Lesions related to glenohumeral dislocation in patients who are older then 40 years old

Abstract

Abstract: 

Introduction

The glenohumeral dislocation of the shoulder is amongst the most frequents articulary dislocations. With a higher occurrence in youngsters, due to traumas or because of articular instability ( ligament – capsule ); although it has a favorable evolution, it presents a high relapse.

Beginning in the fourth decade of life, the occurrence of the relapse decreases, but the frequence of lesions associated like fracture, rotator cuff tear, ligament – capsule lesion and articulary rigidness.

Objective:

To describe anatomic lesions associated to glenohumeral dislocations in patients who are older tan 40 years old.

Material and Methods:

Transversal retrospective study of registered cases by a medical traumatological guard in a high complex health institution. Patients with acute glenohumeral dislocation, over tan 40 years old, treated betwen january 2019 and december 2020 were included. Cases with recurrent dislocations, previous pathological or surgical antecedents and with previously diagnosed lesions were excluded. After the medical examination, a shoulder bone scan ( front and contour ) was required, in order to confirm diagnose; afterwards the orthopedic reduction was conducted. Later, control reduction bone scans were performed, and then a Computed Tomography ( CT ) and a Magnetic Resonance Imaging ( MRI ) for assessment in out patient office were performed.

Results:

15458 patients in the consigned period were seen to; 0,13 % ( 21 cases )belonged to people who were older tan 40 years old with acute glenohumeral dislocation. Meduim age was 54 years old ( range 41-90 ); 12 ( 57 % ) were female and 9 ( 43% ) male. 85 % ( 19 cases ) were resolved in medical guard orthopedic reduction maneuvers and 2 cases ( 15 % ) required surgical sedation. In 10 cases ( 47,6 % ) the complementary studies did not show associated lesions. In 5 cases ( 23,8 %) a rotator cuff lesion was observed, 3 patients ( 14 % ) showed lesion associated to the rotator cuff and Bankart; 2 patients ( 95 % ) presented lesion of the rotator cuff combined with Hill-Sachs and 1 patient ( 5 % ) presented joint injury of Bankart/Slap and Hill/Sachs.

Conclusions:

The complementary studies, both CT and MRI are of hifher importance in order to identify associated lesions; in our study almost half of the patients were older tan 40 years old presented associated lesions.