The traditional treatment for a primary anterior shoulder dislocation has been immobilisation in a sling with the arm in adduction and internal rotation. The recurrence rates after the initial traumatic event range from 20% to 94%. However, recent results have suggested that recurrent instability after primary shoulder dislocation may be reduced with immobilisation in external rotation. Since then, controversy exists regarding the position of immobilisation following these injuries. The objective of the present study was to compare immobilisation in internal and external rotation after a primary anterior shoulder dislocation. Fifty patients presenting to our fracture clinic with a primary traumatic anterior dislocation of the shoulder were randomly assigned to treatment with immobilisation in either internal rotation (IR; 25 patients) or external rotation (ER; 25 patients) for three weeks. In addition of a two-years clinical follow-up, patients underwent a magnetic resonance imaging (MRI) of the shoulder with intra-articular contrast within four days following the traumatic event, and then at three months of follow-up. The primary outcome was a recurrent dislocation within 24 months of follow-up. The secondary outcome was the healing rate of the labral lesion seen on MRI (if present) within each immobilisation group. The follow-up rate after two years was 92% (23 of 25) in the IR group and 96% (24 of 25) in the ER group. The recurrence rate in the IR group (11 of 23; 47.8%) was higher than that in the ER group (7 of 24; 29.2%) but the difference did not reach statistical significance (p=0.188). However, in the subgroup of patients aged 20–40 years, the recurrence rate was significantly lower in the ER group (3 of 17; 6.4%) than that in the IR group (9 of 18; 50%, p<0,01). In the subgroup of patients with a labral lesion present on the initial MRI, the healing rate of the lesion was 46.2% (6 of 13) in the IR group and 60% (6 of 10) in the ER group (p=0.680). Overall, the recurrence rate among those who showed healing of the labrum (regardless of the immobilisation group) was 8.3% (1 of 12), but patients who did not healed their labrum had a recurrence rate of 45.5% (5 of 11; p=0.069). This study suggests that immobilisation in ER reduces the risk of recurrence after a primary anterior shoulder dislocation in patients aged between 20 and 40 years. At two years follow-up, the recurrence rate is lower in patients who demonstrated a healed labrum at three months, regardless of the position of immobilisation. Future studies are required in order to identify factors that can improve healing of the damaged labrum following a traumatic dislocation of the shoulder

Aims. To describe the distribution and clinical presentation of SLAP tears in rugby players, and time taken for return to sport. Method. A retrospective review of 51 shoulder arthroscopies performed on professional rugby players over a 35 month period was carried out. All patients diagnosed with a SLAP lesion at arthroscopy were identified. Each patient's records were reviewed to record age, injury side, mechanism of injury, clinical diagnosis, investigations and results, management, and return to play. Results. The incidence of SLAP tears was 35%. All 18 patients were male with an average age of 27 yrs. There were 11 isolated SLAP tears (61%), 3 SLAP tears associated with a Bankart lesion (17%), 2 SLAP tears associated with a posterior labral lesion (11%) and 2 SLAP tears associated with an anterior and posterior labral injury (11%). Of the 18 SLAP tears, 14 (78%) were Type 2, 3 (17%) were Type 3 and 1 (5%) was Type 4. All patients recalled a specific heavy tackle with fall onto the lateral aspect of shoulder. No patient sustained a complete dislocation. None of the patients presented with symptoms of instability. MR Arthrograms were performed in 17 of the 18 patients. SLAP tears were detected in 13 patients (76%). All patients underwent arthroscopic reconstruction within 6 months post-injury. At Arthroscopy 7 patients (39%) were found to have associated injuries. Pre-operatively 11% of patients were satisfied with their shoulder. By 6 months post-surgery 89% of patients were satisfied and 95% were back to their previous activity level. Patients with isolated SLAP tears returned to sports at an average of 2.6 months post-surgery. Conclusion. SLAP tears are a common injury in rugby players with shoulder pain following injury. These can often be diagnosed with MR arthrography. Arthroscopic repair is associated with excellent results and early return to sports

Shoulder instability and impingement are common in tennis players. During tennis, several impingements could occur: subcoracoid and anterosuperior impingements at the follow-through phase of forehand and the backhand preparation phase; subacromial and postero-superior impingements at the cocking phase of serve. The precise causes for these impingements remain unclear, but it is believed that repetitive contact, glenohumeral instability may play a role. Impingement and glenohumeral instability at critical tennis positions have never been dynamically evaluated in-vivo. The purpose of this study was to develop a patient-specific measurement technique based on motion capture and MRI to accurately determine glenohumeral kinematics (rotations and translations). The second objective was to evaluate impingements and stability in tennis. Shoulder MR arthrography and motion capture were performed in 10 tennis players. Motion data were recorded during tennis movements. Glenohumeral kinematics was computed from the markers trajectories using a global optimisation algorithm with loose constraints on joint translations (accuracy: translational error ≈3mm, rotational error <4°). The translations patterns computed with the model were in good agreement with previous works. The resulting computed motions were applied to the subject's shoulder 3D bony models reconstructed from MRI data. While simulating the shoulder joint, minimum humero-acromial, humero-coracoid and humero-glenoid distances were measured at critical tennis positions. Given the thickness of the potential impinged tissues, impingement was considered when the computed distance was <5 mm (<6 mm for the humero-acromial distance). During serve, glenohumeral stability was assessed at the cocking, deceleration and finish phases. Glenohumeral translation was defined as the anterior-posterior and superior-inferior motion of the humeral head centre relative to a glenoid coordinate system. Subluxation was defined as the ratio (in %) between the humeral head centre translation and the radius of the width (antero-posterior subluxation) or height (supero-inferior subluxation) of the glenoid surface. Instability was thus considered when the subluxation was >50%, corresponding to a loss of congruence superior to half the radius of the width (or height) of the glenoid. No subcoracoid impingement was detected. Antero-superior impingements were observed in two subjects (29%) during forehand. Anterior and lateral subacromial impingements occurred during the cocking phase of serve in three (29%) and four subjects (42%), respectively. Postero-superior impingements during the cocking phase of serve were the most frequent (7 subjects, 75%). In this position, glenohumeral translation was anterior (mean: 34%) and superior (mean: 13%). During the deceleration phase, anterior and superior translation varied between 8–57% and between 5–34%, respectively. During the finish phase, anterior translation was slightly more intense (mean: 44%), while superior translation remained low (mean: 1%). MRI revealed eleven rotator cuff lesions in five subjects, and six labral lesions in five subjects. Postero-superior impingement was frequent when serving. No instability could be noted. Tennis players presented frequent radiographic signs of structural lesions which seem to be mainly related to postero-superior impingement due to repetitive abnormal motion contacts. Our findings are consistent with this hypothesis. To our knowledge, this is the first study demonstrating that a dynamic and precise motion analysis of the shoulder is feasible using an external measurement system, such as motion capture

Background. It is still controversial whether “labral tear” in the pelvis or “pincer type's femoroacetabular impingement syndrome” should be considered a pathologic lesion, and whether they cause the early onset of osteoarthritis in the pelvis. Hypothesis. The disruption of chondrolabral junction causes degenerative change on hip joint, and the disruption of the vessel tissue to the labrum induces the rapidly progressive degeneration of outside in osteoarthritis changes. Methods. Femoral acetabulum has been escaped from the chondrolabral junction and expanded to the acetabulum inside or outward. Therefore we report the cases. Results. We found cases which has chondrolabral junction disruptive slippage, and disruption of the vessel tissue and inverted or everted labral pathologic lesion, which we named COLADIS, chondrolabral junction disruptive slippage. Conclusion. COLADIS (chondrolabral junction disruptive slippage) caused symptoms on patient's hip, and may be the pre-pathologic lesion of early osteoarthritis