Sommario
La lussazione posteriore di spalla è una condizione clinica riscontrata raramente e spesso la formulazione diagnostica avviene in ritardo rispetto l’episodio lussante. Nel quadro della lussazione posteriore di spalla si distinguono tre diverse entità anatomopatologiche: instabilità posteriore con sublusssazione, lussazione posteriore glenomerale propria, frattura dell’estremo prossimale di omero con lussazione posteriore del segmento omerale prossimale.
La lesione di McLaughlin, da sola o associata ad altre, è l’elemento identificativo fondamentale del capitolo della lussazione posteriore di spalla. Tale lesione è prodotta dall’impatto della glena sulla testa omerale, che perde parte della sua convessità. Numerosi Autori, nel tentativo di fornire linee guida precise sul trattamento di tale lesione, hanno elaborato diverse stadiazioni della lesione di McLaughlin, senza tuttavia pervenire al raggiungimento di una classificazione univocamente condivisa.
L’approccio diagnostico e la stadiazione della lesione, oltre che della clinica, si basano su esami strumentali quali RX, TC, RM e artroRM.
Il trattamento della lussazione posteriore di spalla, cruento o incruento, differisce in base ad alcune variabili oltre all’aspetto strumentale (eziologia, cronologia dell’evento, presenza e tipo della lesione di McLaughlin, lesioni associate, condizioni generali del paziente) e anche sotto questo aspetto non si è ancora riusciti ad ottenere delle linee guida universalmente approvate.
Abstract
The posterior shoulder dislocation is an infrequent clinical condition that is often diagnosed after a long lapsed time from the causative event. This lesion is divided into three different condition: posterior shuolder instability with subluxation, glenohumeral posterior dislocation and proximal humeral fracture with proximal humeral segment posterior dislocation.
McLaughlin lesion, eventually associated with others lesions, is the most important element for the identification of posterior shoulder dislocation; it is caused by an anteromedial humeral head impaction fracture, with loss of part of normal humeral head convessity.
During the last years, many authors formulated various classification of this lesion, without the achievment of a shared grading. Diagnosis and classification of the dislocation are based on clinical and strumental findings (Rx, TC, RM and artro RM).
The treatment, surgical or conservative, depends on many factors (etiology, delay of the diagnosis, type of McLaughlin lesion, associated lesions, patient’s general conditions), but no shared guidelines have already been established.
In this paper, basing on the literature avaible, the Authors offer a starting point of observation concernig diagnosis and tratment of posterior shoulder dislocation and show their clinical and surgical experience about this lesion.
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References
Cooper A (1844) A Treatise on dislocations and fractures of the joints. In: London US national library of medicine, pp 299–332
McLaughlin HL (1952) Posterior dislocation of the shoulder. J Bone Jt Surg Am A-3:584
Gor DM (2002) The trough line sign. Radiology 224(2):485–486
Robinson CM, Aderinto J (2005) Posterior shoulder dislocations and fracture-dislocations. J Bone Jt Surg Am 87:639–650
Lazarus MD, Sidles JA, Harryman DT 2nd, Matsen FA 3rd (1996) Effect of a chondral-labral defect on glenoid concavity and glenohumeral stability. A cadaveric model. J Bone Jt Surg Am 78(1):94–102
Randelli M (1988) La fracture-luxation postérieure de l’épaule: nouveaux élements de classification et therapeutiques. In: 2∘ congrés SECEC, Bern
Cicak N (2004) Posterior dislocation of the shoulder. J Bone Jt Surg Br 86:324–332
Bhatia DN, de Beer JF, van Rooyen KS, du Toit DF (2007) The reverse terrible triad of the shoulder: circumferential glenohumeral musculoligamentous disruption and neurologic injury associated with posterior shoulder dislocation. J Shoulder Elbow Surg 16(3):e13–7
Wilson JC, McKeever FM (1949) Traumatic posterior (retroglenoid) dislocation of the humerus. J Bone Jt Surg Am 31:160–172
Matsen FA, Thomas SC, Rockwood CA, Wirth MA (1998) Glenohumeral instability. In: Rockwood CA, Matsen FA (eds) The shoulder, vol 2. Saunders, Philadelphia, pp 611–754
Ogawa K, Yoshida A, Inokuchi W (1999) Posterior shoulder dislocation associated with fracture of the humeral anatomic neck: treatment guidelines and long-term outcome. J Trauma 46:318–323
Porteous MJ, Miller AJ (1990) Humeral rotation osteotomy for chronic posterior dislocation of the shoulder. J Bone Jt Surg Br 72:468–469
Gerber C, Lambert SM (1996) Allograft reconstruction of segmental defects of the humeral head for the treatment of chronic locked posterior dislocation of the shoulder. J Bone Jt Surg Am 78:376–382
Ogawa K, Yoshida A, Inokuchi W (1999) Posterior shoulder dislocation associated with fracture of the humeral anatomic neck: treatment guidelines and long-term outcome. J Trauma 46:318–323
Merrell GA, Barrie KA, Katz DL, Wolfe SW (2001) Results of nerve transfer techniques for restoration of shoulder and elbow function in the context of a meta-analysis of the English literature. J Hand Surg Am 26:303–314
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Viola, E., Rendina, M. & Ciucio, F. Lussazioni posteriori della scapolo-omerale: diagnosi e terapia. Aggiornamenti 19, 57–68 (2013). https://doi.org/10.1007/s10351-013-0015-7
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DOI: https://doi.org/10.1007/s10351-013-0015-7