Irreducible superolateral dislocation of the glenohumeral joint

Wyatt, Alvin R.; Porrino, Jack; Shah, Samir; Hsu, Jason E.

doi:10.1007/s00256-015-2183-8

Cited by 8 publications

(10 citation statements)

References 19 publications

(19 reference statements)

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“…After review, 12 articles fit our inclusion criteria ( Figure 1 ). 5 – 10 , 15 , 18 , 22 , 24 , 25 , 30 All studies were single case reports (level 4 evidence).…”

Section: Resultsmentioning

confidence: 99%

A Systematic Review of Acute Irreducible Shoulder Dislocations in the 21st Century

Liechti

Shepet

Glener

et al. 2022

Orthopaedic Journal of Sports Medicine

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Background: Rarely, closed reduction cannot be achieved in patients with acute shoulder dislocation, necessitating open management. A paucity of literature exists regarding these cases. Purpose: To perform a systematic review on the mechanism, management, and outcome data of acute irreducible shoulder dislocations. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review of the literature was performed using the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, PubMed, and MEDLINE between 2000 and 2020. Inclusion criteria were as follows: human participants, acute irreducible shoulder dislocation requiring open management, English language, and publication within the past 20 years. We excluded basic science articles, technique articles, reviews, editorials, and studies of chronic shoulder dislocations or dislocations with ipsilateral humeral shaft fractures. Results: Twelve articles fit the inclusion criteria and were considered for review. All studies were single case reports (level 4 evidence). Ten of the 12 studies were of male patients. The direction of dislocation included 7 anterior/anteroinferior, 2 posterior, 1 inferior, 1 bilateral inferior, and 1 superolateral. Most dislocations were irreducible owing to a mechanical block to reduction. The most common type of block was an incarcerated long head of the biceps tendon, followed by interposition of 1 of the rotator cuff tendons. The axillary and musculocutaneous nerves, displaced fracture fragments, and Hill-Sachs and bony Bankart lesions were other causes of blocks to reduction. Eleven patients were treated with open surgery, while 1 patient was treated arthroscopically. Procedures performed were dependent on concurrent pathology. Final follow-up ranged from 6 weeks to 2 years, with no repeat dislocation episodes reported. Complications after open reduction included 1 case of brachial plexopathy (posterior cord) and 1 case of musculocutaneous nerve palsy. Conclusion: There is a paucity of literature on the management of irreducible acute shoulder dislocations. The most common irreducible dislocation found in this systematic review was anterior with a mechanical block attributed to interposition of the long head of the biceps tendon. When patients were treated with an open or arthroscopic procedure, recurrence was low, with none reporting recurrent dislocation in limited follow-up.

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“…After review, 12 articles fit our inclusion criteria ( Figure 1 ). 5 – 10 , 15 , 18 , 22 , 24 , 25 , 30 All studies were single case reports (level 4 evidence).…”

Section: Resultsmentioning

confidence: 99%

A Systematic Review of Acute Irreducible Shoulder Dislocations in the 21st Century

Liechti

Shepet

Glener

et al. 2022

Orthopaedic Journal of Sports Medicine

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“…It has been reported that anterosuperior shoulder dislocation, in which dislocation occurs in the direction anterior to the acromion, is caused by a combination of rotator cuff insufficiency including the supraspinatus and subscapularis tendons, a loss of the coracoacromial arch, and a rupture of deltoid anterior fibers [4, 5]. In addition, it has been reported that superolateral dislocation, in which dislocation occurs in the direction of the lateral side of the acromion, is caused by a longitudinal split tear of the anterolateral deltoid muscle and a massive rotator cuff tear [7]. However, dislocation in the direction of the posterior acromion, namely posterosuperior dislocation, was observed for the first time in the present case.…”

Section: Discussionmentioning

confidence: 99%

“…Surgical options for superior shoulder dislocations include rotator cuff repair or reverse shoulder arthroplasty, in addition to deltoid repair. While there is a report stating that open reduction and rotator cuff repair achieved reduction in a young patient with superolateral dislocation [7], another report states that early re-dislocation was observed in an elderly patient with Parkinson’s disease suffering from anterosuperior dislocation, and a rotator cuff repair was performed [5]. Therefore, the outcome of rotator cuff repair for superior shoulder dislocation remains controversial and further research and investigation is needed.…”

Section: Discussionmentioning

confidence: 99%

“…Anterior or posterior shoulder dislocations are the most commonly seen of all shoulder dislocations, and superior shoulder dislocation is extremely rare [1]. Previous reports on superior shoulder dislocation to date include anterosuperior dislocation, in which the humeral head dislocates in the direction of the anterior acromion [2–5]; superolateral shoulder dislocation, in which the humeral head dislocates in the direction of the lateral acromion [6, 7]; and locked superior shoulder dislocation, in which the humeral head dislocates and is locked in the space between the superior margin of the glenoid and acromion [8]. While it has been reported that the occurrence of superior shoulder dislocation is associated with deltoid rupture [4, 5, 7] or deltoid contracture [3], due to its rarity, little is known about its mechanism of onset and risk factors.…”

Section: Introductionmentioning

confidence: 99%

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Posterosuperior shoulder dislocation due to the rupture of deltoid posterior fibers: a case report

Furuhata

Kiyota

Ikeda

et al. 2019

BMC Musculoskelet Disord

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Background Superior shoulder dislocation is a rare type of shoulder dislocation. Its occurrence is thought to be associated with rupture of the deltoid; however, few reports are available on the mechanism of onset and the treatment of a superior shoulder dislocation. Here we describe a case of dislocation in the direction of the posterior acromion, referred to as posterosuperior shoulder dislocation, caused by the traumatic rupture of deltoid posterior fibers. Case presentation An 83-year-old woman who fell on her right elbow in the hospital presented to our department with complaints of right shoulder pain. She had been undergoing conservative treatment for a massive rotator cuff tear and a rupture of the long head of biceps tendon 5 years previously. X-ray radiography images at the time of the trauma revealed that the right humeral head was dislocated upwards and in the direction of the posterior acromion. Magnetic resonance imaging (MRI) revealed newly ruptured deltoid posterior fibers, in addition to the massive rotator cuff tear. Closed reduction was performed and the shoulder joint was held in external rotation at 30 degrees for 6 weeks. However, re-dislocation was observed at an early stage after the removal of the orthosis and marked instability remained. Conclusions This is the first case of posterosuperior shoulder dislocation. It suggests that rupture of the deltoid posterior fibers contributes to the onset of posterosuperior shoulder dislocation in patients with a massive rotator cuff tear. Moreover, in superior shoulder dislocation, conservative treatment may result in continuing instability which requires surgical treatment.

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“…Interposition of the LHBT alone or in combination with greater tuberosity fracture was the most common obstacle to reduction [5, 7, 9, 11-16], followed by subscapularis tendon interposition either tightened around the humeral head or as soft tissue hindrance inside glenoid [17, 19-24]. Other reasons for an unsuccessful closed reduction were the interference of bony fragments [18, 25] or the labrum [7] inside glenoid, the presence of a “shield” fracture of both tuberosities [15], interposition of the musculocutaneus nerve [26] and two cases of anterosuperior dislocation with torn rotator cuff and the humeral head lying underneath deltoid muscle [8, 10]. …”

Section: Discussionmentioning

confidence: 99%

Irreducible Anterior Shoulder Dislocation with Interposition of the Long Head of the Biceps and Greater Tuberosity Fracture: A Case Report and Review of the Literature

Pantazis¹,

Panagopoulos²,

Tatani³

et al. 2017

TOORTHJ

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Background:Failure of closed manipulative reduction of an acute anterior shoulder dislocation is seldom reported in the literature and is usually due to structural blocks such as soft tissue entrapment (biceps, subscapularis, labrum), bony fragments (glenoid, greater tuberosity) and severe head impaction (Hill-Sachs lesion).Case report:We present a case of an irreducible anterior shoulder dislocation in a 57-year-old male patient after a road-traffic accident. He had severe impaction of the head underneath glenoid rim and associated fracture of the greater tuberosity. Closed reduction performed in the emergency room under sedation and later at the theatre under general anaesthesia was unsuccessful. Open reduction using the dectopectoral approach revealed that the reason for obstruction was the posterolateral entrapment of the biceps tendon between the humeral head and the tuberosity fragment. Reduction was achieved after subscapularis tenotomy and opening of the joint; the tuberosity fragment was fixed with transosseous sutures and the long head of the biceps tendon was tenodesized. The patient had an uneventful postoperative recovery and at his last follow up, 12 months postoperatively, he had a stable joint, full range of motion and a Constant score of 90.Conclusion:A comprehensive literature review revealed 22 similar reports affecting a total of 30 patients. Interposition of the LHBT alone or in combination with greater tuberosity fracture was the most common obstacle to reduction, followed by subscapularis tendon interposition and other less common reasons. Early surgical intervention with open reduction and confrontation of associated injuries is mandatory for a successful outcome.

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Irreducible superolateral dislocation of the glenohumeral joint

Cited by 8 publications

References 19 publications

A Systematic Review of Acute Irreducible Shoulder Dislocations in the 21st Century

A Systematic Review of Acute Irreducible Shoulder Dislocations in the 21st Century

Posterosuperior shoulder dislocation due to the rupture of deltoid posterior fibers: a case report

Irreducible Anterior Shoulder Dislocation with Interposition of the Long Head of the Biceps and Greater Tuberosity Fracture: A Case Report and Review of the Literature

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