IMAGING IN ANTERIOR SHOULDER DISLOCATION

2021 ◽  
Vol 37 ◽  
pp. 25-32
Author(s):  
Przemyslaw Lubiatowski ◽  
Joanna Wałecka ◽  
Jakub Stefaniak
Keyword(s):  
Shoulder Dislocation ◽  
Therapeutic Process ◽  
Conventional Radiography ◽  
Musculoskeletal Injury ◽  
Radiographic Evaluation ◽  
X Rays ◽  
Nerve Injuries ◽  
Keywords Shoulder ◽  
Diagnostic Modalities ◽  
Successful Reduction

Shoulder dislocation is a very common musculoskeletal injury. Imaging in such cases serves an important role in the diagnostic and therapeutic process. Despite a pretty simple clinical diagnosis, the process itself is long for the patient and associated with multiple steps and decision making to regain function with low risk of prolonged disability (Zygmunt et al., 2013; Lubiatowski et al., 2016). There are also many controversies as well as significant diversity among surgeons regarding the timing and choice of particular diagnostic modalities used in diagnostics of different scenarios of shoulder dislocation. The aim of imaging in shoulder dislocation is to confirm dislocation and its direction and finally successful reduction. That usually is served by conventional radiography. Additionally, imaging may be required to identify soft tissue or bone injuries or, when necessary vascular and nerve injuries using different modalities (CT, MR, US). The selective radiographic evaluation may reduce the number of X-rays, costs, and most of all time before reduction and spent by a patient in an emergency unite. That should be used carefully to avoid misdiagnosis. Keywords: shoulder dislocation, imaging, radiography, instability, magnetic resonance

scholarly journals Novel Radiographic Indexes for Elbow Stability Assessment: Part B—Preliminary Clinical Study

2021 ◽  
Author(s):  
Francesco Luceri ◽  
Davide Cucchi ◽  
Enrico Rosagrata ◽  
Carlo Eugenio Zaolino ◽  
Alessandra Menon ◽  
...  
Keyword(s):  
Case Series ◽  
Radiographic Evaluation ◽  
Healthy Population ◽  
X Rays ◽  
The Novel ◽  
Level Of Evidence ◽  
Orthopaedic Surgeons ◽  
Joint Congruency ◽  
Radiological Parameters ◽  
The Mean

Abstract Introduction The coronoid process plays a key-role in preserving elbow stability. Currently, there are no radiographic indexes conceived to assess the intrinsic elbow stability and the joint congruency. The aim of this study is to present new radiological parameters, which will help assess the intrinsic stability of the ulnohumeral joint and to define normal values of these indexes in a normal, healthy population. Methods Four independent observers (two orthopaedic surgeons and two radiologists) selected lateral view X-rays of subjects with no history of upper limb disease or surgery. The following radiographic indexes were defined: trochlear depth index (TDI); anterior coverage index (ACI); posterior coverage index (PCI); olecranon–coronoid angle (OCA); radiographic coverage angle (RCA). Inter-observer and intra-observer reproducibility were assessed for each index. Results 126 subjects were included. Standardized lateral elbow radiographs (62 left and 64 right elbows) were obtained and analysed. The mean TDI was 0.46 ± 0.06 (0.3–1.6), the mean ACI was 2.0 ± 0.2 (1.6–3.1) and the mean PCI was 1.3 ± 0.1 (1.0–1.9). The mean RCA was 179.6 ± 8.3° (normalized RCA: 49.9 ± 2.3%) and the mean OCA was 24.6 ± 3.7°. The indexes had a high-grade of inter-observer and intra-observer reliability for each of the four observers. Significantly higher values were found for males for TDI, ACI, PCI and RCA. Conclusion The novel radiological parameters described are simple, reliable and easily reproducible. These features make them a promising tool for radiographic evaluation both for orthopaedic surgeons and for radiologists in the emergency department setting or during outpatient services. Level of evidence Basic Science Study (Case Series). Clinical relevance The novel radiological parameters described are reliable, easily reproducible and become handy for orthopaedic surgeons as well as radiologists in daily clinical practice.

Peripheral nerve injuries due to osteochondromas: analysis of 20 cases and review of the literature

2014 ◽  
Vol 120 (5) ◽  
pp. 1105-1112 ◽  
Author(s):  
Selçuk Göçmen ◽  
Ali Kıvanç Topuz ◽  
Cem Atabey ◽  
Hakan Şimşek ◽  
Kenan Keklikçi ◽  
...  
Keyword(s):  
Peripheral Nerve ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Nerve Compression ◽  
Radiographic Evaluation ◽  
Peripheral Nerve Injuries ◽  
Nerve Injuries ◽  
En Bloc ◽  
Duration Of Symptoms ◽  
Nerve Decompression

Object Nerve compressions due to osteochondromas are extremely rare. The aim of this retrospective study was to investigate the mechanisms, diagnostic evaluations, and treatment of nerve lesions due to osteochondromas, and to review the literature. Methods The authors retrospectively reviewed their clinic data archive from 1998 through 2008, and 20 patients who were operated on due to peripheral nerve injuries caused by osseous growth were enrolled in the study. Patients' age, duration of symptoms, localizations, intraoperative findings, and modified British Medical Research Council (MRC) and electromyography data obtained from hospital records were evaluated. The literature on this topic available in PubMed was also reviewed. All 20 patients underwent surgery, which consisted of tumor excision performed by orthopedic surgeons and nerve decompression performed by neurosurgeons. Results There were 17 men and 3 women included in the study, with a mean age of 21 years (range 18–25 years). Three patients had multiple hereditary exostoses, and 17 had a solitary exostosis. All of the patients underwent en bloc resection. The most common lesion site was the distal femur (45%). The peroneal and posterior tibial nerves were the structures that were affected the most frequently. The mean follow-up was 3.9 years (range 2–7 years). After the surgery, all patients (100%) experienced good sensory recovery (modified MRC Grade S4 or S5). Conclusions To the authors' knowledge, no large series have reported peripheral nerve compression due to exostoses. The authors have several recommendations as a result of their findings. First, all patients with peripheral nerve compression due to an osteochondroma should undergo surgery. Second, preoperative electromyographic examinations and radiographic evaluation, consisting of MRI and CT to provide optimal information about the lesion, are crucially important. Third, immediate treatment is mandatory to regain the best possible recovery. And fourth, performing nerve decompression first and en bloc resection of osteochondroma consecutively in a multidisciplinary fashion is strongly recommended to avoid peripheral nerve injury.

scholarly journals The Paradox of Happy Hypoxia in COVID 19

2021 ◽  
pp. 119-124
Author(s):  
Madhu Bansode ◽  
Pankaj Bansode
Keyword(s):  
Young Patients ◽  
The Elderly ◽  
Clinical Implications ◽  
X Rays ◽  
The Novel ◽  
Human Race ◽  
Self Monitoring ◽  
Diagnostic Modalities ◽  
High Index Of Suspicion ◽  
Rule Out

Ever since the human race has been exposed to the novel COVID 19 illness, newer and newer intriguing features of the COVID viral plethora are seen with each passing day. Many manifestations of the COVID 19 illness have been baffling and unexplainable to researchers currently. One such unusual presentation seen is ‘happy hypoxia’ or silent hypoxemia in a third of patients' total number. This review article is intending to put some light on the puzzling condition of happy hypoxia. We authors refer you through various theories postulated for happy hypoxia. It has definite clinical implications in the sense that it can be lifesaving if detected early and promptly in a COVID patient. We conclude that happy hypoxia or silent hypoxemia is a new entity and should be diagnosed with a high index of suspicion in COVID suspect patients in both young patients with no co morbidities and the elderly and diabetics. Diagnostic modalities like pulse oximeter should be widely used at hospitals and clinics and for self-monitoring by the patients at homes. Also, chest X-rays or HRCT imaging of the lungs is essential in the early stages to identify the early infective changes with compromised lung function and rule out this happy hypoxia. Also, further research is essential to find the exact ethologic of this subclinical though ominous prognostic entity.

scholarly journals TOMOGRAFIA COMPUTADORIZADA: VANTAGENS SOBRE A RADIOGRAFIA PANORÂMICA NA AVALIAÇÃO DE TERCEIROS MOLARES INFERIORES INCLUSOS

DENS ◽  
2007 ◽  
Vol 15 (2) ◽  
Author(s):  
Carolina LAZAROTTO ◽  
Grasielle KARPSTEIN ◽  
Wilson Kenji SHIROMA
Keyword(s):  
Oral Surgery ◽  
Third Molar ◽  
Oral Pathology ◽  
Conventional Radiography ◽  
Mandibular Canal ◽  
Radiographic Evaluation ◽  
Third Molar Surgery ◽  
Oral Radiology ◽  
Conventional Tomography ◽  
Macroscopic Findings

Tomografia Computadorizada: vantagens sobre a Radiografia Panorâmica na avaliação de terceiros molares inferiores inclusos.   A cirurgia dos terceiros molares inferiores retidos pode levar a alterações sensoriais importantes, devido a trauma no nervo alveolar inferior, o qual no seu trajeto, apresenta relação intra-óssea importante com as raízes dos molares. A relação entre os ápices do terceiro molar e o canal mandibular deve ser previamente identificada à intervenção cirúrgica. O presente trabalho tem por objetivo a comparação das imagens, da relação dos terceiros molares inferiores retidos com o canal mandibular, fornecidas por radiografias panorâmicas (RP) e por tomografias computadorizadas (TC). Metodologia: Comparação de radiografias panorâmicas e suas respectivas TC, levando em consideração a relação de proximidade dos ápices dentários com o canal mandibular. Resultados: Das RP avaliadas, todas apresentaram imagem de sobreposição do canal mandibular, e uma delas, também sugeriu trajeto interradicular do mesmo. Na TC comprovou-se tridimensionalmente relação de proximidade dos mesmos e em um caso, descartou-se a possibilidade de um trajeto interradicular do canal mandibular. Conclusão: Pelo material analisado, sugere-se que a TC mostra-se superior no diagnóstico e planejamento cirúrgico de terceiros molares inclusos.  Palavras-Chave: Tomografia; Radiografia Panorâmica; Nervo Mandibular  Referências Bibliográficas 1. DÍAZ-TORRES, M. J. et al. Fatores clínicos y radiológicos de “verdadera relación” entre el nervio dentário y  el tercer molar. Revista Española de Cirurgia Oral y Maxillofacial, v. XII, n. 2, p. 51-57, 1990.2. FREDERIKSEN, N.L.; Diagnostic imaging in dental implantology. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontics. v.80, 540-554, 1995.3. KINGLE, B.; PETERSSON, A.; MALY, P. Location of the mandibular canal: comparison of Macroscopic findings, conventional radiography, and computed tomography. Int J Oral Maxillofac Implants. v. 4, p. 327-332, 1989.4. LINDH, C.; PETERSON, A. Radiologic examination for location the mandibular canal: A comparision between panoramic radiography and conventional tomography. The International Journal of Oral & Maxillofacial Implants. V. 4, n. 3, p.249-253, 1989.5. SINN, D. P.; KARAS, N. D. Radiographic evaluation of facial injuries. In: FONSECA, R. J.; WALKER, R. V. Oral and Maxillofacial Trauma. 2. ed. Saunders Company, 1997. p. 391-418.6. GRAZIANI, Mario. Cirurgia bucomaxilofacial. 8. ed. Rio de Janeiro: Guanabara Koogan, c1995.7. GOMES, A. C. et al. Estudo das lesões nervosas após cirurgia dos terceiros molares inferiores retidos. Dissertação de Mestrado em odontologia – Faculdade de Odontologia de Pernambuco – Camaragibe-Pe, 2001. 123 p.8. FÉLEZ-GUTIÉRREZ, J. et al. Las lesiones Del nervio dentario inferior en el tratamiento quirúrgico del tercer molar inferior retenido: aspectos radiológicos, prognósticos y preventivos. Archivos de Odontoestomatología, v. 13, n. 2, p. 73-83, 1997.9. KINGLE, B.; PETERSSON, A.; MALY, P. Location of the mandibular canal: comparison of macroscopic findings, conventional radiography, and computedtomography. Int J Oral Maxillofac Implants, v. 4, p. 327-332, 1989.10. RUD, J. Third molar surgery: relationship of root to mandibular canal and injuries to inferior dental nerve. Tandlaegebladet, v. 87, n. 18, p. 619-630, 1983.

scholarly journals RADIOGRAPHIC EVALUATION OF THORACOLUMBAR STABILIZATION USING TWO DIFFERENT ORTHOSIS SYSTEMS

2018 ◽  
Vol 17 (4) ◽  
pp. 300-302
Author(s):  
Murilo Tavares Daher ◽  
Vinício Nunes Nascimento ◽  
Pedro Felisbino Jr ◽  
Nilo Carrijo Melo ◽  
Brenda Cristina Ribeiro Araújo ◽  
...  
Keyword(s):  
Cobb Angle ◽  
Thoracolumbar Junction ◽  
Radiographic Evaluation ◽  
Neutral Position ◽  
X Rays ◽  
Level Of Evidence ◽  
Institutional Review ◽  
Thoracolumbar Region ◽  
Boston Brace ◽  
Orthostatic Position

ABSTRACT Objective: To evaluate radiographically the stability of the thoracolumbar junction comparing the two types of thoracolumbosacral orthosis (TLSO) most used in our environment, the Jewett and the Boston braces. Methods: After approval by the institutional review board, nine participants were submitted to X-rays in the profile view, with the beam focused on T12, in the orthostatic position, maximal flexion without brace and maximal flexion with the Jewett and the Boston braces. The Cobb angle of the thoracolumbar junction (T10-L2) was measured and the values compared using the student T test (p <0.05). Results: The Boston brace promoted greater stabilization of the thoracolumbar junction during flexion of the trunk compared to the Jewett brace (p <0.05). In addition, there was no statistical difference in the Cobb angle of the thoracolumbar junction in the orthostatic (neutral) position and in flexion using the Boston brace. Conclusion: The Boston brace presented greater stabilization of the thoracolumbar region during flexion of the trunk compared to the Jewett brace. Level of Evidence II; Prospective comparative study.

Traumatic bilateral posterior dislocation of the shoulder: a case report

Open Medicine ◽  
2013 ◽  
Vol 8 (6) ◽  
pp. 810-813
Author(s):  
C. Garving ◽  
T. Dienstknecht ◽  
K. Horst ◽  
M. Pishnamaz ◽  
P. Kobbe ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Shoulder Dislocation ◽  
Limited Range ◽  
Clinical Suspicion ◽  
Posterior Dislocation ◽  
X Rays ◽  
Posterior Shoulder Dislocation ◽  
Limited Range Of Motion ◽  
Posterior Shoulder ◽  
Bilateral Posterior Shoulder Dislocation

AbstractIntroduction. Bilateral posterior dislocation of the shoulder is a rare injury, accounted for about 2–5% of all shoulder dislocations. Main courses are electrical shock, epilepsy or extreme trauma with uncontrolled muscle forces. We report about a case of bilateral posterior shoulder dislocation without additional fractures but with a concomitant acromioclavicular joint dislocation. Case presentation. A 46-year-old Caucasian motorcyclist presented to our facility after a fall on slippery ground. He claimed pain in both shoulders with limited range of motion. The initial X-rays were inconclusive, clinical examination showed typical findings of a Rockwood injury with an additional limited external rotation so that a posterior shoulder dislocation was suspected. The CT scan confirmed the clinical suspicion. A closed reduction was performed followed by immobilization in a shoulder abduction pillow for 4 weeks and continuous physiotherapy. Upon follow up normal function with full range of motion was observed. Conclusion. A bilateral posterior shoulder dislocation can be caused by trauma and results in a limited range of motion with often additional injuries. Due to the unusually presentation the risk of missing the injury is increased. Therefore it is most important to consider this rare diagnosis and in case of clinical suspicion perform a careful algorithm of diagnostic.

Inhaled methoxyflurane for the reduction of acute anterior shoulder dislocation in the emergency department

CJEM ◽  
2019 ◽  
Vol 21 (4) ◽  
pp. 468-472 ◽  
Author(s):  
Etimbuk Umana ◽  
Josephine Hannah Kelliher ◽  
Christiaan Johannes Blom ◽  
Brian McNicholl
Keyword(s):  
Emergency Department ◽  
Shoulder Dislocation ◽  
Recovery Time ◽  
Patient Flow ◽  
Hospital Setting ◽  
Anterior Shoulder Dislocation ◽  
Fracture Dislocations ◽  
Record Review ◽  
The Impact ◽  
Successful Reduction

ABSTRACTObjectivesMethoxyflurane is an inhalation analgesic used in the emergency department (ED) but also has minimal sedative properties. The major aim of this study was to evaluate the success rate of methoxyflurane for acute anterior shoulder dislocation (ASD) reduction. The secondary aim was to assess the impact of methoxyflurane on ED patient flow compared to propofol.MethodsA health record review was performed for all patients presenting with ASD who underwent reduction with either methoxyflurane or propofol over a 13-month period (December 2016 – December 2017). The primary outcome was reduction success for methoxyflurane, while secondary outcomes such as recovery time and ED length of stay (LOS) were also assessed compared to propofol. Patients with fracture dislocations, polytrauma, intravenous, or intramuscular opioids in the pre-hospital setting, no sedation for reduction, and alternative techniques of sedation or analgesia for reduction were excluded.ResultsA total of 151 patients presented with ASD during the study period. Eighty-two patients fulfilled our inclusion criteria. Fifty-two patients had ASD reduction with propofol while 30 patients had methoxyflurane. Successful reduction was achieved in 80% (95% CI 65.69% to 94.31%) patients who used methoxyflurane. The median recovery time and ED LOS were 30 minutes [19.3-44] and 70.5 minutes [49.3-105], which was found to be shorter for the methoxyflurane group, who had successful reductions compared to sedation with propofol.ConclusionMethoxyflurane was used successfully in 30% of the 82 patients undergoing reduction for ASD, while potentially improving ED efficiency.

Retained Foreign Bodies after Emergent Trauma Surgery: Incidence after 2526 Cavitary Explorations

2007 ◽  
Vol 73 (10) ◽  
pp. 1031-1034 ◽  
Author(s):  
Pedro G.R. Teixeira ◽  
Kenji Inaba ◽  
Ali Salim ◽  
Carlos Brown ◽  
Peter Rhee ◽  
...  
Keyword(s):  
Foreign Bodies ◽  
Damage Control ◽  
Trauma Surgery ◽  
Radiographic Evaluation ◽  
Trauma Patients ◽  
X Rays ◽  
Chest X Ray ◽  
Cavity Closure ◽  
Level 1 Trauma Center

Trauma patients are thought to be at high risk for iatrogenic retained foreign bodies (RFBs). The objective of this study was to evaluate this incidence. All cases of RFB after cavitary trauma surgery were identified by review of Morbidity and Mortality reports at a Level 1 trauma center from January 1998 to December 2005 and confirmed by the Octagon Risk Management System. Over 8 years, 10,053 trauma operations were performed (2075 laparotomies, 377 thoracotomies, and 74 sternotomies). Three cases (0.1%) of RFB (all sponges) occurred during one single-stage and two damage control laparotomies. The counts were correct before definitive closure in two of three cases. No postoperative x-rays were obtained in any of the cases. RFB diagnosis occurred between days 3 and 9, one on a routine chest x-ray and the other two on abdominal computed tomography scans during a septic workup. Four-month to 8-year follow up documented one pleural effusion and one abscess resulting from the RFB. Iatrogenic RFBs after emergent cavitary trauma surgery occur at a rate of 0.12 per cent and are associated with significant morbidity. In addition to standard preventive strategies, in emergent cases with risk factors such as requiring damage control, before final cavity closure, even with a correct sponge count, radiographic evaluation is warranted.

scholarly journals The Efficacy of External Rotation Method for The Reduction of Acute Anterior Shoulder Dislocation With and Without Greater Tuberosity Fracture

2018 ◽  
Vol 3 (2) ◽  
pp. 408-412 ◽  
Author(s):  
Gopal Prasad Gnawali ◽  
Indra Dhakal ◽  
Kishor Khatri ◽  
Shanta Sharma
Keyword(s):  
Shoulder Dislocation ◽  
External Rotation ◽  
Reduction Process ◽  
Anterior Dislocation ◽  
Emergency Setting ◽  
Anterior Shoulder Dislocation ◽  
Greater Tuberosity ◽  
Rotation Method ◽  
Cause Of Failure ◽  
Successful Reduction

Introduction: Several methods of reduction technique have been described for the anterior dislocation of shoulder but none technique is said to be ideal. The aim of this study was to show the efficacy of external rotation method which could be safe and painless method for the reduction of the acute anterior shoulder dislocation with or without fracture of the greater tuberosity and to search the cause of failure of reduction.Objective: Objective of this study was to assess the efficacy of the external rotation method for reduction of acute anterior shoulder dislocation and to find the cause of failure of reduction.Methodology: All cases of anterior dislocation encountered in emergency department reduced by external rotation method by consultant orthopedic surgeon using basic emergency setting for resuscitation were included in the study. Fifty cases of shoulder dislocation was treated by this method and prospective evaluation done with regard to type of dislocation, the effectiveness of the procedure in achieving reduction, the need for pre-medication, the ease of performing reduction and complication if any.Results: Out of 50 cases, successful reduction was achieved in 42 patients. Premedication was not required in 36 successful reduction. Average time of reduction was 2 minutes in 30 patients and 5 minutes in 8 patients. Four Patients complained severe pain during reduction process. This method was not successful in 8 patients 2 of whom had displaced greater tuberosity fracture.Conclusion: The external rotation method is reliable and safe method for the reduction of acute anterior shoulder dislocation which can be performed relatively with less pain for both subcoracoid and subglenoid dislocation provided there is no displaced fracture of the greater tuberosity.  BJHS 2018;3(2)6: 408-412.

scholarly journals Bilateral Luxatio Erecta Humeri With Acute Anterior-inferior Re-dislocation

2019 ◽  
Vol 4 (1) ◽  
pp. 38-41
Author(s):  
Adam Kessler ◽  
Jacob Hinkley ◽  
David Houserman ◽  
Jacob Lytle ◽  
Michael Sorscher
Keyword(s):  
Humeral Head ◽  
Shoulder Dislocation ◽  
Reduction Method ◽  
Low Energy ◽  
Rare Form ◽  
Rare Type ◽  
Luxatio Erecta ◽  
Successful Reduction ◽  
Glenohumeral Dislocation

Luxatio erecta is a description for a specific and rare type of shoulder dislocation where the humeral head dislocates directly inferior. This rare form of glenohumeral dislocation accounts for only 0.5% of shoulder dislocations. It is even less common for both shoulders to be bilaterally dislocated inferiorly with the characteristic “hands up” posture. A limited number of these bilateral occurrences are described in the literature to date and most have been from higher energy trauma. We have described a low energy case of bilateral luxatio erecta and the reduction method used and the continued instability following successful reduction under procedural anesthesia.

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