• Bankart repair
• arthroscopy
• instability
• shoulder
• surgery

• Humans
• Joint Instability/surgery
• Joint Instability/diagnosis
• Arthroscopy
• Recurrence
• Female
• Male
• Adult
• Shoulder Dislocation/surgery
• Shoulder Dislocation/diagnosis
• Young Adult
• Retrospective Studies
• Bankart Lesions/surgery
• Bankart Lesions/diagnosis
• Severity of Illness Index
• Adolescent
• Shoulder Joint/surgery
• Predictive Value of Tests

• None

• Dislocation
• Fracture
• Greater tuberosity
• Humerus
• Shoulder

• Humans
• Aged
• Retrospective Studies
• Radiography
• Shoulder Fractures
• Joint Dislocations/diagnostic imaging
• Joint Dislocations/surgery
• Arthrodesis

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

• GLAD lesion
• adolescent
• cartilage
• glenolabral
• instability
• shoulder

• Bankart lesions
• Glenohumeral joint
• Hill-Sachs lesion
• Joint instability
• Rotator cuff injuries

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

• Acromioclavicular dislocation
• Anterior shoulder instability
• Coracoid fracture
• Nonunion
• Scapular fracture

• Coracoid Process
• Female
• Fractures, Bone/diagnostic imaging
• Humans
• Male
• Shoulder Dislocation
• Shoulder Injuries
• Upper Extremity

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Bankart Lesions/diagnostic imaging
• Female
• Humans
• Male
• Middle Aged
• Radiography/methods
• Reproducibility of Results
• Retrospective Studies
• Sensitivity and Specificity
• Shoulder/diagnostic imaging
• Young Adult

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

• child
• children
• dislocation
• epidemiology
• instability
• reduction
• shoulder
• surgery
• young

• Adolescent
• Child
• Child, Preschool
• Female
• Hospitalization
• Humans
• Incidence
• Infant
• Infant, Newborn
• Italy/epidemiology
• Male
• Shoulder
• Shoulder Dislocation/epidemiology
• Shoulder Dislocation/therapy

• Brachial plexus injury
• Glenohumeral dislocation
• Infraclavicular brachial plexus
• Nerve injury
• Shoulder dislocation
• Terrible triad of the shoulder

• Brachial Plexus/injuries
• Brachial Plexus/surgery
• Brachial Plexus Neuropathies/etiology
• Brachial Plexus Neuropathies/surgery
• Humans
• Neurosurgical Procedures/methods
• Shoulder Dislocation/complications
• Shoulder Dislocation/epidemiology
• Shoulder Dislocation/surgery
• Treatment Outcome

Bony lesions of the glenoid and Hill-Sachs lesions are the most common injuries after a first-time traumatic shoulder dislocation. However, fracture of the coracoid process after traumatic shoulder dislocation is rare. A single, open surgical procedure could be performed by a Latarjet procedure using a fractured fragment of the coracoid process. If a fracture of the coracoid process is associated with a traumatic anterior shoulder dislocation, the Latarjet procedure may be the most appropriate surgical option.

• Bankart lesion
• Coracoid process
• Shoulder dislocation

• glenoid labrum
• shoulder instability

Shoulder dislocation is the most common feature in emergencies, while the anterior dislocation of the glenohumeral joint is the most frequent and requires reduction. Accompanied nerve injury is common with an incidence of 21%, while radial nerve palsy is very rare. We describe the case of a 56-year-old man who presented with an anterior dislocation of the left shoulder due to a fall on an outstretched hand with wrist drop 8 hours after injury. Neurological examination revealed loss of sensation along the radial border of the forearm. Closed reduction with Kocher procedure was performed. Magnetic resonance image demonstrated a rotator cuff tear, and 3 weeks after the injury electromyography showed complete radial nerve palsy. A physiotherapy program was applied to the wrist and fingers with the goal of maintaining a full passive range of motion in all joints affected while shoulder rehabilitation started 6 weeks after his fall. Isolated radial nerve palsy associated with an anterior dislocation of the shoulder is very rare but not impossible to occur. Correct diagnosis of the nerve injury associated with the anterior dislocation is very important because it has serious implications on the management and activity morbidity.

• anterior shoulder dislocation
• radial palsy
• terrible triad of the shoulder

• Bankart
• baseball
• dislocation
• infielder
• pitcher
• return to play

Traumatic anterior dislocation of the shoulder is one of the most common directions of instability following a traumatic event. Although the incidence of shoulder dislocation is similar between young and elderly patients, most studies have traditionally focused on young patients due to relatively high rates of recurrent dislocations in this population. However, shoulder dislocations in older patients also require careful evaluation and treatment selection because they can lead to persistent pain and disability due to rotator cuff tears and nerve injuries. This article provides an overview of the nature and pathology of acute primary anterior shoulder dislocation, widely accepted management modalities, and differences in treatment for young and elderly patients.

• Glenohumeral joint
• Shoulder dislocation
• Treatment

• Joint instability
• Osteoarthritis
• Shoulder
• Surgery

• Adolescent
• Adult
• Follow-Up Studies
• Humans
• Joint Instability/surgery
• Quality of Life
• Retrospective Studies
• Shoulder Dislocation/surgery
• Shoulder Injuries
• Shoulder Joint/surgery
• Young Adult

Recurrence rates after primary traumatic shoulder dislocation are distinctly high. We hypothesized that concomitant isolated fractures of the greater tuberosity are associated with low rates of persistent instability but decreased range of motion.

Between 2007 and 2013, 66 consecutive shoulders in 64 patients were treated for primary shoulder dislocation combined with an isolated fracture of the greater tuberosity with either a nonsurgical (48 shoulders, 72.7%) or surgical (18 shoulders, 27.3%) treatment approach. In all, 55 cases (83.3%) were available for clinical follow-up examination after an average of 59.0 ± 20.7 months (range: 25–96 months) and of these, 48 (72.7%) patients consented to radiological evaluation to determine healing and position of the greater tuberosity.

The mean range of motion of the affected shoulder was significantly decreased by 9° of elevation (p = 0.016), 11° of abduction (p = 0.048), 9° of external rotation in 0° of abduction (p = 0.005), and 10° of external rotation in 90° of abduction (p = 0.001), compared with the unaffected shoulder. The mean WOSI score was 373 ± 486 points, the mean Constant and Murley score was 75.1 ± 19.4 points, and the mean Rowe score was 83 ± 20 points. Three cases (5.5%) of re-dislocation were reported among the cohort, all of them were due to a relevant trauma. Radiological evaluation revealed anatomically healed fragments in 31 shoulders (65%), dislocation of the fragment in ten shoulders (21%), impaction into the humeral head in four shoulders (8%), and absorption in three shoulders (6%).

A concomitant isolated fracture of the greater tuberosity leads to low recurrence rates along with a significant decrease in range of motion after primary traumatic anterior shoulder dislocation.

• Conservative treatment
• Range of motion
• Recurrence
• Shoulder fractures
• Surgery

Brachial plexus injuries (BPIs) caused by shoulder dislocation usually have a transient character and tend to resolve spontaneously. However, in some patients the symptoms can persist and require operative intervention. This work aims to determine the risk factors for persistent BPIs resulting from shoulder dislocation. The study comprised 73 patients (58 men, 15 women; mean age: 50 years) treated operatively between the years 2000 and 2016 for persistent BPIs resulting from shoulder dislocation. Patient age, gender, type of initial trauma, number of affected nerves, presence of accompanying injuries, and time interval from dislocation to its reduction were analysed. Elderly patients more often sustained multiple-nerve injuries, while single nerve injuries were more often observed in younger patients. Injury to a single nerve was diagnosed in 30% of the patients. Axillary nerve was most commonly affected. Fracture of the greater tuberosity of humerus coincided with total BPI in 50% of the cases. Longer unreduced period caused injury to multiple nerves. Analysis of our patient group against relevant literature revealed that persistent BPI after shoulder dislocation is more common in older patients. Injuries to ulnar and median nerves more often require operative intervention due to low potential for spontaneous recovery of these nerves.

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

• Anterior shoulder dislocation
• coracoid process fracture
• functional outcome
• glenoid fracture
• greater tuberosity fracture
• surgery

• Arthroscopy
• Associated injuries
• Greater tuberosity
• Shoulder dislocation
• Shoulder fracture

• Dislocation
• Dislocation arthropathy
• Long-term prognosis
• Shoulder

• Adolescent
• Adult
• Child
• Female
• Humans
• Joint Diseases/epidemiology
• Joint Diseases/etiology
• Male
• Prognosis
• Prospective Studies
• Radiography
• Recurrence
• Shoulder Dislocation/diagnostic imaging
• Shoulder Dislocation/epidemiology
• Shoulder Dislocation/etiology
• Shoulder Dislocation/therapy
• Shoulder Injuries
• Shoulder Joint/surgery
• Surveys and Questionnaires
• Sweden/epidemiology
• Young Adult

One complication of anteroinferior glenohumeral shoulder dislocation is a critical bone defect that requires surgical repair to prevent recurrent instability. However, controversy exists regarding the surgical management because both open and arthroscopic surgeries have respective advantages and disadvantages. Moreover, it is difficult to determine the patient’s preferred treatment, as factors that influence treatment choice include recurrence rates, morbidity of the procedures, and patient preferences.

Patients who have a higher probability of recurrent instability after arthroscopic surgery will select open surgery whereas patients with a lower probability of recurrent instability after arthroscopic surgery will favor arthroscopy.

Economic and decision analysis; Level of evidence, 2.

A decision tree was constructed to model each hypothetical outcome after open or arthroscopic surgery for glenohumeral instability in patients with bone defects. A literature review was performed to determine the probability of occurrence for each node while utility values for each outcome were obtained via patient-administered surveys given to 50 patients without prior history of shoulder injury or dislocation. Fold-back analysis was then performed to show the optimal treatment strategy. Finally, sensitivity analysis established the thresholds at which open treatment becomes the optimal treatment.

The ultimate expected value—the objective evaluation of all potential outcomes after choosing either open or arthroscopic surgery—was found to be greater for arthroscopic surgery than for open surgery (87.17 vs 81.64), indicating it to be the preferred treatment. Results of sensitivity analysis indicated that open surgery becomes the preferred treatment when probability of recurrence after arthroscopic treatment is ≥23.8%, although varying the utility, defined as an aggregate patient preference for a particular outcome, has no effect on the model. When the rate of no complication after open surgery is 97.6%, open surgery becomes the patient’s preferred treatment.

Arthroscopic surgery is an acceptable treatment if recurrent instability occurs consistently at ≤23.8%. This has important implications given the technical difficulty of successfully performing arthroscopic fixation to resolve recurrent anteroinferior glenohumeral dislocations associated with critical osseous defects. However, due to a lack of clinical outcomes studies, more research is needed to better predict the optimal operative treatment.

• Latarjet
• arthroscopic
• decision analysis
• glenoid
• shoulder dislocation
• shoulder instability

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

• shoulder
• dislocation
• survey
• guideline
• implementation
• treatment

• Shoulder dislocation
• braces
• clinical trial
• immobilization
• management
• rehabilitation

• epidemiology
• glenohumeral instability
• orthopaedics
• shoulder dislocation

• Shoulder dislocation
• elderly
• shoulder instability

The aim of this study was to identify the factors that affect the progress of a traumatic anterior dislocation of the shoulder.

Two hundred and thirty-eight patients (246 shoulders) with a traumatic anterior dislocation were enrolled in this study. The mean age at the time of surgery was 25 years (range, 14 to 47 years). There were 214 men and 24 women.

One hundred and sixty-four shoulders (67%) were younger than 20 years at the time of the first dislocation. Patients younger than 20 years showed a shorter interval of redislocation (p = 0.001) and a higher frequency of dislocation (p = 0.001). Athletic patients experienced their first dislocation at a younger age (p = 0.023) and showed a shorter interval of redislocation (p = 0.001) than their non-athetic counterparts. The incidence of classic and non-classic Bankart lesions was unaffected by age at the time of the first dislocation, interval between the first and second dislocation or the frequency of dislocation. Patients with bony Bankart lesions had a higher frequency of dislocation (p = 0.043).

The age at the time of the first dislocation and athletic activity were related to early redislocation and a high frequency of dislocation. Bony Bankart lesions were observed more often in patients with a higher frequency of dislocation. Early surgical treatment is a good option for young athletic patients with a bony Bankart lesion and a short interval between the first and second dislocation.

• Anterior
• Prognostic factor
• Shoulder dislocation
• Traumatic

• Germany
• Humans
• Joint Instability/pathology
• Models, Anatomic
• Shoulder Dislocation/pathology
• Shoulder Joint/pathology

• Adolescent
• Adult
• Cartilage, Articular/injuries
• Female
• Humans
• Immobilization
• Magnetic Resonance Imaging
• Male
• Middle Aged
• Range of Motion, Articular
• Shoulder Dislocation/therapy
• Shoulder Injuries
• Young Adult