scholarly journals Current Concepts in the Diagnosis and Management of Traumatic, Anterior Glenohumeral Subluxations

2017 ◽  
Vol 5 (3) ◽  
pp. 232596711769433 ◽  
Author(s):  
Joseph A. Gil ◽  
Steven DeFroda ◽  
Brett D. Owens
Keyword(s):  
Surgical Treatment ◽  
Natural History ◽  
Treatment Outcomes ◽  
Humeral Head ◽  
High Rate ◽  
Young Athletes ◽  
Glenohumeral Instability ◽  
Recurrent Instability ◽  
Labral Tears ◽  
History Of

Traumatic anterior glenohumeral subluxations comprise the majority of glenohumeral instability events and are endemic in young athletes. Unlike the definitive complete dislocation event, subluxation events may often be more subtle in presentation and, therefore, may be overlooked by clinicians. Glenohumeral subluxation events are associated with a high rate of labral tears as well as humeral head defects. While less is known of the natural history of these injuries, young athletes are at risk for recurrent instability events if not properly diagnosed and treated. While reports of surgical treatment outcomes isolated to subluxation events are limited, arthroscopic and open Bankart repair have been shown to result in excellent outcomes. The purpose of this paper is to review the etiology and pathoanatomy of traumatic anterior glenohumeral subluxations as well as to review the appropriate evaluation and management of patients with this injury.

scholarly journals Prospective Evaluation of Glenoid Bone Loss After First-time and Recurrent Anterior Glenohumeral Instability Events

2019 ◽  
Vol 47 (5) ◽  
pp. 1082-1089 ◽  
Author(s):  
Jonathan F. Dickens ◽  
Sean E. Slaven ◽  
Kenneth L. Cameron ◽  
Adam M. Pickett ◽  
Matthew Posner ◽  
...  
Keyword(s):  
Cohort Study ◽  
Bone Loss ◽  
Shoulder Instability ◽  
Glenoid Bone Loss ◽  
Anterior Instability ◽  
Glenohumeral Instability ◽  
Recurrent Instability ◽  
History Of ◽  
Anterior Glenohumeral Instability ◽  
First Time

Background: Determining the amount of glenoid bone loss in patients after anterior glenohumeral instability events is critical to guiding appropriate treatment. One of the challenges in treating the shoulder instability of young athletes is the absence of clear data showing the effect of each event. Purpose: To prospectively determine the amount of bone loss associated with a single instability event in the setting of first-time and recurrent instability. Study Design: Cohort study; Level of evidence, 2. Methods: The authors conducted a prospective cohort study of 714 athletes surveilled for 4 years. Baseline assessment included a subjective history of shoulder instability. Bilateral noncontrast shoulder magnetic resonance imaging (MRI) was obtained for all participants with and without a history of previous shoulder instability. The cohort was prospectively followed during the study period, and those who sustained an anterior glenohumeral instability event were identified. Postinjury MRI with contrast was obtained and compared with the screening MRI. Glenoid width was measured for each patient’s pre- and postinjury MRI. The projected total glenoid bone loss was calculated and compared for patients with a history of shoulder instability. Results: Of the 714 athletes (1428 shoulders) who were prospectively followed during the 4-year period, 22 athletes (23 shoulders) sustained a first-time anterior instability event (5 dislocations, 18 subluxations), and 6 athletes (6 shoulders) with a history of instability sustained a recurrent anterior instability event (1 dislocation, 5 subluxations). On average, there was statistically significant glenoid bone loss (1.84 ± 1.47 mm) after a single instability event ( P < .001), equivalent to 6.8% (95% CI, 4.46%-9.04%; range, 0.71%-17.6%) of the glenoid width. After a first-time instability event, 12 shoulders (52%) demonstrated glenoid bone loss ≥5% and 4 shoulders, ≥13.5%; no shoulders had ≥20% glenoid bone loss. Preexisting glenoid bone loss among patients with a history of instability was 10.2% (95% CI, 1.96%-18.35%; range, 0.6%-21.0%). This bone loss increased to 22.8% (95% CI, 20.53%-25.15%; range, 21.2%-26.0%) after additional instability ( P = .0117). All 6 shoulders with recurrent instability had ≥20% glenoid bone loss. Conclusion: Glenoid bone loss of 6.8% was observed after a first-time anterior instability event. In the setting of recurrent instability, the total calculated glenoid bone loss was 22.8%, with a high prevalence of bony Bankart lesions (5 of 6). The findings of this study support early stabilization of young active patients after a first-time anterior glenohumeral instability event.

Common knee conditions

2011 ◽  
Author(s):  
Shahryar Noordin ◽  
Andrew Howard
Keyword(s):  
Surgical Treatment ◽  
Natural History ◽  
Osteochondritis Dissecans ◽  
Open Physes ◽  
Lateral Dislocation ◽  
Clinical Presentations ◽  
Spine Pathology ◽  
History Of ◽  
Dislocation Of The Patella

♦ All children who complain of knee symptoms must be assessed for ipsilateral hip and spine pathology♦ Congenital or persistent lateral dislocation of the patella and obligatory dislocation of the patella have two different clinical presentations: surgical treatment (if required) is often complex♦ The natural history of stable osteochondritis dissecans lesions is generally favourable in a child with open physes.

A European collaborative study of treatment outcomes in 346 patients with cardiac stage III AL amyloidosis

Blood ◽  
2013 ◽  
Vol 121 (17) ◽  
pp. 3420-3427 ◽  
Author(s):  
Ashutosh D. Wechalekar ◽  
Stefan O. Schonland ◽  
Efstathios Kastritis ◽  
Julian D. Gillmore ◽  
Meletios A. Dimopoulos ◽  
...  
Keyword(s):  
Natural History ◽  
Treatment Outcomes ◽  
Collaborative Study ◽  
Stage Iii ◽  
Al Amyloidosis ◽  
Poor Risk ◽  
Key Points ◽  
History Of ◽  
European Collaborative Study

Key PointsDeep clonal responses improve outcomes and can change the natural history of advanced (cardiac stage III) AL amyloidosis. NT-proBNP >8500 ng/L and SBP <100 mm Hg identify a very poor risk subgroup of stage III AL amyloidosis.

Prevalence and natural history of otitis media with perforation in Maori school children

1991 ◽  
Vol 105 (4) ◽  
pp. 257-260 ◽  
Author(s):  
M. Giles ◽  
I. Asher
Keyword(s):  
New Zealand ◽  
Natural History ◽  
Otitis Media ◽  
School Children ◽  
Developed Countries ◽  
High Rate ◽  
Age Group ◽  
History Of ◽  
First Time ◽  
Practical Implications

AbstractNew Zealand Maoris are one of five ethnic groups in developed countries known to have a high rate of ear disease, including perforation of the eardrum (CSOM). It is a strongly held belief by otolaryngologists whose practice dates back to the 1960's that the prevalence of CSOM in Maori children is gradually falling. Despite the obvious practical implications this change has not yet been documented.The aim of the study was to compare the prevalence of CSOM in two surveys conducted in 1978 and 1987 of children living in a North Island Maori community. A second aim was to examine the natural history of CSOM in these children.The raw data from the 1978 study were reviewed. Of 134 children aged 4–13,12 had CSOM. In 1987 the same age group yielded 12 children out of 250 with CSOM. The prevalence of CSOM fell from 9 per cent to 4 per cent. The incidence of new perforations in 1987 was 1.3 per cent per child per year. It is concluded there has been a fall in the rate of CSOM, although otitis media remains a significant problem for these children.The probability of a perforation healing was influenced by whether or not the perforation had been observed before: at least 35 per cent of perforations seen for the first time healed, but none of the perforations seen on two occsaions healed spontaneously. It was concluded that perforation of the eardrum can be managed conservatively at first.

Natural History of Scaphoid Non-Union, with Special Reference to “Asymptomatic” Cases

1992 ◽  
Vol 17 (6) ◽  
pp. 697-700 ◽  
Author(s):  
G. LINDSTRÖM ◽  
Å. NYSTRÖM
Keyword(s):  
Surgical Treatment ◽  
Natural History ◽  
Special Reference ◽  
Prognostic Indicator ◽  
X Rays ◽  
Degenerative Arthritis ◽  
X Ray ◽  
Non Union ◽  
History Of ◽  
Carpal Joint

33 patients with non-union of the carpal scaphoid were diagnosed by X-ray examination two to 37 years following the original trauma. All of the patients could be contacted and summoned for a re-examination ten to 17 years later. X-rays revealed a 100% incidence of progressive radio-carpal osteoarthritis. It is concluded that freedom of pain is not a reliable prognostic indicator, and that all patients with non-union of the carpal scaphoid are likely to benefit from surgical treatment of the pseudarthrosis. The only exception to this rule might be the patient in whom the radio-carpal joint is already deteriorated by an advanced degenerative arthritis.

Surgical treatment supposed natural history of the tethered cord with occult spinal dysraphism

1997 ◽  
Vol 13 (5) ◽  
pp. 268-274 ◽  
Author(s):  
I. Koyanagi ◽  
Yoshinobu Iwasaki ◽  
Kazutoshi Hida ◽  
Hiroshi Abe ◽  
T. Isu ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Natural History ◽  
Spinal Dysraphism ◽  
Tethered Cord ◽  
Occult Spinal Dysraphism ◽  
History Of

scholarly journals Prospective Evaluation of Glenoid Bone Loss After First-Time and Recurrent Anterior Glenohumeral Instability Events

2018 ◽  
Vol 6 (7_suppl4) ◽  
pp. 2325967118S0009 ◽  
Author(s):  
Jonathan F. Dickens ◽  
Sean E. Slaven ◽  
Kenneth L. Cameron ◽  
Adam M. Pickett ◽  
Matthew A. Posner ◽  
...  
Keyword(s):  
Bone Loss ◽  
Shoulder Instability ◽  
Glenoid Bone Loss ◽  
Anterior Instability ◽  
Glenohumeral Instability ◽  
Post Injury ◽  
Recurrent Instability ◽  
History Of ◽  
Anterior Glenohumeral Instability ◽  
First Time

Objectives: Determining the amount of glenoid bone loss in patients following anterior glenohumeral instability events is critical to guiding appropriate treatment. One of the challenges in managing shoulder instability in young athletes is the absence of clear data showing the impact of each event. The purpose of this study was to prospectively determine the amount of bone loss associated with a single instability event, in the setting of both first-time and recurrent instability. Methods: We conducted a prospective cohort study of 714 athletes followed for four years. Baseline assessment included a subjective history of shoulder instability. Bilateral shoulder MRIs were obtained in all participants with and without a history of previous shoulder instability. The cohort was prospectively followed during the study period and those who sustained an anterior glenohumeral instability event were identified. A post-injury MRI was obtained and compared to the screening MRI. Glenoid width was measured for each patient’s pre- and post-injury MRI. The projected total glenoid bone loss was calculated and compared for patients with a prior history of shoulder instability. Results: Of the 714 athletes that were prospectively followed during the four-year period, 23 shoulders in 22 subjects sustained a first-time anterior instability event (5 dislocations, 18 subluxations), and six subjects with a previous history of instability sustained a recurrent anterior instability event (1 dislocation, 5 subluxations). On average, there was statistically significant glenoid bone loss (1.84 ± 1.47 mm) following a single instability event (p<0.001), equivalent to 6.8% (95% CI: 4.46%, 9.04%, range 0.71%-17.6%) of the glenoid width. Twelve shoulders (52%) demonstrated glenoid bone loss ≥ 5%, 4 shoulders demonstrated glenoid bone loss ≥13.5% and no shoulders had ≥20% glenoid bone loss after a first-time instability event. Pre-existing glenoid bone loss in subjects with a history of instability was 10.2% (95% CI: 1.96%, 18.35%, range 0.6% - 21.0%). This bone loss increased to 22.8% (95% CI: 20.53%, 25.15%, range 21.2% to 26.0%) following an additional instability event (P=0.0117). All six shoulders with recurrent instability had >20% glenoid bone loss. Conclusion: Glenoid bone loss of 6.8% was observed after a first-time anterior instability event. In the setting of recurrent instability, the total calculated glenoid bone loss was 22.8% with a high prevalence of bony Bankart lesions (5/6). The findings of this study support early stabilization of young, active subjects following a first-time anterior glenohumeral instability event. [Figure: see text][Table: see text]

scholarly journals Natural History of Anterior Shoulder Instability

2017 ◽  
Vol 11 (1) ◽  
pp. 909-918 ◽  
Author(s):  
Eduardo Palma Carpinteiro ◽  
Andre Aires Barros
Keyword(s):  
Surgical Treatment ◽  
Natural History ◽  
Age Of Onset ◽  
Young Patients ◽  
The Body ◽  
Joint Disease ◽  
First Episode ◽  
Anterior Shoulder Instability ◽  
Bone Lesions ◽  
History Of

Background:The shoulder is the most complex joint in the body. The large freedom of motion in this joint is the main cause of instability. Instability varies in its degree, direction, etiology and volition and there is a large spectrum of conditions.Methods:Based on literature research and also in our own experience, we propose to elucidate the reader about the natural history of instability and its importance for the appropriate management of this pathology, by answering the following questions:What happens in the shoulder after the first dislocation? Which structures suffer damage? Who are the patients at higher risk of recurrence? How does the disease evolve without treatment? Will surgical treatment avoid future negative outcomes and prevent degenerative joint disease? Who should we treat and when?Results:80% of anterior-inferior dislocations occur in young patients. Recurrent instability is common and multiple dislocations are the rule. Instability is influenced by a large number of variables, including age of onset, activity profile, number of episodes,delay between first episode and surgical treatment.Conclusion:Understanding the disease and its natural evolution is determinant to decide the treatment in order to obtain the best outcome. It is crucial to identify the risk factors for recurrence. Delay in surgical treatment, when indicated, leads to worse results. Surgical technique should address the type and severity of both soft tissue and bone lesions, when present.

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