Anterior shoulder dislocation : Aspects of alternative methods of treatment and MR imaging

Sammanfattning: Sixty patients (16-30 years) with traumatic primary anterior shoulder dislocation were allocated to arthroscopic lavage or non-operative treatment. The arthroscopic lavage group had a lower recurrence rate, better functional outcome and anterior stability after one year.Thirty patients were treated with arthroscopic lavage or non-operatively after traumatic primary anterior shoulder dislocation in a randomised trial. At two year follow-up the recurrence rate was lowerin the lavage group (20%) than in the non-operated group (60%).Sixteen patients were allocated to lavage or non-operative treatment after primary anterior shoulder dislocation. Weekly ultrasound examination of the pathologic joint effusion showed a significant more rapid reduction of joint effusion in the patients treated with lavage.Twenty-eight recurrent anterior dislocating shoulders in each of two groups, were operated on with open Bankart procedure using suture-anchor fixation or screw-fixation with a washer. Evaluation (>=2 years) revealed a better anterior stability, better functional outcome and wider external rotation for the patients operated with the suture-anchor technique.Twelve shoulders with anterior instability were assessed with an alternative MR technique, using the apprehension test position, an open MR device and with indirect gadodiamide MR arthrography. The apprehension test position showed to be beneficial in evaluating capsulo-labral and skeletal lesions associated with anterior shoulder instability.Sixteen patients with anterior shoulder instability were examined with indirect MR arthrography in the ABER (abduction, external rotation) and the apprehension position for comparison. The apprehension position showed to be a more beneficial MRI position than the ABER position in indirect arthrography.Fourteen patients with recurrent anterior shoulder instability and 6 shoulder healthy controls were examined with intravenous MR arthrography, using standard (0.1 mmol/kg) and triple dose (0.3 mmol/kg) of gadodiamide. Joint fluid enhancement in the unstable shoulders were 155% with standard dose while the triple dose only gave a 39% further increase. The standard dose produced an enhancement of 84-93% in the stable shoulders while the triple dose resulted in an further increase of 109-115%.

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