Afacan Muhammed Yusuf, Davulcu Cumhur Deniz
Department of Orthopaedics and Traumatology, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, TUR.
Cureus. 2024 Aug 20;16(8):e67267. doi: 10.7759/cureus.67267. eCollection 2024 Aug.
This case report evaluates the effectiveness of conservative treatment for an isolated greater tuberosity fracture-dislocation, detailing the treatment process and addressing post-traumatic subacromial impingement syndrome with a mini-review of the literature. A 26-year-old male fell from a height, resulting in a self-reduced dislocated shoulder. Examination revealed extensive ecchymosis, pain, and limited motion in the right shoulder. Radiological assessments showed an isolated greater tuberosity fracture, partial tears of the supraspinatus and subscapularis muscles, a suspected ALPSA lesion, and periarticular effusion. Initial treatment included a shoulder sling, passive elbow and wrist exercises, and pendulum exercises starting in the second week. At six weeks, persistent pain prompted TENS therapy and advanced rehabilitation exercises. At three months, the patient continued to experience pain and restricted shoulder movement. An MRI ruled out labral pathology, and a shoulder ultrasound revealed post-traumatic subacromial bursitis, leading to a diagnosis of subacromial impingement. A diagnostic ultrasound-guided injection of prilocaine into the subacromial bursa significantly improved the range of motion and alleviated pain within one hour. Treatment recommendations included avoiding overhead activities, NSAIDs, and continued rehabilitation. By six months, the patient had achieved a pain-free range of motion of 180 degrees. This case demonstrates that conservative treatment and appropriate rehabilitation can effectively manage isolated greater tuberosity fractures and associated glenohumeral joint dislocations. Early diagnosis and suitable rehabilitation strategies for post-traumatic subacromial impingement syndrome positively influenced the patient's recovery. Given the patient's youth and swimming background, steroid injections were avoided due to potential complications, with successful recovery achieved through NSAIDs, overhead activity restriction, and rehabilitation.
本病例报告评估了保守治疗孤立性大结节骨折脱位的有效性，详细介绍了治疗过程，并通过文献综述探讨了创伤后肩峰下撞击综合征，一位26岁男性从高处坠落，导致肩关节自行复位脱位。检查发现右肩广泛瘀斑、疼痛且活动受限。影像学评估显示孤立性大结节骨折、冈上肌和肩胛下肌部分撕裂、疑似ALPSA损伤以及关节周围积液。初始治疗包括使用肩部吊带、被动进行肘部和腕部锻炼，并在第二周开始进行钟摆运动。六周时，持续疼痛促使采用经皮电刺激神经疗法（TENS）和强化康复锻炼。三个月时，患者仍有疼痛且肩部活动受限。磁共振成像（MRI）排除了盂唇病变，肩部超声显示创伤后肩峰下滑囊炎，从而诊断为肩峰下撞击。在诊断性超声引导下向肩峰下滑囊注射丙胺卡因，在一小时内显著改善了活动范围并减轻了疼痛。治疗建议包括避免进行过头活动、使用非甾体抗炎药（NSAIDs）以及持续康复。到六个月时，患者实现了180度无痛活动范围。本病例表明，保守治疗和适当的康复能够有效处理孤立性大结节骨折及相关的盂肱关节脱位。对创伤后肩峰下撞击综合征的早期诊断和合适的康复策略对患者的恢复产生了积极影响。鉴于患者年轻且有游泳背景，由于潜在并发症而避免使用类固醇注射，通过使用NSAIDs、限制过头活动和康复成功实现了康复。
