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The treatment of unreduced dislocation of the shoulder. A review of 12 cases.

The clinical and radiographic features and the results of treatment are analysed in 12 cases of shoulder dislocation (5 anterior and 7 posterior) in which the dislocation had been present for periods ranging from 3 weeks to 6 months. The follow-up ranged from 9 months to 16 years. Anterior dislocations are easily diagnosed on anteroposterior radiographs. Posterior dislocations may be suspected clinically because of the position of the limb in internal rotation and loss of external rotation, but can easily be missed on A.P. films, which show only a flattened appearance of the humeral head. A definite diagnosis is obtained only with a lateral (axillary) projection. All the anterior dislocations in our series were uncomplicated, but 4 of the posterior dislocations were associated with fractures of the humeral head and/or the greater tuberosity. Two of the 5 anterior dislocations were treated with physiotherapy and remedial exercises alone, while 2 were successfully reduced by manipulation; in the only patient submitted to surgery, ablation of the humeral head was performed. Results were excellent in one of the 2 patients treated with physiokinesitherapy where dislocation had been reduced spontaneously (the only such case described in the literature), and in one of the two cases submitted to nonoperative reduction of the dislocation. Results were good in the second patient subjected to nonoperative reduction and in the patient operated on. All 7 cases of posterior dislocation were treated surgically: in 3 cases the dislocation was reduced, in one the humeral head was removed, in one a partial shoulder prosthesis was applied, and in 2 cases the whole of the proximal extremity of the humerus was resected. In the latter 2 cases the results were poor and fair respectively, while in the remaining cases the results were good. The best surgical treatment of inveterate dislocations is reduction of the dislocation, which in the posterior forms requires a wide antero-supero-posterior approach. The alternative to surgical reduction is the application of a shoulder prosthesis, the result of which (as in resection of the humeral head) is related to the integrity of the greater tuberosity and the rotator cuff.