Common Surgical Shoulder Injury Repairs
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1 Common Surgical Shoulder Injury Repairs Mr Ilia Elkinson BHB, MBChB, FRACS (Ortho), FNZOA Orthopaedic and Upper Limb Surgeon Bowen Hospital Wellington Hospital
2 Objectives Review pertinent anatomy of the shoulder Review common shoulder injuries requiring surgery
3 Four Joints: Glenohumeral Scapulothoracic Acromioclavicular Sternoclavicular
4 Anatomy Glenohumeral joint Passive vs Dynamic Stability Passive Stability: Joint conformity: convex concave joint Glenoid labrum (50%) Ligaments Bony restraints Negative Joint Pressure Dynamic Stability: Rotator Cuff Tendons
5 Rotator Cuff Muscles Anatomy S Supraspinatus I Infraspinatus T - Teres minor S- Supscapularis
6 Anatomy Rotator Cuff
7 Anatomy - Rotator Cuff
8 Shoulder Injuries Shoulder Instability SLAP Tear (Superior Labrum Anterior to Posterior) AC Joint Dislocation/Separation Rotator Cuff Tears Fractures + Fracture/Dislocation
9 Shoulder Instability Papyrus 3000 BC: Case of shoulder dislocation reported Hippocrates 460 BC: Technique for shoulder relocation: Four cases 1900 s: Several procedures described (non-anatomical): Bone transfer Bone graft glenoid Tendon transfer
10 Shoulder Instability Incidence: 50% of ALL joint dislocations The most unstable joint in body! West Point Study (Am J Sports Med 2007): 2.8% incidence Male 6.3 : 1 (in other studies 2 : : 1) Subluxations included Main cause = sports: Falls Collisions
11 Direction of Shoulder Instability Direction of instability: Unidirectional Bidirectional, or Multidirectional Anterior dislocations = 97% of recurrent dislocations Posterior dislocations = 3% Inferior and superior dislocations = rare Superior instability = massive rotator cuff tear
12 Surgery Historical Procedures More than 150 described! Magnuson-Stack: 1940s Subscapular Transposition Putti Platt: 1920s Subscapularis Shortening Weber Humeral Rotational Osteotomy: 1971 Internal rotation of humeral head
13 Anterior Shoulder Stabilisation Anatomical: Open vs. Arthroscopic Bone anchors Capsular shift Non-Anatomical: Latarjet Procedure Coracoid Transfer with conjoint tendon to anterior glenoid If glenoid bone loss > 25%
14 Open Bankart Stabilisation Procedure
15 Arthroscopic Bankart Procedure
16 Arthroscopic Bankart Procedure
17 Open Laterjet Procedure
18 SLAP Tear (Superior Labrum Anterior to Posterior)
19 SLAP Tear Cause: Acute trauma or by repetitive shoulder motion An acute SLAP : MVA A fall onto an outstretched arm Forceful pulling on the arm Rapid or forceful movement of the arm when it is above the level of the shoulder Shoulder dislocation
20 SLAP Tear Symptoms: A sensation of locking, popping, catching, or grinding Pain with movement of the shoulder or with holding the shoulder in specific positions Pain with lifting objects, especially overhead Decrease in shoulder strength A feeling that the shoulder is going to "pop out of joint" Throwing Athlete: a decrease in throw velocity, or the feeling of a "dead arm"
21 Arthroscopic SLAP Repair
22 Arthroscopic SLAP Repair
23 Arthroscopic SLAP Repair
24 AC Joint Dislocation AC Sprain / Separation Typically due to fall onto tip of shoulder (acromion) Treatment depends on type
25 AC Joint Dislocation/Separation
26 AC Joint Dislocation/Separation
27 Rotator Cuff Tears Partial Thickness vs. Full Thickness Four classical tear patterns: Crescent-shaped U-shaped L-shaped Massive, contracted, immobile tears
28 Crescent-Shaped RC Tear
29 U-Shaped RC Tear
30 Acute L-shaped RC Tear
31 Chronic L-shaped RC Tear
32 Massive Contracted RC Tear
33 Arthroscopy + RC Repair Portals
34 Arthroscopy + Glenohumeral Portals
35 Arthroscopy + Subacromial Portals
36 Shoulder Arthroscopy Posterior Portal View
37
38
39 Type of Repair: Single vs. Double Row?
40 Fractures Around the Shoulder Clavicle Proximal Humerus Fracture -Dislocations
41 Clavicle Fractures Up to 5% of all fractures % = mid-shaft clavicle 10 30% = lateral clavicle
42 Midshaft Clavicle Fractures
43 Midshaft Clavicle Fractures
44 Midshaft Clavicle Fractures
45 Midshaft Clavicle Fractures
46 Lateral Clavicle Fractures
47 Lateral Clavicle Fractures
48 Proximal Humerus Fractures
49 Proximal Humerus Fractures
50 Fracture Non-Union
51 Fracture Mal-Union
52 Fracture-Dislocation
53 Fracture-Dislocation
54 Fracture-Dislocation
55 One Year Post Op
56 Severe Mal-Union Post Fracture Resurfacing Hemiathroplasty
57 Massive Rotator Cuff Tear + OA
58 64yr Massive Rotator Cuff Tear
59 64 yr Partial Resurfacing Hemiarthroplasty
60 Severe Fracture Humerus
61 When You Thought You Have Seen It All
62 Thank You
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