Purpose Purpose of this study was to evaluate the mid- to long-term outcome after conservatively treated first-time posterior shoulder dislocations and to determine structural defects associated with failure. Methods In this multi-centric retrospective study, 29 shoulders in 28 patients with first-time acute posterior shoulder dislocation (Type A1 or A2 according to the ABC classification) and available cross-sectional imaging were included. Outcome scores as well as radiological and magnetic resonance imaging were obtained at a mean follow-up of 8.3 ± 2.7 years (minimum: 5 years). The association of structural defects with redislocation, need for secondary surgery, and inferior clinical outcomes were analysed. Results Redislocation occurred in six (21%) shoulders and nine shoulders (31%) underwent secondary surgery due to persistent symptoms. The posttraumatic posterior glenohumeral subluxation was higher in the redislocation group compared to the no redislocation group; however, statistical significance was not reached (61.9 ± 12.5% vs. 50.6 ± 6.4%). Furthermore, a higher adapted gamma angle was observed in the failed conservative treatment group versus the conservative treatment group, similarly without statistically significant difference (97.8° ± 7.2°, vs. 93.3° ± 9.7°). The adapted gamma angle was higher than 90° in all patients of failed conservative therapy and the redislocation group. An older age at the time of dislocation showed a significant correlation with better clinical outcomes (SSV: r = 0.543, p = 0.02; ROWE: r = 0.418, p = 0.035 and WOSI: r = 0.478, p = 0.045). Posterior glenohumeral subluxation after trauma correlated with a worse WOSI (r = − 0.59, p = 0.02) and follow-up posterior glenohumeral decentring (r = 0.68, p = 0.007). The gamma angle (r = 0.396, p = 0.039) and depth of the reverse Hill–Sachs lesion (r = 0.437, p = 0.023) correlated significantly with the grade of osteoarthritis at follow-up. Conclusion Conservative treatment is a viable option in patients with an acute traumatic posterior shoulder dislocation with good outcome after mid- and long-term follow-up especially in patients with centred joint, low gamma angle, and middle or old age. Level of evidence IV.
In this retrospective single-center trial, we analyze 109 consecutive patients (female: 27.5%, median age: 69 years, median left ventricular ejection fraction: 20%) who survived sudden cardiac death (SCD) and needed hemodynamic support from an Impella assist device between 2008 and 2018. Rhythm monitoring is investigated in this population and associations with hospital survival are analyzed. Hospital mortality is high, at 83.5%. Diverse cardiac arrhythmias are frequently registered during Impella treatment. These include atrial fibrillation (AF, 21.1%) and ventricular tachycardia (VT, 18.3%), as well as AV block II°/III° (AVB, 7.3%), while intermittent asystole (ASY) is the most frequently observed arrhythmia (42.2%). Nevertheless, neither ventricular nor supraventricular tachycardias are associated with patients’ survival. In patients who experience intermittent asystole, a trend towards a fatal outcome is noted (p = 0.06). Conclusions: Mortality is high in these severely sick patients. While cardiac arrhythmias were frequent, they did not predict hospital mortality in this population. The hemodynamic support of the pump seems to counterbalance the adverse effects of these events.
ZusammenfassungDer M. biceps brachii besitzt 2 proximale Ursprünge und einen distalen Ansatz. Dabei kann die lange Bizepssehne (LBS) häufig als Ursache für den vorderen Schulterschmerz identifiziert werden. Zahlreiche Pathologien wie eine Tendinitis, (Partial-)Risse oder Subluxation der LBS sind dafür grundlegend. Rupturen der Rotatorenmanschette stellen dabei auch ursächliche Veränderungen für Beschwerden der LBS dar. Scheitert die konservative Therapie, kann entsprechend dem körperlichen Anspruch eine Tenotomie resp. Tenodese der LBS erfolgen. Sowohl supra- als auch subpektorale LBS-Tenodesen führen dabei zu guten funktionellen Ergebnissen. Die LBS-Tenotomie kann bei Patienten mit geringeren funktionellen Anforderungen angewandt werden, jedoch mit einem höheren Risiko für eine postoperative Distalisierung des Muskelbauchs des Biceps brachii.Die distale Bizepssehne (DBS) ist der wichtigste Supinator des Unterarms und fungiert als sekundärer Flexor des Ellenbogens. Rupturen der DBS treten am häufigsten bei Männern mittleren Alters im Rahmen eines traumatischen Ereignisses auf. Bei körperlichem Anspruch mit relevantem Defizit von Supinationskraft und -ausdauer ist die chirurgische Versorgung indiziert. Verschiedene Operationstechniken sind zur Refixation der DBS beschrieben. In unserer Praxis hat sich die unikortikale Onlay-Refixation sowohl mit dem Kortikalis-Button als auch mit All-Suture-Ankern bewährt. Bei chronischen Rupturen der DBS kann eine Augmentation durch ein Transplantat durchgeführt werden.Dieser Artikel bietet einen umfassenden Überblick über Therapie von proximalen und distalen Sehnenrupturen des Biceps brachii.
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