Traumatology of the shoulder region

Abstract

Acute injuries to the shoulder region have been described for nearly 5000 years. This paper deals primarily with pathophysiology, diagnosis and treatment of glenohumeral and acromioclavicular dislocations.

Ninety-eight percent of glenohumeral dislocations are anterior. Physical examination or the anterior-posterior radiograph are usually diagnostic. Following reduction of the initial dislocation the patient’s shoulder is immobilized for three to six weeks to minimize a chance of recurrent dislocation. Generally, the greater the initial trauma the less the chance of recurrence. Patients under twenty years of age with an anterior dislocation have an 80–90% chance of recurrent dislocation while the risk for those over forty drops to 10–15%. Posterior glenohumeral dislocations are rare and frequently not diagnosed. Diagnostic error is due to the near normal appearance of the anterior-posterior radiograph, therefore a second view is essential. Several views are available but the axillary view is the most easily interpreted. Treatment of the initial dislocation is again immobilization. External rotation of the humerus may be necessary to maintain reduction. Surgical procedures exist to treat the recurrent form of both types of glenohumeral dislocation. The actual repair performed is tailored to fit the existing pathology.

In acromioclavicular dislocations the treatment for first and second degree lesions is clearly nonoperative. Third degree lesions are treated both operatively and nonoperatively, but the author favors closed treatment for most cases as no study has shown surgical treatment to give superior functional end results. The most common late complication of acromioclavicular separation is arthritis of the acromioclavicular joint, and the most interesting complication is osteolysis of the distal clavicle. Both these sequella may, if troublesome, be treated by resection of the distal clavicle.

Although diagnostic and therapeutic progress has been made, challenges still exist to find more effective therapy for shoulder injuries.