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Large scale study explores epidemiology of injuries associated with anterior glenohumeral dislocations
From possibly the largest investigation to date of injuries associated with primary anterior shoulder dislocations, researchers from the Edinburgh Shoulder Clinic found an associated rotator cuff envelope (RCE) or neurological deficit in (bifocal injury) 30% of patients, and both RCE and neurological deficit (trifocal injury) in 8% of patients.
“This is the biggest study of its kind exploring nerve injuries and RCE injuries associated with anterior shoulder dislocations,” Iain R. Murray, BmedSci, MRCSEd, told Orthopaedics Today Europe in an interview prior to the 12th EFORT Congress in Copenhagen, where he is scheduled to present the results. Previous investigations of neurological deficits associated with dislocations have been small studies or case reports, he said.
“Our study highlights the prevalence of injuries associated with anterior dislocations and awareness of these injuries by attending physicians will improve diagnosis and facilitate earlier treatment,” Murray said of the paper, which is being considered for the EFORT Congress Copenhagen 2011 Free Paper Award.
The study involved 3,626 consecutive adults attending with primary anterior shoulder dislocation from January 1995 to May 2009. They were interviewed and assessed radiologically by an orthopaedic trauma surgeon within 1 week of injury and data were prospectively recorded.
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Epidemiological confirmation
In discussing the study’s importance, Murray said, “Much of what we did was to confirm in a large study what is already suspected about these injuries. The epidemiology and bimodal distribution of the unifocal injuries has been well documented. We were surprised to find how common associated RCE injuries were in older patients. Bifocal dislocations involving the rotator cuff were more common in those aged over 60 than unifocal dislocations.”
Murray and colleagues defined the RCE as the greater tuberosity (GT) with the RC. They classified glenohumeral dislocations with either a RCE or neurological deficit as “bifocal,” and dislocations associated with both RCE and neurological deficit as trifocal injuries.
Bifocal, trifocal concerns
According to the results, 2,228 patients (62%) had unifocal injuries. These were bimodally distributed with 34% in the 20- to 29-year-old group and 23% in the group older than age 60. Among bifocal and trifocal dislocations, RC tears and GT fractures occurred most often. Isolated injury to the axillary nerve was the most common neurological deficit. Compared with unifocal injuries, the greatest incidence of trifocal injuries was in older women who suffered low-energy falls.
Murray encouraged orthopaedists and attending physicians to be on the lookout for patients that may have some of these added injuries in conjunction with an anterior glenohumeral dislocation.
“They should be actively looking for these injuries. Otherwise they miss that early window where intervention is most beneficial,” he said. – by Susan M. Rapp
Reference:
- Murray IR, Shur N, Sharpe, et al. Injuries associated with acute anterior dislocation of the glenohumeral joint. Scheduled to be presented June 1, 14:00-14:10, at the 2011 EFORT Congress. June 1-4. Copenhagen.
- Iain R. Murray, BmedSci, MRCSEd, can be reached in the Department of Orthopaedics and Trauma, University of Edinburgh, Royal Infirmary of Edinburgh, Little France, Edinburgh, UK EH16 4SU; +44-790-336-1554; email: iain.murray@ed.ac.uk.
- Disclosure: He has no relevant financial disclosures.
