Arthroscopic anterior instability repair
Andreas B. Imhoff, Jonathan B. Ticker, Augustus D. Mazzocca, Andreas Voss in Atlas of Advanced Shoulder Arthroscopy, 2017
Traumatic anterior instability of the shoulder is described as an anterior–inferior capsulo-labral disruption associated with anterior shoulder dislocation.1 It characteristically occurs in young individuals during sports, with an estimated incidence of 11.2 cases per 100,000 persons annually.2–8 It is the most frequent type of joint dislocation and a significant cause of disability, leading to time lost from sports and work.9 Recurrence of anterior shoulder dislocation following an initial injury is strongly associated with age at the time of dislocation, with recurrence rates ranging anywhere from 60% to 100%.5,10–13 Younger patients, ages less than 20 years, have a recurrence rate as high as 86.7%, which declines with age.5,6,8
Shocks and Surgeries
Petteri Pietikainen in Madness, 2015
An uncomfortable problem with Cardiazol treatment was that many patients hated it. This was because the injection produced a violent convulsion, which lasted about a minute. When the tonic contractions began, patients lost consciousness, but between injection and seizure there was about a ten-second period of intense purgatory during which patients often felt extreme anxiety and fear of death. During the seizure itself, clonic jerks and spasms quickly came on, the skin turned blue, the pupils would widen and incontinence was common. After about 40 seconds of convulsions, patients fell into a comatose sleep for ten minutes or so. One psychoanalyst aptly called Cardiazol therapy ‘a violent thunderstorm’ (McCrae 2006, 81). Although the risk of death was small, convulsions could be physically risky, because they caused severe stress on the musculoskeletal system. Extreme contractions could cause joint dislocations, bone fractures and obstruction of the blood vessels. Another risk was that the epileptic condition did not end, but lingered on (this was called status epilepticus). If the treatment continued for a longer period of time, there was an additional risk of lasting cognitive impairment – it could impair the mental functioning of patients. As this risk became known to psychiatrists, the administration of Cardiazol became more class specific: it was considered less risky for uneducated people who did not have to rely on intellectual function in their work (McCrae 2006, 78). The same criterion was applied to the selection of suitable patients to psychosurgical treatment.
Systemic causes of CSF rhinorrhea
Jyotirmay S. Hegde, Hemanth Vamanshankar in CSF Rhinorrhea, 2020
Two subtypes have been described:5–7Ehlers-Danlos syndrome classic type: Characterized by joint hypermobility and extensive skin involvement: skin hyperextensibility, abnormal wound healing, and scar formation. Fragility of other connective tissues is also noted, causing cervical insufficiency in pregnancy, recurrent hernias, and rectal prolapse. Cauliflower deformity of skin collagen fibrils on histology is characteristic of the classic type of EDS. Diagnosis is usually clinical, but almost 50% have mutations of the COL5A1 or COL5A2 gene. However, a negative test cannot rule out its absence.Ehlers-Danlos syndrome hypermobility type: This is the more common subtype of EDS. It presents with chronic painful instability of joints associated with joint dislocations. This further leads to degenerative joint disease in young adults. Skin involvement, however, is mild: soft skin that bruises easily. The genetic basis of this subtype is unknown. A positive family history may sometimes be elicited in these patients. Diagnosis is clinical.
Growth of Cutibacterium acnes is common on osteosynthesis material of the shoulder in patients without signs of infection
Published in Acta Orthopaedica, 2018
Anna Both, Till O Klatte, Andreas Lübke, Henning Büttner, Maximilian J Hartel, Lars G Grossterlinden, Holger Rohde
Patients in the clavicle group (n = 34) had suffered a closed clavicle fracture or a closed dislocation of the acromioclavicular (AC) joint due to trauma. In case of a lateral clavicle fracture (n = 7) or dislocation of the AC joint (n = 12), open reduction and fixation with a hook plate was performed. To avoid any complication due to the design of this plate routine removal was considered necessary after 4 months in the case of AC joint dislocation and after 6 months in the case of a lateral clavicle fracture. The other clavicle fractures (n = 15) were treated by open reduction and internal fixation with a standard plate.
Simultaneous bilateral shoulder dislocation during pilates reformer exercise: A case report
Published in Physiotherapy Theory and Practice, 2023
Metin Ergün, İhsan Yörük, Ogün Köyağasioğlu
Major joint dislocations can be the consequence of unsupervised exercises, even low-impact ones such as Pilates Reformer, due to inadequate muscle control and joint stabilization. In addition to effective trauma care, it is important to design personalized rehabilitation programs with supervision and to follow-up closely in order to ensure that these rare cases can ameliorate with daily comfort and return to sport performance at the pre-injury or nearest level.
Implementation of a Prehospital Patella Dislocation Reduction Protocol
Published in Prehospital Emergency Care, 2020
Spencer Lord, James Brodell, Heather Lenhardt, Michael Dailey, Jeremy Cushman
While this convenience sample supports the ability to successfully and safely perform patella reduction, further research is needed to study the economic and medical differences between pre-hospital and in-hospital reductions, as well as to further delineate time from injury to reduction, number of attempts required for successful reduction, medial and lateral distribution of injury, and ability of prehospital personnel to differentiate patella dislocation from other pathology (e.g. knee dislocation, fracture). Further, we caution, and in no way suggest, that prehospital reduction of patella dislocation precludes assessment by a qualified healthcare provider who will still need to assess for additional occult injury such as fracture or ligamentous injury. Despite the significant improvement in pain after reduction, prior studies have shown no correlation between post-reduction pain and the presence or absence of a fracture, therefore follow up care remains a necessity (9). In a 10-year retrospective review of primary acute patella dislocations in a pediatric population, Seeley found that nearly 40%, 46/122, had fractures on MRI, and more importantly, 26 of these required surgery (22). Also, joint dislocation often leads to increased incidence of osteoarthritis, subluxation and recurrence (16). Further, nearly fifty percent of individuals with nonoperative repair will have recurrent instability, dislocation, or develop patellofemoral osteoarthritis (17). While our study found successful reduction in patients of all ages, there is some growing evidence that the technique to reduce the patella in the geriatric population is more nuanced as Feibel et al. found that positioning into less flexion than normal can provide easier translation of the patella in this population (13). Thus, EMS providers would likely benefit by further training to adequately identify potentially irreducible patella dislocations, such as those with a rotational component and those occurring in our geriatric population.
Related Knowledge Centers
- Muscle
- Subluxation
- Tendon
- Ligament
- Joint
- Injury
- Nerve
- Reduction
- Hypermobility
- Projectional Radiography