The aetiology of posterior glenohumeral dislocations and occurrence of associated injuries

Abstract

Aims The glenohumeral joint is the most frequently dislocated articulation, but possibly due to the lower prevalence of posterior shoulder dislocations, approximately 50% to 79% of posterior glenohumeral dislocations are missed at initial presentation. The aim of this study was to systematically evaluate the most recent evidence involving the aetiology of posterior glenohumeral dislocations, as well as the diagnosis and treatment. Materials and Methods A systematic search was conducted using PubMed (MEDLINE), Web of Science, Embase, and Cochrane (January 1997 to September 2017), with references from articles also evaluated. Studies reporting patients who experienced an acute posterior glenohumeral joint subluxation and/or dislocation, as well as the aetiology of posterior glenohumeral dislocations, were included. Results A total of 54 studies met the inclusion criteria. In total, 182 patients were included in this analysis; study sizes ranged from one to 66 patients, with a mean age of 44.2 years (sd 13.7). There was a higher proportion of male patients. In all, 216 shoulders were included with 148 unilateral injuries and 34 bilateral. Seizures were implicated in 38% of patients (n = 69), with falls, road traffic accidents, electric shock, and iatrogenic reasons also described. Time to diagnosis varied across studies from immediate up to a delay of 25 years. Multiple associated injuries are described. Conclusion This review provides an up-to-date insight into the aetiology of posterior shoulder dislocations. Our results showed that seizures were most commonly implicated. Overall, reduction was achieved via open means in the majority of shoulders. We also found that delayed diagnosis is common.

The utilization of computer planning and 3D-printed guide in the surgical management of a reverse Hill-Sachs lesion

“…The small number of posterior dislocations and the difficulties associated with their radiographic identification could make those injuries go unnoticed in an initial analysis, 11 , 19 as occurred in our case, and a delay in diagnosis worsens the prognosis of the lesion. 1 , 10 , 12 New 3D imaging techniques can improve visualization, thus facilitating the diagnosis and choice of treatment.…”

“…In the present case, which was not successfully diagnosed in the emergency department, a CT scan showed the relationships between different bone structures in detail, revealing the glenohumeral dislocation and reverse Hill-Sachs lesion. 21 Several authors recommend using this imaging technique when radiographs are inconclusive, 10 , 11 , 19 and others have noted the importance of complementing CT with magnetic resonance imaging to enable the recognition of associated lesions in the labrum or joint capsule. 20 …”

“…Although glenohumeral dislocation is a relatively common condition, only 2% of all shoulder dislocations are in the posterior direction. 1 , 11 Because such dislocations are rare and difficult to radiographically visualize, between 50% and 79% of posterior glenohumeral dislocations are not diagnosed at the initial examination. 10 , 11 , 19 Most of these dislocations occur in men aged between 20 and 49 years 19 after a combined movement involving adduction, flexion, and internal rotation of the arm.…”

“…10 , 11 , 19 Most of these dislocations occur in men aged between 20 and 49 years 19 after a combined movement involving adduction, flexion, and internal rotation of the arm. 10 , 11 Two etiologies account for this condition: two-thirds of cases have a traumatic origin, and the remaining cases have an atraumatic origin related to seizures (due to epilepsy, electrocution, or another condition), hyperlaxity, infantile paralysis (polio), brachial plexus birth palsy, or Ehlers-Danlos disease. 1 , 4 , 11 , 17 , 18 , 19 …”

“…10 , 11 Two etiologies account for this condition: two-thirds of cases have a traumatic origin, and the remaining cases have an atraumatic origin related to seizures (due to epilepsy, electrocution, or another condition), hyperlaxity, infantile paralysis (polio), brachial plexus birth palsy, or Ehlers-Danlos disease. 1 , 4 , 11 , 17 , 18 , 19 …”