scholarly journals Clinical forms of shoulder instability in pediatric patients

2016 ◽  
Vol 4 (4) ◽  
pp. 41-46
Author(s):  
Yaroslav N. Proshchenko ◽  
Alexei G. Baindurashvili ◽  
Ananstasiya I. Brianskaia ◽  
Evgeny V. Prokopovich ◽  
Maksim S. Nikitin ◽  
...  
Keyword(s):  
Shoulder Instability ◽  
Shoulder Joint ◽  
Shoulder Dislocation ◽  
Joint Instability ◽  
Pediatric Patients ◽  
Recurrent Dislocation ◽  
Study Cohort ◽  
Clinical Forms ◽  
Chronic Shoulder Instability ◽  
Recurrent Shoulder Dislocation

Background. The recurrence rate of adolescent chronic shoulder instability is approximately 56%–68%. However, this pathology is often missed in childhood and adolescence.Aim. To identify the clinical forms of shoulder joint instability in pediatric patients.Materials and methods. The authors present the data from 57 pediatric patients aged 3−17 years with a total of 61 unstable shoulder joints. All patients were divided into groups according to the form of instability. Traumatic chronic shoulder instability was identified in 40 patients (Bankart and Hill–Sachs injuries). Of these, non-traumatic shoulder instability was diagnose in 17, including five with recurrent dislocation, and spontaneous shoulder dislocation due to dysplasia of glenoid and labrum was diagnosed in 12. Of the 57 patients in the study cohort, 53 underwent surgery. Postoperatively, two patients developed recurrent shoulder dislocation (Andreev–Boichev technique) due type III shoulder dysplasia in the first patient and multidirectional injury in the second.Conclusions. Shoulder joint instability should be considered as the traumatic or non-traumatic form. Treatment decisions should be based on anatomical characteristics that predispose to recurrent dislocation.

scholarly journals The Shoulder Instability: An Overview

2021 ◽  
Author(s):  
Balaji Zacharia ◽  
Arun Prakas ◽  
Subramanian Vaidyanathan ◽  
Antony Roy ◽  
Mohammed Komalam Ayyub
Keyword(s):  
Natural History ◽  
Shoulder Instability ◽  
Shoulder Joint ◽  
Shoulder Dislocation ◽  
Narrative Review ◽  
Pathological Anatomy ◽  
Dynamic Factors ◽  
History Of ◽  
Classification And Treatment

AbstractInstability of the shoulder joint is common but most of the time it is unrecognized by the treating surgeon. The symptoms can vary from subtle pain to shoulder dislocation. In many cases, there is no history of trauma. The shoulder joint is stabilized by both static and dynamic factors, and treatment is complex, with recurrence more common in young athletic individuals. Open and arthroscopic techniques of stabilization are available with specific indications for each of these methods. In this narrative review of shoulder instability, we describe the pathological anatomy, evaluation, natural history, classification, and treatment of shoulder instability.

scholarly journals POSTTRAUMATIC SHOULDER INSTABILITY IN CHILDREN: CLINICAL PRESENTATION, DIAGNOSIS AND TREATMENT

2014 ◽  
Vol 2 (3) ◽  
pp. 47-52
Author(s):  
Yaroslav Nikolaevich Proshchenko ◽  
Pavel Sergeevich Shumkov ◽  
Anatoliy Vasilievich Ovsyankin ◽  
Pavel Igorevich Bortulev ◽  
Alexey Polikarpovich Drozdetskiy ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Shoulder Instability ◽  
Humeral Head ◽  
Shoulder Dislocation ◽  
Clinical Presentation ◽  
Chronic Instability ◽  
Unsatisfactory Result ◽  
Traumatic Dislocation ◽  
Chronic Shoulder Instability ◽  
Type 3

The article presents an analysis of the treatment of 15 patients with posttraumatic shoulder instability aged 11-17 years, as a result of primary traumatic dislocation and chronic instability. We identified the following causes of chronic shoulder instability: Bankart injury, SLAP-injury; Hill-Sachs defect; fracture of the glenoid, type 3 humeral head-glenoid relation, and retroversion of the humeral head, as well as defects in the treatment of primary shoulder dislocation. Surgical treatment is performed in 7 patients with chronic instability (7 joints). Unsatisfactory result was detected in 1 patient (1 joints), which is caused by a type 3 humeral head-glenoid relation.

scholarly journals The Painful Anterior Apprehension Test – An Indication Of Occult Shoulder Instability

2020 ◽  
Author(s):  
Yau Hong Ng ◽  
Gin Way Law ◽  
Zhaowen Dennis Ng ◽  
Jun Hao Tan ◽  
Keng Lin Francis Wong ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Shoulder Instability ◽  
Shoulder Dislocation ◽  
Biceps Tendon ◽  
Univariate Analysis ◽  
Rotator Cuff Tears ◽  
Pain Patient ◽  
Study Cohort ◽  
Patient Profile ◽  
Concomitant Surgery

Abstract Background To evaluate the clinical relevance of the painful anterior apprehension test in shoulder instability. Methods We performed a retrospective study of 155 patients that underwent arthroscopic anterior Bankart repair between 2014–2016. Exclusion criteria were previous ipsilateral shoulder surgery, bony Bankart lesions, glenohumeral osteoarthritis and concomitant surgery involving rotator cuff tears, biceps tendon pathology and SLAP lesions. The study cohort was divided into 3 groups: apprehension test with apprehension only, apprehension test with pain only, and apprehension test with both apprehension and pain. Patient demographics, clinical characteristics, radiological imaging, arthroscopy findings and surgical outcomes (Constant, ASES, SF-36 scores) were evaluated. Results 115 (74.2%) had apprehension only, 26 (16.8%) had pain only and 14 (9.0%) had pain and apprehension with the apprehension test. Univariate analysis showed significant differences between the groups in patients with traumatic shoulder dislocation (p=0.028), patients presenting with pain (p=0.014) and patients presenting with recurrent dislocations (p=0.046). Patients with a purely painful apprehension test were more likely to have a traumatic shoulder dislocation, more likely to present only with pain, and less likely to present with recurrent shoulder dislocations. Multivariate analysis showed that none of these factors alone were significant as single predictors for shoulder instability. All 3 groups were otherwise similar in patient profile, MRI and arthroscopic assessments, and clinical outcomes of surgery. Excellent clinical outcomes were achieved in all groups with no difference in preoperative and postoperative scores across all groups at all time points. Conclusions The painful apprehension test may suggest underlying shoulder instability.

scholarly journals First time traumatic anterior shoulder dislocation: Will it always result in recurrent shoulder dislocation in all patients?

2020 ◽  
Vol 27 (04) ◽  
pp. 695-699
Author(s):  
Faaiz Ali Shah ◽  
Mian Amjad Ali ◽  
Naeemullah
Keyword(s):  
Shoulder Joint ◽  
Shoulder Dislocation ◽  
Rehabilitation Program ◽  
Monthly Interval ◽  
Anterior Shoulder Dislocation ◽  
Number Of Patients ◽  
Traumatic Anterior Shoulder Dislocation ◽  
Recurrent Shoulder Dislocation ◽  
First Time

Objectives: To determine the frequency of recurrent shoulder dislocation after first time traumatic anterior shoulder dislocation treated non operatively. Study Design: Prospective observational cohort study. Setting: Department of Orthopedics and Traumatology Lady Reading Hospital Peshawar. Period: 25th May 2011 to 25th December 2018. Material & Methods: Patients of all ages and both gender with first time. Traumatic anterior shoulder dislocation meeting the inclusion criteria were included in the study. In the included subjects shoulder joint was relocated under general anesthesia and immobilized in a poly sling for four weeks followed by supervised physiotherapy and rehabilitation program without any surgical stabilization of the shoulder joint. All these patients were instructed for follow up at monthly interval or before if recurrence occurred. Results: A total of 52 patients with mean age 35±9.4 years (range 16-55 years) were enrolled in our study. Male patients were 43(82.6%) while female patients were 9(17.3%). Right sided dislocation was noted in 38(73%) and left in 14(26.9%). Recurrent shoulder dislocation was reported in 32(61.5%) patients during a minimal follow up period of three years. Most (46.8%, n=15) of the patients with recurrent shoulder dislocation were 30 years of age or below. Conclusion: First time traumatic anterior shoulder dislocation treated non operatively not always result in recurrent shoulder dislocation in all patients. However a large number of patients and particularly younger patients suffered recurrence.

Anterior Instability of the Shoulder: Effect of Arm Position and Relative Contributions of Bony Bankart and Hill-Sachs Defects

2013 ◽  
Author(s):  
Piyush Walia ◽  
Anthony Miniaci ◽  
Morgan H. Jones ◽  
Stephen D. Fening
Keyword(s):  
Shoulder Dislocation ◽  
Recurrent Dislocation ◽  
Anterior Instability ◽  
Arm Position ◽  
Bony Bankart ◽  
Anterior Glenoid ◽  
Recurrent Shoulder Dislocation ◽  
The Relationship ◽  
Shoulder Stability

Shoulder stability can be significantly reduced in the presence of bony defects. Bony Bankart and Hill-Sachs lesions are known causes for recurrent shoulder dislocation. It has been shown in literature that often these defects are present together during cases of recurrent dislocation. 1 However, past studies have only analyzed the effects of isolated bony Bankart or Hill-Sachs lesions. 2, 3 Recent studies have stated that a Hill-Sachs lesion that “engages” the anterior glenoid has a critical impact on shoulder stability. 4 It is important to understand the relationship between these two bony defects, as this would lead to better management of the shoulders’ instability.

scholarly journals The Painful Anterior Apprehension Test – An Indication of Occult Shoulder Instability

2020 ◽  
Author(s):  
Yau Hong Ng ◽  
Gin Way Law ◽  
Zhaowen Dennis Ng ◽  
Jun Hao Tan ◽  
Keng Lin Francis Wong ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Shoulder Instability ◽  
Shoulder Dislocation ◽  
Biceps Tendon ◽  
Univariate Analysis ◽  
Rotator Cuff Tears ◽  
Pain Patient ◽  
Study Cohort ◽  
Patient Profile ◽  
Concomitant Surgery

Abstract Background To evaluate the clinical relevance of the painful anterior apprehension test in shoulder instability.MethodsWe performed a retrospective study of 155 patients that underwent arthroscopic anterior Bankart repair between 2014–2016. Exclusion criteria were previous ipsilateral shoulder surgery, bony Bankart lesions, glenohumeral osteoarthritis and concomitant surgery involving rotator cuff tears, biceps tendon pathology and SLAP lesions. The study cohort was divided into 3 groups: apprehension test with apprehension only, apprehension test with pain only, and apprehension test with both apprehension and pain. Patient demographics, clinical characteristics, radiological imaging, arthroscopy findings and surgical outcomes (Constant, ASES, SF-36 scores) were evaluated.Results115 (74.2%) had apprehension only, 26 (16.8%) had pain only and 14 (9.0%) had pain and apprehension with the apprehension test. Univariate analysis showed significant differences between the groups in patients with traumatic shoulder dislocation (p=0.028), patients presenting with pain (p=0.014) and patients presenting with recurrent dislocations (p=0.046). Patients with a purely painful apprehension test were more likely to have a traumatic shoulder dislocation, more likely to present only with pain, and less likely to present with recurrent shoulder dislocations. Multivariate analysis showed that none of these factors alone were significant as single predictors for shoulder instability. All 3 groups were otherwise similar in patient profile, MRI and arthroscopic assessments, and clinical outcomes of surgery. Excellent clinical outcomes were achieved in all groups with no difference in preoperative and postoperative scores across all groups at all time points.ConclusionsThe painful apprehension test may suggest underlying shoulder instability.

scholarly journals Treatment after traumatic shoulder dislocation: a systematic review with a network meta-analysis

2018 ◽  
Vol 52 (23) ◽  
pp. 1498-1506 ◽  
Author(s):  
Lauri Kavaja ◽  
Tuomas Lähdeoja ◽  
Antti Malmivaara ◽  
Mika Paavola
Keyword(s):  
Systematic Review ◽  
Surgical Management ◽  
Shoulder Instability ◽  
Shoulder Dislocation ◽  
Meta Analysis ◽  
Ovid Medline ◽  
Chronic Shoulder Instability ◽  
Post Traumatic ◽  
First Time ◽  
Quality Evidence

ObjectiveTo review and compare treatments (1) after primary traumatic shoulder dislocation aimed at minimising the risk of chronic shoulder instability and (2) for chronic post-traumatic shoulder instability.DesignIntervention systematic review with random effects network meta-analysis and direct comparison meta-analyses.Data sourcesElectronic databases (Ovid MEDLINE, Cochrane Clinical Trials Register, Cochrane Database of Systematic Reviews, Embase, Scopus, CINAHL, Ovid MEDLINE Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid MEDLINE Daily, DARE, HTA, NHSEED, Web of Science) and reference lists were searched from inception to 15 January 2018.Eligibility criteria for selecting studiesRandomised trials comparing any interventions either after a first-time, traumatic shoulder dislocation or chronic post-traumatic shoulder instability, with a shoulder instability, function or quality of life outcome.ResultsTwenty-two randomised controlled trials were included. There was moderate quality evidence suggesting that labrum repair reduced the risk of future shoulder dislocation (relative risk 0.15; 95% CI 0.03 to 0.8, p=0.026), and that with non-surgical management 47% of patients did not experience shoulder redislocation. Very low to low-quality evidence suggested no benefit of immobilisation in external rotation versus internal rotation. There was low-quality evidence that an open procedure was superior to arthroscopic surgery for preventing shoulder redislocations.ConclusionsThere was moderate-quality evidence that half of the patients managed with physiotherapy after a first-time traumatic shoulder dislocation did not experience recurrent shoulder dislocations. If chronic instability develops, surgery could be considered. There was no evidence regarding the effectiveness of surgical management for post-traumatic chronic shoulder instability.

Outcomes of arthroscopy in recurrent shoulder instability at Viet Duc University Hospital

2021 ◽  
Vol 11 (2) ◽  
Author(s):  
Đình Bằng Cao ◽  
Keyword(s):  
Shoulder Instability ◽  
Shoulder Dislocation ◽  
Constant Score ◽  
Excellent Result ◽  
Modern Technology ◽  
Arthroscopic Repair ◽  
University Hospital ◽  
Bankart Repair ◽  
Arthroscopic Bankart Repair ◽  
Recurrent Shoulder Dislocation

Abstract Introduction: This study aims to assess the results of patients with recurrent shoulder dislocation treated with arthroscopic Bankart repair. Patients and Method: 31 patients (26 males and 5 females, with an average age of 28.7) were treated with arthroscopic Bankart repair from 2017 to 2018. Those with multidirectional instability, posterior shoulder instability and more-than-25% Hill-Sachs defects, along with those who had prior shoulder surgeries were excluded. Average follow-up time after surgery is 15.13 months. Frequency of pre-operative dislocation, post-operative dislocation, functional status and daily activity performance were evaluated. The results were assessed using CONSTANT score. Results: One patient had post-operative dislocation (3.23%). One patient had post-operative joint adhesion (3.23%). Assessment using CONSTANT score showed an excellent result in 67.4%, good in 12.9%, moderate in 12.9% and average in 6.46%. There was no case with poor result. One patient had post-operative dislocation due to a sport injury. Conclusions: Arthroscopic repair is a modern technology, and is being used widely in diagnosing and treating shoulder lesions. This study shows that arthroscopic repair for recurrent shoulder dislocation may bring good result for patients. Keywords: Shoulder instability, arthroscopy, Bankart.

scholarly journals Long-Term Outcome of Rockwood Capsular Shift for Recurrent Shoulder Dislocation

2016 ◽  
Vol 24 (3) ◽  
pp. 392-397 ◽  
Author(s):  
Luigi Murena ◽  
Nicola Guindani ◽  
Stefano Turino ◽  
Federico A Grassi ◽  
Paolo Cherubino
Keyword(s):  
Shoulder Dislocation ◽  
Recurrent Dislocation ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Capsular Shift ◽  
Shoulder Range Of Motion ◽  
Recurrent Shoulder Dislocation ◽  
Glenohumeral Osteoarthritis

Purpose To review the long-term outcome of Rockwood capsular shift for recurrent shoulder dislocation secondary to trauma. Methods Records of 30 males and 4 females who underwent Rockwood capsular shift for recurrent (≥2 episodes) anterior shoulder dislocation were reviewed. An additional Bankart repair with different techniques was performed in 24 of the patients by 2 different surgeons. The outcome was assessed using the Western Ontario Shoulder Instability Index (WOSI) and the Western Ontario Osteoarthritis of the Shoulder (WOOS) index questionnaires, the modified Rowe score, and the Constant-Murley score. Shoulder range of motion (ROM) was measured. Degenerative joint changes were evaluated on radiographs. Results During a mean follow-up of 13 (range, 10–16) years, 6 (18%) patients had a mean of 1.2 recurrent dislocations. Four of the patients reported a traumatic event during recurrent dislocation. Of the 6 patients, 3 had undergone a Bankart lesion repair. Better Rowe and adjusted Constant scores were associated with lower age at first dislocation, at the index surgical procedure, and at follow-up. Four patients developed glenohumeral osteoarthritis: 2 were mild or moderate and 2 were severe and symptomatic. Glenohumeral osteoarthritis was associated with follow-up duration (p=0.03) and poorer Rowe score (p=0.012), adjusted Constant score (p=0.001), and WOOS score (p=0.006). Conclusion Rockwood capsular shift can preserve shoulder ROM, with rates of recurrent dislocation and degenerative joint changes comparable with other techniques.

scholarly journals Clinical outcomes of pediatric macular edema associated with non-infectious uveitis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Anh Hong Nguyen ◽  
Bethlehem Mekonnen ◽  
Eric Kim ◽  
Nisha R. Acharya
Keyword(s):  
Visual Acuity ◽  
Macular Edema ◽  
San Francisco ◽  
Pediatric Patients ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Study Cohort ◽  
Common Diagnosis ◽  
Corticosteroid Injections

Abstract Background Macular edema (ME) is the most frequent cause of irreversible visual impairment in patients with uveitis. To date, little data exists about the clinical course of ME in pediatric patients. A retrospective, observational study was performed to examine the visual and macular thickness outcomes of ME associated with chronic, noninfectious uveitis in pediatric patients. Methods Pediatric patients with noninfectious uveitis complicated by ME seen in the University of California San Francisco Health System from 2012 to 2018 were identified using ICD-9 and ICD-10 codes. Data were collected from medical records including demographics, diagnoses, ocular history, OCT imaging findings, complications, and treatments at first encounter and at 3, 6, 9, and 12-month follow-up visits. Cox proportional hazards regression was used to investigate the association between different classes of treatment (steroid drops, steroid injections, oral steroids and other immunosuppressive therapies) and resolution of macular edema. Results The cohort comprised of 21 children (26 eyes) with a mean age of 10.5 years (SD 3.3). Undifferentiated uveitis was the most common diagnosis, affecting 19 eyes (73.1%). The majority of observed macular edema was unilateral (16 patients, 76.2%) and 5 patients had bilateral macular edema. The mean duration of follow-up at UCSF was 35.3 months (SD 25.7). By 12 months, 18 eyes (69.2%) had achieved resolution of ME. The median time to resolution was 3 months (IQR 3–6 months). Median best-corrected visual acuity (BCVA) at baseline was 0.54 logMAR (Snellen 20/69, IQR 20/40 to 20/200). Median BCVA at 12 months was 0.1 logMAR (Snellen 20/25, IQR 20/20 to 20/50) Corticosteroid injections were associated with a 4.0-fold higher rate of macular edema resolution (95% CI 1.3–12.2, P = 0.01). Conclusions Although only 15% of the pediatric patients with uveitis in the study cohort had ME, it is clinically important to conduct OCTs to detect ME in this population. Treatment resulted in 69% of eyes achieving resolution of ME by 12 months, accompanied with improvement in visual acuity. Corticosteroid injections were significantly associated with resolution of macular edema.

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