Abstract
The purpose of this study was to determine arthroscopically the pathology following anterior shoulder dislocation and assess visually whether rotation of the arm affected the reduction of the capsulolabral complex in cases where this was detached.
Over a sixteen month period from December 2000 to March 2002 we have arthroscoped and followed up prospectively a cohort of thirty patients. All patients were immobilised in a sling for four weeks and rehabilitated in a similar fashion with physiotherapy. The average age of the patients was 31 years and all patients were arthroscoped within six weeks of injury. The Hill Sachs lesion and capsulolabral complex injury were the most common pathology and were seen in two thirds of the patients. In the remaining group capsular tears and stretching were the most frequent injuries seen.
Injuries to the capsulolabral complex were seen in 22 patients. In seventeen of these the capsulolabral complex was still mobile and the time to arthroscopy averaged 10.3 days (Range 0–25). In the remaining five patients the labrum had healed in a malreduced position. The average time to arthroscopy in these patients was 30.8 days (Range 19–42).
In the patients where the capsulolabral complex had not reattached 14/17 (82%) patients demonstrated a better reduction of the labrum onto the glenoid with the arm in external rotation.
Based on these findings we conclude that:
The traditional use of a sling with the arm internally rotated may contribute to the capsulolabral complex healing in a malreduced position. This may be a contributory factor to the high redislocation rates found in young adults. Splinting the arm in a position of external rotation for four weeks may allow better reduction of the capsulolabral complex onto the glenoid.
The abstracts were prepared by David Stanley. Correspondence should be addressed to him c/o British Orthopaedic Association, Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PN.
