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Daniel B. Whelan - One of the best experts on this subject based on the ideXlab platform.
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Immobilization in External Rotation Versus Internal Rotation After Primary Anterior Shoulder Dislocation A Meta-analysis of Randomized Controlled Trials
The American journal of sports medicine, 2015Co-Authors: Daniel B. Whelan, Stephanie N. Kletke, Geoffrey Schemitsch, Jaskarndip ChahalAbstract:Background:The recurrence rate after primary anterior Shoulder Dislocation is high, especially in young, active individuals. Recent studies have suggested external rotation immobilization as a method to reduce the rate of recurrent Shoulder Dislocation in comparison to traditional sling immobilization.Purpose:To assess and summarize evidence from randomized controlled trials on the effect of internal rotation versus external rotation immobilization on the rate of recurrence after primary anterior Shoulder Dislocation.Study Design:Meta-analysis.Methods:PubMed, MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, and abstracts from recent proceedings were searched for eligible studies. Two reviewers selected studies for inclusion, assessed methodological quality, and extracted data.Results:Six randomized controlled trials (632 patients) were included in this review. Demographic and prognostic variables measured at baseline were similar in the pooled groups. The average age was 30.1 years in ...
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external rotation immobilization for primary Shoulder Dislocation a randomized controlled trial
Clinical Orthopaedics and Related Research, 2014Co-Authors: Daniel B. Whelan, Robert Litchfield, Elizabeth Wambolt, Katie N DaintyAbstract:Background The traditional treatment for primary anterior Shoulder Dislocations has been immobilization in a sling with the arm in a position of adduction and internal rotation. However, recent basic science and clinical data have suggested recurrent instability may be reduced with immobilization in external rotation after primary Shoulder Dislocation.
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anatomic bankart repair compared with nonoperative treatment and or arthroscopic lavage for first time traumatic Shoulder Dislocation
Arthroscopy, 2012Co-Authors: Jaskarndip Chahal, Paul Marks, Peter B. Macdonald, Prakesh S. Shah, John Theodoropoulos, Bheeshma Ravi, Daniel B. WhelanAbstract:Purpose The objective of this systematic review was to determine the efficacy of anatomic Bankart repair in patients with a first-time Shoulder Dislocation compared with either arthroscopic lavage or traditional sling immobilization. Methods We searched the Cochrane Central Register of Controlled Trials, Medline, Embase, CINAHL, Web of Science, LILACS, and a clinical trials registry for ongoing and completed randomized or quasi-randomized controlled trials comparing anatomic Bankart repair with either rehabilitation or arthroscopic lavage. Two reviewers selected studies for inclusion, assessed methodologic quality, and extracted data. Pooled analyses were performed by use of a random-effects model, and risk ratio (RR) and 95% confidence intervals (CIs) were computed. Results We included 3 randomized trials and 1 quasi-randomized trial comprising 228 patients. Of the included trials, 2 compared anatomic Bankart repair with sling immobilization whereas 2 compared Bankart repair with arthroscopic lavage. A meta-analysis of all 4 trials showed that the rate of recurrent instability was significantly lower among participants undergoing anatomic Bankart repair compared with those undergoing either immobilization or arthroscopic lavage (RR, 0.18; 95% CI, 0.10 to 0.33). Subgroup analysis showed that this effect persisted when Bankart repair was compared with arthroscopic lavage alone (2 studies) (RR, 0.14; 95% CI, 0.06 to 0.31) or sling immobilization alone (2 studies) (RR, 0.26; 95% CI, 0.10 to 0.67). Western Ontario Shoulder Instability scores were better with anatomic Bankart repair compared with either arthroscopic lavage or immobilization (2 studies) (mean difference, –232; 95% CI, –317 to –146). Conclusions There is evidence to suggest treatment of young patients with a first-time Shoulder Dislocation with anatomic Bankart repair with the goal of lowering the rate of recurrent instability over the long-term and improving short-term quality of life. Level of Evidence Level II, systematic review of Level I and II studies.
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generalized ligamentous laxity as a predisposing factor for primary traumatic anterior Shoulder Dislocation
Journal of Shoulder and Elbow Surgery, 2010Co-Authors: Jaskarndip Chahal, Jeff Leiter, Michael D Mckee, Daniel B. WhelanAbstract:Hypothesis The purpose of this study was to determine whether generalized ligamentous laxity and increased Shoulder external rotation represent predisposing factors for primary traumatic anterior Shoulder Dislocation in young, active patients. We hypothesized that generalized ligamentous laxity and increased Shoulder external rotation would be more common in individuals with first-time traumatic Shoulder Dislocations compared with controls. Materials and methods This retrospective case-control study examined hyperlaxity and Shoulder external rotation >85° in 57 consecutive individuals (age Results Generalized ligamentous laxity was present in 33.3% of the cases compared with 15.2% of controls (P = .014). Increased contralateral Shoulder external rotation (>85°) was observed in 38.6% of the study group compared with 22.8% of controls (P = .043). Men who had dislocated their Shoulder were 6.8 times more likely to demonstrate generalized ligamentous laxity and increased Shoulder external rotation compared with age and sex matched controls (P = .003). Discussion Identifying hyperlax individuals may allow for Shoulder-specific proprioceptive training. Conclusion Generalized joint laxity and increased external rotation in the contralateral Shoulder were more common in patients who had sustained a primary Shoulder Dislocation.
Jaskarndip Chahal - One of the best experts on this subject based on the ideXlab platform.
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Immobilization in External Rotation Versus Internal Rotation After Primary Anterior Shoulder Dislocation A Meta-analysis of Randomized Controlled Trials
The American journal of sports medicine, 2015Co-Authors: Daniel B. Whelan, Stephanie N. Kletke, Geoffrey Schemitsch, Jaskarndip ChahalAbstract:Background:The recurrence rate after primary anterior Shoulder Dislocation is high, especially in young, active individuals. Recent studies have suggested external rotation immobilization as a method to reduce the rate of recurrent Shoulder Dislocation in comparison to traditional sling immobilization.Purpose:To assess and summarize evidence from randomized controlled trials on the effect of internal rotation versus external rotation immobilization on the rate of recurrence after primary anterior Shoulder Dislocation.Study Design:Meta-analysis.Methods:PubMed, MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, and abstracts from recent proceedings were searched for eligible studies. Two reviewers selected studies for inclusion, assessed methodological quality, and extracted data.Results:Six randomized controlled trials (632 patients) were included in this review. Demographic and prognostic variables measured at baseline were similar in the pooled groups. The average age was 30.1 years in ...
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epidemiology of primary anterior Shoulder Dislocation requiring closed reduction in ontario canada
American Journal of Sports Medicine, 2014Co-Authors: Timothy Leroux, Jaskarndip Chahal, David Wasserstein, Christian Veillette, Amir Khoshbin, Patrick Henry, Peter C Austin, Nizar N MahomedAbstract:Background:There is a lack of high-quality population-based literature describing the epidemiology of primary anterior Shoulder Dislocation.Purpose:To (1) calculate the incidence density rate (IDR) of primary anterior Shoulder Dislocation requiring closed reduction (CR; “index event”) in the general population and demographic subgroups, and (2) determine the rate of and risk factors for repeat Shoulder CR.Study Design:Cohort study (prognosis); Level of evidence, 2.Methods:All patients who underwent Shoulder CR by a physician in Ontario between April 2002 and September 2010 were identified with administrative databases. Exclusion criteria included age 70 years, posterior Dislocation, and prior Shoulder Dislocation or surgery. Index event IDR was calculated for all populations/subgroups, and IDR comparisons were made. Repeat Shoulder CR was sought until September 2012. Risk factors for repeat Shoulder CR were identified with a Prentice, Williams, and Peterson proportional hazards model.Results:Ther...
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anatomic bankart repair compared with nonoperative treatment and or arthroscopic lavage for first time traumatic Shoulder Dislocation
Arthroscopy, 2012Co-Authors: Jaskarndip Chahal, Paul Marks, Peter B. Macdonald, Prakesh S. Shah, John Theodoropoulos, Bheeshma Ravi, Daniel B. WhelanAbstract:Purpose The objective of this systematic review was to determine the efficacy of anatomic Bankart repair in patients with a first-time Shoulder Dislocation compared with either arthroscopic lavage or traditional sling immobilization. Methods We searched the Cochrane Central Register of Controlled Trials, Medline, Embase, CINAHL, Web of Science, LILACS, and a clinical trials registry for ongoing and completed randomized or quasi-randomized controlled trials comparing anatomic Bankart repair with either rehabilitation or arthroscopic lavage. Two reviewers selected studies for inclusion, assessed methodologic quality, and extracted data. Pooled analyses were performed by use of a random-effects model, and risk ratio (RR) and 95% confidence intervals (CIs) were computed. Results We included 3 randomized trials and 1 quasi-randomized trial comprising 228 patients. Of the included trials, 2 compared anatomic Bankart repair with sling immobilization whereas 2 compared Bankart repair with arthroscopic lavage. A meta-analysis of all 4 trials showed that the rate of recurrent instability was significantly lower among participants undergoing anatomic Bankart repair compared with those undergoing either immobilization or arthroscopic lavage (RR, 0.18; 95% CI, 0.10 to 0.33). Subgroup analysis showed that this effect persisted when Bankart repair was compared with arthroscopic lavage alone (2 studies) (RR, 0.14; 95% CI, 0.06 to 0.31) or sling immobilization alone (2 studies) (RR, 0.26; 95% CI, 0.10 to 0.67). Western Ontario Shoulder Instability scores were better with anatomic Bankart repair compared with either arthroscopic lavage or immobilization (2 studies) (mean difference, –232; 95% CI, –317 to –146). Conclusions There is evidence to suggest treatment of young patients with a first-time Shoulder Dislocation with anatomic Bankart repair with the goal of lowering the rate of recurrent instability over the long-term and improving short-term quality of life. Level of Evidence Level II, systematic review of Level I and II studies.
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generalized ligamentous laxity as a predisposing factor for primary traumatic anterior Shoulder Dislocation
Journal of Shoulder and Elbow Surgery, 2010Co-Authors: Jaskarndip Chahal, Jeff Leiter, Michael D Mckee, Daniel B. WhelanAbstract:Hypothesis The purpose of this study was to determine whether generalized ligamentous laxity and increased Shoulder external rotation represent predisposing factors for primary traumatic anterior Shoulder Dislocation in young, active patients. We hypothesized that generalized ligamentous laxity and increased Shoulder external rotation would be more common in individuals with first-time traumatic Shoulder Dislocations compared with controls. Materials and methods This retrospective case-control study examined hyperlaxity and Shoulder external rotation >85° in 57 consecutive individuals (age Results Generalized ligamentous laxity was present in 33.3% of the cases compared with 15.2% of controls (P = .014). Increased contralateral Shoulder external rotation (>85°) was observed in 38.6% of the study group compared with 22.8% of controls (P = .043). Men who had dislocated their Shoulder were 6.8 times more likely to demonstrate generalized ligamentous laxity and increased Shoulder external rotation compared with age and sex matched controls (P = .003). Discussion Identifying hyperlax individuals may allow for Shoulder-specific proprioceptive training. Conclusion Generalized joint laxity and increased external rotation in the contralateral Shoulder were more common in patients who had sustained a primary Shoulder Dislocation.
Kaiming Chan - One of the best experts on this subject based on the ideXlab platform.
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prevalence pattern and spectrum of glenoid bone loss in anterior Shoulder Dislocation ct analysis of 218 patients
American Journal of Roentgenology, 2008Co-Authors: James F Griffith, Gregory E Antonio, Patrick Shuhang Yung, Anil T Ahuja, Eric Wong, Kaiming ChanAbstract:OBJECTIVE. The purpose of our study was to determine the prevalence, pattern, and spectrum of glenoid bone loss in anterior Shoulder Dislocation, to relate this to the frequency of Dislocation, and to test the appropriateness of the measurement method.SUBJECTS AND METHODS. Two hundred eighteen patients with single or recurrent anterior Shoulder Dislocation underwent Shoulder CT examination. Fifteen patients had bilateral Dislocation. Prevalence and severity of glenoid bone loss and glenoid fracture were assessed. CT examinations of 56 control subjects without Shoulder Dislocation were evaluated for glenoid contour and side-to-side variation in glenoid width.RESULTS. Glenoid bone loss was present in 27 (41%) of 66 patients with first-time unilateral Dislocation and 118 (86%) of 137 patients with recurrent unilateral Dislocation. Glenoid bone loss ranged from –0.3% to –33% (mean, –10.8% ± 7.9%). Seventy-four (51%) of 145 patients had ≤ 10% glenoid bone loss, 54 (37%) had between 10% and 20%, eight (6%) had ...
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the surgical outcome of immediate arthroscopic bankart repair for first time anterior Shoulder Dislocation in young active patients
Knee Surgery Sports Traumatology Arthroscopy, 2008Co-Authors: Billy Kanyip Law, Patrick Shuhang Yung, Joseph Jeremy Hsitse Chang, Kaiming ChanAbstract:This study evaluated the surgical outcomes of young active patients with arthroscopic Bankart repair within 1 month after first-time anterior Shoulder Dislocation. From July 2002-October 2004, patients presented with first-time traumatic anterior Shoulder Dislocation and treated with arthroscopic stabilization within 1 month of injury were retrospectively reviewed. Magnetic resonance imaging and computed tomography were performed before the operation in all cases. Cases with contralateral Shoulder multidirectional instability or glenoid bone loss of more than 30% on preoperative computed tomography on the injury side were excluded. All patients were treated with arthroscopic Bankart repair, using metallic suture anchors or soft tissue bio-absorbable anchors by a same group of surgeons and followed the same rehabilitation protocol. Recurrence, instability signs, range of motion, WOSI score, Rowe score and complications were assessed. Thirty-eight patients were recruited: the average age was 21 (16-30). All patients had definite trauma history. Radiologically, all patients had Bankart/Hill-Sachs lesion. All the operations were done within 1 month after injury (6-25 days). The average hospital stay was 1.2 days (1-5 days). The average follow-up was 28 months (24-48 months). There were two cases of posttraumatic re-Dislocation (5.2%). The average external rotation lag was 5 degrees (0-15) in 90 degrees Shoulder abduction when compared with contralateral side. 95% of patients had excellent or good Rowe score. The average WOSI score was 83%. There was one case of transient ulnar nerve palsy and one case of superficial wound infection. This study concluded that immediate arthroscopic Bankart repair with an accelerated rehabilitation program is an effective and safe technique for treating young active patients with first-time traumatic anterior Shoulder Dislocation.
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first time Shoulder Dislocation high prevalence of labral injury and age related differences revealed by mr arthrography
Journal of Magnetic Resonance Imaging, 2007Co-Authors: Gregory E Antonio, James F Griffith, Patrick Shuhang Yung, Kaiming Chan, Anil T AhujaAbstract:Purpose To evaluate abnormalities and age-related differences after first-time Shoulder Dislocation. Materials and Methods MRA images of first-time dislocators were assessed for labral-ligamentous-capsular / rotator cuff abnormalities and analyzed the age-related differences (< and ≥30 years old). Results Sixty-six patients (34 <30 years old vs. 32 ≥30 years; 51 males; all anterior Dislocations) were imaged. Forty-eight patients (73%) showed anteroinferior labral avulsion, consisting of: 6% (4/34 vs. 0/32) Perthes; 23% (8/34 vs. 7/32) free ALPSA (anterior labrum periosteal sleeve avulsion) lesion); 6% (1/34 vs. 3/32) adherent ALPSA; 23% (9/34 vs. 6/32) Bankart; 14% (5/34 vs. 4/32) inferiorly displaced avulsed labrum; 2% (1/34 vs. 0/32) GLAD. Extensive labral detachment (extended above 3 o'clock position) was present in 31% (11/28 vs. 4/20). There were 14% (6/34 vs. 3/32) superior labrum anterior-posterior (SLAP) lesion; 27% (1/34 vs. 17/34) rotator cuff tendon tear; 71% (25/34 vs. 22/32) Hill-Sachs defect. Young patients were more likely to have extensive labral avulsions (P = 0.054), but less likely to have rotator cuff tears (P < 0.001). Conclusion A high prevalence and wide variety of labral avulsions after first-time Shoulder Dislocation, especially adherent ALPSA, inferiorly displaced avulsed labrum, or GLAD lesion, may influence treatment choice and outcome, suggesting a role for early MRA to assist in treatment triage. J. Magn. Reson. Imaging 2007;26:983–991. © 2007 Wiley-Liss, Inc.
Marco Zanetti - One of the best experts on this subject based on the ideXlab platform.
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Acute Traumatic Posterior Shoulder Dislocation: MR Findings
Radiology, 2008Co-Authors: Nadja Saupe, Lawrence M. White, Robert R. Bleakney, Mark E. Schweitzer, Michael P. Recht, Bernhard Jost, Marco ZanettiAbstract:Purpose: To retrospectively evaluate the appearance of lesions of osseous and soft-tissue structures of the glenohumeral joint on magnetic resonance (MR) images after first-time traumatic posterior Shoulder Dislocation. Materials and Methods: The study was institutional review board approved and HIPAA compliant, as appropriate, for the four institutions at which the involved patients were treated. Informed patient consent was obtained, were applicable. Thirty-six male patients (age range, 15–80 years; mean age, 40.2 years) with clinically documented first-time traumatic posterior Shoulder Dislocation were examined with MR arthrography (18 patients) or conventional Shoulder MR imaging (18 patients). Causes of posterior Shoulder Dislocation were electric shock in one patient, seizure in one patient, and trauma in 34 patients. Hill-Sachs lesions, rotator cuff tears, biceps tendon abnormalities, posterior labrocapsular complex lesions, humeral head translation, and osseous glenoid version angle were evaluated...
Rene K Marti - One of the best experts on this subject based on the ideXlab platform.
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fracture of the coracoid process the greater tuberosity and the glenoid rim after acute first time anterior Shoulder Dislocation a case report
Journal of Shoulder and Elbow Surgery, 2001Co-Authors: Ron Te L Slaa, Henny Verburg, Rene K MartiAbstract:of complications, such as fractures of the greater tuberosity and glenoid fractures.1,11,18 We present a case of a patient with an acute first-time anterior Shoulder Dislocation and associated fractures of the coracoid process, the greater tuberosity, and the glenoid rim. To our knowledge, this combination of fractures with a Dislocation of the Shoulder has not been described in the literature before.