Tanujan Thangarajah1, Simon Lambert2. 1. The Shoulder and Elbow Service, The Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK. Electronic address: tanujan1@hotmail.com. 2. The Shoulder and Elbow Service, The Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK.
Abstract
BACKGROUND: The purpose of this study was to review our experience with recurrent shoulder instability in epileptic patients and to discuss factors influencing its management. METHODS: A retrospective review was conducted at a single facility. All patients with epilepsy and recurrent shoulder instability were included for study. RESULTS: A consecutive series of 33 patients with 49 unstable shoulders presented during a 15-year period. Mean age at the time of the index dislocation was 20 years (range, 9-31). There were 24 patients with 36 anteriorly unstable shoulders, 6 patients with 8 posteriorly unstable shoulders, and 3 patients with 5 multidirectionally unstable shoulders. A large Hill-Sachs lesion was present in 21 shoulders. Glenoid bone loss was seen in 11 cases and involved >25% of the anterior-inferior margin in 6 cases and >50% in 2 cases. Thirty-six shoulders in 31 patients underwent surgery. Ongoing postoperative instability was found in 61% (22 of 36 shoulders) of the anterior group, 38% (3 of 8 shoulders) of the posterior group, and 40% (2 of 5 shoulders) of the multidirectional group. Skeletal reconstruction was found to be associated with a significantly lower rate of recurrence compared with an isolated soft tissue repair (P = .004). Glenohumeral arthrosis was found in 17 patients (22 shoulders) a mean of 12 years (range, 5-20) after the index dislocation. CONCLUSION: The presence of bone loss and degenerative changes are the principal factors affecting the specific surgical strategy employed to treat shoulder instability in patients with epilepsy.
BACKGROUND: The purpose of this study was to review our experience with recurrent shoulder instability in epilepticpatients and to discuss factors influencing its management. METHODS: A retrospective review was conducted at a single facility. All patients with epilepsy and recurrent shoulder instability were included for study. RESULTS: A consecutive series of 33 patients with 49 unstable shoulders presented during a 15-year period. Mean age at the time of the index dislocation was 20 years (range, 9-31). There were 24 patients with 36 anteriorly unstable shoulders, 6 patients with 8 posteriorly unstable shoulders, and 3 patients with 5 multidirectionally unstable shoulders. A large Hill-Sachs lesion was present in 21 shoulders. Glenoid bone loss was seen in 11 cases and involved >25% of the anterior-inferior margin in 6 cases and >50% in 2 cases. Thirty-six shoulders in 31 patients underwent surgery. Ongoing postoperative instability was found in 61% (22 of 36 shoulders) of the anterior group, 38% (3 of 8 shoulders) of the posterior group, and 40% (2 of 5 shoulders) of the multidirectional group. Skeletal reconstruction was found to be associated with a significantly lower rate of recurrence compared with an isolated soft tissue repair (P = .004). Glenohumeral arthrosis was found in 17 patients (22 shoulders) a mean of 12 years (range, 5-20) after the index dislocation. CONCLUSION: The presence of bone loss and degenerative changes are the principal factors affecting the specific surgical strategy employed to treat shoulder instability in patients with epilepsy.
Authors: Obiajulu Agha; Caitlin M Rugg; Drew A Lansdown; Shannon Ortiz; Carolyn M Hettrich; Brian R Wolf; Brian T Feeley Journal: Arthroscopy Date: 2020-06-12 Impact factor: 4.772
Authors: Stephen G Thon; Katherine Branche; Darby A Houck; Tracey Didinger; Armando F Vidal; Rachel M Frank; Jonathan T Bravman Journal: JSES Int Date: 2020-12-10