Strategies for Failed Instability Repair

Size: px
Start display at page:

Download "Strategies for Failed Instability Repair"

Transcription

1 Strategies for Failed Instability Repair Robert E Hunter MD Director, Orthopedic Sports Medicine Center HRRMC Salida, Colorado CU Sports Medicine Course Sept 28, 2012

2 Conflict of Interest Paid Consultant: Smith & Nephew Biomet Institutional Support: Smith & Nephew Synthes Biomet Breg

3 Primary Arthroscopic Stabilization of Anterior Shoulder Instability 83 Consecutive Patients Bankart Repair With Anchor Technique F/U Months Recurrence In 18% (13 Patients) Increase Recurrence With: Age <25 y/o Ligament Laxity Large Hill-Sachs Lesion Recurrence In Patients <20 y/o 37.5% HSS Sports Medicine Service Voos et al 10

4 Risk Factors For Recurrent Shoulder Instability After Arthroscopic Repair 91 Consecutive Patients F/U Mean 36 Months Mean Time to Recurrence 17.6 Months Risk For Recurrence Higher With: Presence of a Bone Defect on the Glenoid and/or Humerus Inferior Hyperlaxity and/or Anterior Hyperlaxity Glenoid Bone Loss and Inferior Hyperlaxity -75% Recurrence 3 Anchors Boileau et al 06

5 Failed = Redislocated Why Does A Reconstructed Shoulder Redislocate? The Correct Procedure Was Done Poorly The Wrong Procedure Was Done The Correct Procedure Was Done Well But Just Didn t Heal Perfect Surgery Was Re-stressed Through A New, Traumatic Injury (After All, You Dislocated A Normal Shoulder the First Time)

6 The Correct Procedure Bankart Reconstruction Potential Cross-Roads Release of Ant/Inferior Capsule Debridement of Ant Glenoid Placement of Anchors Number of Anchors Knot Tying Management of Associated Pathology

7 Release of Ant/Inferior Capsule Virtually All Chronic Instabilities Require Capsule Release View the Release From the Ant/Sup Portal Release From Superior Extent of Lesion to 6 Release Until: Labrum/Capsule Floats Up to the Glenoid Surface A Grasper Can Easily Mobilize the Capsule to the Desired Position On the Glenoid

8 Debridement of Ant Glenoid Remove All Soft Tissue See the Black Hole Debride the Ant Glenoid Neck to Raw Bone (Synovial Resector)

9 Placement of Anchors 1mm On the Glenoid Surface Lowest Anchor at 5-6 Anchor Below the Bone (Not Below the Cartilage)

10 Number of Anchors For a Simple Bankart Always More Than 1 Always Less Than 5 Generally 3 Space the Anchors About 8-10 mm Apart Place 3 Anchors From 3-6

11 Knot Tying There a Many Ways to Tie An Effective Knot There Are Even More Ways to Do it Wrong.

12 Management of Associated Pathology Inferior Laxity (Interval Closure?) SLAP (SLAP Repair) Biceps (Tenodesis vs Tenotomy) Posterior Laxity (Plication vs Reverse Bankart) ~25% Are Bankart+

13 Management of Associated Pathology Inferior Laxity (Interval Closure?) SLAP (SLAP Repair) Biceps (Tenodesis vs Tenotomy) Posterior Laxity (Plication vs Reverse Bankart) ~25% Are Bankart+

14

15

16 The Wrong Procedure Where Will a Standard Bankart Reconstruction Fail? Associated Pathology Is Not Addressed Hyperlax Patients not Plicated (In Addition to a Bankart Repair) Hyperlax Patients Mobilized Too Early Anterior Glenoid Deficiency Exceeds ~20% Hill-Sachs Lesion That Easily Engages the Ant Glenoid Glenoid Deficiency + Hill-Sachs HAGL

17 The Wrong Procedure Where Will a Standard Bankart Reconstruction Fail? Associated Pathology Is Not Addressed Hyperlax Patients not Plicated (In Addition to a Bankart Repair) Hyperlax Patients Mobilized Too Early Anterior Glenoid Deficiency Exceeds ~20% Hill-Sachs Lesion That Easily Engages the Ant Glenoid Glenoid Deficiency + Hill-Sachs HAGL

18 The Wrong Procedure Where Will a Standard Bankart Reconstruction Fail? Associated Pathology Is Not Addressed Hyperlax Patients not Plicated (In Addition to a Bankart Repair) Hyperlax Patients Mobilized Too Early Anterior Glenoid Deficiency Exceeds ~20% Hill-Sachs Lesion That Easily Engages the Ant Glenoid Glenoid Deficiency + Hill-Sachs HAGL

19

20 Questions to Ask Why Did the First Surgery Fail? What Must I Do Differently or Better This Time? What Obstacles Stand In My Way? What Do I Need to Do Successful Surgery?

21 Why Did the First Surgery Fail? I Always Get Four Things: Op Report New X-Rays MRI CT (With 3D Reconstruction)

22 Why Did the First Surgery Fail? I Always Get Four Things: Op Report Findings Potential Problems Encountered Technique Used Type and Location of Anchors

23 Why Did the First Surgery Fail? I Always Get Four Things: New X-Rays Anchors: Numbers/Location Status of Articular Surfaces Information re. Glenoid Deficiency Hill-Sachs Lesion

24

25 Why Did the First Surgery Fail? I Always Get Four Things: MRI Capsule (R/O HAGL) Posterior Labrum/Capsule Cuff Information re. Bone

26

27 Why Did the First Surgery Fail? I Always Get Four Things: CT (With 3D Reconstruction) Anterior Glenoid Rim Posterior Humeral Head

28 Right MRI

29 Right Scapula

30 Right Humerus

31 Left MRI

32 Left Scapula

33 Left Humerus

34 What Must I Do Differently or Better This Time? Prepare For and Don t Be Afraid of Opening Address Bone Pathology Don t Be Myopic Look For Associated Pathology Address Associated Pathology Just Better Isn t Generally Enough

35 What Obstacles Stand In My Way? Incisions/Skin Anchors Heat Nerve Bone Scar

36 What Do I Need? Bone Resurface Options Allograft Non-Biologic Equipment to Open

37 My Approach EUA Motion Stability Arthroscopic Exam Posterior and Anterior/Superior Portals Complete Exam Determine Scope vs Open

38 Scope Revision If the Pathology Lends Itself to an Arthroscopic Approach, There is No Added Advantage to an Open Procedure.

39 The Correct Procedure Bankart Reconstruction Potential Cross-Roads Release of Ant/Inferior Capsule Debridement of Ant Glenoid Placement of Anchors Number of Anchors Knot Tying Management of Associated Pathology

40 IGHL Suture (#1 PDS) passed through the IGHL from the ant/inf. portal G

41 Open Revision I have a Very Low Threshold For Proceeding to an Open Approach Glenoid Deficiency Glenoid + Humeral Head Deficiency HAGL

42 R Shoulder Ant/Sup Portal H A IGHL Neck G P

43

44 Large Hill-Sachs Defect

45 Large Hill-Sachs Defect HemiCAP could plug the defect Can use 25, 30, or 35 mm components

46 Questions to Ask Why Did the First Surgery Fail? What Must I Do Differently or Better This Time? What Obstacles Stand In My Way? What Do I Need to Do Successful Surgery?

47 Subjective and Objective Outcome Following Arthroscopic Revision Shoulder Stabilization 20 Consecutive Revisions Compared to 20 Primary Sx s. Using the Same Technique F/U 24 Months (Minimum) No Recurrent Instability in Either Group Revisions Showed Consistently Lower Subjective Results Intra-articular Degenerative Changes Greater with Revisions Conclude: Revisions Don t Do As Well Krueger et al 11

48 Arthroscopic Revision of Failed 1 Reconstruction 15 Patients 14 Hill-Sachs Lesions 13 CM Ant Glenoid 10 Recurrent Bankart Lesions 9 Capsular Attenuation Revision With Anchors (Av= 2.5) 4 Failures (27%) Ryu and Ryu 11

49 Arthroscopic Revision of Failed 1 Reconstruction 56 Patients F/U Months Anchor Technique- Minimum 3 in Ant/Inf Quadrant Recurrence 11% (6 Shoulders) Patient Rating- 86% Good or Excellent Bartl et al 11

50 The Latarjet Procedure for Failed Primary Reconstruction(s) 49 Consecutive Patients F/U Mean 38 Months No Recurrent Dislocations 2 Subluxations No Further Surgeries Patient Rating- 88% Good or Excellent Schmid et al 12

51 Thank You

Patient ID. Case Conference. Physical Examination. Image examination. Treatment 2011/6/16

Patient ID. Case Conference. Physical Examination. Image examination. Treatment 2011/6/16 Patient ID Case Conference R3 高逢駿 VS 徐郭堯 55 y/o female C.C.: recurrent right shoulder dislocation noted since falling down injury 2 years ago Came to ER because of dislocation for many times due to minor

More information

Management of Humeral Bone Loss in Anterior Shoulder Instability. Scott D. Mair, MD University of Kentucky Sports Medicine

Management of Humeral Bone Loss in Anterior Shoulder Instability. Scott D. Mair, MD University of Kentucky Sports Medicine Management of Humeral Bone Loss in Anterior Shoulder Instability Scott D. Mair, MD University of Kentucky Sports Medicine Disclosure Smith and Nephew Endoscopy fellowship support Importance Bone loss (glenoid

More information

Arthroscopic Rotator Cuff Repair: Mastering the Essentials

Arthroscopic Rotator Cuff Repair: Mastering the Essentials Arthroscopic Rotator Cuff Repair: Mastering the Essentials Dr. Robert Hunter Director, Orthopedic Sports Medicine Center Heart of the Rockies Regional Medical Center Salida, Colorado CU Sports Medicine

More information

SHOULDER INSTABILITY

SHOULDER INSTABILITY SHOULDER INSTABILITY Dr.KN Subramanian M.Ch Orth., FRCS (Tr & Orth), CCT Orth(UK) Consultant Orthopaedic Surgeon, Special interest: Orthopaedic Sports Injury, Shoulder and Knee Surgery, SPARSH Hospital

More information

Shoulder Instability

Shoulder Instability J F de Beer, K van Rooyen, D Bhatia Shoulder Instability INSTABILITY means that the shoulder dislocates completely (dislocation) or partially (subluxation). Anatomy The shoulder consists of a ball (humeral

More information

The suction cup mechanism is enhanced by the slightly negative intra articular pressure within the joint.

The suction cup mechanism is enhanced by the slightly negative intra articular pressure within the joint. SHOULDER INSTABILITY Stability A. The stability of the shoulder is improved by depth of the glenoid. This is determined by: 1. Osseous glenoid, 2. Articular cartilage of the glenoid, which is thicker at

More information

P.O. Box Sierra Park Road Mammoth Lakes, CA Orthopedic Surgery & Sports Medicine

P.O. Box Sierra Park Road Mammoth Lakes, CA Orthopedic Surgery & Sports Medicine P.O. Box 660 85 Sierra Park Road Mammoth Lakes, CA 93546 SHOULDER: Instability Dislocation Labral Tears The shoulder is the most mobile joint in the body, but to have this amount of motion, it is also

More information

Intern Arthroscopy Course 2015 Shoulder Arthroscopy Cases

Intern Arthroscopy Course 2015 Shoulder Arthroscopy Cases Intern Arthroscopy Course 2015 Shoulder Arthroscopy Cases Mary Lloyd Ireland, M.D. University of Kentucky Dept. of Orthopaedic Surgery & Sports Medicine Lexington, KY Broken screw s/p Bristow procedure

More information

Management of Anterior Shoulder Instability

Management of Anterior Shoulder Instability Management of Anterior Shoulder Instability Angelo J. Colosimo, MD Head Orthopaedic Surgeon University of Cincinnati Athletics Director of Sports Medicine University of Cincinnati Medical Center Associate

More information

GOAL. Open Bankart: Why and How? 2/16/2017. Richard J. Hawkins, MD. Convince You That Open Bankart should be in our toolbox

GOAL. Open Bankart: Why and How? 2/16/2017. Richard J. Hawkins, MD. Convince You That Open Bankart should be in our toolbox Current Solutions in Shoulder & Elbow Surgery Tampa, Florida February 9 12, 2017 Open Bankart: Why and How? Richard J. Hawkins, MD Steadman Hawkins Clinic of the Carolinas Hawkins Foundation Greenville,

More information

SHOULDER PROBLEMS & ARTHROSCOPIC MANAGEMENT

SHOULDER PROBLEMS & ARTHROSCOPIC MANAGEMENT SHOULDER PROBLEMS & ARTHROSCOPIC MANAGEMENT DR.SHEKHAR SRIVASTAV Sr. Consultant-KNEE & SHOULDER Arthroscopy Sant Parmanand Hospital,Delhi Peculiarities of Shoulder Elegant piece of machinery It has the

More information

Thinking About Shoulder Instability Surgery (a.k.a Why do we do what we do?)

Thinking About Shoulder Instability Surgery (a.k.a Why do we do what we do?) Thinking About Shoulder Instability Surgery (a.k.a Why do we do what we do?) Thomas J. Gill Chief, MGH Sports Medicine Dept. of Orthopedic Surgery Massachusetts General Hospital Boston, MA Look, just do

More information

This presentation is the intellectual property of the author. Contact them at for permission to reprint and/or distribute.

This presentation is the intellectual property of the author. Contact them at for permission to reprint and/or distribute. January 19, 2012 John W. Hinchey, MD Dept of Orthopaedic Surgery Shoulder & Elbow Service This live activity is designated for a maximum of 1 AMA PRA Category 1 Credit tm. Physicians should claim only

More information

Posterior Shoulder Instability

Posterior Shoulder Instability Posterior Shoulder Instability Robert A. Arciero, MD Professor of Orthopaedics University of Connecticut USA Classification of Posterior Instability Dislocation -acute -chronic- fixed or locked Subluxation

More information

Shoulder Injuries: Treatments that Work, Do Not Work, and When ENOUGH is Enough? Mark Ganjianpour, M.D. Beverly Hills, CA April 20, 2012

Shoulder Injuries: Treatments that Work, Do Not Work, and When ENOUGH is Enough? Mark Ganjianpour, M.D. Beverly Hills, CA April 20, 2012 Shoulder Injuries: Treatments that Work, Do Not Work, and When ENOUGH is Enough? Mark Ganjianpour, M.D. Beverly Hills, CA April 20, 2012 Multiaxial ball and socket Little Inherent Instability Glenohumeral

More information

Page 1. Shoulder Injuries in Sports.

Page 1. Shoulder Injuries in Sports. www.schulterteam.ch Shoulder Injuries in Sports Matthias A Zumstein Shoulder, Elbow and Orthopaedic Sports Medicine Department of Orthopedic Surgery and Traumatology University of Berne, Switzerland matthias.zumstein@insel.ch

More information

SHOULDER INSTABILITY

SHOULDER INSTABILITY SHOULDER INSTABILITY Your shoulder is the most flexible joint in your body, allowing you to throw fastballs, lift a heavy suitcase, scratch your back, and reach in almost any direction. Your shoulder joint

More information

Case 1: Primary Dislocation. How I Manage Failed Instability Surgery. Case Presentations: Shoulder Instability

Case 1: Primary Dislocation. How I Manage Failed Instability Surgery. Case Presentations: Shoulder Instability Case Presentations: Shoulder Instability Chicago Professor, Department of Orthopedics Head, Section of Shoulder and Elbow Surgery Team Physician, Chicago White Sox and Bulls Chief Medical Editor, Orthopaedics

More information

Shoulder Case Studies

Shoulder Case Studies Shoulder Case Studies Eden Raleigh Orthopaedic Surgeon Shoulder & Knee Surgery Ph: 9421 1900 0402697115 dredenraleigh@gmail.com My Background Specialising in Shoulder and Knee Surgery Main focus on Arthroscopic/Sports

More information

RECURRENT SHOULDER DISLOCATIONS WITH ABSENT LABRUM

RECURRENT SHOULDER DISLOCATIONS WITH ABSENT LABRUM RECURRENT SHOULDER DISLOCATIONS WITH ABSENT LABRUM D R. A M R I S H K R. J H A M S ( O R T H O ) A S S I S T A N T P R O F E S S O R M E D I C A L C O L L E G E, K O L K A T A LABRUM Function as a chock-block,

More information

Revision Instability Repair

Revision Instability Repair Revision Instability Repair Anthony A. Romeo, MD Professor, Department of Orthopedics Head, Section of Shoulder and Elbow Surgery Team Physician, Chicago White Sox and Bulls Chief Medical Editor, Orthopaedics

More information

Anatomy GH Joint. Glenohumeral Instability. Components of Stability. Components of Stability 7/7/2017. AllinaHealthSystem

Anatomy GH Joint. Glenohumeral Instability. Components of Stability. Components of Stability 7/7/2017. AllinaHealthSystem Glenohumeral Instability Dr. John Steubs Allina Sports Medicine Conference July 7, 2017 Anatomy GH Joint Teardrop or oval shape Inherently unstable Golf ball and tee analogy Stabilizers Static Dynamic

More information

Arthroscopic Rotator Cuff Repair: Mastering the Essentials

Arthroscopic Rotator Cuff Repair: Mastering the Essentials Arthroscopic Rotator Cuff Repair: Mastering the Essentials Dr. Robert Hunter Director, Orthopedic Sports Medicine Center Heart of the Rockies Regional Medical Center Salida, Colorado U of Colorado Sports

More information

Glenohumeral Joint Instability. Static Stabilizers of the GHJ. Static Stabilizers of the GHJ. Static Stabilizers of the GHJ

Glenohumeral Joint Instability. Static Stabilizers of the GHJ. Static Stabilizers of the GHJ. Static Stabilizers of the GHJ 1 Glenohumeral Joint Instability GHJ Joint Stability: Or Lack Thereof! Christine B. Chung, M.D. Assistant Professor of Radiology Musculoskeletal Division UCSD and VA Healthcare System Static Stabilizers

More information

Glenohumeral Joint Instability: An Athlete s Perspective

Glenohumeral Joint Instability: An Athlete s Perspective Anatomic Considerations Glenohumeral Joint Instability: An Athlete s Perspective Michael D. Loeb, MD Texas Orthopedics, Sports Medicine, and Rehabilitation Associates Austin, Texas Static Stabilizers Osseous

More information

Sports Medicine: Shoulder Arthrography. Christine B. Chung, M.D. Professor of Radiology Musculoskeletal Division UCSD and VA Healthcare System

Sports Medicine: Shoulder Arthrography. Christine B. Chung, M.D. Professor of Radiology Musculoskeletal Division UCSD and VA Healthcare System Sports Medicine: Shoulder Arthrography Christine B. Chung, M.D. Professor of Radiology Musculoskeletal Division UCSD and VA Healthcare System Disclosure Off-label use for gadolinium Pediatric Sports Injuries

More information

Orthopaedic and Spine Institute 21 Spurs Lane, Suite 245, San Antonio, TX Tel#

Orthopaedic and Spine Institute 21 Spurs Lane, Suite 245, San Antonio, TX Tel# Orthopaedic and Spine Institute 21 Spurs Lane, Suite 245, San Antonio, TX 78240 www.saspine.com Tel# 210-487-7463 PATIENT GUIDE TO SHOULDER INSTABILITY LABRAL (BANKART) REPAIR / CAPSULAR SHIFT WHAT IS

More information

OBJECTIVES. Therapists Management of Shoulder Instability SHOULDER STABILITY SHOULDER STABILITY WHAT IS SHOULDER INSTABILITY? SHOULDER INSTABILITY

OBJECTIVES. Therapists Management of Shoulder Instability SHOULDER STABILITY SHOULDER STABILITY WHAT IS SHOULDER INSTABILITY? SHOULDER INSTABILITY Therapists Management of Shoulder Instability Brian G. Leggin, PT, DPT, OCS Lead Therapist, Penn Therapy and Fitness at Valley Forge Adjunct Assistant Professor, Department of Orthopaedics, University

More information

Shoulder Arthroscopy Lab Manual

Shoulder Arthroscopy Lab Manual Shoulder Arthroscopy Lab Manual Dalhousie University Orthopaedic Program May 5, 2017 Skills Centre OBJECTIVES 1. Demonstrate a competent understanding of the arthroscopic anatomy and biomechanics of the

More information

Shoulder Instability. Fig 1: Intact labrum and biceps tendon

Shoulder Instability. Fig 1: Intact labrum and biceps tendon Shoulder Instability What is it? The shoulder joint is a ball and socket joint, with the humeral head (upper arm bone) as the ball and the glenoid as the socket. The glenoid (socket) is a shallow bone

More information

Recurrent Shoulder Dislocation.

Recurrent Shoulder Dislocation. Recurrent Shoulder Dislocation www.fisiokinesiterapia.biz Anatomy of the Shoulder Shoulder Dislocations Case Study Rehabilitation Pick List Anatomy of the Shoulder Articulations Sternoclavicular Acromioclavicular

More information

Jon JP Warner, MD Chief, MGH Shoulder Service Chair, Q&S Committee, MGOA Professor of Orthopedic Surgery

Jon JP Warner, MD Chief, MGH Shoulder Service Chair, Q&S Committee, MGOA Professor of Orthopedic Surgery Jon JP Warner, MD Chief, MGH Shoulder Service Chair, Q&S Committee, MGOA Professor of Orthopedic Surgery Disclosures Wright Medical: Royalty on Rotator cuff implant; Consultant IMASCAP: Stock Smith and

More information

MRI of the Shoulder What to look for and how to find it? Dr. Eric Handley Musculoskeletal Radiologist Cherry Creek Imaging

MRI of the Shoulder What to look for and how to find it? Dr. Eric Handley Musculoskeletal Radiologist Cherry Creek Imaging MRI of the Shoulder What to look for and how to find it? Dr. Eric Handley Musculoskeletal Radiologist Cherry Creek Imaging MRI of the Shoulder Benefits of Ultrasound: * Dynamic * Interactive real time

More information

ANATOMIC STABILITY OF THE SHOULDER. Felix H. Savoie III, MD Tulane Institute of Sports Medicine New Orleans, LA

ANATOMIC STABILITY OF THE SHOULDER. Felix H. Savoie III, MD Tulane Institute of Sports Medicine New Orleans, LA HYPERLAXITY: CAPSULAR AUGMENTATION AND ROTATOR INTERVAL CLOSURE Felix H. Savoie III, MD Tulane Institute of Sports Medicine New Orleans, LA Royalties: Exactech < $1000 Stock: none Consultant: DePuy Mitek,

More information

First-Time Anterior Shoulder Dislocation: Is it time to take a stand?

First-Time Anterior Shoulder Dislocation: Is it time to take a stand? Evaluation and Treatment of the Injured Athlete Martha s Vineyard July 22nd, 2018 First-Time Anterior Shoulder Dislocation: Is it time to take a stand? Robert A. Arciero, MD Professor, Orthopaedics University

More information

JuggerKnot Soft Anchor 1.4/1.5 mm with Percutaneous Instrumentation for Low Profile/Trans-Cuff SLAP Repair

JuggerKnot Soft Anchor 1.4/1.5 mm with Percutaneous Instrumentation for Low Profile/Trans-Cuff SLAP Repair JuggerKnot Soft Anchor 1.4/1.5 mm with Percutaneous Instrumentation for Low Profile/Trans-Cuff SLAP Repair Surgical Technique by Shabi Kahn, MD One Surgeon. One Patient. Over 1 million times per year,

More information

Christopher A Brown, MD Sports Medicine Orthopedist. Duke Orthopedic Residency Sports Medicine Fellowship Stanford

Christopher A Brown, MD Sports Medicine Orthopedist. Duke Orthopedic Residency Sports Medicine Fellowship Stanford Christopher A Brown, MD Sports Medicine Orthopedist Duke Orthopedic Residency Sports Medicine Fellowship Stanford Office Geneva Newark Opening Canandaigua and Penfield Topics Of Discussion Shoulder dislocation

More information

Shoulder Injuries. Glenoid labrum injuries. SLAP Lesions

Shoulder Injuries. Glenoid labrum injuries. SLAP Lesions Shoulder Injuries functional anatomy clinical perspective impingement rotator cuff injuries glenoid labrum injuries dislocation Glenoid labrum injuries SLAP lesions stable or unstable traction/compression

More information

ANTERIOR SHOULDER INSTABILITY which operation is best? Dr Jerome Goldberg Shoulder Surgery

ANTERIOR SHOULDER INSTABILITY which operation is best? Dr Jerome Goldberg Shoulder Surgery ANTERIOR SHOULDER INSTABILITY which operation is best? DISCLOSURE Arthrex fund POW Shoulder fellowship Co Director of POW Orthopaedic Research Laboratory MAC of Device Technologies Chairman AusBio Board

More information

SLAP Repairs Versus Biceps Tenodesis in Athletes 15 min

SLAP Repairs Versus Biceps Tenodesis in Athletes 15 min SLAP Repairs Versus Biceps Tenodesis in Athletes 15 min Power Points Not all SLAP tears need surgery Preservation of Native Anatomy GOAL Not all labral repairs are equal Kinetic chain MUST be addressed

More information

The Management of Shoulder Instability. By Debbie Prince Clinical Shoulder Specialist

The Management of Shoulder Instability. By Debbie Prince Clinical Shoulder Specialist The Management of Shoulder Instability By Debbie Prince Clinical Shoulder Specialist Shoulder Dislocation The most common joint dislocation Traumatic Instability, highest incidence in males aged 21 to

More information

Shoulder Arthroscopy Portals

Shoulder Arthroscopy Portals Shoulder Arthroscopy Portals Alper Deveci and Metin Dogan 7 7.1 Bony Landmarks Before starting shoulder arthroscopy, the patient must be positioned and draping applied. Then the bony landmarks are identified

More information

Rotator Cuff Repair TRENDS OF REPAIRS. Evolution of Arthroscopic Repair. Shoulder Girdle. Rotator Cuff Repair 8/29/2013

Rotator Cuff Repair TRENDS OF REPAIRS. Evolution of Arthroscopic Repair. Shoulder Girdle. Rotator Cuff Repair 8/29/2013 Rotator Cuff Repair Indications, Patient Selection, Outcomes James C. Vailas, M.D. New Hampshire Orthopaedic Center September 14, 2013 New Hampshire Musculoskeletal Institute 20 th Annual Symposium Evolution

More information

Learning Curve of Arthroscopic Anatomic Glenoid Reconstruction: Comparison to the Arthroscopic Bristow Latarjet

Learning Curve of Arthroscopic Anatomic Glenoid Reconstruction: Comparison to the Arthroscopic Bristow Latarjet Learning Curve of Arthroscopic Anatomic Glenoid Reconstruction: Comparison to the Arthroscopic Bristow Latarjet Iustin Moga MD George Konstantinidis MD, PhD Cathy Coady MD, FRCS(C) Ivan Wong MD, FRCS(C)

More information

PARIS SHOULDER SYMPOSIUM 2018

PARIS SHOULDER SYMPOSIUM 2018 PARIS SHOULDER SYMPOSIUM 2018 Shoulder instability update and controversies > CHAIRMEN : Ph. Valenti (Paris) L. Lafosse (Annecy) FIRST ANNOUNCEMENT FEBRUARY 1-2-3, 2018 _ Paris, France www.paris-shoulder-symposium.com

More information

DK7215-Levine-ch12_R2_211106

DK7215-Levine-ch12_R2_211106 12 Arthroscopic Rotator Interval Closure Andreas H. Gomoll Department of Orthopedic Surgery, Brigham and Women s Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A. Brian J. Cole Departments

More information

Common Surgical Shoulder Injury Repairs

Common Surgical Shoulder Injury Repairs Common Surgical Shoulder Injury Repairs Mr Ilia Elkinson BHB, MBChB, FRACS (Ortho), FNZOA Orthopaedic and Upper Limb Surgeon Bowen Hospital Wellington Hospital Objectives Review pertinent anatomy of the

More information

Index. Note: Page numbers of article titles are in boldface type.

Index. Note: Page numbers of article titles are in boldface type. Index Note: Page numbers of article titles are in boldface type. A Abduction pillow, ultrasling, 880, 881, 882, 883 Adolescents, shoulder instability in. See Shoulder, instability of, pediatric and adolescent.

More information

SHOULDER ARTHROSCOPY

SHOULDER ARTHROSCOPY SHOULDER ARTHROSCOPY PATIENT HANDBOOK Physical/Occupational Therapy 3755 Orange Place, Suite 101 Beachwood, OH 44122 216-312-6045 Therapist: Post-Op Visit: Anatomy and Function of the Shoulder The shoulder

More information

www.fisiokinesiterapia.biz Shoulder Problems Fractures Instability Impingement Miscellaneous Anatomy Bones Joints / Ligaments Muscles Neurovascular Anatomy Anatomy Supraspinatus Anterior Posterior Anatomy

More information

Glenohumeral Capsule Tears in Baseball Pitchers

Glenohumeral Capsule Tears in Baseball Pitchers Glenohumeral Capsule Tears in Baseball Pitchers Christopher S. Ahmad, MD Professor Orthopedic Surgery Chief Sports Medicine Head Team Physician New York Yankees New York City Football Club Disclosure 1.

More information

APPROPRIATE USE GUIDELINES

APPROPRIATE USE GUIDELINES APPROPRIATE USE GUIDELINES Appropriateness of Advanced Imaging Procedures (MRI, CT, Bone Scan/PET) in Patients with Shoulder Pain CDI QUALITY INSTITUTE: PROVIDER LED ENTITY (PLE) Compiled by Rob Liddell,

More information

Acute anterior dislocation of the shoulder www.fisiokinesiterapia.biz Anatomy Stability: - ball & socket = compression in concavity effect Bone - big head small cup = unstable Menisci - labium = depth

More information

Active, yet simple deployment, now with a curved approach. SUTUREFIX All-Suture Anchor

Active, yet simple deployment, now with a curved approach. SUTUREFIX All-Suture Anchor Active, yet simple deployment, now with a curved approach SUTUREFIX All-Suture Anchor Active, yet simple deployment, now with a curved delivery system The SUTUREFIX All-Suture Anchor delivery system tells

More information

Anterior shoulder instability: Evaluation using MR arthrography.

Anterior shoulder instability: Evaluation using MR arthrography. Anterior shoulder instability: Evaluation using MR arthrography. Poster No.: C-2407 Congress: ECR 2016 Type: Educational Exhibit Authors: C. Lord, I. Katsimilis, N. Purohit, V. T. Skiadas; Southampton/UK

More information

Shoulder Instability and Tendon Injuries

Shoulder Instability and Tendon Injuries Shoulder Instability and Tendon Injuries Shoulder Update Spire Hospital Leeds November 2017 Simon Boyle Consultant Shoulder and Elbow Surgeon Simon Boyle York and Leeds Nuffield Trained in Yorkshire, Annecy,

More information

Shoulder Arthroscopy. Dr. J.J.A.M. van Raaij. NOV Jaarvergadering Den Bosch 25 jan 2018

Shoulder Arthroscopy. Dr. J.J.A.M. van Raaij. NOV Jaarvergadering Den Bosch 25 jan 2018 Shoulder Arthroscopy Dr. J.J.A.M. van Raaij NOV Jaarvergadering Den Bosch 25 jan 2018 No disclosures Disclosure Shoulder Instability Traumatic anterior Traumatic posterior Acquired atraumatic Multidirectional

More information

My shoulder popped out what now?

My shoulder popped out what now? My shoulder popped out what now? Richard Dallalana Epworth Shoulder Symposium June 2017 Shoulder Dislocation First event Best approach? Manual Reduction Should it be put back on field? - YES Prone lying

More information

HAGL lesion of the shoulder

HAGL lesion of the shoulder HAGL lesion of the shoulder A 24 year old rugby player presented to an orthopaedic surgeon with a history of dislocation of the left shoulder. It reduced spontaneously and again later during the same match.

More information

Double bucket handle tears of the superior labrum

Double bucket handle tears of the superior labrum Case Report http://dx.doi.org/10.14517/aosm13013 pissn 2289-005X eissn 2289-0068 Double bucket handle tears of the superior labrum Dong-Soo Kim, Kyoung-Jin Park, Yong-Min Kim, Eui-Sung Choi, Hyun-Chul

More information

Rehabilitation Guidelines for Labral/Bankert Repair

Rehabilitation Guidelines for Labral/Bankert Repair Rehabilitation Guidelines for Labral/Bankert Repair The true shoulder joint is called the glenohumeral joint and consists humeral head and the glenoid. It is a ball and socket joint. Anatomy of the Shoulder

More information

Disclosure. Traumatic Anterior Shoulder Instability 7/23/2018. Orthopaedics for the Primary Care Practitioner & Rehabilitation Therapist

Disclosure. Traumatic Anterior Shoulder Instability 7/23/2018. Orthopaedics for the Primary Care Practitioner & Rehabilitation Therapist Orthopaedics for the Primary Care Practitioner & Rehabilitation Therapist Christopher E. Baker M.D. Sports Medicine Shoulder Reconstruction Traumatic Anterior Shoulder Instability Disclosure Speaking/Consulting

More information

Instability of the shoulder Orthopaedic Department Patient Information Leaflet. Under review. Page 1

Instability of the shoulder Orthopaedic Department Patient Information Leaflet. Under review. Page 1 Instability of the shoulder Orthopaedic Department Patient Information Leaflet Page 1 Shoulder instability There is a balance between movements in the shoulder whilst maintaining stability. When the shoulder

More information

The Athlete s Shoulder

The Athlete s Shoulder The Athlete s Shoulder Lennard Funk lenfunk@shoulderdoc.co.uk Decision Making NORMATIVE evidence base COGNITIVE environmental PSYCHOLOGICAL individual needs, bias, preferences, values Three P s 1. Major

More information

Specialists in Joint Replacement, Spinal Surgery, Orthopaedics and Sport Injuries The Latarjet Procedure (coracoid transfer) Shoulder Stabilisation Surgery Ms. Ruth Delaney Consultant Orthopaedic Surgeon

More information

MRI SHOULDER WHAT TO SEE

MRI SHOULDER WHAT TO SEE MRI SHOULDER WHAT TO SEE DR SHEKHAR SRIVASTAV Sr. Consultant- Knee & Shoulder Arthroscopy Sant Parmanand Hospital Normal Anatomy Normal Shoulder MRI Coronal Oblique Sagital Oblique Axial Cuts Normal Coronal

More information

Anterior Shoulder Instability

Anterior Shoulder Instability Anterior Shoulder Instability Anterior shoulder instability typically results from a dislocation injury to the shoulder joint when the humeral head (ball) of the humerus (upper arm bone) is displaced from

More information

The Spectrum of Lesions and Clinical Results of Arthroscopic Stabilization of Acute Anterior Shoulder Instability

The Spectrum of Lesions and Clinical Results of Arthroscopic Stabilization of Acute Anterior Shoulder Instability Original Article DOI 10.3349/ymj.2010.51.3.421 pissn: 0513-5796, eissn: 1976-2437 Yonsei Med J 51(3): 421-426, 2010 The Spectrum of Lesions and Clinical Results of Arthroscopic Stabilization of Acute Anterior

More information

Musculoskeletal Applications for CT. Tal Laor, MD Cincinnati Children s Hospital University of Cincinnati College of Medicine

Musculoskeletal Applications for CT. Tal Laor, MD Cincinnati Children s Hospital University of Cincinnati College of Medicine Musculoskeletal Applications for CT Tal Laor, MD Cincinnati Children s Hospital University of Cincinnati College of Medicine I have no commercial disclosures. Why CT? Complimentary to other modalities

More information

Arthroscopy / MRI Correlation Conference. Department of Radiology, Section of MSK Imaging Department of Orthopedic Surgery 7/19/16

Arthroscopy / MRI Correlation Conference. Department of Radiology, Section of MSK Imaging Department of Orthopedic Surgery 7/19/16 Arthroscopy / MRI Correlation Conference Department of Radiology, Section of MSK Imaging Department of Orthopedic Surgery 7/19/16 Case 1: 29 YOM with recurrent shoulder dislocations Glenoid Axial T1FS

More information

SLAP Lesions Assessment & Treatment

SLAP Lesions Assessment & Treatment SLAP Lesions Assessment & Treatment Kevin E. Wilk,, PT, DPT Glenoid Labral Lesions Introduction Common injury - difficult to diagnose May occur in isolation or in combination SLAP lesions: Snyder: Arthroscopy

More information

JuggerKnot Soft Anchor 1.5 mm with Percutaneous Instrumentation for Low Profile/Trans-Cuff PASTA Repair

JuggerKnot Soft Anchor 1.5 mm with Percutaneous Instrumentation for Low Profile/Trans-Cuff PASTA Repair JuggerKnot Soft Anchor 1.5 mm with Percutaneous Instrumentation for Low Profile/Trans-Cuff PASTA Repair Surgical Technique by Shabi Kahn, MD One Surgeon. One Patient. Over 1 million times per year, Biomet

More information

Chronic Shoulder Disorders

Chronic Shoulder Disorders Chronic Shoulder Disorders Dr. Mustafa Elsingergy Consultant orthopedic surgeon Dallah Hospita Prof. Mamoun Kremli Almaarefa Medical College Contents INTRINSIC Shoulder Pain Due to causes in the shoulder

More information

Secret shoulder secrets Dominik Meyer

Secret shoulder secrets Dominik Meyer Secret shoulder secrets Dominik Meyer Head of the prostheses better too big or too small? In case of stiffness: smaller (loosening of capsule) In case of hyperlaxity / instability or strong correction

More information

Body Planes. (A) Transverse Superior Inferior (B) Sagittal Medial Lateral (C) Coronal Anterior Posterior Extremity Proximal Distal

Body Planes. (A) Transverse Superior Inferior (B) Sagittal Medial Lateral (C) Coronal Anterior Posterior Extremity Proximal Distal Body Planes (A) Transverse Superior Inferior (B) Sagittal Medial Lateral (C) Coronal Anterior Posterior Extremity Proximal Distal C B A Range of Motion Flexion Extension ADDUCTION ABDUCTION Range of Motion

More information

A modification of Bristow Latarjet procedure and results at 2 years follow-up

A modification of Bristow Latarjet procedure and results at 2 years follow-up 2017; 1(3): 26-30 ISSN (P): 2521-3466 ISSN (E): 2521-3474 Clinical Orthopaedics www.orthoresearchjournal.com 2017; 1(3): 26-30 Received: 06-08-2017 Accepted: 07-09-2017 Dr. Raja Shekhar K Assistant Professor,

More information

(More than you may want to know about) Shoulder Instability

(More than you may want to know about) Shoulder Instability (More than you may want to know about) Shoulder Instability Lindsey Dietrich MD Sports Medicine and Orthopedic Surgery Lindsey Dietrich, MD Sports Medicine and Orthopedic Surgery Orthopedic Medicine Specialists

More information

Shoulder Labral Tear and Shoulder Dislocation

Shoulder Labral Tear and Shoulder Dislocation Shoulder Labral Tear and Shoulder Dislocation The shoulder joint is a ball and socket joint with tremendous flexibility and range of motion. The ball is the humeral head while the socket is the glenoid.

More information

Arthroscopic procedures for the treatment of anterior shoulder instability: local experiences!"#$%&'()*+,-%&./0123

Arthroscopic procedures for the treatment of anterior shoulder instability: local experiences!#$%&'()*+,-%&./0123 ST Choi PYT Tse ORIGINAL ARTICLE Arthroscopic procedures for the treatment of anterior shoulder instability: local experiences!"#$%&'()*+,-%&./03 Objective. To review the outcomes of arthroscopic stabilisation

More information

This article was published in an Elsevier journal. The attached copy is furnished to the author for non-commercial research and education use, including for instruction at the author s institution, sharing

More information

PROGRAM THURSDAY APRIL 5, 2018

PROGRAM THURSDAY APRIL 5, 2018 PROGRAM THURSDAY APRIL 5, 2018 Welcome Hot And Controversial Topics Anterior Shoulder Instability Invited Special Guest Lecture 07:00 Registration 07:45-08:00 Welcome 07:45 Why are we here? Scheibel Session

More information

Arthroscopic Findings After Traumatic Shoulder Instability in Patients Older Than 35 Years

Arthroscopic Findings After Traumatic Shoulder Instability in Patients Older Than 35 Years Arthroscopic Findings After Traumatic Shoulder Instability in Patients Older Than 35 Years Elisabeth C. Robinson,* MD, Vijay B. Thangamani, MD, Michael A. Kuhn, MD, and Glen Ross, MD Investigation performed

More information

Arthroscopic Shoulder Instability Repair Using the Curved Guide and Anchor Delivery System

Arthroscopic Shoulder Instability Repair Using the Curved Guide and Anchor Delivery System SHOULDER TECHNIQUE GUIDE Arthroscopic Shoulder Instability Repair Using the Curved Guide and Anchor Delivery System Roy Majors, MD KNEE HIP SHOULDER EXTREMITIES Arthroscopic Shoulder Instability Repair

More information

Rehabilitation Protocol: Arthroscopic Anterior Capsulolabral Repair of the Shoulder - Bankart Repair Rehabilitation Guidelines

Rehabilitation Protocol: Arthroscopic Anterior Capsulolabral Repair of the Shoulder - Bankart Repair Rehabilitation Guidelines Rehabilitation Protocol: Arthroscopic Anterior Capsulolabral Repair of the Shoulder - Bankart Repair Rehabilitation Guidelines Department of Orthopaedic Surgery Lahey Hospital & Medical Center, Burlington

More information

Approach To The Failed Hip Scope. Disclosures. Who/What is to Blame? 8/10/2016

Approach To The Failed Hip Scope. Disclosures. Who/What is to Blame? 8/10/2016 Approach To The Failed Hip Scope Michael J. Salata, MD Assistant Professor, CWRU UH Sports Medicine Institute Associate Team Physician, Cleveland Browns Director, Joint Preservation and Cartilage Restoration

More information

Shoulder Instability in the Contact Athlete - I do it arthroscopically Brian J. Cole, MD, MBA

Shoulder Instability in the Contact Athlete - I do it arthroscopically Brian J. Cole, MD, MBA Shoulder Instability in the Contact Athlete - I do it arthroscopically Brian J. Cole, MD, MBA bcole@rushortho.com Key points: o Greater incidence of anterior shoulder instability in contact and collision

More information

CU Sports Medicine Symposium Oct 2, 2015

CU Sports Medicine Symposium Oct 2, 2015 Revision ACL Surgery: Technical Pearls to Maximize Outcomes Robert Hunter MD Director, Orthopedic Sports Medicine Center Salida, Colorado CU Sports Medicine Symposium Oct 2, 2015 Conflict of Interest Statement

More information

Types of shoulder Dislocation: Shoulder dislocation. 1. Anterior 2. Posterior 3. Luxatio erecta (inferior dislocation)

Types of shoulder Dislocation: Shoulder dislocation. 1. Anterior 2. Posterior 3. Luxatio erecta (inferior dislocation) Types of shoulder Dislocation: Shoulder dislocation 1. Anterior 2. Posterior 3. Luxatio erecta (inferior dislocation) Anterior Dislocation: head is dislocated anterior to the glenoid Most common among

More information

Surgical Technique. Guide. Bristow-Latarjet Instability Shoulder System Open and Arthroscopic Techniques

Surgical Technique. Guide. Bristow-Latarjet Instability Shoulder System Open and Arthroscopic Techniques Surgical Technique Guide Bristow-Latarjet Instability Shoulder System Open and Arthroscopic Techniques a letter from dr. lafosse Dear Friends, Shoulder Instability has been treated differently with time

More information

SureLock All-Suture Anchor System

SureLock All-Suture Anchor System SureLock All-Suture Anchor System Guide for Bankart Repair Surgical Technique 2 SureLock All-Suture System Bankart Repair Surgical Technique Figure 1 *Curved and straight drill guides are available for

More information

Management of Massive/Revision Rotator Cuff Tears

Management of Massive/Revision Rotator Cuff Tears Management of Massive/Revision Rotator Cuff Tears Nikhil N. Verma MD, Director Sports Medicine, Rush University Medical Center, Midwest Orthopedics at Rush, Chicago, IL nverma@rushortho.com I. Anatomy

More information

Recurrence after arthroscopic Bankart repair: Is quantitative radiological analysis of bone loss of any predictive value?

Recurrence after arthroscopic Bankart repair: Is quantitative radiological analysis of bone loss of any predictive value? Orthopaedics & Traumatology: Surgery & Research (2012) 98, 514 519 Available online at www.sciencedirect.com ORIGINAL ARTICLE Recurrence after arthroscopic Bankart repair: Is quantitative radiological

More information

11/15/2017. Biceps Lesions. Highgate Private Hospital (Whittington Health NHS Trust) E: LHB Anatomy.

11/15/2017. Biceps Lesions. Highgate Private Hospital (Whittington Health NHS Trust) E: LHB Anatomy. Biceps Lesions Mr Omar Haddo (Consultant Orthopaedic Surgeon MBBS, BmedSci, FRCS(Orth) ) Highgate Private Hospital (Whittington Health NHS Trust) E: admin@denovomedic.co.uk LHB Anatomy Arise from superior

More information

Conflict of Interest. New Strategies in Rotator Cuff Repair. Objectives. Learner Outcome

Conflict of Interest. New Strategies in Rotator Cuff Repair. Objectives. Learner Outcome Conflict of Interest New Strategies in Rotator Cuff Repair Sheri Lankford, BSN, CNOR I hereby certify that, to the best of my knowledge, no aspect of my current personal or professional situation might

More information

Shoulder Restoration System

Shoulder Restoration System Shoulder Restoration System Arthroscopic SLAP Repair using the PressFT COMMITTED TO INNOVATION SURGICAL TECHNIQUE Arthroscopic SLAP Repair using the PressFT The PressFT Anchor from ConMed Linvatec can

More information

POSTERIOR INSTABILITY OF THE SHOULDER Vasu Pai

POSTERIOR INSTABILITY OF THE SHOULDER Vasu Pai POSTERIOR INSTABILITY OF THE SHOULDER Vasu Pai Posterior instability is less common among cases of shoulder instability, accounting for 2% to 10% of all cases of instability. More common in sporting groups:

More information

Acute traumatic posterior shoulder instability is

Acute traumatic posterior shoulder instability is Arthroscopic Treatment of a Reverse Hill-Sachs Lesion Richard E. Duey, M.D., and Stephen S. Burkhart, M.D. Abstract: Acute traumatic posterior shoulder instability is a rare injury. Such injuries can result

More information

evicore MSK joint surgery procedures requiring prior authorization

evicore MSK joint surgery procedures requiring prior authorization evicore MSK joint surgery procedures requiring prior authorization Moda Health Commercial Group and Individual Members* Updated 1/30/2018 *Check EBT to verify member enrollment in evicore program Radiology

More information

Current Concepts. W. Ben Kibler, MD. AC joint injuries in the overhead athlete. A-C Separations. Shoulder stability, function 7/7/2017

Current Concepts. W. Ben Kibler, MD. AC joint injuries in the overhead athlete. A-C Separations. Shoulder stability, function 7/7/2017 Current Concepts AC joint injuries in the overhead athlete W. Ben Kibler, MD Medical director Shoulder stability, function Anterior- curved clavicle to SC joint Posterior- muscles to spine, chest wall

More information