Anterior shoulder dislocation in adolescents

doi:10.1067/mse.2000.108385

Journal of Shoulder and Elbow Surgery

Volume 9, Issue 6, November–December 2000, Pages 470-474

https://doi.org/10.1067/mse.2000.108385 Get rights and content

Abstract

Of 780 patients treated for primary anterior shoulder dislocations, 33 (4.2%) were aged 12 to 17 years at the time of the dislocation. We clinically evaluated 28 of these patients a mean of 7.1 years after the initial dislocation. All patients were radiographed, and 15 underwent magnetic resonance imaging or computed arthrotomography of the shoulder. The primary dislocation had been traumatic in 21 patients (75%) and atraumatic in 7 patients (25%). Recurrent dislocations had occurred in 24 cases (86%), the number of recurrences ranging from 1 to 30. In the group with traumatic primary dislocations, the rate of recurrences was 92% and the mean number of redislocations was 7 in the patients who had been 14 to 17 years of age at the time of the initial injury, whereas the corresponding figures were 33% and 0.3 in the patients who had been 13 years of age or less at the time of the initial injury. Imaging studies showed a Bankart lesion in 80% of cases; each of these patients had had a traumatic primary dislocation and was 14 to 17 years old at the time of injury. During the follow-up period, operative stabilizing procedures had been performed in 7 cases. At follow-up evaluations, all nonoperated patients showed clinical evidence of anterior or multidirectional instability of the involved shoulder; of the operated patients, each of those with traumatic primary dislocations reported no recurrences and had a satisfactory result, whereas both of the patients with atraumatic primary dislocations continued to have subluxation and/or dislocations of the operated shoulder. In the 14- to 17-year-old adolescents with traumatic primary dislocations in whom imaging studies show Bankart lesions, there is an indication for prophylactic stabilizing surgery at the time of the initial injury. (J Shoulder Elbow Surg 2000;9:470-4.)

Section snippets

Patients and methods

We reviewed the clinical records of all patients who had been treated for primary anterior dislocations of the shoulder not associated with fractures of the humerus or scapula at the Emergency Department of our hospital between 1988 and 1992. There were 780 such patients. Of these, 33 (4.2%) were aged 12 years 3 months to 17 years 8 months at the time of the primary dislocation. Radiographs of each of these 33 dislocated shoulders showed a radiolucent line of varying thickness corresponding to

Results

The primary dislocation was traumatic in 21 patients (75%) and atraumatic in 7 patients (25%; Table). Recurrent dislocations occurred in 24 patients (86%), of whom 18 had had traumatic and 6 atraumatic primary dislocations. The number of recurrences ranged from 1 to 30, the average being 6. With respect to the redislocators, 16 patients (67%) had 3 or more recurrences. The mean time lapse between the initial dislocation and the first recurrence was 14 months in those patients who had 1 to 3

Discussion

Of the adolescents in our series, 86% had recurrences of the dislocation and 67% of the redislocators reported 3 or more redislocations. These findings are consistent with the observation that the proportion of patients who redislocate and the number of recurrences are inversely related to age at the time of the primary dislocation.2, 3, 4, 5, 10, 15, 17

Two groups of adolescents with traumatic primary dislocations could be identified in our study: those aged 14 to 17 years at the time of the

References (18)

K Mizuno et al.
Inferior capsular shift for inferior and multidirectional instability of the shoulder in young children: report of two cases
J Shoulder Elbow Surg
(1992)
CR Constant et al.
A clinical method of functional assessment of the shoulder
Clin Orthop
(1987)
S Gumina et al.
Anterior dislocation of the shoulder in elderly patients
J Bone Joint Surg
(1997)
JH Henry et al.
Natural history of glenohumeral dislocation revisited
Am J Sports Med
(1982)
MA Hoelen et al.
Prognosis of primary anterior shoulder dislocation in young adults
Arch Orthop Trauma Surg
(1990)
L. Hovelius
Anterior dislocation of the shoulder in teen-agers young adults. Five-year prognosis
J Bone Joint Surg
(1987)
L. Hovelius
Primary anterior dislocation of the shoulder in the young: treatment and prognostic aspects
L Hovelius et al.
Primary anterior dislocation of the shoulder in young patients
J Bone Joint Surg
(1996)
L Hovelius et al.
Primary dislocation of the shoulder: factors affecting the two-year prognosis
Clin Orthop
(1982)

There are more references available in the full text version of this article.

Cited by (138)

Anterior shoulder dislocation and clavicle fracture in a 6-year-old boy: a case report and literature review
2024, JSES Reviews, Reports, and Techniques
Size and morphology of the coracoid and glenoid in pediatric and adolescent patients: implications for Latarjet procedure
2023, JSES International
Glenohumeral instability is a challenging problem in children and adolescents. For patients with anterior glenoid bone loss, the Latarjet procedure is an effective treatment option. However, concerns about coracoid size and morphology may limit its utilization within this patient population. The purpose of this study was to establish normative data on coracoid and glenoid size and morphology among a large cohort of adolescent patients and describe the anatomic relationships with demographic factors.
This is a retrospective cross-sectional study of a consecutive series of 584 patients aged 12-21 years after a chest computed tomography scan for non-shoulder related trauma at a single level I trauma center. Demographic characteristics were collected from the electronic medical record, and the following coracoid anatomic measurements were obtained from computed tomography scans: coracoid length, coracoid thickness, coracoid width, glenoid height, and glenoid width. The ratio of coracoid thickness to glenoid width was calculated to estimate the percent bone loss that could be addressed with a traditional Latarjet coracoid transfer. To ensure reliability among 3 reviewers, all measured the same 25 scans and inter-rater reliability was excellent with all Kappa coefficients >0.81. The remaining scans were divided equally and assessed separately by these reviewers. Correlation coefficients were used to quantify the relationships between all anatomic measures and the age, weight, and height of individuals. Growth curves for each measurement were modeled using quantile regression with height and height∗height as predictors. Additionally, we stratified the growth curves by sex, when significant. Of the 584 subjects, 55% were male, and average age was 19 years (range 12, 21).
All growth curves illustrated increase anatomic size across the height range of 145-190 cm. The growth curve including all patients (Fig. 1) illustrated that the 50% percentile of median coracoid length increased from approximately 28 to 32 mm. In addition to height, sex was a significant predictor for coracoid width and glenoid width. The median coracoid width increased from approximately 9.5 to 10.2 mm for females compared to an increased width from approximately 10 to 11 mm for males. The median glenoid width for females increased from approximately 21 to 25 mm and for males the median glenoid width increased from just under 22 to 25.5 mm.
Among children and adolescents, coracoid and glenoid size are correlated with patient height. These data can help guide patient selection for the Latarjet procedure.
Dynamic pediatric shoulder instability: Etiology, pathogenesis and treatment
2023, Orthopaedics and Traumatology: Surgery and Research
Dynamic shoulder instability in children or adolescents, whose glenohumeral growth plates are still open, is a rare condition with an etiology that is hard to decipher. Atraumatic and recurrent forms are most common, contrary to adults. Disruptions to capsule and ligament maturation, muscle balance or bone growth can lead to glenohumeral instability. The etiology assessment, which needs to be multidisciplinary in atraumatic forms, aims to collect the medical history, analyze the direction of the instability, determine whether it is voluntary or involuntary, and look for a history of trauma, connective tissue abnormality, psychological disorder, neuromuscular pathology or congenital malformation. The initial treatment is conservative. It requires a multidisciplinary team when the shoulder instability is voluntary. Surgical treatment is reserved for symptomatic forms that do not respond to conservative treatment and have an impact on daily life and/or sports participation after a minimum of 6 months of well-conducted rehabilitation. The results of surgical stabilization mainly depend on the features of the instability, the anatomical structures damaged and the etiology. Episodes of recurrent instability in children/adolescents with open glenohumeral growth plates can fade in adulthood or can get worse with the development of structural damage. Early detection of poor outcomes and suitable treatment will help to limit the occurrence of osteoarthritis in the medium and long term.
Expert opinion
Dynamic pediatric shoulder instability: Etiology, pathogenesis and treatment
2022, Revue de Chirurgie Orthopedique et Traumatologique
L’instabilité dynamique de l’épaule chez l’enfant ou adolescent, aux cartilages de croissance glénohuméraux ouverts, est un symptôme rare dont l’étiologie reste problématique. Les formes atraumatiques et récidivantes sont majoritaires contrairement à l’adulte. Les perturbations de la maturation capsuloligamentaire, de l’équilibre musculaire ou de la croissance osseuse peuvent conduire à une instabilité glénohumérale. Le bilan étiologique, multidisciplinaire dans les formes atraumatiques, s’attache à recueillir les antécédents médicaux, à analyser la direction de l’instabilité, à apprécier son caractère volontaire ou non et à rechercher un antécédent traumatique, une anomalie du tissu conjonctif, un trouble psychologique, une pathologie neuromusculaire ou une malformation congénitale. La prise en charge thérapeutique est, dans un premier temps, fonctionnelle. Elle associe une équipe multidisciplinaire lors d’une instabilité volontaire. Le traitement chirurgical est réservé aux formes symptomatiques, résistantes au traitement médical, et avec un retentissement sur la vie quotidienne et/ou la pratique sportive après au minimum 6 mois de rééducation bien conduite. Le résultat de la stabilisation chirurgicale dépend principalement des caractéristiques de l’instabilité, des lésions anatomopathologiques et du diagnostic étiologique. Les épisodes d’instabilité récidivante survenus chez l’enfant/adolescent, aux cartilages de croissance glénohuméraux ouverts, peuvent s’estomper à l’âge adulte ou s’aggraver avec l’apparition de lésions structurelles. Le dépistage précoce d’une évolution défavorable et le traitement adéquat permet de limiter la survenue de lésions arthrosiques à moyen et long terme.
Clinical assessment of the shoulder
2022, Orthopaedics and Trauma
This article is aimed at the general orthopaedic surgeon or trainee looking to have a useful summary and approach to clinical assessment of the shoulder joint. Here we discuss a systematic approach, including a description of some of the special tests. This is not exhaustive, as a large number (estimated at around 130^1,2) of these special tests have been described in the literature – far too extensive a list to be discussed in detail. We have therefore concentrated on a core of common, simple and useful tests that can be applied alongside the rest of the clinical assessment to aid in differential diagnosis and treatment.
The impact of COVID-19 on shoulder and elbow trauma in a skeletally immature population: an Italian survey
2021, JSES International
Citation Excerpt :
In literature, there is a tremendous amount of information about the causes predisposing to the shoulder and/or elbow trauma in the skeletally immature population. It is ascertained that reasons are mainly attributable to recreational activities and school traumas in patients of early and second childhood, whereas for adolescents, sports injuries and traffic accidents (falls from bicycles or motor vehicles) are the most frequent traumatic mechanisms.1,3–14,17 The lockdown period, characterized by the closure of schools, public parks, and sports clubs and by the prohibition of events that could aggregate people outside the family unit (scouting, religion, music, and various art courses), has substantially eliminated most of the activities at risk for shoulder and elbow injuries.
The aim of this study was to evaluate the impact of COVID-19 on the shoulder and elbow trauma in a skeletally immature population in 30 days starting from March 8, 2020, the first day of restrictions in Italy, and to compare it with the same period of 2019.
All the skeletally immature (younger than 18 years) patients managed in the emergency unit of our hospital between March 8, 2020, and April 8, 2020 (COVID-19 [C19] period), for a shoulder and elbow trauma were retrospectively included and compared with patients with similar ages admitted in the same period of 2019 (no COVID-19 period). Six categories of diagnosis were distinguished: (1) contusions, (2) no physeal fractures, (3) physeal fractures (Salter-Harris), (4) sprains/subluxations, (5) dislocations, and (6) others (tendinitis, wounds, low back pain, and joint inflammation). According to the mechanism of injury, we arbitrarily distinguished 5 subgroups: (1) accidental fall; (2) sport trauma; (3) accident at school; (4) high-energy trauma occurred by car, public transport, and pedestrian investment; and (5) fall from height.
During the C19 period, the number of total accesses in our trauma center steeply decreased: two-thirds less. Regardless of the patient age, we performed 65% less first aid shoulder/elbow services. The number of skeletally immature patients treated at our trauma center for all types of injuries was 350 during the no COVID-19 period and 54 during the C19 period; therefore, the influx of pediatric patients during the C19 period decreased by 84.6%. Furthermore, during the C19 period, (1) there were no cases of fractures, physeal fractures, and dislocations of the shoulder; (2) there were no cases of contusion, physeal fractures, and dislocations of the elbow; and (3) we observed the absence of high-energy, sports, and school injuries; and (4) during the pandemic, shoulder and elbow injuries mainly occurred as a result of accidental fall at home.
The pandemic forced us to become aware of the ways and places where skeletally immature subjects report shoulder and elbow traumas; therefore, it would be desirable that more considerable attention be directed toward the prevention of injury in areas at risk.

View all citing articles on Scopus

^*: Reprint requests: S. Gumina, MD, Via Tacito 74 B, 00193, Rome, Italy.

^**: J Shoulder Elbow Surg 2000;9:470-4

View full text

Original ArticlesAnterior shoulder dislocation in adolescents*,**

Abstract

Section snippets

Patients and methods

Results

Discussion

J Shoulder Elbow Surg

A clinical method of functional assessment of the shoulder

Clin Orthop

Anterior dislocation of the shoulder in elderly patients

J Bone Joint Surg

Natural history of glenohumeral dislocation revisited

Am J Sports Med

Prognosis of primary anterior shoulder dislocation in young adults

Arch Orthop Trauma Surg

Anterior dislocation of the shoulder in teen-agers young adults. Five-year prognosis

J Bone Joint Surg

Primary anterior dislocation of the shoulder in the young: treatment and prognostic aspects

Primary anterior dislocation of the shoulder in young patients

J Bone Joint Surg

Primary dislocation of the shoulder: factors affecting the two-year prognosis

Clin Orthop

Original Articles
Anterior shoulder dislocation in adolescents*,**