Haemarthrosis Aspiration in Treatment of Anterior Dislocation of the Shoulder

Trimmings, N. P

doi:10.1177/014107688507801209

Cited by 11 publications

(5 citation statements)

References 4 publications

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“…We also found no differences in complications between the techniques. Our results were consistent with previous research indicating that an intra-articular lidocaine injection is safe with a low risk of neurovascular injury [12,18]. However, although previous articles support the idea that the risks of infection and chondrolysis are low [5,6,8,14], we cannot definitively state this because both complications typically occur after an extended amount of time, and our study only had a 2-week follow-up period.…”

Section: Length Of Stay In the Emergency Department And Complicationssupporting

confidence: 90%

“…Although we did not have direct confirmation that the injected anesthetic agent reached the shoulder in the landmark-guided technique, we believe that determining the correct intra-articular placement might not be necessary if we observed blood during the aspiration. This belief is supported by Trimmings [18], who confirmed that even when the needle was not in the joint, a hematoma could still be aspirated. We hypothesize that a capsular tear could allow blood to be outside and inside the joint, suggesting that if we could access the hematoma, lidocaine would reach its intended location.…”

Section: Pain Reductionmentioning

confidence: 83%

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Is Ultrasound-guided or Landmark-guided Intra-articular Lidocaine Injection More Effective for Pain Control in Anterior Shoulder Dislocation Reduction? A Randomized Controlled Trial

Rungsinaporn,

Innarkgool,

Kongmalai

2023

Clin Orthop Relat Res

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Background Effective pain control during reduction of shoulder dislocation is essential for patient comfort. However, there is a lack of comprehensive research comparing the efficacy of different pain management techniques, specifically landmark-guided and ultrasound-guided intra-articular analgesic injections. Questions/purposes Among patients undergoing closed reduction of a shoulder dislocation, were there differences between an intra-articular shoulder injection placed using anatomic landmarks and an ultrasound-guided intra-articular injection in terms of (1) pain before versus after the injection and pain before injection versus after the reduction, or (2) length of stay in the emergency department and complications of the procedure? Methods Between August 2021 and March 2023, 28 patients with anterior shoulder dislocation were treated at the emergency department of a tertiary referral care center. They were randomly assigned to either the landmark-guided or ultrasound-guided intra-articular lidocaine injection group. Differences in pain levels between preinjection and postinjection, preinjection and postreduction, length of hospital stay, and complications were assessed and compared between the two groups. Patients were followed for 2 weeks. Results There were no between-group differences in terms of age, gender, baseline pain score, and any other relevant factors. There were no differences between the groups in terms of pain reduction between preinjection and postinjection (landmark-guided: ΔVAS 2.8 ± 1.1, ultrasound-guided: ΔVAS 2.9 ± 1.0, mean difference -0.14 [95% confidence interval -0.97 to 0.68]; p = 0.72) or between preinjection and postreduction (landmark-guided: ΔVAS 6.6 ± 2.1, ultrasound-guided: ΔVAS 5.8 ± 1.8, mean difference 0.79 [95% CI -0.74 to 2.31]; p = 0.30). There were no differences in length of stay in the emergency department (landmark-guided: 162 ± 38 minutes, ultrasound-guided: 184 ± 73 minutes, mean difference 22 minutes [95% CI -67 to 24]; p = 0.33), and no complications were reported in either group during the 2-week follow-up period. Conclusion The results of the landmark-guided technique were not different from those of ultrasound-guided injection in terms of lower pain levels, length of stay, and complications. These findings provide valuable guidance for orthopaedic surgeons, enabling them to make informed decisions based on their expertise and available resources. Level of Evidence Level I, therapeutic study.

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Section: Length Of Stay In the Emergency Department And Complicationssupporting

confidence: 90%

Section: Pain Reductionmentioning

confidence: 83%

Is Ultrasound-guided or Landmark-guided Intra-articular Lidocaine Injection More Effective for Pain Control in Anterior Shoulder Dislocation Reduction? A Randomized Controlled Trial

Rungsinaporn,

Innarkgool,

Kongmalai

2023

Clin Orthop Relat Res

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“…5,[11][12][13] Anecdotal experience suggests that aspiration of a hematoma from the shoulder joint prior to injection of local anesthetic is not a reliable determinant of correct intraarticular placement, with one study indicating the aspiration of blood even when the needle was in the wrong position. 14 To date, none of the literature has evaluated the accuracy of LGI for treatment of acute anterior shoulder dislocation.…”

Section: How Does This Improve Population Health?mentioning

confidence: 99%

Accuracy of Landmark-guided Glenohumeral Joint Injections as Assessed by Ultrasound in Anterior Shoulder Dislocations

Omer

Perez

Berona

et al. 2021

WestJEM

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Introduction: To determine the accuracy of landmark-guided shoulder joint injections (LGI) with point-of-care ultrasound for patients with anterior shoulder dislocations. Methods: Patients with anterior shoulder dislocations who underwent LGI were enrolled at our tertiary-care and trauma center. LGI attempts were recorded by an ultrasound fellowship-trained ED physician who determined if they were placed successfully. Pain and satisfaction scores were recorded. Results: A total of 34 patients with anterior shoulder dislocation and their treating ED physicians were enrolled. 41.1% of all LGI were determined to be misplaced (n=14). Patients with successful LGI had a greater decrease in mean pain scores post-LGI. Conclusions: LGI had a substantial failure rate in our study. Using ultrasound-guidance to assist intra-articular injections may increase its accuracy and thus reduce pain and the need for subsequent procedural sedation.

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“…Joint hematoma, which is a common finding in dislocated shoulders for the first 3–7 weeks, thus the crucial period of soft-tissue healing has been identified as a factor impairing coaptation, because it interposes between anterior capsulolabral structures and the glenoid [ 4 , 15 , 26 ]. Arthroscopic lavage removing joint effusion reduces the rate of recurrence [ 26 , 27 ]. Reduction of joint hematoma can also be achieved nonsurgically by placing the arm in ER, which pushes the hematoma away from the anterior aspect of the joint cavity [ 25 ].…”

Section: Imaging Studiesmentioning

confidence: 99%

Position of Immobilization After First-Time Traumatic Anterior Glenohumeral Dislocation: A Literature Review

2017

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Anterior glenohumeral dislocation affects about 2% of the general population during the lifetime. The incidence of traumatic glenohumeral dislocation ranges from 8.2 to 26.69 per 100 000 population per year. The most common complication is recurrent dislocation occurring in 17–96% of the patients. The majority of patients are treated conservatively by closed reduction and immobilization in internal rotation for 2–3 weeks. However, no clear conservative treatment protocol exists. Immobilization in external rotation can be considered an alternative. A range of external rotation braces are commercially available.The purpose of this work was to review the current literature on conservative management of glenohumeral dislocation and to compare the results of immobilization in internal and external rotation.A comprehensive literature search and review was performed using the keywords “glenohumeral dislocation”, “shoulder dislocation”, “immobilization”, “external rotation”, and “recurrent dislocation” in PubMed, MEDLINE, Cochrane Library, Scopus, and Google Scholar databases from their inceptions to May 2016.Three cadaveric studies, 6 imaging studies, 10 clinical studies, and 4 meta-analyses were identified. The total number of 734 patients were included in the clinical studies.Literature analysis revealed better coaptation of the labrum on the glenoid rim in external rotation in cadaveric and imaging studies. However, this tendency was not confirmed by lower redislocation rates or better quality of life in clinical studies.On the basis of the available literature, we cannot confirm the superiority of immobilization in external rotation after glenohumeral dislocation when compared to internal rotation. A yet-to-be-determined group of patients with specific labroligamentous injury pattern may benefit from immobilization in external rotation. Further studies are needed to identify these patients.

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Haemarthrosis Aspiration in Treatment of Anterior Dislocation of the Shoulder

Cited by 11 publications

References 4 publications

Is Ultrasound-guided or Landmark-guided Intra-articular Lidocaine Injection More Effective for Pain Control in Anterior Shoulder Dislocation Reduction? A Randomized Controlled Trial

Is Ultrasound-guided or Landmark-guided Intra-articular Lidocaine Injection More Effective for Pain Control in Anterior Shoulder Dislocation Reduction? A Randomized Controlled Trial

Accuracy of Landmark-guided Glenohumeral Joint Injections as Assessed by Ultrasound in Anterior Shoulder Dislocations

Position of Immobilization After First-Time Traumatic Anterior Glenohumeral Dislocation: A Literature Review

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