event, with an incidence of 1% to 4% of all shoulder dislocations. Because of the infrequency of this condition, the diagnosis is often missed, with significant consequences to the patient Injury in the athlete is usually from a direct blow or fall onto an outstretched arm. After such an injury, symptoms may be confused with a shoulder contusion or rotator cuff injury. Significant complications such as chronic posterior dislocation and degenerative disease of the shoulder can occur if the diagnosis is missed. A careful history and physical examination, complete radiographic evaluation, and a high level of suspicion are required to identify posterior shoulder dislocation. Treatment consists of prompt closed reduction, or operative repair if this is unsuccessful.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/12. The often overlooked posterior dislocation of the shoulder.Unlike most shoulder dislocations, the posterior dislocation is truly a diagnostic challenge to the treating physician because it may be missed more often than it is recognized. In fact, more than 60% of posterior dislocations are misdiagnosed initially by the treating orthopedic surgeon, and the correct diagnosis is often delayed for months or years. A history of seizures, electroshock, or a fall onto a flexed, adducted arm should alert the physician to the possibility of posterior dislocation. A careful physical examination with comparison to the unaffected arm must be performed with particular attention given to subtle posterior fullness and anterior flatness of the shoulder, along with a lack of external rotation and abduction. A radiographic trauma series made in the scapular plane must always be obtained in cases of shoulder trauma to rule out posterior dislocation. A computed tomographic scan may also be necessary. The correct diagnosis of this injury will facilitate proper orthopedic evaluation and treatment and will reduce the incidence of missed posterior shoulder dislocation and its associated morbidity.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
3/12. Radiographic findings of spontaneous subluxation of the sternoclavicular joint.Eight middle-aged women with spontaneous atraumatic subluxation of the sternoclavicular joint were evaluated with radiography and computed tomography. All patients were employed in occupations involving moderate to heavy physical labour, and no patients could recall a specific traumatic incident associated with onset of symptoms. In seven of the eight patients, the displacement of the medial clavicle was in a cranial direction; in four of the eight patients, there was an associated anterior subluxation, and in one patient, the subluxation was purely anterior. All five patients with an anterior component to the sternoclavicular subluxation had associated condensing osteitis of the clavicle. The sclerosis of the medial clavicle is possibly the result of chronic abrasion on the sternum and first costal cartilage in association with normal respiration and with upper extremity motion.- - - - - - - - - - ranking = 0.2465124228998keywords = physical (Clic here for more details about this article) |
4/12. Posterior dislocation in a voluntary subluxator: a case report.PURPOSE: Posterior instability of the shoulder is an uncommon occurrence. Its etiology has been classified as traumatic or atraumatic and its type as voluntary (individual can subluxate the shoulder posteriorly) or involuntary. Typically, patients with posterior voluntary instability do not have a history of trauma, can be treated successfully with physical therapy; and undergo surgery if the instability becomes symptomatic or develops an involuntary component. We present a patient with voluntary posterior subluxation who developed a symptomatic posterior instability after a traumatic event. PATIENT PRESENTATION: This patient was unable to return to his preinjury function despite nonoperative interventions, including rehabilitation, and required operative treatment of his posterior labrum lesion. This patient had a rare combination of voluntary, atraumatic instability that coexisted with traumatic posterior shoulder instability. CONCLUSION: This case emphasizes the importance of recognizing this constellation of instability patterns and documents that traumatic posterior instability, even in the presence of preexisting voluntary posterior subluxations, may require operative intervention in young, active individuals.- - - - - - - - - - ranking = 0.2465124228998keywords = physical (Clic here for more details about this article) |
5/12. Treatment of limited shoulder motion using an elevation splint.This article describes the management of a patient with limited shoulder range of motion (ROM) by use of an elevation splint. The limited ROM was believed to be due to structural changes in the tissues surrounding the glenohumeral joint following a Magnuson-Stack repair for anterior glenohumeral instability. The patient's ROM plateaued approximately 6 months postoperatively and did not improve with a variety of physical therapy techniques. Use of an inexpensive, easily fabricated elevation splint was begun 8 months postoperatively, and subsequent improvements in ROM were observed. The rationale and suggestions for clinical use of the splint are discussed.- - - - - - - - - - ranking = 0.2465124228998keywords = physical (Clic here for more details about this article) |
6/12. Anterior dislocation of the shoulders with bilateral brachial plexus injury.A case of bilateral anterior shoulder dislocation accompanied by bilateral brachial plexus injuries is presented. A 53-year-old man fell and landed on his chest and arms flexed at the elbows. The dislocations were satisfactorily reduced using the forward elevation, flexion maneuver. electromyography and nerve conduction studies confirmed bilateral brachial plexus lesions. Arthrogram of the right shoulder demonstrated a rotator cuff tear. The patient is undergoing physical therapy and making a slow recovery.- - - - - - - - - - ranking = 0.2465124228998keywords = physical (Clic here for more details about this article) |
7/12. Recurrent anterior transient subluxation of the shoulder. The "dead arm" syndrome.attention is directed to a subtle, unresponsive cause of shoulder disability in the young adult who has sustained a forceful overextension of the shoulder. A careful office evaluation will identify this lesion. A number of factors differentiate it from the numerous other causes of shoulder disability. 1. Usually a young athletic adult. 2. A characteristic history of forceful overextension of the shoulder. 3. Poor response to routine types of treatment. 4. Negative radiographic study. 5. Usually a frustrated and discouraged patient because no one has diagnosed or helped his "dead arm." 6. Consistent physical findings of a positive apprehension test.- - - - - - - - - - ranking = 0.2465124228998keywords = physical (Clic here for more details about this article) |
8/12. 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 = 0.2465124228998keywords = physical (Clic here for more details about this article) |
9/12. diagnosis of post-traumatic syringohydromyelia presenting as neuropathic joints. Report of two cases and review of the literature.Two paraplegic men with post-traumatic syringohydromyelia presented initially with neuropathic arthropathy of the elbow and shoulder, respectively. Both patients had sustained spinal trauma years earlier and had been lost to orthopedic and neurosurgical follow-up study. Characteristic history and physical findings were present in both patients. Conventional myelography failed to demonstrate the lesion in the first patient. The diagnosis in the second patient was confirmed by lumbar injection of low-dose metrizamide followed by immediate and delayed computerized axial tomography in the supine and lateral positions. Both patients were treated by surgical decompression and subarachnoid shunts with arrest of the neurologic deterioration. To the authors' knowledge, this is the first report of patients with post-traumatic syringohydromyelia presenting with neuropathic joints. The present case reports illustrate the need for long-term follow-up studies of patients with spine injury in specialty clinics. The use of computerized axial tomography and low-dose intrathecal metrizamide is advocated for diagnosing post-traumatic syringohydromyelia.- - - - - - - - - - ranking = 0.2465124228998keywords = physical (Clic here for more details about this article) |
10/12. Posterior dislocation of the shoulder: report of six cases.Posterior dislocation of the shoulder is a rare lesion. We have seen six of these dislocations in recent years. review of these six cases indicated that posterior dislocations of the shoulder have consistent causes and physical and roentgenographic findings. Recent dislocations can be treated conservatively with closed reduction. Recurrent or unreduced dislocations can be treated successfully with the McLaughlin technic of open reduction and suturing of the subscapularis tendon into the defect in the humeral head. Our results were satisfactory with either closed or open treatment.- - - - - - - - - - ranking = 0.2465124228998keywords = physical (Clic here for more details about this article) |
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