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The Journal of Bone and Joint Surgery, Vol 69, Issue 6 904-913, Copyright © 1987 by Journal of Bone and Joint Surgery, Inc
A modified Bristow-Helfet-May procedure for recurrent dislocation and subluxation of the shoulder. Report of two hundred and twelve cases
JS Torg, FC Balduini, C Bonci, RC Lehman, JR Gregg, JL Esterhai and FJ Hensal
A modified Bristow-Helfet-May procedure was performed for recurrent
dislocation or subluxation of the glenohumeral joint in 207 patients (212
shoulders), whose average age at the time of surgery was 20.3 years (range,
fourteen to forty-seven years). The procedure was modified by directing the
coracoid segment and conjoined tendon over the superior border rather than
through the substance of the subscapularis tendon and muscle. The
indications were either documented recurrent anterior dislocation of the
glenohumeral joint or subluxation with instability as demonstrated on
examination with the patient under anesthesia. The procedure was evaluated
on the basis of the rate of recurrence of dislocation and subluxation,
postoperative complications, the patients' subjective evaluation, and the
effect of the procedure on the motion of the glenohumeral joint and the
strength of the muscles of the shoulder as related to overhead throwing.
Eight (3.8 per cent) of the shoulders redislocated and ten (4.7 per cent)
had one or more subjective episodes of subluxation after the procedure.
Complications included postoperative infection in two patients and problems
with the screw that required its removal in ten. One hundred and thirty-one
(62 per cent) of the patients responded to a questionnaire regarding their
subjective evaluation of the results of surgery. Eleven (8 per cent) were
unable to perform daily activities that involved overhead work, and
forty-five (34 per cent) stated that they still had some degree of
discomfort or pain in the shoulder. One hundred and twenty-six patients
(96.2 per cent) stated that they were happy with the results of the surgery
and would have the procedure again. Thirty patients had Cybex testing of
the muscles of the shoulder. Only three (16 per cent) of the nineteen
athletes whose dominant arm had been operated on returned to their
pre-injury level of throwing. Data obtained with regard to changes in the
range of motion and strength of the glenohumeral joint indicate that this
loss of throwing ability was not due solely to a loss of glenohumeral
motion. It appeared to be also related to a concomitant loss of strength at
the extreme of external rotation of the humerus and the initiation of
internal rotation of the humerus.
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