SLAP Repairs Versus Biceps Tenodesis in Athletes 15 min
|
|
- Claude Arnold
- 6 years ago
- Views:
Transcription
1 SLAP Repairs Versus Biceps Tenodesis in Athletes 15 min
2 Power Points Not all SLAP tears need surgery Preservation of Native Anatomy GOAL Not all labral repairs are equal Kinetic chain MUST be addressed
3 Power Points Biceps DOES have a function Tenodesis has consequences Tenodesis relieves pain reliably BUT long term effects uncertain
4 SLAPAHOLIC T. Romeo One who fixes EVERY SLAP TEAR and anything that remotely looks like one!
5 Not all SLAP Tears Need Surgery SLAP tears way overdiagnosed Beware of positive imaging study - negative exam Slight labral separation may allow thrower to get the slot
6 MRI May OVERDIAGNOSE Specificity ranges from 63% to 91%
7 MRI and Anatomic Variants Meniscoid labrum Buford complex Cord like MGHL Age related attritional tear ALL CAN LOOK LIKE SLAP TEARS ON MRI!!
8 Meniscoid Labrum
9 Buford Complex
10 Labral Tears are Part of the Aging Pfahler et al JSES 2003 Process!
11 MANY LABRAL TEARS RESPOND TO REHAB!!!! Nonoperative Treatment of Superior Labrum Anterior Posterior Tears Improvements in Pain, Function, and Quality of Life Edwards et al Approx. 50% of non operatively treated patients avoided surgery! Scapular strengthening, posterior capsular stretching
12 Overtreat >>>> NIGHTMARE
13 Make Sure History Consistent with SLAP event Sudden loss of velocity (dead arm) Large increase in pain mechanical symptoms usually present Rehab no longer effective
14 Exam Hold Key!!! Load Shift Passive Distraction test Mayo Shear O Brien Test (anterior) Kim test Relocation Test
15 Mayo Shear Numero Uno in Literature
16 Passive Distraction
17 KIM Lesion KIM Test
18 Surgery? Failure of GOOD rehab Experienced shoulder therapist GIRD addressed Scapula Rehab Kinetic Chain Eval Mechanical Symptoms (SLAP EVENT, frayed labrum from prolonged internal impingement) MRI Confirmatory
19 Kinetic Chain Must Be Addressed Hip abductors Spine Mobility Internal Rotation deficit Lead Hip Tight quads Lead Leg Scapula Dyskinesis Unrehabbed ankle sprain Poor balance
20 Need True Pathologic Labral Separation (fissuring, hemorrhage, abortive healing) for TRUE LABRAL TEAR
21 Biceps Tenodesis Becoming more frequent Reliable pain relief Higher success labral repair (labral repair failure rates as high as 50%) BUT IS IT GOOD FOR ATHLETES??????
22 Tenodesis Reasonable for salvage of failed labral repair in presence of POOR tissue Over age 35 reasonable option NON PHYSIOLOGIC
23 Don t throw away labral repair!! We can do a better labral repair Many degenerative, aged related tears should not be repaired Tenodesis removes an important stabilizer (Biceps) Biceps tendon ACL of the shoulder : Craig Morgan MD
24 Biceps Has a Role Rodosky Biceps confers anterior stability Patzer Superior labrum requires intact biceps to ensure stability Warner Joint compression afforded by biceps stabilizes joint
25 Tenodesis: not a free ride Kumar 1989 Severing of LHBT > decrease over 5mm in acromial humeral distance Upward migration if humeral head may not cause symptoms initially!
26 Hanypsiak AANA 2012 Cadaveric study Biceps loaded 10, 20 and 40N Humeral translation measured 3D digitizer Tenodesis caused posterior shift humerus late cocking, ant. superior shift follow through
27 Do Better Labral repair Bumper restoration only Address posterior capsule Avoid knot suture issues Address interval laxity FIX KINETIC CHAIN
28 Surgery: Do it right and address all pathologic elements SLAP Tear Bankart Kim Lesion Interval Laxity Posterior Tightness Cuff Lesion
29
30 Goals: Preserve native anatomy Restore bumper Avoid knot/suture morbidity Avoid tensioning capsule Address interval
31 Labral Surgery Lateral Decubitus Traction Kindness to tissue! Percutaneous Portals! (avoid cannulas in cuff)
32 Lateral Decub.great Access
33 Surgical Goals Fix true labral tears (Plicate anterior capsule/interval if necessary) Release posterior capsule if necessary Fix cuff ONLY if full thickness..otherwise debride or do partial repair
34 Restore Labral Bumper Lazarus 1996 increase in glenolabral depth directly related to stability
35 Be Wary of Capturing Anterior Capsule!
36 Portals
37 Surgical Tips Labral Repair Percutaneous anchor insertion Keep Knots Away!!!! Or go KNOTLESS Or..use PDS (CDM)
38 Prominent Knots Hard Suture Prediction?
39 Percutaneous Portals
40 Percutaneous Shuttling
41 Address the Rotator Interval Unrecognized source of labral repair failure Potential attenuation with extensive throwing Anterior biceps pain in late cocking
42 Rotator Interval Biceps Outlet ( Pulley/ Sling ) Arthroscopic Anatomy: SGHL, SS Tendon, CHL Morgan
43 Mechanism of Injury: Throwing Across Body with High Flexion Angle during the Follow-Through Phase of Pitching Morgan
44 Morgan Arthrogram MRI - Sagittal Oblique Images Goniometric Measurement (Degrees) The Sagittal Rotator Interval Angle
45 Arthroscopic Findings - SGHL Injured: Dorsal Biceps Hyperemic Synovitis Morgan
46 Operative Repair: 2 North-South Capsular Stitches between SGHL & MGHL Morgan
47 Reliable Diagnostic Parameters for Rotator Interval Pathology: Clinical, MRI, & Scope Digital Pain in the Upper Bicipital Groove. Anterior Superior Shoulder Pain in ABER relieved by Jobe Relocation Maneuver. Increased GH External Rotation and TMA on the Dominant versus the Nondominant Shoulder. Asymmetric Sulcus Sign on the Dominant versus the Non-dominant Shoulder ( Neutral and ER). A Widened Rotator Interval on Sagittal Oblique Arthrogram MRI with Bicep Tendon Drop Out from central in the Pulley. Arthroscopic visualized Widened Biceps Outlet. Hyperemic Biceps, SGHL, and Upper MGHL with Parallel Adhesions going into the Biceps Outlet. Laxity in the Upper MGHL. Morgan
48 Address Posterior Capsule Posterior capsular release non responders of sleeper stretch more mature throwers capsule should be thick..if not, don t do it!!!
49 Fig /jars ) Copyright 2003 Arthroscopy Association of North America Term
50
51 Hug Glenoid
52 Address Rotator Cuff Hypertwist Leads to Failure
53 Cuff Tear Anterior leading edge supraspinatus (tension) Posterior- junction supra-infra. (internal impingement) Laminated tears PAINT partial articular intratendinous tear (shear) May approach full thickness
54 Internal Impingement
55 ABER VIEW
56 Cuff Testing
57 Management Cuff Debride if less than 80-90% Side to side, laminar/intrasubstance tear repair Do not advance leading edge cuff to bone! (they will never find the slot again) Cuff tear allows shoulder to hypertwist
58 Conway Side to Side Repair In Situ
59 College Pitcher
60 PASTA
61 Take Home Don t be a slapaholic choose wisely If addressing labral tear..be kind, and use percutaneous portals Release posterior capsule in stretch non responders Don t be a hero with the rotator cuff!
62 Take Home Restore native anatomy Address the interval Correct kinetic chain Tenodesis LAST RESORT
63 THANK YOU
R. Frank Henn III, MD. Associate Professor Chief of Sports Medicine Residency Program Director
R. Frank Henn III, MD Associate Professor Chief of Sports Medicine Residency Program Director Disclosures No financial relationships to disclose 1. Labral anatomy 2. Adaptations of the throwing shoulder
More informationSuperior Labral Pathology in Throwers
Superior Labral Pathology in Throwers Disclosures Available via AAOS website None relevant to this presentation L. Pearce McCarty, III M.D. Team Physician, Minnesota Twins Chairman, Orthopedic Surgery,
More informationAnatomy 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 informationDisclosure 11/14/2016. Partial Thickness Rotator Cuff Tears in the Throwing Athlete. Partial Thickness Rotator Cuff Tears. Neal S. ElAttrache, M.D.
Partial Thickness Rotator Cuff Tears in the Throwing Athlete Neal S. ElAttrache, M.D. Disclosure I, Neal ElAttrache, or a family member(s), have relevant financial relationships to be discussed, directly
More informationCommon Shoulder Injuries in the Throwing Athlete: Amateur to Professional
Common Shoulder Injuries in the Throwing Athlete: Amateur to Professional Steven B. Cohen, MD Associate Professor: Dept Orthopedic Surgery / Rothman Institute Asst Team Physician Philadelphia Phillies
More informationManagement 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 informationP.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 informationType II SLAP lesions are created when the biceps anchor has pulled away from the glenoid attachment.
Arthroscopic Superior Labral (SLAP) Repair Protocol-Type II, IV, and Complex Tears The intent of this protocol is to provide the clinician with a guideline of the post-operative rehabilitation course of
More informationIntern 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 informationThrowing Injuries and Prevention: The Physical Therapy Perspective
Throwing Injuries and Prevention: The Physical Therapy Perspective Andrew M Jordan, PT, DPT, OCS Staff Physical Therapist, Cayuga Medical Center Physical Therapy and Sports Medicine ajordan@cayugamed.org
More informationDisclosures 7/25/2018. SLAP Tears In Overhead Athletes: Should We Be Fixing Them? How Do We Fix Them?
SLAP Tears In Overhead Athletes: Should We Be Fixing Them? How Do We Fix Them? Michael T. Freehill M.D. Associate Professor of Orthopaedic Surgery University of Michigan 10th Annual Detroit Regional Sports
More informationANATOMY / BIOMECHANICS LONG HEAD OF BICEPS ATTACHES AT THE SUPERIOR GLENOIDAL TUBERCLE WITH THE LABRUM FIBROCARTILAGINOUS TISSUE IF THERE IS A TORN SU
SLAP LESIONS Management Of Glenoid Labrum Injuries INTRODUCTION First described by Andrews AJSM 85 Throwers 60% Normal Variants Sublabral Foramen Buford Complex Meniscoid Snyder Arth. 1990 termed SLAP
More informationIntroduction & Question 1
Page 1 of 7 www.medscape.com To Print: Click your browser's PRINT button. NOTE: To view the article with Web enhancements, go to: http://www.medscape.com/viewarticle/424981 Case Q & A Shoulder Pain, Part
More informationSLAP 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 informationRotator 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 informationArthroscopic Labral Repair Protocol-Type II, IV, and Complex Tears:
Arthroscopic Labral Repair Protocol-Type II, IV, and Complex Tears: The intent of this protocol is to provide the clinician with a guideline of the postoperative rehabilitation course of a patient that
More informationTechnique For SLAP Repair in 2016
Technique For SLAP Repair in 2016 Eric J. Strauss MD Division of Sports Medicine NYU Hospital for Joint Diseases Hospital for Joint Diseases Department of Orthopaedic Surgery Disclosures Joint Restoration
More information11/6/2013. Keely Behning, PT, SCS, ATC MNPTA Fall Conference November 16, 2013
Keely Behning, PT, SCS, ATC MNPTA Fall Conference November 16, 2013 Upon completion of this course, attendees should be able to: Understand pertinent anatomy and biomechanics as they relate to specific
More informationSHOULDER 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 informationLabral Tears. Fig 1: Intact labrum and biceps tendon
Labral Tears 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 that is
More informationDK7215-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 informationSHOULDER 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 informationGlenohumeral 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 informationUpper Extremity Injuries in Youth Baseball: Causes and Prevention
Upper Extremity Injuries in Youth Baseball: Causes and Prevention Biomechanics Throwing a baseball is an unnatural movement Excessively high forces are generated at the elbow and shoulder Throwing requires
More informationShoulder 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 informationI (and/or my co-authors) have something to disclose.
Shoulder Anatomy And Biomechanics Nikhil N Verma, MD Director of Sports Medicine Professor, Department of Orthopedics Rush University Team Physician, Chicago White Sox and Bulls I (and/or my co-authors)
More informationManagement 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 informationPatient 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 informationReview shoulder anatomy Review the physical exam of the shoulder Discuss some common causes of acute shoulder pain Discuss some common causes of
Review shoulder anatomy Review the physical exam of the shoulder Discuss some common causes of acute shoulder pain Discuss some common causes of chronic shoulder pain Review with some case questions Bones:
More informationShoulder arthroscopy. Mohammad nasir Naderi, MD Fellowship in shoulder and arthroscopic surgery
Shoulder arthroscopy Mohammad nasir Naderi, MD Fellowship in shoulder and arthroscopic surgery Shoulder arthroscopy Evolve understanding of anatomy and pathophysiology of shoulder This technology, allow
More informationROTATOR CUFF DISORDERS/IMPINGEMENT
ROTATOR CUFF DISORDERS/IMPINGEMENT 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
More informationThe Cryo/Cuff provides two functions: 1. Compression - to keep swelling down. 2. Ice Therapy - to keep swelling down and to help minimize pain. Patien
The Cryo/Cuff provides two functions: 1. Compression - to keep swelling down. 2. Ice Therapy - to keep swelling down and to help minimize pain. Patients, for the most part, experience less pain and/or
More informationANATOMIC 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 informationShoulder 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 informationMRI 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 informationShoulder 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 informationMRI 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 informationThe ball-and-socket articulation at the glenohumeral joint is between the convex
SLAP Lesion Repair Emily Cotey, Emily Hurysz, and Patrick Schroeder Abstract SLAP lesion, which stands for Superior Labrum Anterior and Posterior, is a detachment tear of the superior labrum that originates
More informationSHOULDER 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 informationThe Shoulder. Jill Inouye Primary Care Sports Medicine Family Medicine Resident School February 26, 2014
The Shoulder Jill Inouye Primary Care Sports Medicine Family Medicine Resident School February 26, 2014 Objectives Review shoulder anatomy Explain and demonstrate shoulder physical exam Diagnosis and management
More informationLawrence Gulotta Gillian Lieberman, MD October Gillian Lieberman, MD. Shoulder Imaging. Lawrence V. Gulotta, HMS IV 10/16/02
October 2002 Shoulder Imaging Lawrence V. Gulotta, HMS IV 10/16/02 Goals Review Anatomy of the Shoulder -Dynamic Stabilizers -> Rotator Cuff -Static Stabilizers -> Labrum and Capsule Systematic Approach
More informationThe 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 information11/15/2017. 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 informationRehabilitation 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 informationShoulder 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 informationIMPINGEMENT-TESTSTESTS
«thinking about.» DIFFERENTIAL DIAGNOSIS: Looking for the causes of Which special tests do you use in your shoulder examination? Ann Cools, PT, PhD Ghent University - Belgium Dept of Rehabilitation Sciences
More informationPartial Thickness Rotator Cuff Tears: All-Inside Repair of PASTA Lesions in Athletes
Partial Thickness Rotator Cuff Tears: All-Inside Repair of PASTA Lesions in Athletes Thomas M. DeBerardino, MD Associate Professor, UConn Health Center Team Physician, Orthopaedic Consultant UConn Huskie
More informationShoulder Injury Evaluation.
Shoulder Injury Evaluation www.fisiokinesiterapia.biz Basic Anatomy & Kinesiology 3 Bone Structures Clavicle Scapula Humerus Evaluation Principles Always follow a standard progression Determine the target
More informationsignificant increase of glenohumeral translation at middle and lower elevation angles [6].
significant increase of glenohumeral translation at middle and lower elevation angles [6]. Two types of injury mechanisms have been postulated for superior labral tears. 1. Traction injury : Chronic repetitive
More informationChristopher 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 informationER + IR = Total Motion
Treating the Thrower s Shoulder Michael M. Reinold, PT, DPT, ATC, CSCS Introduction Common site of injury» Repetitive forces / stresses Tremendous joint forces» Anterior shear forces 1-1.5 1.5 X BW» Distraction
More informationRehabilitation Guidelines for Shoulder Arthroscopy
Rehabilitation Guidelines for Shoulder Arthroscopy 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 informationDiagnosis and Treatment of Common Shoulder Disorders
Diagnosis and Treatment of Common Shoulder Disorders NAOEM Oct 14 th, 2017 Michael Codsi, M.D. www.drcodsi.com Learning Objectives SLAP tears diagnosis, imaging and treatment How to diagnose rotator cuff
More informationSHOULDER ANATOMY Karl Wieser, MD Department of Orthopedics, University of Zurich, Balgrist, Switzerland
20th Course in Shoulder Surgery Balgrist SHOULDER ANATOMY Karl Wieser, MD Department of Orthopedics, University of Zurich, Balgrist, Switzerland www.balgrist.ch ANATOMY OVERVIEW courtesy of Georg Lajtai
More informationRehabilitation Guidelines for Biceps Tenodesis with Hardware Fixation
UW HEALTH SPORTS REHABILITATION Rehabilitation Guidelines for Biceps Tenodesis with Hardware Fixation The shoulder has two primary joints. One part of the shoulder blade, called the glenoid fossa forms
More informationInjury to the superior labrum i.e. superior labral anterior
Original Article Correlation of the slap lesion with lesions of the medial sheath of the biceps tendon and intra-articular subscapularis tendon William F Bennett Abstract Background: Superior labral anterior
More information4/12/2016. Goals. Anatomy. Basic Anatomy. Biomechanics. Function. Traumatic Rupture of Proximal Biceps: In-season Rehabilitation and Management
Goals Traumatic Rupture of Proximal Biceps: In-season Rehabilitation and Management Thomas F. LaPorta, MD To understand the anatomy of the biceps at the shoulder To present the mechanism, signs and symptoms,
More informationArthroscopy / 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 informationSports 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 informationAnatomy Your shoulder is made up of three bones: your upper arm bone (humerus), your shoulder blade (scapula), and your collarbone (clavicle).
Shoulder Impingement/Rotator Cuff Tendinitis One of the most common physical complaints is shoulder pain. Your shoulder is made up of several joints combined with tendons and muscles that allow a great
More informationWEEKEND 2 Shoulder. Shoulder Active Range of Motion Assessment
Virginia Orthopedic Manual Physical Therapy Institute - 2016 Technique Manual WEEKEND 2 Shoulder Shoulder Active Range of Motion Assessment - Patient Positioning: Standing, appropriately undressed so that
More informationJoint G*H. Joint S*C. Joint A*C. Labrum. Humerus. Sternum. Scapula. Clavicle. Thorax. Articulation. Scapulo- Thoracic
A*C Joint Scapulo- Thoracic Articulation Thorax Sternum Clavicle Scapula Humerus S*C Joint G*H Joint Labrum AC Ligaments SC Ligaments SC JOINT AC Coracoacromial GH GH Ligament Complex Coracoclavicular
More informationStrategies for Failed Instability Repair
Strategies for Failed Instability Repair Robert E Hunter MD Director, Orthopedic Sports Medicine Center HRRMC Salida, Colorado CU Sports Medicine Course Sept 28, 2012 Conflict of Interest Paid Consultant:
More informationShoulder Surgery. Gregory M. Behm, MD Ravalli Orthopedics & Sports Medicine
Shoulder Surgery The purpose of this handout is to help you understand the way I perform shoulder surgeries and to help you plan for the recovery. Below are some general items that apply to most surgeries
More informationThrowing Athlete Rehabilitation. Brett Schulz LAT/CMSS Sport and Spine Physical Therapy
Throwing Athlete Rehabilitation Brett Schulz LAT/CMSS Sport and Spine Physical Therapy Disclosure No conflicts to disclose Throwing Athlete Dilemma The shoulder must have enough range of motion to allow
More informationRehabilitation Guidelines for Large Rotator Cuff Repair
Rehabilitation Guidelines for Large Rotator Cuff 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
More informationShoulder Pain: Diagnosis and Management
Shoulder Pain: Diagnosis and Management Thomas J. Gill, M.D. Director, Boston Sports Medicine and Research Institute Associate Professor of Orthopedic Surgery Tufts Medical School www.bostonsportsmedicine.com
More informationRehabilitation Guidelines for Arthroscopic Capsular Shift
UW HEALTH SPORTS REHABILITATION Rehabilitation Guidelines for Arthroscopic Capsular Shift The anatomic configuration of the shoulder joint (glenohumeral joint) is often compared to a golf ball on a tee.
More informationDIFFERENTIAL DIAGNOSIS: Looking for the causes of impingement
DIFFERENTIAL DIAGNOSIS: Looking for the causes of Ann Cools, PT, PhD Ghent University - Belgium Dept of Rehabilitation Sciences & Physiotherapy Ann.Cools@UGent.be «thinking about.» Which special tests
More informationPhase I : Immediate Postoperative Phase- Protected Motion. (0-2 Weeks)
Phase I : Immediate Postoperative Phase- Protected Motion (0-2 Weeks) Appointments Progression Criteria 2 weeks after surgery Rehabilitation appointments begin within 7-10 days of surgery, continue 1-2
More informationDr. Denard s Rehabilitation Protocols Arthroscopic Shoulder Surgery
2780 E. Barnett Rd Medford, OR 97530 541-779-6250 Dr. Denard s Rehabilitation Protocols Arthroscopic Shoulder Surgery These rehabilitation protocols are based on current studies detailing healing time
More informationShoulder Ultrasonography as a Diagnostic Tool for Rotator Cuff Disease
Shoulder Ultrasonography as a Diagnostic Tool for Rotator Cuff Disease Jay D Keener, MD Associate Professor Shoulder and Elbow Service Washington University Disclosure No relevant financial disclosures
More informationPosition Statement. Journal of Athletic Training 209
Journal of Athletic Training 2018;53(3):209 229 doi: 10.4085/1062-6050-59-16 Ó by the National Athletic Trainers Association, Inc www.natajournals.org Position Statement National Athletic Trainers Association
More informationOrthopedic Physical Assessment with Special Tests Shoulder
Orthopedic Physical Assessment with Special Tests Shoulder COURSE DESCRIPTION Detailed video demonstrations of tests and procedures common in musculoskeletal assessment are supplemented by high-quality
More informationBaseball players and other athletes who spend much of
A practical guide to shoulder injuries in the throwing athlete Repeatedly throwing a ball can take a toll on an athlete s shoulder. Prompt diagnosis and treatment hinges on asking some targeted questions
More informationPosterior 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 information1. The coordinated action of a scapular upward rotation and humeral abduction is known as the:
1 1. The coordinated action of a scapular upward rotation and humeral abduction is known as the: a. Carrying angle of the arm b. Scapulohumeral rhythm c. Glenohumeral capsular pattern d. Abduction resistance
More informationClinical pearls for the shoulder/arm exam and the treatment. What is seeing youare you seeing it
Clinical pearls for the shoulder/arm exam and the treatment What is seeing youare you seeing it W. Ben Kibler, MD Medical director Case 1 18 y/o R hand dominant high school pitcher, with 6 week hx gradual
More informationSLAP Lesions Rehabilitation Concepts
SLAP Lesions Rehabilitation Concepts Kevin E. Wilk, PT, DPT, FAPTA Glenoid Labral Lesions Introduction Classification of SLAP tears Andrews & Carson: AJSM 85 Snyder: Arthroscopy 90 (Type I IV) Maffet et
More informationShoulder Joint Examination. Shoulder Joint Examination. Inspection. Inspection Palpation Movement. Look Feel Move
Shoulder Joint Examination History Cuff Examination Instability Examination AC Joint Examination Biceps Tendon Examination Superior Labrum Examination Shoulder Joint Examination Inspection Palpation Movement
More informationCommon 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 informationRotator Cuff Tears Our approach
Rotator Cuff Tears Our approach Terry R. Malone EdD., PT, ATC Professor of Physical Therapy University of Kentucky Nothing to disclose only wish Deep Musculature & Glenoid RC Insertion Data The RC insertion
More informationThe Shoulder. Systematically scanning the shoulder provides extremely useful diagnostic information. The Shoulder
1 ! The most ACCESSIBLE to sonographic exam! The most MOBILE and VULNERABLE extremity AND Systematically scanning the shoulder provides extremely useful diagnostic information! The Goal for this section
More informationStefan C Muzin, MD PM&R Attending Physician, Beth Israel Deaconess Medical Center, Harvard Medical School Onsite Physiatrist, GE Aviation, Lynn, MA
Stefan C Muzin, MD PM&R Attending Physician, Beth Israel Deaconess Medical Center, Harvard Medical School Onsite Physiatrist, GE Aviation, Lynn, MA Consultant, OEHN (Occupational and Environmental Network)
More informationShoulder examination. P Sripathi Rao Arthroscopy & Sports Injuries Unit Dean, Kasturba Medical College
Shoulder examination P Sripathi Rao Arthroscopy & Sports Injuries Unit Dean, Kasturba Medical College Manipal University, Manipal Common symptoms Tingling Numbness Pain Loss of movements Weakness Approach
More informationGlenohumeral 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 informationThinking 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 informationAcromioplasty. Surgical Indications and Considerations
1 Acromioplasty Surgical Indications and Considerations Anatomical Considerations: Any abnormality that disrupts the intricate relationship within the subacromial space may lead to impingement. Both intrinsic
More informationChronic 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 informationA science-based protocol for the conservative and postoperative treatment of SLAP LESIONS & BICEPS PATHOLOGY
A science-based protocol for the conservative and postoperative treatment of SLAP LESIONS & BICEPS PATHOLOGY Prof dr Ann Cools, PT, PhD Dept Rehab. Sciences & Physiotherapy Ghent University, Belgium From
More informationRehabilitation Guidelines for Shoulder Arthroscopy
UW HEALTH SPORTS REHABILITATION Rehabilitation Guidelines for Shoulder Arthroscopy Front View Acromion Supraspinatus Back View Supraspinatus Long head of bicep Type I Infraspinatus Short head of bicep
More informationBiceps Tendon Rupture
Disclaimer This movie is an educational resource only and should not be used to manage Orthopaedic Health. All decisions about Biceps Tendon Rupture must be made in conjunction with your Physician or a
More informationTIPS FOR SUCCESSFUL SHOULDER TREATMENT. In Service Training 16 th May 2014
TIPS FOR SUCCESSFUL SHOULDER TREATMENT In Service Training 16 th May 2014 Training day aims to address: Controversies of impingement syndrome diagnosis Controversies of MRI/USS imaging Clinical diagnosis
More informationShoulder Anatomy and a preface on the Shoulder Arthroscopy.
Shoulder Anatomy and a preface on the Shoulder Arthroscopy www.fisiokinesiterapia.biz Shoulder Anatomy Shoulder Anatomy Greatest ROM No inherent bony stability Relies on soft tissues for stability Many
More informationBody 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 informationGregory P. Nicholson, M.D. Disclosures. Indications for Open RCR. Open RC Repairs 2015 and Role of Tendon Transfers. Associate Professor
Open RC Repairs 2015 and Role of Tendon Transfers Gregory P. Nicholson, M.D. Associate Professor Rush University Medical Center Chicago, Illinois Disclosures Research and Educational Support: Tornier,
More informationDouble 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 informationPhysical Examination of the Shoulder
General setup Patient will be examined in both the seated and supine position so exam table needed 360 degree access to patient Expose neck and both shoulders (for comparison); female in gown or sports
More information