Background & Aims

Hill Sachs lesion describes a posterossuperior injury of the humeral head associated with glenohumeral dislocation that ranges from 67 to 93% of anterior dislocations, with an incidence rate of 100% in cases of recurrent anterior instability. The clinical evaluation is done through anterior and posterior instability tests, and the treatment is guided by the analysis of the involvement of the articular surface area of the humeral head, which can be conservative or surgical.

The study aims to analyze a case in which the patient was affected by a primary glenohumeral dislocation, with failure of the initial conservative treatment, which generated a picture of unstable chronic pain.

Methods

The reported information was obtained through medical record review, patient interview, imaging exam record, and literature review. The literature review was conducted via the PubMed platform, using the search strategy: Primary shoulder dislocation [Title/Abstract] OR Shoulder dislocation treatment [Title/Abstract] OR Shoulder dislocation diagnosis [Title/Abstract], with a timeline of 5 years back, language restriction in English, thus obtaining 162 articles to be analyzed.

Another strategy was carried out for the study of acute to chronic pain, using the PubMed platform the following search was performed: Transition from acute to chronic pain [Title/Abstract] OR Chronic shoulder pain [Title/Abstract] AND Acute shoulder pain [Title/Abstract], with a timeline of 10 years back, language restriction in English, thus obtaining 44 articles to be investigated.

In addition to this platform, literary bibliography on physical examination and prognosis was used, such as Tarcísio et al.

Results

This is a case of chronic complex pain stemming from acute nociceptive pain caused by a primary glenohumeral dislocation in a 22-year-old patient, an active participant in CrossFit. The patient suffered a primary dislocation as a result of a left shoulder flexion with eccentric contraction. The patient initially presented with a primary glenohumeral dislocation, leading to a Grade I Hill Sachs lesion. Treatment was conservative, with anti-inflammatories and physiotherapy. However, weak anti-inflammatories were used without adjuvants, and there was no indication for analgesic or motor physical therapy. This led to persistent neuroplasticity changes, transitioning from acute to chronic pain, with symptoms such as “stabbing”, “burning”, “pricking”, and “electric shock”. This case illustrates the transition from acute to chronic pain following a traumatic event in a young, physically active individual.

Conclusions

This case report indicates the importance of appropriate initial treatment in preventing the transition from acute to chronic pain. It serves as a reminder that even seemingly simple cases can have complex outcomes if not managed correctly. Also, it contributes to the ongoing discourse on pain management and has implications for improving patient care.

References

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Presenting Author

Luisa Mesquita De Morais

Poster Authors

Victor Giacomini

MD

Centro Avançado de Dor e Especialidades Médicas - Distrito Federal

Lead Author

Lukas Eiki Moriyama

Student/trainee

Universidade Federal da Grande Dourados

Lead Author

Pedro Vinicius Araújo de Abreu

Student/trainee

Escola Superior de Ciências da Saúde (ESCS) - Distrito Federal

Lead Author

Matheus da Silva Ribeiro

MD

Centro Avançado de Dor e Especialidades Médicas - Distrito Federal

Lead Author

Lucio Gusmão Rocha

MD

Centro Avançado de Dor e Especialidades Médicas - Distrito Federal

Lead Author

Luisa Mesquita de Morais

MD

Centro Avançado de Dor e Especialidades Médicas - Distrito Federa

Lead Author

Rafael Vieira Rocha

MD

Centro Avançado de Dor e Especialidades Médicas - Distrito Federa

Lead Author

Gulliver Rezende Teodoro Ribeiro

MD

Centro Avançado de Dor e Especialidades Médicas - Distrito Federal

Lead Author

Fabio Koiti Nishimori

MD

Centro Ortopédico de Taguatinga (COT) - Distrito Federal

Lead Author

Frederico Barra de Moraes

MD

Centro Avançado de Dor e Especialidades Médicas - Distrito Federal

Lead Author

Topics

  • Joint Pain