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PRİMER ANTERİOR OMUZ ÇIKIĞINDA KONSERVATİF TEDAVİ YETERİ KADAR BAŞARILI MI?

Year 2023, Volume: 56 Issue: 2, 80 - 83, 30.09.2023
https://doi.org/10.20492/aeahtd.1216569

Abstract

Amaç: Primer anterior omuz çıkığı nedeniyle hastaneye başvuran hastaların tedavi sonuçlarını, tekrar çıkık oranlarını ve tedavi sonuçlarına etki eden faktörleri değerlendirmek
Gereç ve Yöntem: Ocak 2016 ve Ocak 2020 tarihleri arasında, ilk kez (primer) anterior omuz çıkığı nedeniyle hastanemize başvuran ve kapalı redüksiyon sonrası geçici immobilizasyon yöntemiyle konservatif olarak tedavi edilen hastaların verileri değerlendirildi. Daha önceden çıkık öyküsü olan, romatolojik hastalığı olan veya verileri eksik olan hastalar çalışmaya dahil edilmedi. Hastaların tekrar çıkık öyküsü olup olmadığı; eğer tekrar çıkık geliştiyse, ilk travmadan ne kadar süre sonra gerçekleştiği bilgileri incelendi. Ayrıca, tüm hastaların fonksiyonel değerlendirmeleri Oxford Shoulder Instability Score (OSIS) ile yapıldı.
Bulgular: Çalışmaya 43 hasta dahil edildi. Hastaların ortalama yaşı 45,23 ± 17,2 olup hasta yaşları 20-76 arasındaydı. Hastaların 33’ü (%76,7) erkek, 10’u (%23,3) kadındı. Hastaların ortalama takip süresi ise 48,8 ± 12,4 olarak bulundu (En az 31, en çok 86 ay). Hastaların son takipteki ortalama OSIS değeri 45 ± 3,45 olarak bulundu. Hastaların takiplerinde, 21 hastada (%48,8) tekrar omuz çıkığı görüldü. Kırk yaş üstü ve 40 yaş altındaki hastalar karşılaştırıldığında tekrar çıkık oranları sırasıyla, 9/25 (%36) ve 12/18 (%66,6) olarak bulundu (p=0,094). Kırık eşlik eden 6 hastada rekürren omuz çıkığı görülmedi.
Sonuç: Primer anterior omuz instabilitesi sonrası, geçici immobilizasyon ile konservatif tedavi edilen hastalarda tekrar çıkık görülme oranları yüksek olduğu bulunmuştur. Proksimal humerusta eşlik eden kırık varlığında tekrar çıkık daha az görülmüştür.

References

  • 1. Cutts S, Prempeh M, Drew S. Anterior shoulder dislocation. Annals of the Royal College of Surgeons of England. 2009;91 (1):2-7.
  • 2. Brophy RH, Marx RG. The treatment of traumatic anterior instability of the shoulder: nonoperative and surgical treatment. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association. 2009;25 (3):298-304.
  • 3. Liavaag S, Svenningsen S, Reikerås O, et al. The epidemiology of shoulder dislocations in Oslo. Scandinavian journal of medicine & science in sports. 2011;21 (6):e334-40.
  • 4. Kavaja L, Lähdeoja T, Malmivaara A, Paavola M. Treatment after traumatic shoulder dislocation: a systematic review with a network meta-analysis. British journal of sports medicine. 2018;52 (23):1498-1506.
  • 5. Polyzois I, Dattani R, Gupta R, Levy O, Narvani AA. Traumatic First Time Shoulder Dislocation: Surgery vs Non-Operative Treatment. The archives of bone and joint surgery. 2016;4 (2):104-8.
  • 6. Youm T, Takemoto R, Park BK. Acute management of shoulder dislocations. The Journal of the American Academy of Orthopaedic Surgeons. 2014;22 (12):761-71.
  • 7. Bankart ASB. The pathology and treatment of recurrent dislocation of the shoulder-joint. BJS (British Journal of Surgery). 1938;26 (101):23-29.
  • 8. Eren TK, Aktaş E, Kaptan AY, Ayanoğlu T, Ulucaköy C, Kanatlı U. Recurrent anterior shoulder instability in patients 40-60 years old. Accompanying injuries and patient outcomes of arthroscopic repair. Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association. 2021;26 (4):584-588.
  • 9. Gill TJ, Micheli LJ, Gebhard F, Binder C. Bankart repair for anterior instability of the shoulder. Long-term outcome. The Journal of bone and joint surgery American volume. 1997;79 (6):850-7.
  • 10. Wintzell G, Hovelius L, Wikblad L, Saebö M, Larsson S. Arthroscopic lavage speeds reduction in effusion in the glenohumeral joint after primary anterior shoulder dislocation: a controlled randomized ultrasound study. Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA. 2000;8 (1):56-60. 11. Sachs RA, Lin D, Stone ML, Paxton E, Kuney M. Can the need for future surgery for acute traumatic anterior shoulder dislocation be predicted? The Journal of bone and joint surgery American volume. 2007;89 (8):1665-74.
  • 12. Leland DP, Bernard CD, Keyt LK, et al. An Age-Based Approach to Anterior Shoulder Instability in Patients Under 40 Years Old: Analysis of a US Population. The American journal of sports medicine. 2020;48 (1):56-62.
  • 13. Arciero RA, Wheeler JH, Ryan JB, McBride JT. Arthroscopic Bankart repair versus nonoperative treatment for acute, initial anterior shoulder dislocations. The American journal of sports medicine. 1994;22 (5):589-94.
  • 14. Wheeler JH, Ryan JB, Arciero RA, Molinari RN. Arthroscopic versus nonoperative treatment of acute shoulder dislocations in young athletes. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association. 1989;5 (3):213-7.
  • 15. Kirkley A, Griffin S, Richards C, Miniaci A, Mohtadi N. Prospective randomized clinical trial comparing the effectiveness of immediate arthroscopic stabilization versus immobilization and rehabilitation in first traumatic anterior dislocations of the shoulder. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association. 1999;15 (5):507-14.
  • 16. Hovelius L, Olofsson A, Sandström B, et al. Nonoperative treatment of primary anterior shoulder dislocation in patients forty years of age and younger. a prospective twenty-five-year follow-up. The Journal of bone and joint surgery American volume. 2008;90 (5):945-52.
  • 17. Chahal J, Marks PH, Macdonald PB, et al. Anatomic Bankart repair compared with nonoperative treatment and/or arthroscopic lavage for first-time traumatic shoulder dislocation. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association. 2012;28 (4):565-75.
  • 18. Matsuki K, Sugaya H. Complications after arthroscopic labral repair for shoulder instability. Current Reviews in Musculoskeletal Medicine. 2015;8 (1):53-58.
  • 19. Braun C, McRobert CJ. Conservative management following closed reduction of traumatic anterior dislocation of the shoulder. The Cochrane database of systematic reviews. 2019;5 (5):Cd004962.
  • 20. Aagaard KE, Randeblad P, Abu-Zidan FM, Lunsjö K. Return to work after early repair of acute traumatic rotator cuff tears. European journal of trauma and emergency surgery : official publication of the European Trauma Society. 2020;46 (4):817-823.
  • 21. Robinson CM, Howes J, Murdoch H, Will E, Graham C. Functional outcome and risk of recurrent instability after primary traumatic anterior shoulder dislocation in young patients. The Journal of bone and joint surgery American volume. 2006;88 (11):2326-36.
  • 22. Olds M, Ellis R, Donaldson K, Parmar P, Kersten P. Risk factors which predispose first-time traumatic anterior shoulder dislocations to recurrent instability in adults: a systematic review and meta-analysis. British journal of sports medicine. 2015;49 (14):913.
  • 23. Olds M, Ellis R, Donaldson K, Parmar P, Kersten P. Risk factors which predispose first-time traumatic anterior shoulder dislocations to recurrent instability in adults: a systematic review and meta-analysis. British journal of sports medicine. 2015;49 (14):913-22.
  • 24. Walton J, Paxinos A, Tzannes A, Callanan M, Hayes K, Murrell GA. The unstable shoulder in the adolescent athlete. Am J Sports Med. 2002;30 (5):758-67.
  • 25. Olds M, Donaldson K, Ellis R, Kersten P. In children 18 years and under, what promotes recurrent shoulder instability after traumatic anterior shoulder dislocation? A systematic review and meta-analysis of risk factors. British journal of sports medicine. 2016;50 (18):1135-41.
  • 26. Murray J-C, Leclerc A, Balatri A, Pelet S. Immobilization in external rotation after primary shoulder dislocation reduces the risk of recurrence in young patients. A randomized controlled trial. Orthopaedics & Traumatology: Surgery & Research. 2020;106 (2):217-222.
  • 27. Chan SKL, Bentick KR, Kuiper JH, Kelly CP. External rotation bracing for first-time anterior dislocation of the shoulder: A discontinued randomised controlled trial comparing external rotation bracing with conventional sling. Shoulder & Elbow. 2018;11 (4):256-264.
  • 28. Dussing F, Plachel F, Grossauer T, et al. Anterior shoulder dislocation and concomitant fracture of the greater tuberosity: Clinical and radiological results. Obere extremitat. 2018;13 (3):211-217.
  • 29. Thangarajah T, Lambert SM. Management of recurrent shoulder instability in patients with epilepsy. Journal of Shoulder and Elbow Surgery. 2016;25 (8):1376-1384.
  • 30. Leroux T, Wasserstein D, Veillette C, et al. Epidemiology of primary anterior shoulder dislocation requiring closed reduction in Ontario, Canada. The American journal of sports medicine. 2014;42 (2):442-50.
  • 31. Leroux T, ogilvie-harris D, Veillette C, et al. The Epidemiology of Primary Anterior Shoulder Dislocations in Patients Aged 10-16 Years and Age-Stratified Risk of Recurrence. Orthopaedic Journal of Sports Medicine. 2015;3 (7 suppl2):

IS CONSERVATIVE TREATMENT SUCCESSFUL ENOUGH FOR THE TREATMENT OF PRIMARY ANTERIOR SHOULDER DISLOCATION?

Year 2023, Volume: 56 Issue: 2, 80 - 83, 30.09.2023
https://doi.org/10.20492/aeahtd.1216569

Abstract

Objective: To evaluate the treatment results, recurrence rate and factors affecting the treatment results of patients admitted to the hospital with primary anterior shoulder dislocation.
Materials and Methods: Patients who applied to our hospital for the first time (primary) anterior shoulder dislocation between January 2016 - January 2020 and were treated conservatively with temporary immobilization after closed reduction were evaluated. Patients with a previous history of dislocation, rheumatological disease or incomplete data were not included in the study. The history of recurrence and in case of recurrence, duration after the first dislocation was also examined. In addition, evaluations of all patients were made with the Oxford Shoulder Instability Score (OSIS).
Results: 43 patients were included in the study. The mean age of the patients was 45.23 ± 17.2, and the patient's age ranged from 20 to 76. Thirty-three (76.7%) of the patients were male and 10 (23.3%) were female. The mean follow-up period of the patients was found to be 48.8 ± 12.4 (minimum 31, maximum 86 months). The mean OSIS value of the patients at the last follow-up was 45 ± 3.45. In the follow-up of the patients, recurrence was observed in 21 patients (48.8%). When patients older than 40 years and younger than 40 years of age were compared, recurrence rate were found to be 9/25 (36%) and 12/18 (66.6%), respectively (p=0.094). No recurrent shoulder dislocation was observed in 6 patients with accompanying proximal humerus fractures.
Conclusion: After primary anterior shoulder instability, recurrence rate was found to be high in patients treated conservatively with temporary immobilization. Recurrence is less common in the presence of accompanying fracture at the proximal humerus.

References

  • 1. Cutts S, Prempeh M, Drew S. Anterior shoulder dislocation. Annals of the Royal College of Surgeons of England. 2009;91 (1):2-7.
  • 2. Brophy RH, Marx RG. The treatment of traumatic anterior instability of the shoulder: nonoperative and surgical treatment. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association. 2009;25 (3):298-304.
  • 3. Liavaag S, Svenningsen S, Reikerås O, et al. The epidemiology of shoulder dislocations in Oslo. Scandinavian journal of medicine & science in sports. 2011;21 (6):e334-40.
  • 4. Kavaja L, Lähdeoja T, Malmivaara A, Paavola M. Treatment after traumatic shoulder dislocation: a systematic review with a network meta-analysis. British journal of sports medicine. 2018;52 (23):1498-1506.
  • 5. Polyzois I, Dattani R, Gupta R, Levy O, Narvani AA. Traumatic First Time Shoulder Dislocation: Surgery vs Non-Operative Treatment. The archives of bone and joint surgery. 2016;4 (2):104-8.
  • 6. Youm T, Takemoto R, Park BK. Acute management of shoulder dislocations. The Journal of the American Academy of Orthopaedic Surgeons. 2014;22 (12):761-71.
  • 7. Bankart ASB. The pathology and treatment of recurrent dislocation of the shoulder-joint. BJS (British Journal of Surgery). 1938;26 (101):23-29.
  • 8. Eren TK, Aktaş E, Kaptan AY, Ayanoğlu T, Ulucaköy C, Kanatlı U. Recurrent anterior shoulder instability in patients 40-60 years old. Accompanying injuries and patient outcomes of arthroscopic repair. Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association. 2021;26 (4):584-588.
  • 9. Gill TJ, Micheli LJ, Gebhard F, Binder C. Bankart repair for anterior instability of the shoulder. Long-term outcome. The Journal of bone and joint surgery American volume. 1997;79 (6):850-7.
  • 10. Wintzell G, Hovelius L, Wikblad L, Saebö M, Larsson S. Arthroscopic lavage speeds reduction in effusion in the glenohumeral joint after primary anterior shoulder dislocation: a controlled randomized ultrasound study. Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA. 2000;8 (1):56-60. 11. Sachs RA, Lin D, Stone ML, Paxton E, Kuney M. Can the need for future surgery for acute traumatic anterior shoulder dislocation be predicted? The Journal of bone and joint surgery American volume. 2007;89 (8):1665-74.
  • 12. Leland DP, Bernard CD, Keyt LK, et al. An Age-Based Approach to Anterior Shoulder Instability in Patients Under 40 Years Old: Analysis of a US Population. The American journal of sports medicine. 2020;48 (1):56-62.
  • 13. Arciero RA, Wheeler JH, Ryan JB, McBride JT. Arthroscopic Bankart repair versus nonoperative treatment for acute, initial anterior shoulder dislocations. The American journal of sports medicine. 1994;22 (5):589-94.
  • 14. Wheeler JH, Ryan JB, Arciero RA, Molinari RN. Arthroscopic versus nonoperative treatment of acute shoulder dislocations in young athletes. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association. 1989;5 (3):213-7.
  • 15. Kirkley A, Griffin S, Richards C, Miniaci A, Mohtadi N. Prospective randomized clinical trial comparing the effectiveness of immediate arthroscopic stabilization versus immobilization and rehabilitation in first traumatic anterior dislocations of the shoulder. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association. 1999;15 (5):507-14.
  • 16. Hovelius L, Olofsson A, Sandström B, et al. Nonoperative treatment of primary anterior shoulder dislocation in patients forty years of age and younger. a prospective twenty-five-year follow-up. The Journal of bone and joint surgery American volume. 2008;90 (5):945-52.
  • 17. Chahal J, Marks PH, Macdonald PB, et al. Anatomic Bankart repair compared with nonoperative treatment and/or arthroscopic lavage for first-time traumatic shoulder dislocation. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association. 2012;28 (4):565-75.
  • 18. Matsuki K, Sugaya H. Complications after arthroscopic labral repair for shoulder instability. Current Reviews in Musculoskeletal Medicine. 2015;8 (1):53-58.
  • 19. Braun C, McRobert CJ. Conservative management following closed reduction of traumatic anterior dislocation of the shoulder. The Cochrane database of systematic reviews. 2019;5 (5):Cd004962.
  • 20. Aagaard KE, Randeblad P, Abu-Zidan FM, Lunsjö K. Return to work after early repair of acute traumatic rotator cuff tears. European journal of trauma and emergency surgery : official publication of the European Trauma Society. 2020;46 (4):817-823.
  • 21. Robinson CM, Howes J, Murdoch H, Will E, Graham C. Functional outcome and risk of recurrent instability after primary traumatic anterior shoulder dislocation in young patients. The Journal of bone and joint surgery American volume. 2006;88 (11):2326-36.
  • 22. Olds M, Ellis R, Donaldson K, Parmar P, Kersten P. Risk factors which predispose first-time traumatic anterior shoulder dislocations to recurrent instability in adults: a systematic review and meta-analysis. British journal of sports medicine. 2015;49 (14):913.
  • 23. Olds M, Ellis R, Donaldson K, Parmar P, Kersten P. Risk factors which predispose first-time traumatic anterior shoulder dislocations to recurrent instability in adults: a systematic review and meta-analysis. British journal of sports medicine. 2015;49 (14):913-22.
  • 24. Walton J, Paxinos A, Tzannes A, Callanan M, Hayes K, Murrell GA. The unstable shoulder in the adolescent athlete. Am J Sports Med. 2002;30 (5):758-67.
  • 25. Olds M, Donaldson K, Ellis R, Kersten P. In children 18 years and under, what promotes recurrent shoulder instability after traumatic anterior shoulder dislocation? A systematic review and meta-analysis of risk factors. British journal of sports medicine. 2016;50 (18):1135-41.
  • 26. Murray J-C, Leclerc A, Balatri A, Pelet S. Immobilization in external rotation after primary shoulder dislocation reduces the risk of recurrence in young patients. A randomized controlled trial. Orthopaedics & Traumatology: Surgery & Research. 2020;106 (2):217-222.
  • 27. Chan SKL, Bentick KR, Kuiper JH, Kelly CP. External rotation bracing for first-time anterior dislocation of the shoulder: A discontinued randomised controlled trial comparing external rotation bracing with conventional sling. Shoulder & Elbow. 2018;11 (4):256-264.
  • 28. Dussing F, Plachel F, Grossauer T, et al. Anterior shoulder dislocation and concomitant fracture of the greater tuberosity: Clinical and radiological results. Obere extremitat. 2018;13 (3):211-217.
  • 29. Thangarajah T, Lambert SM. Management of recurrent shoulder instability in patients with epilepsy. Journal of Shoulder and Elbow Surgery. 2016;25 (8):1376-1384.
  • 30. Leroux T, Wasserstein D, Veillette C, et al. Epidemiology of primary anterior shoulder dislocation requiring closed reduction in Ontario, Canada. The American journal of sports medicine. 2014;42 (2):442-50.
  • 31. Leroux T, ogilvie-harris D, Veillette C, et al. The Epidemiology of Primary Anterior Shoulder Dislocations in Patients Aged 10-16 Years and Age-Stratified Risk of Recurrence. Orthopaedic Journal of Sports Medicine. 2015;3 (7 suppl2):
There are 30 citations in total.

Details

Primary Language Turkish
Subjects Clinical Sciences
Journal Section Original research article
Authors

Toygun Kağan Eren 0000-0002-4526-4216

Atakan Erdoğan 0000-0003-3649-1721

Cem Nuri Aktekin 0000-0001-5240-8516

Publication Date September 30, 2023
Submission Date December 8, 2022
Published in Issue Year 2023 Volume: 56 Issue: 2

Cite

AMA Eren TK, Erdoğan A, Aktekin CN. PRİMER ANTERİOR OMUZ ÇIKIĞINDA KONSERVATİF TEDAVİ YETERİ KADAR BAŞARILI MI?. Ankara Eğitim ve Araştırma Hastanesi Tıp Dergisi. September 2023;56(2):80-83. doi:10.20492/aeahtd.1216569