Dislocation of the shoulder may occur during
seizures in epileptics and other patients who have convulsions. Following
the initial injury, recurrent instability is common owing to a tendency
to develop large bony abnormalities of the humeral head and glenoid
and a susceptibility to further seizures. Assessment is difficult
and diagnosis may be missed, resulting in chronic locked dislocations
with protracted morbidity. Many patients have medical comorbidities,
and successful treatment requires a
We reviewed 101 patients with injuries of the
terminal branches of the infraclavicular brachial plexus sustained between
1997 and 2009. Four patterns of injury were identified: 1) anterior
glenohumeral dislocation (n = 55), in which the axillary and ulnar
nerves were most commonly injured, but the axillary nerve was ruptured
in only two patients (3.6%); 2) axillary nerve injury, with or without
injury to other nerves, in the absence of dislocation of the shoulder
(n = 20): these had a similar pattern of nerve involvement to those
with a known dislocation, but the axillary nerve was ruptured in
14 patients (70%); 3) displaced proximal humeral fracture (n = 15),
in which nerve injury resulted from medial displacement of the humeral
shaft: the fracture was surgically reduced in 13 patients; and 4) hyperextension
of the arm (n = 11): these were characterised by disruption of the
musculocutaneous nerve. There was variable involvement of the median
and radial nerves with the ulnar nerve being least affected. Surgical intervention is not needed in most cases of infraclavicular
injury associated with dislocation of the shoulder. Early exploration
of the nerves should be considered in patients with an axillary
nerve palsy without dislocation of the shoulder and for musculocutaneous
nerve palsy with median and/or radial nerve palsy. Urgent operation
is needed in cases of nerve injury resulting from fracture of the
humeral neck to relieve pressure on nerves.
There are many types of treatment used to manage the frozen shoulder, but there is no consensus on how best to manage patients with this painful and debilitating condition. We conducted a review of the evidence of the effectiveness of interventions used to manage primary frozen shoulder using the Cochrane Database of Systematic Reviews, the Database of Abstracts of Reviews of Effects, the Physiotherapy Evidence Database, MEDLINE and EMBASE without language or date restrictions up to April 2009. Two authors independently applied selection criteria and assessed the quality of systematic reviews using the Assessment of Multiple Systematic Reviews (AMSTAR) tool. Data were synthesised narratively, with emphasis placed on assessing the quality of evidence. In total, 758 titles and abstracts were identified and screened, which resulted in the inclusion of 11 systematic reviews. Although these met most of the AMSTAR quality criteria, there was insufficient evidence to draw firm conclusions about the effectiveness of treatments commonly used to manage a frozen shoulder. This was mostly due to poor methodological quality and small sample size in primary studies included in the reviews. We found no reviews evaluating surgical interventions. More rigorous randomised trials are needed to evaluate the treatments used for frozen shoulder.