Лікування «нещасливої Тріади» Плечового Суглоба

Страфун, С.С.; Богдан, С В; Lysak, A.S.

doi:10.22141/1608-1706.6.17.2016.88617

Cited by 2 publications

(2 citation statements)

References 14 publications

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“…Seddon et al classified nerve injuries as neuroapraxia, axonotmesis, and neurotmesis, with neurotmesis leading to complete functional loss and the need for surgical intervention [21,22]. Specifically for the shoulder terrible triad injury pattern, Strafun et al proposed a conservative approach, especially for the nerve injuries preserving 30% of nerve conduction during preoperative EMG [23]. One mechanism of nerve injury proposed is the crushing of the humoral head in the axillary border, but the mechanism of traction of the brachial plexus and distal nerves prevails, with the position of the limb during the accident affecting the nerves injured [24].…”

Section: Nerve Lesionsmentioning

confidence: 99%

Terrible Triad of the Shoulder: A Case Series and Literature Review

Kokkalis,

Giannatos,

Papagiannis

et al. 2023

Cureus

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Introduction: The shoulder terrible triad is an underdiagnosed injury pattern consisting of anterior shoulder dislocation, rotator cuff tear, and nerve injury from the brachial plexus in its original description. The purpose of this study is to raise awareness of the condition, suggest treatment strategies, and emphasize the difficulties in treating this condition.Methods: This case series of seven patients from the same institution. All patients underwent x-rays before and after the reduction of the dislocation, MRI to assess the musculoskeletal injuries, and EMG and clinical examination to assess the nerve lesions. Early arthroscopic repair was opted for the rotator cuff tears. A conservative approach was chosen for the nerve lesions. Active forward flexion and external rotation, Constant score, and Visual to Analogue Scale (VAS) were recorded pre-and post-operatively.Results: All the patients showed an improvement in function postoperatively. However, four of the seven patients did not recover fully. The mean Constant and VAS scores were improved from 15.2 +/-2.8 (12 to 19) to 67 +/-16.6 (44 to 86) and from 7.5 +/-1 (6 to 9) to 2.3 +/-0.8 (1 to 3), respectively. The patients were followed up for a mean time of 28.2 +/-10.1 months (18 to 43 months). Time-to-surgery shorter than four weeks showed better results, but not statistically significant.Conclusions: The diagnosis of the shoulder terrible triad requires a high level of suspicion. Early arthroscopic repair for the rotator cuff tears and waiting for the nerve recovery is suggested. Delayed time from injury to surgery might be related to worse outcomes, but higher-level research is needed in this direction.

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Section: Nerve Lesionsmentioning

confidence: 99%

Terrible Triad of the Shoulder: A Case Series and Literature Review

Kokkalis,

Giannatos,

Papagiannis

et al. 2023

Cureus

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“…However, if adequate RCT reconstruction does not cause the limb movement to improve, nerve function should be reassessed and operative treatment considered [17,18]. According to Strafun et al, if in preoperative EMG examination more than 30% of axillary nerve conduction is preserved, the patient should be operated-on for RCT and the treatment of neural injury should be conservative, but if conduction is less than 30%, early surgical exploration of axillary nerve is advocated [20]. Simonich et al concluded that the final functional result of the affected limb is more dependent on nerve recovery than on complete RCT repair [70].…”

Section: Accompanying Injuriesmentioning

confidence: 99%

Brachial plexus injury after shoulder dislocation: a literature review

et al. 2018

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Brachial plexus injuries are among the rarest but at the same time the most severe complications of shoulder dislocation. The symptoms range from transient weakening or tingling sensation of the upper limb to total permanent paralysis of the limb associated with chronic pain and disability. Conflicting opinions exist as to whether these injuries should be treated operatively and if so when surgery should be performed. In this review, available literature dedicated to neurological complications of shoulder dislocation has been analysed and management algorithm has been proposed. Neurological complications were found in 5.4-55% of all dislocations, with the two most commonly affected patient groups being elderly women sustaining dislocation as a result of a simple fall and young men after high-energy injuries, often multitrauma victims. Infraclavicular part of the brachial plexus was most often affected. Neurapraxia or axonotmesis predominated, and complete nerve disruption was observed in less than 3% of the patients. Shoulder dislocation caused injury to multiple nerves more often than mononeuropathies. The axillary nerve was most commonly affected, both as a single nerve and in combination with other nerves. Older patient age, higher energy of the initial trauma and longer period from dislocation to its reduction have been postulated as risk factors. Brachial plexus injury resolved spontaneously in the majority of the patients. Operative treatment was required in 13-18% of the patients in different studies. Patients with suspected neurological complications require systematic control. Surgery should be performed within 3-6 months from the injury when no signs of recovery are present.

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Лікування «нещасливої Тріади» Плечового Суглоба

Cited by 2 publications

References 14 publications

Terrible Triad of the Shoulder: A Case Series and Literature Review

Terrible Triad of the Shoulder: A Case Series and Literature Review

Brachial plexus injury after shoulder dislocation: a literature review

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