posterior shoulder
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Hand ◽  
2021 ◽  
pp. 155894472110650
Author(s):  
Ajay C. Kanakamedala ◽  
Jared S. Bookman ◽  
David L. Furgiuele ◽  
Jacques H. Hacquebord

Regional blocks are being increasingly utilized for anesthesia for various orthopedic procedures. Several studies have shown that regional anesthesia has fewer side effects and improved postoperative pain relief compared to general anesthesia, but regional blocks are not without risks. We present case reports of 2 patients who experienced posterior shoulder instability, one of whom had a posterior shoulder dislocation, immediately in the postanesthesia care unit after undergoing hand surgery with regional anesthesia. This paper highlights the importance of being aware that patients might be at increased risk of shoulder instability after upper extremity regional anesthesia, and appropriate perioperative precautions should be taken.


2021 ◽  
pp. 175857322110560
Author(s):  
Huda Sardar ◽  
Sandra Lee ◽  
Nolan S. Horner ◽  
Latifah AlMana ◽  
Peter Lapner ◽  
...  

Background There is limited evidence examining glenoid osteotomy as a treatment for posterior shoulder instability. Methods A search of Medline, Embase, PubMed and Cochrane Central Register of Controlled Trials was conducted from the date of origin to 28th November 2019. Nine out of 3,408 retrieved studies met the inclusion criteria and quality was assessed using the Methodological Index for Non-randomized Studies tool. Results In 356 shoulders, the main indication for osteotomy was excessive glenoid retroversion (greater than or equal to approximately −10°). The mean preoperative glenoid version was −15° (range, −35° to −5°). Post-operatively, the mean glenoid version was −6° (range, −28° to 13°) and an average correction of 10° (range, −1° to 30°) was observed. Range of motion increased significantly in most studies and all standardized outcome scores (Rowe, Constant–Murley, Oxford instability, Japan Shoulder Society Shoulder Instability Scoring and mean shoulder value) improved significantly with high rates of patient satisfaction (85%). A high complication rate (34%, n = 120) was reported post-surgery, with frequent cases of persistent instability (20%, n = 68) and fractures (e.g., glenoid neck and acromion) (4%, n = 12). However, the revision rate was low (0.6%, n = 2). Conclusion Glenoid osteotomy is an appropriate treatment for posterior shoulder instability secondary to excessive glenoid retroversion. However, the high rate of persistent instability should be considered when making treatment decisions. Level of Evidence: Systematic review; Level 4


Author(s):  
Juho Park ◽  
Joo Yeon Kim ◽  
David Kim ◽  
Brandon Gardner ◽  
Sarah Jenkins ◽  
...  

Author(s):  
Katja Rüttershoff ◽  
Doruk Akgün ◽  
Philipp Moroder

AbstractChronic locked posterior shoulder dislocations are challenging to treat and often warrant total shoulder arthroplasty. While joint preserving treatment is preferable in young patients, surgical techniques to treat this pathology have rarely been described in the literature. This technical note presents the treatment of a 30-year-old male patient with a chronic locked posterior shoulder dislocation by means of combined humeral allograft reconstruction and posterior glenoid autograft augmentation. Restoration of the spheric humeral head surface was obtained using a fresh-frozen femoral allograft fixed with two reabsorbable screws. Due to the intraoperatively persistent posterior instability after humeral reconstruction, the posterior glenoid was augmented with a tricortical iliac crest autograft, which was fixed with two metal screws. This treatment strategy resulted in a full range of motion and a centered stable shoulder joint at one-year follow-up. Therefore, the procedure of segmental reconstruction of the humeral head with a fresh-frozen allograft combined with a posterior glenoid augmentation with an iliac crest bone autograft is a joint-preserving treatment alternative to shoulder arthroplasty in young patients when humeral head reconstruction alone does not suffice.


2021 ◽  
pp. 175319342110569
Author(s):  
Petra Grahn ◽  
Antti Sommarhem ◽  
Yrjänä Nietosvaara

Children with permanent brachial plexus birth injury have a high risk of developing posterior shoulder subluxation. In 2010, we implemented a protocol to reduce the incidence of this deformity, including early passive exercises, ultrasound screening, botulinum toxin-A injections, shoulder splinting and targeted surgeries. Two-hundred and thirty-seven consecutive children treated at our institution, with a mean follow-up of 11 years (range 1 to 17) were compared in three groups: children born from 1995 to 1999 ( n = 53), 2000–2009 ( n = 109) and 2010–2019 ( n = 75). Posterior shoulder subluxation developed in 48% of all patients but the mean age at detection of shoulder subluxation decreased from 5 years to 4.9 months. Need for shoulder relocation surgery also decreased from 28% to 7%. Mean active shoulder external rotation in adduction improved from 2° to 46°. In conclusion, our established protocol has the potential to reduce the incidence of posterior shoulder subluxation in children with brachial plexus birth injury. Level of evidence: II


2021 ◽  
Vol 1 (6) ◽  
pp. 263502542110319
Author(s):  
Gautam P. Yagnik ◽  
Kevin West ◽  
Bhavya K. Sheth ◽  
Luis Vargas ◽  
John W. Uribe

Background: Gross posterior instability is rare and when found likely has an injury or deficiency to the posterior static restraints of shoulder associated with it. Traditionally, injuries to the posterior capsule have been difficult to diagnose and visualize with magnetic resonance imaging preoperatively, and very little literature regarding arthroscopic repair of posterior capsular tears exists currently. Indications: We present a repair of a posterior midcapsular and posterior labral tear in a 26-year-old man with recurrent left posterior shoulder instability using a novel all–arthroscopic technique. Technique Description: We performed a shoulder arthroscopy in a lateral decubitus position with the arm at 45° of abduction using standard posterior viewing and anterior working portals. Diagnostic arthroscopy revealed a large posterior midcapsular rupture approximately 2 cm lateral to the glenoid with an associated posterior labral tear. We created an accessory posterolateral portal with needle localization that was outside the capsular defect yet allowed access to the posterior labrum. Anatomic closure of the capsular tear was achieved arthroscopically with 3 interrupted No. 2 nonabsorbable sutures in a side–to–side fashion. Posterior labral repair and capsular shift were done to further address the instability using 2 knotless all–suture anchors percutaneously placed at the 7 o'clock and 9 o'clock position. We closed the posterior portal with a combination of curved and penetrating suture passers. Incisions were closed with interrupted 4-0 nylon. Postoperatively, the patient was placed in an ultra–sling for 4 weeks before physical therapy. We allowed light strengthening at 8 weeks, full strengthening at 12 weeks, and estimated return to sport at 4 months. Results: At 6 months postoperatively, the patient has regained symmetric motion, full strength, and has no residual pain or instability. Conclusion: Gross posterior instability is a rare and difficult condition to diagnose and manage. If no significant labral injuries are identified, injury to the posterior capsule must be considered and full assessment should be done when visualizing from the anterior portal. Repair of the posterior capsule is necessary and can be achieved all arthroscopically with this technique.


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