Magnetic resonance imaging evaluation of capsulolabral tears after traumatic primary anterior shoulder dislocation. A prospective comparison with arthroscopy of 25 cases.

The purpose of our study was to evaluate the use of static magnetic resonance imaging (MRI) as a preoperative diagnostic tool in young patients with a traumatic primary anterior shoulder dislocation. Twenty-five patients who had acute primary traumatic anterior shoulder dislocation were examined with MRI and arthroscopy. The patients (18 male and 7 female) were between 16 and 39 years old (mean age, 27 years). They had no previous shoulder dislocations. The dislocations were confirmed radiographically. Examination with MRI and arthroscopy was performed within 10 days after the trauma. The MRI evaluation was performed before the arthroscopic examination, and the images were interpreted by an experienced magnetic resonance radiologist. No information from the MRI examination was available to the orthopedic surgeons before arthroscopy. The standard of reference for comparison was arthroscopy. Subacute MRI evaluation identified 15 labral tears, 12 Hill-Sachs lesions, 1 total rotator cuff lesion, 1 partial joint side rotator cuff lesion, and 1 partial rupture of the biceps tendon. Arthroscopic examination revealed 22 labral tears, 15 Hill-Sachs lesions, 1 total rotator cuff lesion, 1 partial joint side rotator cuff tear, 1 partial rupture of the biceps tendon, and 1 osseous Bankart lesion. Anterior capsulolabral tears and Hill-Sachs lesions appeared with a high incidence after acute anterior primary shoulder dislocation. Conventional MRI was only moderately reliable in the preoperative evaluation of labral tears and Hill-Sachs lesions, and it failed to give an accurate, differentiated preoperative diagnosis of the capsulolabral lesions.

[Reduction of traumatic primary anterior shoulder dislocation under local analgesia]. / Reponering af traumatisk primaer anterior skulderluksation i lokal analgesi.

The aim of the present study was to evaluate the value of local versus intravenous anaesthesia in the reduction of acute shoulder dislocations. Patients with a primary traumatic dislocation of the shoulder were randomized to either local lidocaine or intravenous anaesthesia with pethidine/diazepam. The local method was performed with 20 ml of 1% lidocaine. The intravenous method was performed with pethidine/diazepam injected intravenously. The patients were observed for any complication during and after the procedure and the used methods were evaluated using a Visual Analogue Scale (VAS). In the period from November 1991 to September 1993 81 patients were admitted to our departments and 68 patients were included. Average age was 48 years (range 15-79) with 29 men and 39 women. Thirty-five patients were randomized to intravenous anaesthesia, 33 had a successful reduction and two failed. Thirty-three patients received local anaesthesia, 32 succeeded and one failed. Ten patients treated with the intravenous method had respiratory depression and six required antidote. No systemic or local side effects and no neuro-vascular injuries were recorded with the use of lidocaine. We did not observe any superficial or deep infection in the lidocaine group. There was no statistical difference between the average VAS value in the two groups. Local anaesthesia used to reduce acute primary anterior dislocation of the shoulder is a simple, safe and well-accepted method with significantly fewer respiratory complications.

Reduction of traumatic secondary shoulder dislocations with lidocaine.

The aim of the present study was to evaluate the value of local anaesthesia versus the commonly used intravenous pethidine/diazepam in the reduction of acute secondary shoulder dislocations. Patients with a traumatic secondary dislocation of the shoulder were randomized to either locally injected lidocaine or intravenously injected pethidine/diazepam. The local method was performed with 20 ml of 1% lidocaine. The patients were observed for any complication during and after the procedure, and the methods used were evaluated with a visual analogue scale (VAS). From November 1991 to September 1993, 62 patients were admitted to our departments of whom 52 were included in the study. Average age was 47 years (range 18-89 years) with 24 men and 28 women. Twenty-six patients were randomized to pethidine/diazepam; 22 had a successful reduction, and 4 were failures. Twenty-six patients received lidocaine, of whom 18 were successful and 8 not. Three patients treated with the intravenous method suffered respiratory depression, and one required an antidote. No systemic or local side-effects, no neurovascular damage and no early or late superficial or deep infection were recorded in the lidocaine group. There was no statistical difference between the average VAS value in the two groups. Lidocaine used to reduce acute secondary dislocations of the shoulder is a simple and safe method. It is as effective as the standard intravenous method and is well accepted by patients.

Intraarticular findings in the chronically painful shoulder. A study of 32 posttraumatic cases.

32 consecutive patients suffering from chronic shoulder pain for more than 6 months after a single, nondislocating shoulder trauma were examined clinically and by special radiographs, dynamic sonography, MRI and arthroscopy. Typical complaints were pain during loading, especially during over the head activities. Symptoms of a "dead arm" and instability were also present. Patients with previous dislocations, traumas or radiographic signs of degenerative shoulder lesions were excluded. The patients had a decreased active range of motion and positive signs of apprehension and impingement, but only 4 had clinical signs of shoulder instability. Diagnostic evaluation identified labral tears, partial and total rotator cuff lesions with subacromial impingement and tendinitis of the biceps tendon. Surgery was performed in 24 patients, using capsulolabral and rotator cuff reconstruction, arthroscopic labral resection and open subacromial decompression. In conclusion, patients with chronic posttraumatic shoulder pain have intraarticular injuries, especially tears of the glenoid labrum. History, clinical findings, radiography and sonography are seldom diagnostic. MRI is valuable, particularly for identification of labral pathology, but arthroscopy appears necessary for a preoperative assessment.

[Arthroscopy of post-traumatic shoulder pain]. / Artroskopi ved posttraumatiske skuldersmerter.

Thirty-two consecutive patients suffering chronic shoulder pain for more than six months after a non-dislocating shoulder trauma were examined clinically and with arthroscopy of the shoulder. The trauma was blunt or simple distortion of the shoulder. The patients complained of pain during loading, especially during over the head activities. Symptoms of dead arm and feeling of instability with a popping sensation inside the shoulder were also present. Patients with previous dislocations, trauma or radiographic signs of degenerative shoulder lesions were excluded. Clinically, 21 patients had decreased range of motion, 19 patients had a positive anterior apprehension sign and four of these had signs of shoulder instability. Nine patients had signs of impingement. The suspected preoperative diagnoses included a tear of the rotator cuff (17), a tear of the labrum (12), tendinitis of the biceps tendon (2) and periarthrosis of the shoulder (1). Arthroscopic findings consisted of 22 labral tears, six partial and three total rotator cuff lesions and three cases of synovitis of the rotator cuff with signs of subacromial impingement. Four patients had tendinitis of the biceps tendon. One patient had a lesion of the greater tubercle. Only two shoulders were found to be unstable under anaesthesia. In conclusion, patients with posttraumatic chronic shoulder pain after a non-dislocating trauma of the shoulder should be evaluated with arthroscopy in order to diagnose possible intraarticular lesions.

Reduction of traumatic, primary anterior shoulder dislocations with local anesthesia.

This study evaluates the use of local anesthesia in the reduction of acute shoulder dislocations. Patients with a primary traumatic dislocation of the shoulder were randomly assigned to receive either local anesthesia or intravenous anesthesia. The patients were observed for any complication during and after the procedure, and the methods used were evaluated with a visual analog scale. In the period from November 1991 to September 1993, 81 patients were admitted to our departments, and 68 patients were included in the study. Average age was 48 years (range 15 to 79 years); 29 men and 39 women were studied. Thirty-five patients were randomly assigned to receive intravenous anesthesia; 33 had a successful reduction, and two had a failed reduction. Thirty-three patients received local anesthesia; 32 had a successful reduction, and one had a failed reduction. Ten patients treated with the intravenous method had respiratory depression, and six required an antidote. No systemic or local side effects and no neurovasculor injuries were recorded. We did not observe any superficial or deep infection in the local anesthetic group. No statistical difference was found between the average visual analog value scale in the two groups. Local anesthesia to reduce acute primary anterior dislocation of the shoulder is a simple and safe method.