Cargando…
Terrible Triad of the Shoulder: A Case Series and Literature Review
Introduction:The shoulder terrible triad is an underdiagnosed injury pattern consisting of anterior shoulder dislocation, rotator cuff tear, and nerve injury from the brachial plexus in its original description. The purpose of this study is to raise awareness of the condition, suggest treatment stra...
Autores principales: | , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Cureus
2023
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10674095/ https://www.ncbi.nlm.nih.gov/pubmed/38022223 http://dx.doi.org/10.7759/cureus.47699 |
_version_ | 1785140755359072256 |
---|---|
author | Kokkalis, Zinon Giannatos, Vasileios Papagiannis, Spyridon Kouzelis, Antonis Panagopoulos, Andreas |
author_facet | Kokkalis, Zinon Giannatos, Vasileios Papagiannis, Spyridon Kouzelis, Antonis Panagopoulos, Andreas |
author_sort | Kokkalis, Zinon |
collection | PubMed |
description | Introduction:The shoulder terrible triad is an underdiagnosed injury pattern consisting of anterior shoulder dislocation, rotator cuff tear, and nerve injury from the brachial plexus in its original description. The purpose of this study is to raise awareness of the condition, suggest treatment strategies, and emphasize the difficulties in treating this condition. Methods:This case series of seven patients from the same institution. All patients underwent x-rays before and after the reduction of the dislocation, MRI to assess the musculoskeletal injuries, and EMG and clinical examination to assess the nerve lesions. Early arthroscopic repair was opted for the rotator cuff tears. A conservative approach was chosen for the nerve lesions. Active forward flexion and external rotation, Constant score, and Visual to Analogue Scale (VAS) were recorded pre- and post-operatively. Results: All the patients showed an improvement in function postoperatively. However, four of the seven patients did not recover fully. The mean Constant and VAS scores were improved from 15.2 +/- 2.8 (12 to 19) to 67 +/- 16.6 (44 to 86) and from 7.5 +/- 1 (6 to 9) to 2.3 +/- 0.8 (1 to 3), respectively. The patients were followed up for a mean time of 28.2 +/- 10.1 months (18 to 43 months). Time-to-surgery shorter than four weeks showed better results, but not statistically significant. Conclusions:The diagnosis of the shoulder terrible triad requires a high level of suspicion. Early arthroscopic repair for the rotator cuff tears and waiting for the nerve recovery is suggested. Delayed time from injury to surgery might be related to worse outcomes, but higher-level research is needed in this direction. |
format | Online Article Text |
id | pubmed-10674095 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Cureus |
record_format | MEDLINE/PubMed |
spelling | pubmed-106740952023-10-26 Terrible Triad of the Shoulder: A Case Series and Literature Review Kokkalis, Zinon Giannatos, Vasileios Papagiannis, Spyridon Kouzelis, Antonis Panagopoulos, Andreas Cureus Orthopedics Introduction:The shoulder terrible triad is an underdiagnosed injury pattern consisting of anterior shoulder dislocation, rotator cuff tear, and nerve injury from the brachial plexus in its original description. The purpose of this study is to raise awareness of the condition, suggest treatment strategies, and emphasize the difficulties in treating this condition. Methods:This case series of seven patients from the same institution. All patients underwent x-rays before and after the reduction of the dislocation, MRI to assess the musculoskeletal injuries, and EMG and clinical examination to assess the nerve lesions. Early arthroscopic repair was opted for the rotator cuff tears. A conservative approach was chosen for the nerve lesions. Active forward flexion and external rotation, Constant score, and Visual to Analogue Scale (VAS) were recorded pre- and post-operatively. Results: All the patients showed an improvement in function postoperatively. However, four of the seven patients did not recover fully. The mean Constant and VAS scores were improved from 15.2 +/- 2.8 (12 to 19) to 67 +/- 16.6 (44 to 86) and from 7.5 +/- 1 (6 to 9) to 2.3 +/- 0.8 (1 to 3), respectively. The patients were followed up for a mean time of 28.2 +/- 10.1 months (18 to 43 months). Time-to-surgery shorter than four weeks showed better results, but not statistically significant. Conclusions:The diagnosis of the shoulder terrible triad requires a high level of suspicion. Early arthroscopic repair for the rotator cuff tears and waiting for the nerve recovery is suggested. Delayed time from injury to surgery might be related to worse outcomes, but higher-level research is needed in this direction. Cureus 2023-10-26 /pmc/articles/PMC10674095/ /pubmed/38022223 http://dx.doi.org/10.7759/cureus.47699 Text en Copyright © 2023, Kokkalis et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Orthopedics Kokkalis, Zinon Giannatos, Vasileios Papagiannis, Spyridon Kouzelis, Antonis Panagopoulos, Andreas Terrible Triad of the Shoulder: A Case Series and Literature Review |
title | Terrible Triad of the Shoulder: A Case Series and Literature Review |
title_full | Terrible Triad of the Shoulder: A Case Series and Literature Review |
title_fullStr | Terrible Triad of the Shoulder: A Case Series and Literature Review |
title_full_unstemmed | Terrible Triad of the Shoulder: A Case Series and Literature Review |
title_short | Terrible Triad of the Shoulder: A Case Series and Literature Review |
title_sort | terrible triad of the shoulder: a case series and literature review |
topic | Orthopedics |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10674095/ https://www.ncbi.nlm.nih.gov/pubmed/38022223 http://dx.doi.org/10.7759/cureus.47699 |
work_keys_str_mv | AT kokkaliszinon terribletriadoftheshoulderacaseseriesandliteraturereview AT giannatosvasileios terribletriadoftheshoulderacaseseriesandliteraturereview AT papagiannisspyridon terribletriadoftheshoulderacaseseriesandliteraturereview AT kouzelisantonis terribletriadoftheshoulderacaseseriesandliteraturereview AT panagopoulosandreas terribletriadoftheshoulderacaseseriesandliteraturereview |