|Beitragstitel||Static Inferior Shoulder Subluxation: A case series|
Introduction: Instability of the shoulder is a condition well accessible to both conservative and surgical treatment options. Operatively, arthroscopic soft-tissue procedures as well as open bone block procedures are routinely employed, depending on the underlying pathomorphology. However, these methods are insufficient for certain types of instabilities, one of them being static inferior instability. We report on a series of 4 cases.
Materials and Methods: Four patients aged 20 to 37 are currently treated for static inferior shoulder subluxation. Clinical and imaging work-ups (radiographs, MR- and/or CT-arthrographies), including neurological/neurophysiological exams, have been performed repeatedly. All have already undergone several surgeries. To address dysfunction of the superior glenohumeral and coracohumeral ligaments as well as capsular laxity, tightening of the rotator interval and inferior capsular shift were performed. As all measures failed, outside opinions were sought. A survey including a presentation of patient histories/findings was emailed to a group of experts in shoulder surgery. Respondents were asked to select 1 out of 7 treatment options (no surgery, arthroscopy, (revision) bone block, reversed total shoulder arthroplasty, glenohumeral joint fusion, other) and to elaborate on the topic. 43 responses were gathered and analyzed. Our patients are scheduled for follow-up visits (orthopaedic, neurologic, radiographic; Constant Score) shortly.
Results: Neurological dysfunction (axillary/suprascapular) could be ruled out in all patients. Their conditions appear to be caused functionally and/or mechanically. One patient with additional advanced osteoarthritis will be recommended glenohumeral joint fusion (survey vote: 51.2%). In the other 3 cases, the majority of survey respondents opted for a conservative treatment agenda, specifically, specialized physical therapy for improvement of delta muscle function, complemented by pain management (survey votes: 30.2, 40.5, and 53.7%). However, some operative solutions, such as open capsular shift, were also proposed more frequently and will be considered.
Conclusion: Static inferior shoulder subluxation is a rare variant of shoulder instability. Patients suffer of pain, dysfunction, and hence, psychological strain. No reliable treatment method is known. In the scope of this study 4 such cases were presented to an expert panel via online survey. Yet, no consensus regarding treatment could be reached.