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Shoulder Dislocation Surgery Workup

  • Author: Scott Welsh, MD; Chief Editor: S Ashfaq Hasan, MD  more...
 
Updated: Dec 17, 2014
 

Imaging Studies

See the list below:

  • Radiography: Conventional radiography should be performed in all patients with suspected shoulder dislocations to confirm the diagnosis and also to exclude associated fractures prior to any attempted reduction.[7] Routine radiographs should include at least an anteroposterior (AP) view and an axillary view.[8]
    • The AP view can be obtained in neutral, internal, or external rotation. In internal rotation, one can easily see a Hill-Sachs lesion of the posterolateral humeral head.
    • The axillary view nicely shows glenohumeral subluxation or dislocation, as well as anterior or posterior glenoid rim fractures.[9] A standard axillary view may be difficult in the acute injury setting because it requires 90° of abduction. However, many modifications exist to avoid excessive movement of the painful extremity. For example, the transverse axillary lateral requires the patient to abduct the arm only 10-30°.
    • Other views that may be useful include the scapular Y view, which is helpful for diagnosing dislocations and scapular fractures. This view, however, should not replace the axillary view because it does not show subtle subluxations of the glenohumeral joint or fractures of the glenoid rim.
      • The true AP or Grashey view is helpful in assessing subtle joint incongruity, superior or inferior subluxation, degenerative changes, or glenoid hypoplasia.
      • The Garth or West Point view is useful in detecting bony Bankart fractures of the anteroinferior glenoid rim as well as Hill-Sachs defects. This view is advantageous in the acute setting because it does not necessitate the patient moving the arm.
      • The Stryker notch view can also be useful in detecting Hill-Sachs lesions. However, this view is of limited usefulness in detecting subluxations or glenoid fractures.
  • Computed tomography (CT) arthrography, magnetic resonance imaging (MRI), and/or magnetic resonance arthrography may be helpful in assessing some shoulder dislocations.[10]
    • CT arthrography was commonly used in the past to evaluate patients with glenohumeral instability either after the initial dislocation or with recurrent instability. However, today, it is used only when an MRI is contraindicated or if glenoid version abnormalities are suspected.
    • MRI and magnetic resonance arthrography have been shown to be more sensitive than other methods in detecting labral and ligamentous pathology, rotator cuff and cartilage tears, capsular abnormalities, and biceps injuries. MR arthrography is more sensitive than MRI alone and is the study of choice after a shoulder dislocation, particularly in cases of recurrent instability, and it is superior to MRI for diagnosing the pathologic lesions mentioned above.
 
 
Contributor Information and Disclosures
Author

Scott Welsh, MD Staff Physician, Department of Orthopedic Surgery, Borgess/Bronson Hospitals, Michigan State University

Scott Welsh, MD is a member of the following medical societies: Michigan State Medical Society

Disclosure: Nothing to disclose.

Coauthor(s)

Mark Veenstra, MD Consulting Staff, K Valley Orthopedics, Southwestern Michigan Sports Medicine Clinic

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Pekka A Mooar, MD Professor, Department of Orthopedic Surgery, Temple University School of Medicine

Pekka A Mooar, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Nothing to disclose.

Chief Editor

S Ashfaq Hasan, MD Associate Professor, Chief, Shoulder and Elbow Service, Department of Orthopaedics, University of Maryland School of Medicine

S Ashfaq Hasan, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Shoulder and Elbow Surgeons

Disclosure: Nothing to disclose.

Additional Contributors

Cato T Laurencin, MD, PhD University Professor, Albert and Wilda Van Dusen Endowed Distinguished Professor of Orthopedic Surgery, and Professor of Chemical, Materials, and Biomolecular Engineering, University of Connecticut School of Medicine

Cato T Laurencin, MD, PhD is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Nothing to disclose.

References
  1. Pettrone FA. Athletic Injuries of the Shoulder. New York:. McGraw-Hill. 1995.

  2. Rockwood CA, Matsen FA, Wirth MA, et al. The Shoulder. 2nd ed. Philadelphia:. WB Saunders Co. 1998.

  3. Rowe CR. The Shoulder. New York:. Churchill Livingstone. 1988.

  4. Keener JD, Wei AS, Kim HM, Steger-May K, Yamaguchi K. Proximal humeral migration in shoulders with symptomatic and asymptomatic rotator cuff tears. J Bone Joint Surg Am. 2009 Jun. 91(6):1405-13. [Medline]. [Full Text].

  5. Fung DA, Menkowitz M, Chern K. Asymmetric bilateral shoulder dislocation involving a luxatio erecta dislocation. Am J Orthop. 2008 May. 37(5):E97-8. [Medline].

  6. Groh GI, Wirth MA, Rockwood CA Jr. Results of treatment of luxatio erecta (inferior shoulder dislocation). J Shoulder Elbow Surg. 2009 Oct 15. [Medline].

  7. Saupe N, White LM, Bleakney R, Schweitzer ME, Recht MP, Jost B, et al. Acute traumatic posterior shoulder dislocation: MR findings. Radiology. 2008 Jul. 248(1):185-93. [Medline].

  8. Braunstein V, Kirchhoff C, Ockert B, Sprecher CM, Korner M, Mutschler W, et al. Use of the fulcrum axis improves the accuracy of true anteroposterior radiographs of the shoulder. J Bone Joint Surg Br. 2009 Aug. 91(8):1049-53. [Medline].

  9. Sanders TG, Morrison WB, Miller MD. Imaging techniques for the evaluation of glenohumeral instability. Am J Sports Med. 2000 May-Jun. 28(3):414-34. [Medline].

  10. Itoi E, Sashi R, Minagawa H, et al. Position of immobilization after dislocation of the glenohumeral joint. A study with use of magnetic resonance imaging. J Bone Joint Surg Am. 2001 May. 83-A(5):661-7. [Medline].

  11. Wen DY. Current concepts in the treatment of anterior shoulder dislocations. Am J Emerg Med. 1999 Jul. 17(4):401-7. [Medline].

  12. Kirkley A, Griffin S, Richards C, et al. Prospective randomized clinical trial comparing the effectiveness of immediate arthroscopic stabilization versus immobilization and rehabilitation in first traumatic anterior dislocations of the shoulder. Arthroscopy. 1999 Jul-Aug. 15(5):507-14. [Medline].

  13. Yuen MC, Yap PG, Chan YT, Tung WK. An easy method to reduce anterior shoulder dislocation: the Spaso technique. Emerg Med J. 2001 Sep. 18(5):370-2. [Medline].

  14. Fernández-Valencia JA, Cuñe J, Casulleres JM, Carreño A, Prat S. The Spaso technique: a prospective study of 34 dislocations. Am J Emerg Med. 2009 May. 27(4):466-9. [Medline].

  15. Kosnik J, Shamsa F, Raphael E, et al. Anesthetic methods for reduction of acute shoulder dislocations: a prospective randomized study comparing intraarticular lidocaine with intravenous analgesia and sedation. Am J Emerg Med. 1999 Oct. 17(6):566-70. [Medline].

  16. Moharari RS, Khademhosseini P, Espandar R, Soleymani HA, Talebian MT, Khashayar P, et al. Intra-articular lidocaine versus intravenous meperidine/diazepam in anterior shoulder dislocation: a randomised clinical trial. Emerg Med J. 2008 May. 25(5):262-4. [Medline].

  17. Yuen CK, To DB. Is operative repair better than conservative treatment after primary anterior shoulder dislocation?. Arthroscopy. 2008 Aug. 24(8):971; author reply 971. [Medline].

  18. Itoi E, Hatakeyama Y, Urayama M, et al. Position of immobilization after dislocation of the shoulder. A cadaveric study. J Bone Joint Surg Am. 1999 Mar. 81(3):385-90. [Medline].

  19. Hovelius L, Olofsson A, Sandström B, Augustini BG, Krantz L, Fredin H, et al. Nonoperative treatment of primary anterior shoulder dislocation in patients forty years of age and younger. a prospective twenty-five-year follow-up. J Bone Joint Surg Am. 2008 May. 90(5):945-52. [Medline].

  20. Maeda A, Yoneda M, Horibe S, et al. Longer immobilization extends the "symptom-free" period following primary shoulder dislocation in young rugby players. J Orthop Sci. 2002. 7(1):43-7. [Medline].

  21. Hovelius L, Augustini BG, Fredin H, et al. Primary anterior dislocation of the shoulder in young patients. A ten- year prospective study. J Bone Joint Surg Am. 1996 Nov. 78(11):1677-84. [Medline].

  22. Finestone A, Milgrom C, Radeva-Petrova DR, Rath E, Barchilon V, Beyth S, et al. Bracing in external rotation for traumatic anterior dislocation of the shoulder. J Bone Joint Surg Br. 2009 Jul. 91(7):918-21. [Medline].

  23. Kralinger FS, Golser K, Wischatta R, et al. Predicting recurrence after primary anterior shoulder dislocation. Am J Sports Med. 2002 Jan-Feb. 30(1):116-20. [Medline].

  24. Robinson CM, Seah M, Akhtar MA. The epidemiology, risk of recurrence, and functional outcome after an acute traumatic posterior dislocation of the shoulder. J Bone Joint Surg Am. 2011 Sep 7. 93(17):1605-13. [Medline].

  25. Gerber C, Costouros JG, Sukthankar A, Fucentese SF. Static posterior humeral head subluxation and total shoulder arthroplasty. J Shoulder Elbow Surg. 2009 Jul-Aug. 18(4):505-10. [Medline].

  26. DeBerardino TM, Arciero RA, Taylor DC, Uhorchak JM. Prospective evaluation of arthroscopic stabilization of acute, initial anterior shoulder dislocations in young athletes. Two- to five-year follow-up. Am J Sports Med. 2001 Sep-Oct. 29(5):586-92. [Medline].

  27. Patel RV, Leith J. Primary arthroscopic stabilization for a first-time anterior dislocation of the shoulder. J Bone Joint Surg Am. 2008 Aug. 90(8):1786; author reply 1786-7. [Medline].

  28. Robinson CM, Jenkins PJ. Primary Arthroscopic Stabilization for a First-Time Anterior Dislocation of the Shoulder. J Bone Joint Surg Am. 2008 Aug. 90-A(8):1786-1787. [Medline].

  29. Larrain MV, Botto GJ, Montenegro HJ, et al. Arthroscopic repair of acute traumatic anterior shoulder dislocation in young athletes. Arthroscopy. 2001 Apr. 17(4):373-7. [Medline].

  30. Arciero RA, Taylor DC, Snyder RJ, Uhorchak JM. Arthroscopic bioabsorbable tack stabilization of initial anterior shoulder dislocations: a preliminary report. Arthroscopy. 1995 Aug. 11(4):410-7. [Medline].

  31. Hintermann B, Gachter A. Arthroscopic findings after shoulder dislocation. Am J Sports Med. 1995 Sep-Oct. 23(5):545-51. [Medline].

  32. Karlsson J, Magnusson L, Ejerhed L, et al. Comparison of open and arthroscopic stabilization for recurrent shoulder dislocation in patients with a Bankart lesion. Am J Sports Med. 2001 Sep-Oct. 29(5):538-42. [Medline].

  33. Owens BD, Harrast JJ, Hurwitz SR, Thompson TL, Wolf JM. Surgical trends in bankart repair: an analysis of data from the american board of orthopaedic surgery certification examination. Am J Sports Med. 2011 Sep. 39(9):1865-9. [Medline].

  34. Beeson MS. Complications of shoulder dislocation. Am J Emerg Med. 1999 May. 17(3):288-95. [Medline].

  35. Guanche CA, Quick DC, Sodergren KM, et al. Arthroscopic versus open reconstruction of the shoulder in patients with isolated Bankart lesions. Am J Sports Med. 1996 Mar-Apr. 24(2):144-8. [Medline].

  36. Sekiya JK, Wickwire AC, Stehle JH, Debski RE. Hill-Sachs Defects and Repair Using Osteoarticular Allograft Transplantation: Biomechanical Analysis Using a Joint Compression Model. Am J Sports Med. 2009 Sep 2. [Medline].

  37. Nourissat G, Kilinc AS, Werther JR, Doursounian L. A prospective, comparative, radiological, and clinical study of the influence of the "remplissage" procedure on shoulder range of motion after stabilization by arthroscopic bankart repair. Am J Sports Med. 2011 Oct. 39(10):2147-52. [Medline].

  38. Scheibel M, Kuke A, Nikulka C, Magosch P, Ziesler O, Schroeder RJ. How long should acute anterior dislocations of the shoulder be immobilized in external rotation?. Am J Sports Med. 2009 Jul. 37(7):1309-16. [Medline].

  39. Owens BD, DeBerardino TM, Nelson BJ, Thurman J, Cameron KL, Taylor DC, et al. Long-term follow-up of acute arthroscopic Bankart repair for initial anterior shoulder dislocations in young athletes. Am J Sports Med. 2009 Apr. 37(4):669-73. [Medline].

  40. Maier M, Geiger EV, Ilius C, Frank J, Marzi I. Midterm results after operatively stabilised shoulder dislocations in elderly patients. Int Orthop. 2009 Jun. 33(3):719-23. [Medline].

  41. Cordischi K, Li X, Busconi B. Intermediate outcomes after primary traumatic anterior shoulder dislocation in skeletally immature patients aged 10 to 13 years. Orthopedics. 2009 Sep. 32(9):[Medline].

  42. Abdelhady A, Abouelsoud M, Eid M. Latarjet procedure in patients with multiple recurrent anterior shoulder dislocation and generalized ligamentous laxity. Eur J Orthop Surg Traumatol. 2014 Oct 24. [Medline].

  43. Longo UG, Loppini M, Rizzello G, Ciuffreda M, Maffulli N, Denaro V. Latarjet, Bristow, and Eden-Hybinette procedures for anterior shoulder dislocation: systematic review and quantitative synthesis of the literature. Arthroscopy. 2014 Sep. 30(9):1184-211. [Medline].

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The rotator cuff interval is closed with a nonabsorbable suture. The T-capsulotomy incision is planned with dotted lines.
Superomedial (SM) and inferomedial (IM) flaps created by T-capsulotomy incision. First, the IM flap will be advanced superiorly and laterally, and then the SM flap will be advanced inferiorly over the top of the IM flap.
The finished repair with the superomedial (SM) flap advanced inferiorly, overlapping the previous inferomedial (IM) flap advancement. Note how the axillary pouch has been eliminated.
 
 
 
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