Marsalli et al reported the terrible triad for shoulder injuries, referencing the more famous terrible triad of the elbow. The authors are from Clinica Universidad de los Andes and Hospital del Trabajador and Clinica Alemana in Chile.

Patient selection: traumatic injury to the upper extremity


Components of the terrible triad - all of the following:

(1) anterior shoulder dislocation

(2) rotator cuff tear

(3) nerve injury to the brachial plexus


Predictors of functional outcome:

(1) injury to a nerve with innervation distal to the shoulder

(2) better functional status prior to surgery (Constant and Murley, Western Ontario Rotator Cuff score)

(3) less severe rotator cuff tear

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