Manejo inicial del paciente con luxación anterior de hombro

Expósito, Rocío Echeverría; Ibán, Miguel Ángel Ruiz; Heredia, Jorge Díaz; Díaz, Rodriguez; Rodríguez, Rafael Massanet; Ayestarán, Adrián Cuéllar

doi:10.24129/j.reaca.24158.fs1701002

Cited by 2 publications

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“…After CT confirmation of the anterior dislocation and the absence of associated fractures, reduction of the shoulder was attempted using the following protocol: First, an intraarticular injection of 10 cm 3 of mepivacaine 1% was performed through a lateral approach [18]. Then a reduction attempt was performed by the orthopaedic surgery resident using the traction/contra-traction manoeuvre [3], the Milch [18] or the FARES method [20]. If, after two attempts, reduction was not obtained, the participant was brought to the surgical theatre and reduction was obtained under deep sedation with propofol (initial bolus of 2 mg/kg, followed by perfusion of 6 mg/kg/h).…”

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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The size of the Hill Sachs defect increases during reduction of a first time shoulder dislocation in older adults: a pilot study in 20 cases

Ruiz Ibán,

Pérez Expósito,

Vicente Bártulos

et al. 2023

J. exp. orthop.

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Purpose To evaluate if the size of Humeral Hill-Sachs Defects (HSDs) increases during reduction in the emergency department (ED) in subjects that have a first-time anterior shoulder dislocation. Methods Subjects more than 18 years old presenting to the ED a first-time anterior shoulder dislocation were included. A computed tomography was performed prior to any reduction attempt (Pre-CT). The shoulder was reduced in the emergency room with intraarticular lidocaine; if two attempts failed, the shoulder was reduced under anaesthesia. A second CT was performed after reduction of the shoulder (Post-CT). CT were evaluated using the Osirix software. A 3-dimensional reconstruction of the humeral head was performed and the maximum width of the humeral defect, maximum depth of the humeral defect and total volume of the humeral defect were measured. The relative increase in size was calculated. Results Twenty subjects were included in the study. All subjects presented HSDs in the Pre-CT that had a width of a median of 9.9(interquartile range:2.9)mm, a depth of 7.0(3.0]mm and a volume of 355(333)mm2. The HSD in the Post-CT had a width of 10.9(3.0)mm (an increase of 7.23[8.5]%, significant differences, p = 0.0001) a depth of 7.2(2.7)mm (an increase of 9.93[20.7]%, significant differences, p < 0.0001) and a volume of 469(271) mm2 (an increase of 27.5[26.9]%, significant differences, p < 0.0001). There were size increases larger than 25% in 15/20 (75%) of subjects. Conclusion Standard reduction manoeuvres performed in a first-time anterior shoulder dislocation increase the size of the HSD. This increase in size is larger than 25% in four out of five cases. Level of evidence IV, prospective cases series study.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

The size of the Hill Sachs defect increases during reduction of a first time shoulder dislocation in older adults: a pilot study in 20 cases

Ruiz Ibán,

Pérez Expósito,

Vicente Bártulos

et al. 2023

J. exp. orthop.

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Lesiones deportivas de la cintura escapular y el hombro

2023

AMF

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Puntos clave En las tendinopatías del manguito rotador, el dolor, la debilidad y el menor arco de movimiento que persisten después de un programa terapéutico conservador denotan la necesidad de valoración de un tratamiento quirúrgico. La capsulitis adhesiva presenta un patrón articular (limitación de movimientos activos y pasivos) y las maniobras contra resistencia pueden no ser dolorosas. El tratamiento del primer episodio de luxación glenohumeral consiste en la inmovilización con cabestrillo en rotación interna y aducción durante 3-4 semanas. En luxaciones recidivantes se inmovilizará el mínimo tiempo posible hasta la resolución del dolor. En el ámbito extrahospitalario, cuando no se disponga de acceso rápido a radiografías, se puede intentar la reducción cerrada sin radiografía previa en luxaciones glenohumerales recidivantes, menores de 40 años y producidas por traumatismo, baja energía. Ante lesiones traumáticas, se debe descartar siempre mediante exploración posibles lesiones neurovasculares coexistentes. Las lesiones de tipo I y II de la articulación acromioclavicular pueden tratarse de manera conservadora mientras que el resto requiere derivación a traumatología para valorar tratamiento quirúrgico.

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Manejo inicial del paciente con luxación anterior de hombro

Cited by 2 publications

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The size of the Hill Sachs defect increases during reduction of a first time shoulder dislocation in older adults: a pilot study in 20 cases

The size of the Hill Sachs defect increases during reduction of a first time shoulder dislocation in older adults: a pilot study in 20 cases

Lesiones deportivas de la cintura escapular y el hombro

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