Physiotherapy and Manual Therapy, 54100 Massa, Italy.
Department of Medicine and Health Science "Vincenzo Tiberio", University of Molise, 86100 Campobasso, Italy.
Medicina (Kaunas). 2019 Aug 25;55(9):529. doi: 10.3390/medicina55090529.
Cycling is a popular source of recreation and physical activity for children and adults. With regard to the total number of sports injuries, cycling has the highest absolute number of injuries per year in the United States population. Cycling injuries can be classified into bicycle contact, traumatic, or overuse injuries. The aims of this case report are to report a rare clinical complication of glenohumeral joint anterior dislocation that resulted in a patient experiencing continuous GHJ dislocations secondary to involuntary violent muscular spasms and emphasize the role of the physical therapist's differential diagnosis and clinical decision-making process in a patient following direct access referral. A professional 23-year-old cyclist presented to a physical therapist with spontaneous multidirectional dislocations to the right shoulder after the recurrence of trauma occurred during a recent cycling race. The dislocations do not occur at night, but occur during the day, randomly, and mostly associated with changes in the patient's psychological conditions. Directly from the clinical history, the physical therapist identified a neuro-physiological orange flag as well as an orthopedic red flag and, therefore, decided it was appropriate to refer the patient to a neurologist. It was determined by the physical therapist to be a priority to focus on the patient's neurologic status and then to evaluate the orthopedic problem. The neurological examination revealed a condition of spontaneous multidirectional dislocation associated with recurrent antero-posterior pain spasms of the shoulder joint. The neurologist prescribed medication. Following the second cycle of medication assumption, the patient was able to continue physiotherapy treatment and was referred to the orthopedic specialist to proceed with shoulder stabilization surgery. Currently, the diagnosis of this unusual clinical condition is still unclear. It is a shared opinion of the authors that the trauma during the past bicycle race awakened an underlying psychological problem of the patient that resulted in a clinical condition of weakness of all the structures of the shoulder, such that these spasms could result in multiple multidirectional dislocations.
骑自行车是儿童和成人娱乐和体育活动的热门来源。就运动损伤总数而言，自行车在美国人口中每年的受伤人数绝对最多。自行车损伤可分为自行车接触、创伤性或过度使用性损伤。本病例报告的目的是报告一种罕见的肩关节前脱位的临床并发症，导致患者因无意识的剧烈肌肉痉挛而持续发生 GHJ 脱位，并强调物理治疗师在直接就诊后的患者中进行鉴别诊断和临床决策过程的作用。一位专业的 23 岁自行车运动员在最近的自行车比赛中再次受伤后，向物理治疗师就诊，出现自发性多向性右肩关节脱位。脱位不在夜间发生，而是在白天随机发生，主要与患者心理状况的变化有关。从临床病史直接来看，物理治疗师发现了一个神经生理橙色标志和一个骨科红色标志，因此决定将患者转介给神经科医生是合适的。物理治疗师确定的首要任务是关注患者的神经状况，然后评估骨科问题。神经系统检查显示出一种自发性多向性脱位的情况，伴有复发性肩关节前-后疼痛痉挛。神经科医生开了药。在服用第二周期的药物后，患者能够继续接受物理治疗，并被转介给骨科专家进行肩部稳定手术。目前，这种不寻常临床情况的诊断仍不清楚。作者们认为，过去自行车比赛中的创伤唤醒了患者潜在的心理问题，导致肩部所有结构的虚弱，以至于这些痉挛可能导致多次多向脱位。
