Mid-term results after operative treatment of rockwood grade III-V acromioclavicular joint dislocations with an AC-hook-plate.
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Acromioclavicular joint dislocations often occur in athletic, young patients after blunt force to the shoulder. Several static and dynamic operative procedures with or without primary ligament replacement have been described. Between February 2003 and March 2009 we treated 313 patients suffering from Rockwood III-V lesions of the AC joint with an AC-hook plate. 225 (72 %) of these patients could be followed up. Mean operation time was 42 minutes in the conventional group and 47 minutes in the minimal invasive group. The postoperative pain on a scale from 1 to 10 (VAS-scale) was rated 2.7 in the conventional group and 2.2 in the minimal invasive group. Taft score showed very good and good results in 189 patients (84%). Constant score showed an average of 92.4 of 100 possible points with 89 % excellent and good results and 11 % satisfying results. All patients had some degree of pain or discomfort with the hook-plate in place. These symptoms were relieved after removal of the plate. The overall complication rate was 10.6 %. There were 6 superficial soft tissue infections, 1 fracture of the acromion, 7 redislocations after removal of the hook-plate. We observed 4 broken hooks which could be removed at the time of plate removal, 4 seromas and 2 cases of lateral clavicle bone infection, which required early removal of the plate. We can conclude that clavicle hook plate is a convenient device for the surgical treatment of Rockwood Grade III-V dislocations, giving good mid-term results with a low overall complication rate compared to the literature. Early functional therapy is possible and can avoid limitations in postoperative shoulder function. (+info)
A prospective study of shoulder pain in primary care: prevalence of imaged pathology and response to guided diagnostic blocks.
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Shoulder injuries - management in general practice.
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BACKGROUND: Shoulder injuries are common in the primary care setting, yet general practitioners may feel unequipped to confidently assess the patient presenting with shoulder pain. OBJECTIVE: This article provides a framework for the initial assessment of a patient presenting with an injured shoulder. DISCUSSION: A solid understanding of the anatomy and unique features of the shoulder is important to adequately assess any injury. A focused history needs to particularly explore the mechanism of injury, the type of dysfunction and the nature of the pain. On examination, particular attention should be paid to loss of symmetry, localisation of tenderness and the range of movement. (+info)
Teaching basic shoulder ultrasonography to orthopaedic postgraduate trainees--effectiveness of a training workshop.
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AIM: Ultrasound examination of the shoulder conducted by orthopaedic surgeons in the diagnosis and treatment of shoulder conditions is increasingly reported. Shoulder ultrasound is not a mandatory component of postgraduate orthopaedic training in the United Kingdom. The aim of this study was to assess the effectiveness of the shoulder ultrasound teaching workshop administered to postgraduate orthopaedic surgical trainees. METHODS: Orthopaedic trainees participated in a teaching workshop on shoulder ultrasound examination with particular emphasis on demonstrating the Acromioclavicluar joint (ACJ) and the long head of the biceps (LHB) in the biciptal groove. The ability of the trainees to demonstrate the ACJ and the LHB using ultrasound was then assessed. RESULTS: Thirty three orthopaedic trainees participated in this study. Twenty three (70%) trainees were able to demonstrate the ACJ and 14 (42%) trainees were able to demonstrate the LHB without assistance, following the ultrasound teaching workshop. The skills acquired by the trainees were independent to the year in training and previous shoulder experience (p > 0.05). CONCLUSION: Our study shows that a basic shoulder ultrasound teaching workshop can be effective in equipping postgraduate orthopaedic trainees with basic ultrasound techniques. It could potentially become part of a structured orthopaedic training programme. (+info)