ABSTRACT
INTRODUCTION AND IMPORTANCE: The shoulder is one of the most unstable joints of the body. Shoulder dislocation accounts for up to 60% of all major joint dislocations. This study reports two cases of primary traumatic shoulder dislocation and shows that in the elderly, primary traumatic shoulder dislocation is associated with a rotator cuff tear (RCT). CASE PRESENTATION: A case report and narrative review included two female patients, aged 63 and 100 years. Presenting symptoms were instability, pain, and restricted shoulder movement. Both were successfully treated by surgery. Arthroscopy was performed in the first patient and open reduction in the second patient. CLINICAL DISCUSSION: In the first case, we found synovitis around the rotator interval, long head of the biceps tendinitis, and tears of the subscapularis tendon, supraspinatus tendon, and subacromial bursitis. The anterior labrum was normal. In the second case, complete detachment of the infraspinatus tendon was found. In both cases, rotator cuff repair was performed. Primary traumatic shoulder dislocation in the elderly is often associated with rotator cuff injury. Therefore, a detailed evaluation and management of the rotator cuff injury is essential. Rotator cuff injuries cause loss of dynamic stabilization of the shoulder, leading to recurrent shoulder dislocation and chronic shoulder instability. CONCLUSION: The associated pathology of the primary traumatic shoulder dislocation in elderly are rotator cuff tear. The management of the rotator cuff tear in primary traumatic shoulder dislocation can prevent further shoulder instability events.
ABSTRACT
PURPOSE: We aimed to evaluate surgical outcomes of high-grade bursal rotator cuff-tear repairs. METHODS: This systematic review was performed in May 2020 in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using PubMed. Inclusion criteria were English-language studies reporting the results of pain improvement, functional outcome scores, and radiographic examinations after repair of bursal side partial rotator-cuff tears at any time point in patients of any age and with all levels of evidence. Exclusion criteria were articles not in English, in vitro or animal studies, epidemiological studies, and such article types as technical notes or narrative reviews. RESULTS: Of 58 articles, five were included in this study, of which three and two had level III and IV evidence, respectively, four were comparative studies, and one was a case series. Visual analogue scales were used in four of the five studies, all showing improvement in pain assessment from 5.87 preoperatively to 1.02 postoperatively. All five studies showed significant improvement on each functional outcome score at the final follow-up. The retear rate for all studies was 10.97% (27 of 246). CONCLUSION: High-grade bursal side partial-thickness rotator cuff-tear repair gave satisfactory results in terms of pain scores, range of motion, and functional outcomes. The retear rate was still considerably high (10.9%), necessitating better understanding of the basic science, such as molecular mechanisms during adaptation, to improve the surgical technique.
ABSTRACT
INTRODUCTION: Lateral winging scapula is rare and generated by the trapezius paralysis. It is most likely iatrogenic from procedures involving the posterior cervical triangle. The modified Eden-Lange procedures one of the options by restoring the major actions of a flaccid trapezius. This case report aims to evaluate the outcomes. CASE REPORT: A 34-year-old female came with right lateral scapular winging after radical neck tumor dissection and miss diagnosed by another hospital and underwent shoulder surgery. We performed a physical examination and showed lateral winging scapula. The best management therapy for this patient used modified Eden-Lange procedure. DISCUSSION: Conservative treatments for Lateral scapular winging caused by spinal accessory nerve injury might be successful in early 20 months. However, our patient was injured 26 months before surgery which made Eden-Lange Procedures was the best choice for the patient. Modifications to this procedure allowed her to achieve excellent results. CONCLUSION: Correction of the lateral scapular winging by modified Eden-Lange procedure combined with physical therapy for patient's trapezius palsy to gain adequate stability for daily activities.
