• Anterior shoulder dislocation
• bone lesion
• first episode
• functional scores
• nonsurgical treatment
• recurrence

• Humans
• Shoulder Dislocation/diagnostic imaging
• Shoulder Dislocation/physiopathology
• Shoulder Dislocation/surgery
• Shoulder Dislocation/complications
• Male
• Adult
• Female
• Adolescent
• Prospective Studies
• Middle Aged
• Young Adult
• Recurrence
• Follow-Up Studies
• Tomography, X-Ray Computed
• Shoulder Joint/diagnostic imaging
• Shoulder Joint/physiopathology
• Time Factors
• Range of Motion, Articular/physiology
• Recovery of Function

• Markov model
• anterior shoulder instability
• arthroscopic Bankart repair
• cost-effectiveness.
• nonoperative management
• shoulder dislocation

• Adolescent
• Adult
• Child
• Humans
• Young Adult
• Arthroscopy/economics
• Decision Support Techniques
• Joint Instability/surgery
• Joint Instability/economics
• Joint Instability/therapy
• Markov Chains
• Monte Carlo Method
• Quality-Adjusted Life Years
• Recurrence
• Shoulder Dislocation/surgery
• Shoulder Dislocation/therapy
• Shoulder Dislocation/economics
• Cost-Effectiveness Analysis

• Humans
• Female
• Aged
• Axillary Artery/surgery
• Axillary Artery/injuries
• Axillary Artery/diagnostic imaging
• Shoulder Fractures/surgery
• Shoulder Fractures/diagnostic imaging
• Arthroplasty, Replacement, Shoulder/adverse effects
• Thrombosis/etiology
• Thrombosis/diagnostic imaging
• Thrombosis/surgery
• Fracture Fixation, Internal/adverse effects
• Postoperative Complications/etiology
• Postoperative Complications/diagnostic imaging
• Open Fracture Reduction/adverse effects
• Reoperation

• Hill-Sachs
• Mechanism
• Proximal humerus fracture
• Shoulder biomechanics
• Shoulder dislocation

• Critical shoulder angle
• Glenoid inclination
• Greater tuberosity fractures
• Scapula morphology
• Shoulder dislocation

• anterior shoulder instability
• dislocation
• recurrent instability
• rotator cuff tear

• Adolescent
• Athletic Injuries/diagnosis
• Athletic Injuries/epidemiology
• Athletic Injuries/etiology
• Child
• Emergency Service, Hospital
• Humans
• Sports

• shoulder dislocation
• suprascapular nerve block

• Aged
• Anesthetics, Local/therapeutic use
• Female
• Humans
• Lidocaine/pharmacology
• Lidocaine/therapeutic use
• Nerve Block/methods
• Shoulder
• Shoulder Dislocation/complications
• Shoulder Dislocation/therapy
• Shoulder Pain/etiology
• Shoulder Pain/therapy

• clinical assessment
• emergency department

• Dislocation
• Elbow
• Hip joint
• Knee joint
• Patella
• Reduction
• Shoulder

• Shoulder dislocation
• age
• glenoid rim fracture
• greater tuberosity fracture
• irreducible
• multivariate analysis
• reduction

Recurrent anterior shoulder dislocation in patients aged ≥ 40 years is not as rare as once thought. The mechanism of instability in this patient population is different—more likely to be attributed to rotator cuff pathology—compared with that in younger individuals. With an increasingly aging active population, surgical management has a rising role in preventing morbidity associated with recurrent instability. Our purpose was to evaluate outcomes of anterior shoulder instability repair (ie, Bankart or bony Bankart repair) with and without rotator cuff repair (RCR) in patients aged ≥ 40 years.

We conducted a retrospective chart review of all patients aged ≥ 40 years who underwent surgical repair for anterior shoulder instability from 2008-2016. Patients were categorized into 4 cohorts: Bankart repair only, bony Bankart repair only, Bankart repair with concomitant RCR, and bony Bankart repair with concomitant RCR. Demographic and history-of-instability data were collected. Clinical and functional outcomes assessed included the Single Assessment Numeric Evaluation score, American Shoulder and Elbow Surgeons score, Penn Shoulder Score, visual analog scale score for pain, Western Ontario Shoulder Instability Index score, and patient satisfaction score.

A total of 146 patients were included in this study, with 103 patients (71%) having ≥2-year outcome scores. Outcome scores were not significantly different among groups. For patients who underwent Bankart repair only, bony Bankart repair only, Bankart repair with RCR, and bony Bankart repair with RCR, the Single Assessment Numeric Evaluation scores were 80.8 ± 19.7, 90.0 ± 10.7, 79.3 ± 29.4, and 87.2 ± 10.6, respectively (P = .284); American Shoulder and Elbow Surgeons scores, 83.8 ± 19.7, 92.4 ± 17.4, 82.5 ± 25.6, and 85.6 ± 12.7, respectively (P = .114); Penn Shoulder Scores for function, 84.5 ± 17.9, 90.9 ± 15.3, 83.6 ± 25.1, and 95.7 ± 13.0, respectively (P = .286); and Western Ontario Shoulder Instability Index scores, 481.0 ± 519.5, 292.1 ± 414.3, 548.9 ± 690.5, and 320.6 ± 258.7, respectively (P = .713). Age at the time of surgery significantly differed between cohorts (P < .001). No patients had recurrence of instability during the study period.

Similar functional outcomes can be achieved in the surgical management of anterior instability in patients aged ≥ 40 years. Rotator cuff tears should be suspected and repaired in patients with anterior instability, especially those aged ≥ 50 years.

• Bankart repair
• Shoulder instability
• arthroscopy
• bony Bankart repair
• middle aged
• rotator cuff repair
• shoulder dislocation

• anterior glenohumeral dislocation
• glenohumeral dislocation in the elderly
• glenohumeral instability
• spectrum of injuries

• Case report
• Posterior shoulder dislocation
• Reverse total shoulder arthroplasty
• Seizure
• Shoulder fracture-dislocation

The recurrence rate following acute anterior shoulder dislocations is high, particularly in young, active individuals. The purpose of this paper is to provide a narrative overview of the best available evidence and results with regards to diagnostic considerations, comorbidities, position of immobilization, surgical versus conservative management, and time to return to play for the management of primary anterior shoulder dislocations. Three independent reviewers performed literature searches using PubMed, MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials. Randomized controlled trials and systematic reviews meeting inclusion criteria from 1930 to April 2019 were appraised and discussed with the intent to consolidate the best available evidence with regards to lowering recurrence rates. A majority of studies support early surgical intervention for individuals between 21 and 30 years of age following primary shoulder dislocations, as this group is particularly susceptible to recurrence. Conservative treatment plans favor 1–3 weeks of immobilization in internal rotation, followed by rehabilitation. Surgical methods are associated with longer time to return to play, but lower recurrence rates. Return to play time is best determined on an individualized basis, when subjective and objective function of both shoulders is determined to be symmetric. This paper broadly summarizes the best available evidence for the management of primary anterior shoulder dislocations. There remains a need for randomized studies to determine ideal long-term treatment following conservative or surgical management, as general timelines for returning to play following injury remain vague.

IV, Narrative Review

• Anterior shoulder dislocation
• Anterior shoulder dislocation management
• Anterior shoulder dislocation recurrence
• Anterior shoulder dislocation treatment

Glenohumeral dislocation is the most commonly encountered dislocation in the emergency department. The most frequent complications of glenohumeral dislocation are rotator cuff tears and an increase in the risk of recurrent dislocation. Less common acute complications include fractures, neurological complications and vascular injuries. The incidence of axillary artery injury associated with shoulder dislocation is reported to be about 1–2%.

An 81-year-old male presented to the emergency department with pain in the right shoulder after a fall. On physical examination, the shoulder was in slight abduction and external rotation. Shoulder movements were painful and there was a swelling in the axillary region which was tender to palpation. There was no sensory or motor deficit and the peripheral pulses were equal and palpable. Following the administration of analgesics, shoulder reduction was performed using the flexion-adduction-external rotation method. After reduction, the patient started complaining of axillary pain. On control examination, the patient did not have any motor or sensory deficits, but peripheral pulses were not palpable on the right arm. The right upper extremity computed tomography angiography, which was performed with the suspicion of vascular injury, revealed a right axillary artery rupture.

Axillary artery injury accompanying anterior shoulder dislocation is a rare but serious condition which may result in limb loss and death.

• Axillary artery injury
• Emergency department
• Reduction
• Shoulder dislocation

Optimal treatment of type II superior labrum anterior and posterior (SLAP) tears is controversial. There has been a recent trend towards biceps tenodesis over SLAP repair in older patients. Few surgeons have performed combined biceps tenodesis and SLAP repair with inferior results.

This case describes a 46-year-old patient who had persistent pain and stiffness after combined biceps tenodesis and SLAP repair for a type II SLAP tear. His pain and motion improved after arthroscopic superior capsular release.

Failed SLAP repair is often multifactorial and a thorough workup is needed. Combined biceps tenodesis and SLAP repair can cause pain, stiffness, and dysfunction which can be successfully treated with arthroscopic superior capsular release.

• Biceps Tenodesis
• Failed Slap Repair
• Shoulder Stiffness
• Slap Tear
• Superior Capsule Release

• Arm plexus paresis
• Brachial plexus lesion
• Shoulder dislocation
• Vascular injury
• decompression

• Fracture
• Geriatric patient
• Humerus, proximal
• Plexus lesion
• Rotator cuff

• dislocated shoulder
• magnetic resonance imaging
• rotator cuff
• shoulder
• upper extremity

Shoulder instability in the older patient traditionally has received less attention in the literature than in the younger patient population. However, when traumatic dislocation does occur, these patients often still have frequent pain, disability, and even continued instability.

To characterize the pathoanatomy of traumatic anterior shoulder instability in the older patient population and to discuss the correlating symptoms that ultimately led to operative treatment.

Case series; Level of evidence, 4.

Patients with a history of an initial traumatic anterior shoulder instability event occurring after the age of 35 years who underwent arthroscopic surgical intervention were prospectively enrolled. Exclusion criteria included posterior instability, major fractures of the shoulder girdle, and multidirectional instability. All patients initially underwent a period of nonoperative rehabilitation. Operative treatment was performed if a patient continued to have pain and/or instability. Operative reports and arthroscopic pictures were reviewed for pathoanatomical findings.

A total of 27 patients (28 shoulders) met the inclusion criteria and were analyzed in this study (22 men and 5 women; mean age, 55 years; age range, 35-74 years). Surgical intervention was performed for recurrent instability in 7 patients, pain for 8 patients, and pain with instability for 13 patients. Arthroscopic findings demonstrated 18 rotator cuff tears (RCTs) (64.3%) and 18 Bankart lesions (64.3%). Nine patients had both an RCT combined with a Bankart lesion (32.1%). Three humeral avulsion of the glenohumeral ligament (HAGL) lesions (10.7%) and 2 anterior labral periosteal sleeve avulsion (ALPSA) lesions (7.1%) were found. All shoulders demonstrated Hill-Sachs lesions of various size and depth.

Traumatic shoulder instability in the older patient may result in a wide array of pathologic findings as well as a diversity of clinical presentations. These findings suggest that the clinical diagnostician should maintain a high index of suspicion for RCT, Bankart lesions, and HAGL lesions in older patients who remain symptomatic after traumatic anterior shoulder instability.

• Bankart lesion
• dislocation
• instability
• rotator cuff tear

• Bankart repair
• Bristow procedure
• coracoid transposition
• recurrent anterior instability of the shoulder

Les auteurs rapportent l'observation d'une paralysie totale du plexus brachial survenue trois mois après un épisode de luxation antéro-interne sous coracoïdienne associée à une fracture du trochiter chez une patiente âgée de 88 ans.

• brachial plexus
• dislocation
• palsy
• shoulder

• Bankart
• Elderly
• Hill-Sachs
• Locked dislocation
• Rotator cuff tear
• Shoulder instability

• Accidents, Traffic
• Adult
• Braces
• Humans
• Imaging, Three-Dimensional
• Joint Instability/etiology
• Joint Instability/surgery
• Male
• Multiple Trauma/diagnostic imaging
• Multiple Trauma/rehabilitation
• Multiple Trauma/surgery
• Range of Motion, Articular
• Recovery of Function
• Rotator Cuff/diagnostic imaging
• Rotator Cuff/surgery
• Rotator Cuff Injuries
• Shoulder Dislocation/complications
• Shoulder Dislocation/diagnostic imaging
• Shoulder Dislocation/rehabilitation
• Shoulder Dislocation/surgery
• Tomography, X-Ray Computed

• Complicaciones
• Complications
• Cuarenta años
• Forty years
• Inestabilidad hombro
• Lesión del manguito
• Rotator cuff tears
• Shoulder instability

• Shoulder dislocation
• elderly
• shoulder instability

There are few previous studies on the incidence of shoulder dislocation in the general population. The aim of the study was to report the incidence of acute shoulder dislocations in the capital of Norway (Oslo) in 2009. Patients of all ages living in Oslo, sustaining a dislocation of the glenohumeral joint, were identified using electronic diagnosis registers, patient protocols, radiological registers of the hospitals, and the Norwegian Patient Register (NPR). The overall incidence rate was 56.3 [95% confidence interval (CI) 50.2–62.4] per 100 000 person-years, with rates of 82.2 (95% CI 71.7–92.8) and 30.9 (95% CI 24.5–37.3) in men and women, respectively. The incidence of primary dislocations was 26.2 (95% CI 22.1–30.4). The overall incidence of shoulder dislocations in Oslo was higher than previously reported incidences. The incidence of primary dislocations was also higher than that in previously reported studies for the general population but it was close to the incidence reported in Malmø, Sweden.