Osteometría-escapulometría glenohumeral en las inestabilidades anteriores recidivantes de hombro. Estudio etiopatogénico de uno de los estabilizadores estáticos mediante tomografía computarizada / Glenohumeral osteometry-scapulometry in anterior shoulder instabilities. Study of one of the static stabilizers through computer tomography

Se realizó un estudio escapulométrico de 98 hombros,mediante TAC: 36 con luxación anterior recidivante(LRH), 37 hombros estables contralaterales de esospacientes (HEC) y 25 hombros normales (HN). Se evaluaronseis parámetros: índice glenohumeral horizontal,índice glenohumeral vertical, inclinación glenoidea,ángulo de anteversión de la escápula, ángulo glenoideoy retroversión humeral.Encontramos diferencias estadísticamente significativasentre los grupos LRH y HEC en relación al índiceglenohumeral horizontal. Ambos grupos (LRH y HEC)mostraban diferencias significativas en comparacióncon el grupo de hombros normales (HN) en relación alíndice glenohumeral horizontal, inclinación glenoidea yángulo de anteversión de la escápula. La desproporcióncefalo-glenoidea y la inclinación anterior glenoidea sonlos factores anatómicos desestabilizantes.Nuestros resultados confirman que, aunque la etiologíade la inestabilidad anterior de hombro es multifactorial,existe una predisposición congénita anatómicaque la favorece y, en menor grado, también en el hombroestable contralateral, confirmando la existencia deuna sutil displasia congénita. Además se revelan comoparámetros relevantes en el estudio de la inestabilidadanterior: el índice glenohumeral horizontal, inclinaciónglenoidea y ángulo de anteversión de la escápula, siendodiscutido el papel de la retroversión humeral(AU)

We have carried out a scapulometric study, usingCT-scan, of 98 shoulders: 36 with recurrent anteriorshoulder dislocation (RAD), 37 stable contralateralshoulders (CSS) and 25 normal shoulders (NS). Sixparameters were evaluated: Horizontal and Verticalglenohumeral index, glenoid tilt, anteversion angle ofthe scapula, glenoid angle and humeral retroversion.We found statistically significant differences betweenthe RAD and CSS groups in the horizontal glenohumeralindex. Both the RAD and CSS groups showed significantdifferences in comparison with the NS group in the horizontalglenohumeral index, glenoid tilt and anteversionangle of the scapula. An imbalance of the head-glenoidsize and the anterior glenoid tilt are the anatomicalfactors which favour instability. The determination ofthese three parameters has great value when assessingpatients with anterior shoulder instability.Our results confirm that although the aetiology ofanterior glenohumeral instability is multifactorial, thereis an anatomical congenital predisposition which favoursinstability and this predisposition affects (to a lesser extent)the stable contralateral side, confirming the roleof subtle congenital dysplasic theory. In addition the followingwere revealed as relevant parameters in the studyof anterior instability: the horizontal glenohumeral index,glenoid tilt and angle of anteversion of the scapula; whilethe value of the humeral retroversion is under discussion(AU)

Pain relief in the treatment of shoulder injury.

Anterior shoulder dislocation (ASD) is a common presentation in emergency departments, yet there is no national guidance on the use of sedation or analgesia. This article gives an overview of the aetiology and treatment of ASD, and reports the results of a literature review on best practice for timely and appropriate treatment of patients with ASD, and the effect of sedation on patient transit times

Retrospective audit of triage of acute traumatic shoulder dislocation by emergency nurses.

INTRODUCTION: Acute traumatic shoulder dislocation (ATSD) is a relatively common presentation to the emergency department. Research into nurse-led triage shows emergency nurses to be accurate at identifying patients with bony injuries and follow protocols to expedite appropriate care. The aim of this study was to assess the quality of triage decisions made by emergency nursing staff in cases of confirmed ATSD, in an emergency department in the United Kingdom. METHODS: A retrospective audit was undertaken on patients with ATSD for 12 months (August 2006-August 2007). The nursing triage sheet and the clinical record forms were used to obtain data detailing the entire patient journey from arrival in the department to discharge. RESULTS: Emergency nurses were less likely to identify ATSD at triage than their physician colleagues during their initial clinical assessment (OR 0.06; 99% CI 0.014-0.272). Failure to identify ATSD at triage affected the efficiency of the remaining patient journey. DISCUSSION: A learning need for nursing staff in the initial assessment and identification of ATSD has been identified. The King's Mill Hospital's integrated care pathway for ATSD has been developed in response to the findings of this study, designed to aid diagnosis at triage and expedite patients through the stages of their ED journey. CONCLUSION: Significant areas for improvement have been identified in the initial assessment and management of patients with ATSD presenting at triage in the emergency department. The impact of the King's Mill Hospital's integrated care pathway on the quality of triage in ATSD requires further assessment.

Post-stroke shoulder subluxation: a concern for neuroscience nurses.

Approximately 84% of all stroke patients with hemiplegia will experience shoulder injury and pain. The importance of maintaining proper posture while positioning and transferring a stroke patient is key to decreasing risk for shoulder injury. Shoulder subluxation injury post-stroke is a consequence of sustained hemiplegia and spasticity. Current research evidence suggests that using therapies such as gentle range of motion and functional electrical stimulation may reduce and prevent shoulder subluxation and hemiplegic shoulder pain. However, physiotherapists are currently the only professionals who can implement such therapies. Considering that stroke care provided by neuroscience nurses includes transferring, positioning and assisting in activities of daily living, it is clear that nurses are an important part of the therapy process. Therefore, the question is: "What is the role of the neuroscience nurse in the reduction and prevention of shoulder pain post-stroke?" The purposes of this paper are to i) discuss the causes of shoulder subluxation and related pain post-stroke, ii) review current best practice in prevention and treatment of shoulder subluxation, and iii) explore ways in which the acute neuroscience nurse can prevent or reduce shoulder subluxation in the hemiplegic stroke patient.