Scapulohumeral dislocation with fracture of the greater tubercle of the left shoulder
Short summary
A 40 year old healthy patient sustained a traumatic dislocation of his shoulder combined with a fracture of the greater tuberosity.
Patient's questions
1) Do you think that the diagnosed therapy is correct?
2) Do you think it necessary to change the current treatment?
3) Do you think it is still right that the physiological articular situation has not yet been completely rehabilitated approximately four months after the trauma? What is the time frame? Will recovery be complete, or only partial?
Medical Background
The patient sustained a traumatic dislocation of his shoulder combined with a fracture of the greater tuberosity. The orthopedist set the dislocation and applied a Gilchrist bandage, immobilizing the shoulder and the upper left limb. Two weeks later the bandage was removed and a brace that blocked movement of the left arm was placed. The orthopedist prescribed physiotherapy of the left shoulder. The patient also underwent a left shoulder NMR, in which the following is documented: “result of fracture of the greater humeral tubercle still in the consolidation stage with appreciable widespread edema of the spongious bone. Fine irregularity and inconsistency of signal of the glenoidal cavity and of the articular capsula on the anterior side as suspected lesion of the medial and inferior glenohumeral ligaments; appropriate specialist videos and possible reassessment at later date, also with arthro MR exam.The signal of the myotendinous structures making up the rotator cuff is normal. The CLB tendon is intact and in its situ, with modest fluid distension of the tendinous sheath at the third distal. No significant increase of the amount of intra-articular fluid”.
Medical opinion
According to the information presented above, I think that the diagnosed therapy is correct, and I don't think it is necessary to change the current treatment at this point.
In relating to the question of prognosis, it must be emphasized that the main late risk after shoulder dislocation is instability and recurrent dislocation. This risk is due to the injury of the anterior capsule and the glenohumeral ligament that occurs as a direct result of the dislocation, and was seen in the NMR. Intact rotator cuff ligaments improve the prognosis in this case.
I think that the time frame for recovery is between 6-9 months, but it also must be mentioned that the recovery may not be 100% complete. 90% is probably acceptable.
If after this period the patient will still be unhappy, an arthro-MRI might be indicated in order to consider farther intervention.
