Arthroscopic findings after shoulder dislocation

Abstract

Background/Aim. Recurrent instability of the shoulder joint is frequently difficult to differentiate from diseased or injured rotator cuff or tendon of the forearm flexor (m. biceps brachii). Shoulder joint arthroscopy has been only recently introduced into instable shoulder joint lesion examination. The aim of this study was to present and analyze an arthroscopic finding on instable shoulder joint in order to determine causes and mechanisms of instability, as well as principles of surgical treatment. Methods. Arthroscopy of the shoulder joint was performed in 158 patients with at least one documented shoulder joint dislocation. These patients were divided into two groups. The group I included the patients with one to three dislocations, while the group II those with more than three dislocations. Preoperative diagnosis was based on anamnestic data and clinical examination using specific tests, and on the diagnosis of shoulder joint using radiography or computed tomography. Results. Out of the total number of the patients 138 (87.34%) had injury of the anterior patellar brim, 119 (75.32%) had failure of the anterior capsule, 126 (79.75%) had compressive cartilage injury of the posterior part of the head of the upper arm bone (Hill-Sachs lesion), 102 (64.56%) had insufficiency of glenohumeral tendon, 11 (6.96) had complete cut of the rotator cuff, 23 (14.56%) had injury of the posterior patellar brim, 12 (7.59%) had injury of the upper anterior-posterior patellar brim (SLAP). Conclusion. According to the obtained results it could be concluded that there is no a unique injury that leads to shoulder joint instability. It is necessary to point out to the significance of anamnesis and clinical examination in making diagnosis. Arthroscopic diagnostics is indicated in clinically unreliable findings as an additional method for determining operative treatment.Uvod/Cilj. Recidivirajuca nestabilnost ramenog zgloba cesto se tesko razlikuje od oboljenja i povreda rotatorne manzetne ili tetive pregibaca podlaktice (m. biceps brachii). Artroskopija ramenog zgloba tek u skorije vreme primenjuje se za ispitivanje lezija nestabilnog ramenog zgloba. Cilj ovog rada bio je da se prikaze i analizira artroskopski nalaz kod nestabilnog zgloba ramena da bi se ustanovili razlozi i mehanizmi nestabilnosti, kao i principi hirurskog lecenja. Metode. Artroskopija ramenog zgloba ucinjena je kod 158 bolesnika koji su imali najmanje jedno dokumentovano iscasenje ramenog zgloba. Bolesnici su bili podeljeni u dve grupe: grupu I u kojoj su bolesnici imali jedno do tri iscasenja i grupu II u kojoj su bolesnici imali vise od tri iscasenja. Preoperativna dijagnoza postavljana je na osnovu anemnestickih podataka i klinickog ispitivanja specificnim testovima, te dijagnozom bolesti ramenog zgloba, radiografski ili kompjuterizovanom tomografijom. Rezultati. Od ispitivanih bolesnika, 138 (87,34%) imalo je povredu prednje casicne usne, 119 (75,32%) slabost prednje kapsule, 126 (79,75%) imalio je kompresivnu povredu hrskavice zadnjeg dela glave nadlakatne kosti (Hill-Sachsovu leziju), 102 (64,56%) bilo je sa insuficijencijom glenohumeralnih ligamenata, 11 (6,96%) je imalo kompletni raskid rotatorne manzetne, 23 (14,56%) ostecenje zadnje casicne usne, 12 (7,59%) ostecenje gornje prednjezadnje casicne usne (SLAP). Zakljucak. Na osnovu prikupljenih podataka moze se zakljuciti da ne postoji jedinstvena povreda koja dovodi do nestabilnosti ramenog zgloba. Potrebno je ukazati na znacaj anamneze i klinickog pregleda pri postavljanju dijagnoze. Artroskopska dijagnostika je indikovana kod klinicki nesigurnih nalaza kao dopunska metoda kojom ce se odrediti plan operativnog lecenja.