Shoulder joint is the most frequently dislocated
joint. Humeral head dislocation pushed the nerve toward medial side. Neglected
shoulder dislocation is difficult to manage and requires extensive procedures to obtain good functional outcome.
In the case of negligence, it is often found loss of the anterior capsule due
to absorption of the capsule. Nerve lesions, in particular the ulnar nerve, often do not receive
attention. Clinically, it often occurred from neurapraxia to severe condition
like claw-hand deformity. In my experience of a neglected case, there was a
53-year-old woman who presented to the orthopaedic clinic with a left anterior
shoulder fracture dislocation following a fall onto the right shoulder and
upper right arm. She had treated herself at home for around six months before
visiting the clinic. She also complained of some deformities on her ring and
little fingers, known as ulnar claw-hand. Numbness and tingling on her left hand especially on the ring and little fingers were observed. These findings were carefully documented and the patient
was aware of these persistent abnormalities. She had electromyography (EMG) and nerve conduction velosity (NCV) examination evidence of persistent ulnar nerve deficit, performed before and after
surgery. We may conclude that this case highlights the need for awareness of
the potential for nerve damage following shoulder dislocation. After treating
the dislocation, the functional and EMG results are very satisfactory.
Cite this paper
Rasyid, H. N. (2017). Ulnar Claw-Hand Related Neglected Post-Traumatic Anterior Shoulder Joint Dislocation. Open Access Library Journal, 4, e3454. doi: http://dx.doi.org/10.4236/oalib.1103454.
Bankart, A.S.B. (1938) The Pathology and Treatment of Recurrent Dislocations of the Shoulder Joint. British Journal of Surgery, 26, 23-29.
https://doi.org/10.1002/bjs.18002610104
Hovelius, L., Augustini, B.G., Fredin, H., Johansson, O., Norlin, R. and Thorling, J. (1996) Primary Anterior Dislocation of the Shoulder in Young Patients. A Ten-Year Prospective Study. The Journal of Bone and Joint Surgery, 78, 1677-1684.
https://doi.org/10.2106/00004623-199611000-00006
Bost, F.C. and Inman, V.C. (1942) The Pathological Changes in Recurrent Dislocation of the Shoulder: A Report of Bankart’s Operative Procedure. The Journal of Bone and Joint Surgery, 23, 596-613.
Aguiar, P.H., Bor-Seng-Shu, E., Gomes-Pinto, F., Almeida-Leme, R.J., Freitas, A.B., Martins, R.S., et al. (2001) Surgical Management of Guyon’s Canal Syndrome, an Ulnar Nerve Entrapment at the Wrist: Report of Two Cases. Arquivos de Neuro-Psiquiatria, 59, 106-111.
https://doi.org/10.1590/S0004-282X2001000100022
Rowe, C.R. and Zarins, B. (1982) Chronic Unreduced Dislocation of the Shoulder. The Journal of Bone and Joint Surgery, 64, 494-505.
https://doi.org/10.2106/00004623-198264040-00004
Ruas, E.S., Castilho, R.S., Maia, P.E.C. and Melo, G.L.R. (2010) Guyon’s Canal Syndrome Due to a Synovial Cyst. Revista Brasileira Ortopedia, 45, 623-626.
https://doi.org/10.1590/S0102-36162010000600020
Visser, C.P., Coene, L.N., Brand, R. and Tavy, H. (1999) The Incidence of Nerve Injury in Anterior Dislocation of the Shoulder and Its Influence on Functional Recovery. A Prospective Clinical and EMG Study. The Journal of Bone and Joint Surgery, 81, 679-685.
Blorn, S. and Dahback, L.O. (1970) Nerve Injuries in Dislocations of the Shoulder Joint and Fractures of the Neck of the Humerus. Acta Chirurgica Scandinavica, 136, 461-466.
Chun, J.M., Groh, G.I. and Rockwood Jr., C. (1994) Two-Part Fractures of the Proximal Humerus. Journal of Shoulder and Elbow Surgery, 3, 273-287.
https://doi.org/10.1016/S1058-2746(09)80071-2
Kim, E., Shin, H.K. and Kim, C.H. (2005) Characteristics of an Isolated Greater Tuberosity Fracture of the Humerus. Journal of Orthopaedic Science, 10, 441-444.
https://doi.org/10.1007/s00776-005-0924-6
Court-Brown, C.M., Garg, A. and McQueen, M.M. (2001) The Epidemiology of Proximal Humeral Fractures. Acta Orthopaedica Scandinavica, 72, 365-371.
https://doi.org/10.1080/000164701753542023
Millet, P.J., Clavert, P. and Warner, J.P. (2005) Open Operative Treatment for Anterior Shoulder Instability: When and Why. The Journal of Bone and Joint Surgery, 87, 419-432.
Platzer, P., Kutscha-Lissberg, F., Lehr, S., Vecsei, V. and Gaebler, C. (2005) The Influence of Displacement on Shoulder Function in Patients with Minimally Displaced Fractures of the Greater Tuberosity. Injury, 36, 1185-1189.
https://doi.org/10.1016/j.injury.2005.02.018
Milton, G.W. (1953) The Mechanism of Circumflex and Other Nerve Injuries in Dislocation of the Shoulder, and the Possible Mechanism of Nerve Injuries during Reduction of Dislocation. Australian and New Zealand Journal of Surgery, 23, 25-30. https://doi.org/10.1111/j.1445-2197.1953.tb05013.x
Wilson, J.C. and McKeever, F.N. (1949) Traumatic Posterior (Retroglenoid) Dislocation of the Humerus. The Journal of Bone and Joint Surgery, 31, 160-172.
https://doi.org/10.2106/00004623-194931010-00018