Shoulder

Comparison of the Latarjet Procedure With the Modified Putti-Platt Surgery for Recurrent Anterior Shoulder Dislocation With Respect to Functional Outcome (2024)

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Type of publication:
Journal article

Author(s):
Anjum, Ihtisham; Ullah, Ubaid; *Fazli Maula, Aimen; Haroon, Hamza; Ahmad, Yaseen; Hassan, Rao E; Shahid, Kashan; Hussain, Saddam; Haider, Waseem; Ullah, Rizwan

Citation:
Cureus. 16(3):e57270, 2024 Mar.

Abstract:
Introduction Shoulder dislocation is the most common injury encountered in orthopedic outpatient department. The choice of procedure depends on the expertise of surgeons. The objective of this study was to compare the Latarjet procedure with the modified Putti-Platt surgery for recurrent anterior shoulder dislocation in terms of functional outcomes. Materials and methods A quasi-experimental study evaluated 60 patients with recurrent anterior shoulder instability. Patients were assigned to either Latarjet or modified Putti-Platt surgery. Functional outcomes were assessed at six months using the Constant-Murley shoulder score. Results This study encompassed 60 patients (mean age: 23.93+/-5.88 years) undergoing shoulder procedures. Functional outcomes exhibited a majority of 55% excellent, 35% good, 6.7% fair, and 3.3% poor outcomes. No significant differences in functional outcomes were found between the procedures. Conclusion Both procedures may be viable options for recurrent shoulder instability. The choice may depend on patient factors and surgeon preference. Further research is needed to refine techniques and identify ideal candidates.

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External rotation bracing for first-time anterior dislocation of the shoulder: A discontinued randomised controlled trial comparing external rotation bracing with conventional sling (2019)

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Type of publication:
Journal article

Author(s):
Chan, Samuel Kl; *Bentick, Kieran R; Kuiper, Jan H; Kelly, Cormac P

Citation:
Shoulder & elbow; Aug 2019; vol. 11 (no. 4); p. 256-264

Abstract:
Introduction: Itoi et al. introduced the concept of bracing in abduction and external rotation to treat traumatic anterior shoulder dislocations. However, controversy remains as studies have reported variable results. Our study investigates whether there is a difference in outcomes between treatment with a conventional sling or external rotation brace.
Methods: A prospective, multi-centre randomised control trial was conducted between 2006 and 2010. The study was discontinued early with 72 (36 cases in each group) first-time anterior shoulder dislocations recruited.
Results: The re-dislocation rate over 24 months was comparable 30% (95% CI: 17-47) sling vs. 24% (95% CI: 13-41) external rotation bracing. Sixteen percent (95% CI: 7-32) of sling patients and 12% (95% CI: 5-27) of external rotation-bracing patients had shoulder stabilisation surgery within 24 months of the initial dislocation (p > 0.05). There was no difference in OSI scores at 24 months between the two treatment groups and intolerability of the external rotation brace was high.
Conclusion: Recruitment to this study was difficult, and lost-to-follow-up rates were high leading to early discontinuation of the study. The results suggest that ER bracing is unlikely to provide clinical benefit in traumatic first-time anterior shoulder dislocation.

Physiotherapists utilizing diagnostic ultrasound in shoulder clinics. How useful do patients find immediate feedback from the scan as part of the management of their problem? (2018)

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Type of publication:
Journal article

Author(s):
*Lumsden, Gordon; *Lucas-Garner, Kerry; *Sutherland, Sarah; *Dodenhoff, Ron

Citation:
Musculoskeletal care; Mar 2018; vol. 16 (no. 1); p. 209-213

Abstract:
AIMSPhysiotherapists are beginning to utilize diagnostic ultrasound imaging in upper limb/shoulder clinics. The aim of the present study was to receive feedback on the views of the patients concerning the usefulness of the information obtained immediately from the scan in the management of their problem.METHODS A questionnaire was offered to all patients attending a physiotherapist-led upper limb/shoulder clinic who underwent ultrasound imaging as part of a shoulder assessment over a 6-month period. A total of 103 patients completed a questionnaire for analysis.RESULTSPatients rated the ultrasound scan to be of benefit in all aspects. Regarding the ability to understand their shoulder problem better and in feeling reassured about their problem, 97% of patients either strongly agreed or agreed that this was the case. Concerning the capability of managing their problem, 89% of patients strongly agreed or agreed that they felt more able to do this. In total, 96% of patients evaluated the ultrasound scan to be of very high/high value to them.CONCLUSION Patients highly rate the information gained from ultrasound imaging in a physiotherapy-led upper limb/shoulder clinic and felt that it assisted them in the understanding, reassurance and management of their problem.

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The subscapularis splitting technique: Beware the aberrant axillary nerve (2014)

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Type of publication:
Journal article

Author(s):
Singh R.A., Ahmed B., Hay B.A., *Hay S.M.

Citation:
Techniques in Shoulder and Elbow Surgery, December 2014, vol./is. 15/4(130-133)

Abstract:
The subscapularis splitting technique has become a very common approach for the open management of shoulder instability, including repair of Bankart lesions, capsular shift procedures, and the increasingly popular Latarjet procedure. It is often used for young athletes, as the attachment and the length of subscapularis are preserved while other open approaches may result in restricted rotation of the shoulder, particularly external rotation. The current literature reports that routine exposure of the axillary nerve is not necessary during anterior stabilization procedures using a subscapularis muscle-splitting approach if proper precautions are taken to protect the nerve. We present a case in which the axillary nerve was fortuitously noted to be coursing in an abnormally lateral position anterior to the subscapularis belly exposing the nerve at risk during subscapularis split. Our case clearly represents an important anatomic variant which must be considered when performing the subscapularis splitting approach, as serious and functional deficits will result if the nerve is irrevocably damaged. Beware the aberrant axillary nerve.

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