Posterior shoulder dislocation is a relatively uncommon event, with an incidence of 1~4% of all shoulder dislocations. Because this condition is rare and because accurately interpreting the radiography is difficult, the diagnosis is often missed. In such a case, significant complications, such as chronic posterior dislocation and degenerative disease of the shoulder, can occur. We experienced the case of a patient in whom bilateral posterior shoulder dislocation occurred following an accidental fall a height of 10m. Fortunately, he had no neurovascular injury of the shoulder and fully recovered after closed reduction, but early diagnosis was missed because other injuries were significant and his vital signs were unstable. A careful history and physical examination, complete radiographic evaluation, and a high level of suspicion are required to identify posterior shoulder dislocation. This case may be helpful for diagnosis of posterior shoulder dislocation.
Accidental Falls* ; Diagnosis ; Dislocations ; Early Diagnosis ; Humans ; Incidence ; Physical Examination ; Radiography ; Shoulder Dislocation* ; Shoulder* ; Vital Signs

Computed tomography (CT) immediately after double-contrast shoulder arthrography was taken in twenty-two young male patients with anterior shoulder instability including recurrent dislocation and subluxation. This recently developed technique called CT arthrography can provide significant information about patients with glenohumeral instability which is difficult to obtain by conventional arthrography. Information about glenoid labrum pathology is useful for proper management of the shoulder with instability. Lesions identified in this study include anterior labral defects (attenuation, tear, displacement), anterior capsular distension and/or detachment, Hill-Sachs lesion, anterior glenoid rim compression fracture, and fracture of scapula. This article describes the method used in CT arthrography of the glenohumeral joint, reviews the normal cross-sectional anatomy, and emphasizes the importance of the application of CT arthrography in the shoulder disorder with instability. CT arthrography of the glenohumeral joint is easy to perform, is accurate, and has lower radiation dose than arthrotomography.
Adult ; Humans ; Male ; Recurrence ; Shoulder Dislocation/*radiography ; *Tomography, X-Ray Computed

Adult ; Female ; Humans ; Humeral Fractures ; complications ; Male ; Middle Aged ; Radiography ; Shoulder Dislocation ; diagnostic imaging ; etiology ; therapy

OBJECTIVE: To compare the image quality of shoulder CT arthrography performed using 120 kVp and 140 kVp protocols. MATERIALS AND METHODS: Fifty-four CT examinations were prospectively included. CT scans were performed on each patient at 120 kVp and 140 kVp; other scanning parameters were kept constant. Image qualities were qualitatively and quantitatively compared with respect to noise, contrast, and diagnostic acceptability. Diagnostic acceptabilities were graded using a one to five scale as follows: 1, suboptimal; 2, below average; 3, acceptable; 4, above average; and 5, superior. Radiation doses were also compared. RESULTS: Contrast was better at 120 kVp, but noise was greater. No significant differences were observed between the 120 kVp and 140 kVp protocols in terms of diagnostic acceptability, signal-to-noise ratio, or contrast-to-noise ratio. Lowering tube voltage from 140 kVp to 120 kVp reduced the radiation dose by 33%. CONCLUSION: The use of 120 kVp during shoulder CT arthrography reduces radiation dose versus 140 kVp without significant loss of image quality.
Adult ; Aged ; Contrast Media/diagnostic use ; Female ; Humans ; Male ; Middle Aged ; Prospective Studies ; Radiation Dosage ; Radiographic Image Interpretation, Computer-Assisted ; Shoulder/*radiography/surgery ; Shoulder Dislocation/pathology/radiography ; Signal-To-Noise Ratio ; *Tomography, X-Ray Computed

OBJECTIVETo investigate the effect of the arthroscopic procedure on the patients with recurrent anterior shoulder dislocation.

METHODSFrom January 2001 to March 2006,52 patients with recurrent anterior shoulder dislocation were treated by arthroscopy. Among them 44 patients were followed up for 12 to 54 months(on average of 26 months). The data of the 44 patients was reviewed. Three evaluation systems, University of California at Los Angeles Shoulder Scores (UCLA), Simple Shoulder Test (SST) and Dawson, were used. The study evaluated the effect based on the Dawson system by the factors as: age, course of the disease, frequency of dislocation and relocation methods and the range of shoulder movement.

RESULTSThe ratio of recurrent dislocation after operation was 4.5%. Assessing through 3 evaluation systems, UCLA, SST and Dawson, results were similar: the follow-up evaluation were extraordinarily different from preoperative assessment, and the rating of good or excellent at the time of the final follow-up reached 91% higher. Based on the Dawson system, the evaluation results had no statistic diversity according to such factors as: age, course of the disease, frequency of dislocation and relocation methods.

CONCLUSIONSThe effects of arthroscopic surgery to the recurrent anterior shoulder dislocation are satisfied and evidence-proved. It is a good option for both common patients and athletes.

Adolescent ; Adult ; Arthroscopy ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Radiography ; Recurrence ; Retrospective Studies ; Shoulder Dislocation ; diagnostic imaging ; surgery ; Treatment Outcome

Shoulder dislocation is frequently encountered by orthopedists, and closed manipulation is often sufficient to treat the injury in an acute setting. Although most dislocations are diagnosed and managed promptly, there are rare cases that are missed or neglected, leading to a chronically dislocated state of the joint. They are usually irreducible and cause considerable pain and functional disability in most affected patients, prompting the need to find a surgical method to reverse the worsening conditions caused by the dislocated joint. However, there are cases of even greater rarity in which chronic shoulder dislocations are asymptomatic with minimal functional or structural degeneration in the joint. These patients are usually left untreated, and most show good tolerance to their condition without developing disabling symptoms or significant functional loss over time. We report on one such patient who had a chronic shoulder dislocation for more than 2 years without receiving treatment.
Accidental Falls ; Aged ; Humans ; Magnetic Resonance Imaging ; Male ; Radiography ; Range of Motion, Articular ; Recurrence ; *Rotator Cuff Injuries/diagnosis/diagnostic imaging/physiopathology ; *Shoulder/diagnostic imaging/pathology/physiopathology ; *Shoulder Dislocation/diagnosis/diagnostic imaging/physiopathology

OBJECTIVETo compare therapeutic effects between Kirschner tension band fixation (TBF) and clavicular hook-plate (CHP) for treating acromioclavicular dislocations of Allman Grade III.

METHODSFrom Jan. 1995 to Dec. 2007, a total of 39 patients who were diagnosed as acromioclavicular joint dislocation of Grade III were treated with Kirschner tension band fixation (TBF 18 patients, 12 patients were male, 6 patients were female, mean age were (27.50 +/- 12.76) years old, average fixation duration were (4.28 +/- 1.27) months) and clavicular hook plate fixation (CHP 21 patients, 18 patients were male, 3 patients were female, mean age were (34.76 +/- 12.39) years old, average fixation during were (8.29 +/- 1.49) months). All the patients were followed up with a mean period over 4 years. The therapeutic effects of the two groups were compared base on complications, Karlsson scores and re-subluxation.

RESULTSThe average period from injury to fixation removal was (4.28 +/- 1.27) and (8.29 +/- 1.49) months in TBF and CHP groups respectively, comparison between the two groups, t = -8.951, P < 0.01, there was statistical difference, and the course of disease in TBF group was shorter than that of CHP group. Five patients in TBF group and 1 patient in CHP group had complications (P = 0.077 > 0.05), as well as 3 patients in TBF group and 1 patient in CHP group had re-subluxation (P = 0.318 > 0.05). Karlsson evaluation results:in TBF group, 15 patients got a grade A result, 3 grade B and 0 grade C; and in CHP groups above data was 20, 1 and 0 respectively (P = 0.530 > 0.05). There was no statistical differences between the two groups in evaluation outcomes.

CONCLUSIONThe two fixation methods are all effective methods to treat Grade III acromioclavicular dislocation of Grade III, and the long-term outcome is satisfactory.

Acromioclavicular Joint ; diagnostic imaging ; injuries ; surgery ; Adolescent ; Adult ; Aged ; Female ; Fracture Fixation, Internal ; methods ; Humans ; Male ; Middle Aged ; Postoperative Complications ; Radiography ; Shoulder Dislocation ; diagnostic imaging ; etiology ; surgery ; therapy ; Treatment Outcome ; Young Adult