Lawrence Owen J, Poyser Emma, Mehta Hemang
Trauma and Orthopaedics, Nevill Hall Hospital, Abergavenny, GBR.
Cureus. 2022 Jul 22;14(7):e27145. doi: 10.7759/cureus.27145. eCollection 2022 Jul.
This case report aims to highlight that not all shoulder dislocations are simple to treat and that early recognition of complications is key in managing these injuries successfully. We report the case of a 68-year-old gentleman who presented to Accident and Emergency (A&E) following a fall and sustaining an anterior dislocation of his right shoulder. This was reduced under sedation; however, the patient had an ongoing feeling that his shoulder "was not right." The subsequent investigation demonstrated persistent anterior subluxation of the humeral head with rotator cuff interposition in the glenohumeral joint. This case appears to be the first of its kind to be reported in which the supraspinatus, subscapularis, and long head of biceps were collectively interposed. This was treated operatively with open reduction and rotator cuff repair, even though the procedure was technically difficult due to tissue fibrosis and the formation of adhesions. The patient progressed well and had a good clinical outcome. This case highlights that rotator cuff interposition following shoulder dislocation is a rare but debilitating complication and is often neglected in initial care. We must recognise that patients are their own experts, and if they report something is "not right," further investigation and prompt treatment are required.
本病例报告旨在强调并非所有肩关节脱位都易于治疗，且早期识别并发症是成功处理这些损伤的关键。我们报告一例68岁男性病例，该患者因跌倒后出现右肩关节前脱位而就诊于急诊室。脱位在镇静下得以复位；然而，患者持续感觉其肩部“不对劲”。随后的检查显示肱骨头持续向前半脱位，肩袖夹置于盂肱关节内。该病例似乎是首例报告的冈上肌、肩胛下肌和肱二头肌长头共同夹置的情况。尽管由于组织纤维化和粘连形成，手术操作在技术上具有难度，但仍通过切开复位和肩袖修复进行了手术治疗。患者恢复良好，临床效果佳。该病例突出表明，肩关节脱位后肩袖夹置是一种罕见但使人衰弱的并发症，在初始治疗中常被忽视。我们必须认识到患者是自身情况的专家，如果他们报告有“不对劲”的情况，就需要进一步检查并及时治疗。
