Riesgo de recaída en pacientes más jóvenes con dislocación primaria aguda glenohumeral.
Re-dislocation is a potential long-term complication of acute primary glenohumeral dislocation, especially in younger patients under the age of 20 years, according to a Dutch mid- to long-term follow-up study. Associated fracture and nerve injuries are also common.
The glenohumeral joint is the most commonly dislocated large joint in the human body. Standard treatment typically includes an initial period of immobilisation to allow soft tissue healing followed by a rehabilitation program to strengthen and condition the shoulder muscles. Some patients also undergo surgery to minimise recurrence of instability.
However, less than 70% of patients return to normal function. Persistent pain, joint stiffness and degenerative joint disease are not uncommon, especially for patients enduring physical labour or those participating in athletic activities that require repetitive overhead movements.
Ron L. te Slaa, MD, and colleagues, Department of Orthopaedics and Traumatology, Reinier de Graaf Groep, Delft, The Netherlands, evaluated mid- to long-term outcome after acute primary glenohumeral dislocation.
Among the 105 patients studied, 34% of the patients had sports-related dislocations and 28% had at-home injuries.
After a follow up period of 46 to 91 months, the mean Rowe score -- reflecting occurrence of instability and functional status -- was 87, ranging from a score of 15 to 100.
Overall probability of dislocation within 4 years of the initial injury was 26%. Associated fractures were observed in 19% of patients and nerve injuries occurred in 21%.
Recurrence of dislocation was significantly more common in younger patients, with 64% of those younger than 20 years have a re-dislocated glenohumeral joint compared to 6% of those over the age of 40.
Age was the most significant indicator of recurrence in this cohort; sporting activity did not influence risk of recurrence. Notably, men and patients less than 40 years old were more likely to be injured during sporting activity, while women and patients older than 40 years were more likely injured at home. Dislocation did not recur in any patients with fracture of the greater tuberosity.
While 34% of patients did not return to former employment during follow-up, 2% did not return due to shoulder injury.
J Bone Joint Surg Br 2004 Jan;86:1:58-64/i><
