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A prospective, observational cohort study of patients presenting to an Emergency Department with acute shoulder trauma : The Manchester Emergency Shoulder (MeSH) project
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Callaghan, Michael J., Baombe, Janos, Horner, Daniel, Hutchinson, Charles E., Sandher, Dilraj and Carley, Simon (2017) A prospective, observational cohort study of patients presenting to an Emergency Department with acute shoulder trauma : The Manchester Emergency Shoulder (MeSH) project. BMC Emergency Medicine, 17 . 40. doi:10.1186/s12873-017-0149-y ISSN 1471-227X.
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Official URL: https://doi.org/10.1186/s12873-017-0149-y
Abstract
Background
Fracture and dislocation of the shoulder are usually identifiable through the use of plain radiographs in an emergency department. However, other significant soft tissue injuries can be missed at initial presentation. This study used contrast enhanced magnetic resonance arthrography (MRA) to determine the pattern of underlying soft tissue injuries in patients with traumatic shoulder injury, loss of active range of motion, and normal plain radiography.
Methods
A prospective, observational cohort study. Twenty-six patients with acute shoulder trauma and no identifiable radiograph abnormality were screened for inclusion. Those unable to actively abduction their affected arm to 90° at initial presentation and at two week’s clinical review were consented for MRA.
Results
Twenty patients (Mean age 44 years, 4 females) proceeded to MRA. One patient had no abnormality, three patients showed minimal pathology. Four patients had an isolated bony/labral injury. Eight patients had injuries isolated to the rotator cuff. Four patients had a combination of bony and rotator cuff injury. Four patients were referred to a specialist shoulder surgeon following MRA and underwent surgery.
Conclusions
Significant soft tissue pathology was common in our cohort of patients with acute shoulder trauma, despite the reassurance of normal plain radiography. These patients were unable to actively abduct to 90° both at initial presentation and at two week’s post injury review. A more aggressive management and diagnostic strategy may identify those in need of early operative intervention and provide robust rehabilitation programmes.
Item Type: | Journal Article | ||||||
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Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Population, Evidence & Technologies (PET) Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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Journal or Publication Title: | BMC Emergency Medicine | ||||||
Publisher: | BioMed Central Ltd. | ||||||
ISSN: | 1471-227X | ||||||
Official Date: | 22 December 2017 | ||||||
Dates: |
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Volume: | 17 | ||||||
Article Number: | 40 | ||||||
DOI: | 10.1186/s12873-017-0149-y | ||||||
Status: | Peer Reviewed | ||||||
Publication Status: | Published | ||||||
Access rights to Published version: | Open Access (Creative Commons) |
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