Surgical Management of Instability and SLAP Lesions SHOULDER AND ELBOW UPDATE Gerald R. Williams, Jr., MD 1
|
|
|
- Louise Scott
- 5 years ago
- Views:
Transcription
1 Surgical Management of Instability and SLAP Lesions Conflict of Interest Slide Surgical Management of Instability and SLAP Lesions Gerald R. Williams, MD John M. Fenlin, Jr, MD Professor, The Rothman Institute Sidney Kimmel Medical College, Department of Orthopaedic Surgery Board of Directors AAOS Stipend Royalties DJO- shoulder arthroplasty Depuy: shoulder arthroplasty Lippincott, Williams, and Wilkins: shoulder texts IMDS/Cleveland Clinic: arthroplasty Research: Tornier, Depuy, Synthasome Stock Ownership: In-vivo therapeutics, CrossCurrent Business Analytics, LLC, OBERD, LLC, Force Therapeutics Agenda Indications Prognostic factors Instability Indications Technique Results SLAP lesions Indications Technique Results Age Number of dislocations Ligamentous laxity Activity Bone deficiency Boileau, et. al. JBJS BR Indications Generalizations Indications Operate for instability not pain Soft-tissue procedures good for soft-tissue problems Soft-tissue stretch must be addressed with more than 5 dislocations Bony procedures good for bone pathology Seizure disorders controlled (6 months) Traumatic TUBS Microtraumatic Atraumatic AMBRI Gerald R. Williams, Jr., MD 1
2 Surgical Management of Instability and SLAP Lesions Traumatic unidirectional Anterior Posterior Traumatic multidirectional Involuntary Atraumatic-- very occassionally Indications Techniques Arthroscopic capsulorrhaphy +/- Remplissage Open Bankart 3-5 times a year Open (arthroscopic) Latarjet Revisions Bipolar bone loss (seizures) Open other grafts allograft, iliac crest Arthroscopic vs. Open Technique Open vs. Arthroscopic Arthroscopic equipment and technique have improved considerably Still a role for both Consider open in revisions or bone loss situations Arthroscopic Repair Results (Penn Score) No labrum, Healed medially Gerald R. Williams, Jr., MD 2
3 Surgical Management of Instability and SLAP Lesions Open vs. Arthroscopic Bone defects Matter Arthroscopic repair was as effective as open reconstruction for traumatic, recurrent, anterior glenohumeral instability in our study population Newer fixation methods provide reliable fixation for experienced shoulder surgeons Arthroscopic repair was not associated with greater patient satisfaction SLAP Repair Prognostic Factors Type I SLAP Age SLAP type Concomitant pathology Injury history Desired activity Very common Can be normal finding Debridement Type II SLAP Type II SLAP Arthroscopic repair 1-2 anterior anchors 1 posterior anchor-- posterior SLAP Posterolateral portal ( Port of Wilmington ) Gerald R. Williams, Jr., MD 3
4 Surgical Management of Instability and SLAP Lesions Type II SLAP Type II Slap Type III SLAP Type IV SLAP Concomitant Pathology Internal Glenoid Impingement AIGHL-- checkrein for ABER Int. Imp. AIGHL laxity vs. Posterior capsular contracture Decreased humeral retroversion Internal Glenoid Impingement Gerald R. Williams, Jr., MD 4
5 Surgical Management of Instability and SLAP Lesions SLAP Repair Conclusions Good with isolated lesions, young patients High incidence of stiffness in older patients Decreasing incidence of repair Biceps tenodesis vs. SLAP repair THANK YOU. Gerald R. Williams, Jr., MD 5
6 Pathophysiology and Surgical Management of Shoulder Arthritis Conflict of Interest Slide Pathophysiology and Surgical Management of Shoulder Arthritis: Total and Reverse Arthroplasty Gerald R. Williams, MD The John M. Fenlin, Jr., MD Professor of Shoulder and Elbow Surgery Sidney Kimmel Medical College Philadelphia, Pennsylvania Board of Directors AAOS Stipend Royalties DJO- shoulder arthroplasty Depuy: shoulder arthroplasty Lippincott, Williams, and Wilkins: shoulder texts IMDS/Cleveland Clinic: arthroplasty Research: Tornier, Depuy, Synthasome Stock Ownership: In-vivo therapeutics, CrossCurrent Business Analytics, LLC, OBERD, LLC, Force Therapeutics Agenda Glenohumeral Arthritis Pathophysiology Pathophysiology Arthroplasty background Anatomic total shoulder arthroplasty Reverse total shoulder arthroplasty Crystalline Arthritis Post-traumatic Arthritis Avascular Necrosis Inflammatory Arthritis Rotator cuff Osteoarthritis Capsule Bone Pathophysiology Primary Pathology Osteoarthritis Osteoarthritis Posttraumatic Arthritis I I Avascular Necrosis Rheumatoid Arthritis I I Cuff Tear Arthritis I Cartilage Loss Soft-Tissue Abnormalities Gerald R. Williams, Jr., MD 1
7 Pathophysiology and Surgical Management of Shoulder Arthritis CT/MRI Inflammatory Arthritis Arthroplasty Decision-making Factors Anatomic Shoulder Arthroplasty Age Activity level Joint geometry Rotator cuff status Capsular contracture Total Shoulder Arthroplasty Surgical Principles (1970) Extended deltopectoral approach Preserve deltoid Soft-tissue balancing Preserve normal anatomy Reconstruct joint anatomically Tuberosity-Head height Lateral offset Version and alignment Rehabilitation Anatomic Shoulder Arthroplasty Results Neer--Results disease dependent Neer, Watson, et.al. JBJS, 64A, 1982 Neer, Shoulder Reconstruction, WB Saunders, % satisfactory results Minimum 2 yr follow-up Approximately 30% glenoid lucent lines 2/615 revised as of 1988 Gerald R. Williams, Jr., MD 2
8 Pathophysiology and Surgical Management of Shoulder Arthritis Anatomic Shoulder Arthroplasty Results Subscapularis Management Torchia, Cofield, et. al. (JSES, 6, 1997) 12 year mean follow-up 44% glenoid loosening 83% good pain relief 117 degrees of elevation (related to cuff disease) Survivorship: 93% at 10 yrs; 87% at 15 years Advancement Advancement -30 ER < 10 Z-Lengthening Post-Operative Subscapularis Failure Lesser Tuberosity Osteotomy Moeckel, B. H.; Altchek, D. W.; Warren, R. F.; Wickiewicz, T. L.; and Dines, D. M.: Instability of the shoulder after arthroplasty. J Bone Joint Surg Am, 75(4): , % Anterior Instability 100% subscapularis rupture Miller, S. L.; Hazrati, Y.; Klepps, S.; Chiang, A.; and Flatow, E. L.: Loss of subscapularis function after total shoulder replacement: A seldom recognized problem. J Shoulder Elbow Surg, 12(1): 29-34, % + lift-off or abdominal compression 92% Subscapularis dysfunction (tuck in shirt) Did not study relationship to outcome score Gerber, C.; et.al. : J Bone Joint Surg Am, 87(8): , % negative ACT; 75% normal LOT Substantially better than historical results with softtissue repair Flatow, E. L.; et.al.: J Shoulder Elbow Surg, 17(1): 68-72, % normal ACT (32.5% previous series-- soft-tissue repair) 83.3% no subscapularis dysfunction (tuck in shirt) Other Perspectives Tendon-to-tendon repair may be better than peal and equivalent to LTO Caplan JL, Whitfield B, Neviaser RJ. J Shoulder Elbow Surg 2009;18:193-6; discussion 7-8. LTO to Tendon-to-tendon no difference in subscapularis function, easier glenoid exposure Levine, et.al. Scalise, Rothman et. Institute al., JBJS, of Orthopaedics 92A, at 2010 Gerald R. Williams, Jr., MD 3
9 Pathophysiology and Surgical Management of Shoulder Arthritis Reverse Total Shoulder Arthroplasty Constrained Arthroplasty Not a new concept Paul Grammont 1985 Dijon, France Delta III (Grammont 1987) How is it Different? Results Large sphere, no neck Medialized center Valgus neck-shaft angle (155 degrees) Werner, Gerber, et.al Early Experience Total complication rate 50% Reoperation rate 33% Primary cases 18% Revisions 39% Hematoma most common complication Reverse arthroplasty is a salvage procedure for severe shoulder dysfunction caused by an irreparable rotator cuff tear associated with other glenohumeral lesions. --Werner CM, Steinmann PA, Gilbart M, Gerber C. J Bone Joint Surg Am 2005;87: Reverse arthroplasty should be used exclusively in patients over seventy years old with low functional demands. Guery J, Favard L, Sirveaux F, Oudet D, Mole D, Walch G. J Bone Joint Surg Am 2006;88: Gerald R. Williams, Jr., MD 4
10 Pathophysiology and Surgical Management of Shoulder Arthritis American Experience Expanding Indications Generally lower complication rate Benefit of European learning curve Still high relative to anatomic implant similar to when anatomic implant first introduced Revision CTA Malunion/nonunion RA Tumor Osteoarthritis with cuff tear Osteoarthritis with intact cuff and bone deformity Post-traumatic arthritis Cuff tear without arthritis Market Impact Conclusions Kim SH, Wise BL, Zhang Y, Szabo RM. J Bone Joint Surg Am 2011;93: Shoulder arthroplasty has come a long way Many more qualified surgeons performing them Outcomes have improved and will continue to The best operation I do! THANK YOU. Gerald R. Williams, Jr., MD 5
11 Rotator Cuff Repair : Who, When, and How Conflict of Interest Slide Rotator Cuff Repair: Who, When, How Gerald R. Williams, MD John M. Fenlin, Jr, MD Professor, The Rothman Institute Sidney Kimmel Medical College, Department of Orthopaedic Surgery Board of Directors AAOS Stipend Royalties DJO- shoulder arthroplasty Depuy: shoulder arthroplasty Lippincott, Williams, and Wilkins: shoulder texts IMDS/Cleveland Clinic: arthroplasty Research: Tornier, Depuy, Synthasome Stock Ownership: In-vivo therapeutics, CrossCurrent Business Analytics, LLC, OBERD, LLC, Force Therapeutics Agenda Cuff Aging/Natural History Asymptomatic Cuff aging/natural history Patient selection who and when Technique of cuff repair-- how Results Conclusions Sher, et.al., JBJS 77A, 1995 Cuff Aging/Natural History Cuff Aging/Natural History Yamaguchi K. et.al. J Bone Joint Surg 2006:88: Yamaguchi, K., A. M. Tetro, et al. JSES (2001). Gerald R. Williams, Jr., MD 1
12 Rotator Cuff Repair : Who, When, and How Patient Selection Prognostic Factors Acuity and Size Acuity Size Patient factors Age Activity Smoking history DM Tissue quality (Fenlin, Goutallier, Gerber, others) Cuff Repair Principles Early vs. Late Repair Cuff Repair Principles Early vs. Late Repair Repair Tension (N) Time from Injury (weeks) Group 1 3 wks Group wks Bassett, R. W. and R. H. Cofield CORR (1983). Gimbel, J. A., S. Mehta, Williams, G, et al. Rothman Institute of (2004). Orthopaedics at Group wks Elevation Pain relief Satis. Satis. Satis. Recommended repair within 3 wks Who? When? Favorable Young (< 70) Small tear Healthy Non-smoker Active Recent injury Unfavorable Older (>70) Large tear Minimal comorbidities Smoker Low demand i.e. may not need it No injury Early Recent injury Large tear (i.e. retraction) Weakness High demand Late No injury Small tear Minimal weakness Low demand Increased age Co-morbidities Gerald R. Williams, Jr., MD 2
13 Rotator Cuff Repair : Who, When, and How Cuff Repair Technique Principles (Neer 1972) Open superior approach Subperiosteal anterior deltoid takedown Coracoacromial ligament excision Anterior acromioplasty Cuff mobilization Cuff repair to bone through tunnels Early (immediate) passive motion Arthroscopic Cuff Repair Technique Mobilization Superficial Deep Interval slides/releases Gerald R. Williams, Jr., MD 3
14 Rotator Cuff Repair : Who, When, and How Cuff Repair Principles Cuff Repair Principles?Acromioplasty? acromioplasty No acromioplasty No type 3s, single tendon tears Gartsman, G. M. and P. O'Connor D JSES (2004). Cuff Repair Principles?Acromioplasty? Cuff Repair Principles?Acromioplasty? No control group The Jury is still out McCallister W. V. et.al. J Bone Joint Surg 2005:87: Results Repair Integrity 105 shoulders, avg 5 year f/u Supraspinatus-- 20% recurrence Two tendons-- 45% recurrence Three tendons-- 65% recurrence Most patients satisfied-- even with recurrent defect Function and satisfaction correlated with integrity Harryman, et.al., JBJS 73A, 1991 Open vs. Arthroscopic Repair Pot. Arthro. Adv. Less deltoid morbidity Less post-operative pain Less subacromial scarring Better cuff mobilization/visualiz ation Better patient acceptance Pot. Arthro. Disadv. Simple sutures Anchors vs. tunnels Cuff repair footprint Surface area available for healing Double row may help Technically demanding-- may be volume dependent Gerald R. Williams, Jr., MD 4
15 Rotator Cuff Repair : Who, When, and How Post-operative Integrity Post-operative Integrity Double Row Bishop, J., S. Klepps, Flatow, E. et al. JSES (2006). Lafosse, L., R. Brozska, et al. JBJS (2007). Cuff Repair Conclusions Acknowledgements Complex event Right patient Right time Correct Surgical technique Louis Soslowsky, PhD, Stavros Thomopoulos, PhD, JJ Sarver, J Gimbel, PhD, Cathy Peltz, LM Dourte THANK YOU. Gerald R. Williams, Jr., MD 5
The Current State of Rotator Cuff Repairs
Conflict of Interest Slide The Current State of Rotator Cuff Repairs Gerald R. Williams, Jr, MD John M. Fenlin, Jr, MD Professor of Shoulder and Elbow Surgery Royalties Depuy: shoulder arthroplasty DJO:
Gerald R. Williams, MD
Reverse Arthroplasty: Is Overutilization a Problem? Gerald R. Williams, MD John M. Fenlin, Jr, MD Professor of Shoulder and Elbow Surgery The Rothman Institute Jefferson Medical College Royalties Conflict
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
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
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
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
Management of the Younger Arthritic Shoulder
Conflict of Interest Slide Management of the Younger Arthritic Shoulder Gerald R. Williams, Jr, MD John M. Fenlin, Jr, MD Professor of Shoulder and Elbow Surgery Royalties Depuy: shoulder arthroplasty
Biomechanical concepts of total shoulder replacement. «Shoulder Course» Day 1. Richard W. Nyffeler Orthopädie Sonnenhof Bern. 11. Sept.
Biomechanical concepts of total shoulder replacement Richard W. Nyffeler Orthopädie Sonnenhof Bern First total shoulder prosthesis Jules Emile Péan, 1830-1898 Monobloc prostheses Charles Neer, 1917-2011
Reverse Total Shoulder Arthroplasty: A New Frontier (of Complications)
Reverse Total Shoulder Arthroplasty: A New Frontier (of Complications) Emilie Cheung, MD Associate Professor Chief Shoulder Elbow Svc Stanford University Department of Orthopedic Surgery Procedure volumes
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
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
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
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
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
Why are these shoulder replacements called a reverse prosthesis?
PATIENT GUIDE TO REVERSE PROSTHESIS Edward G. McFarland MD The Division of Sports Medicine and Shoulder Surgery The Department of Orthopaedic Surgery The Johns Hopkins University Baltimore MD Why are these
www.fisiokinesiterapia.biz Shoulder Problems Fractures Instability Impingement Miscellaneous Anatomy Bones Joints / Ligaments Muscles Neurovascular Anatomy Anatomy Supraspinatus Anterior Posterior Anatomy
Management of arthritis of the shoulder. Omar Haddo Consultant Orthopaedic Surgeon
Management of arthritis of the shoulder Omar Haddo Consultant Orthopaedic Surgeon Diagnosis Pain - with activity initially. As disease progresses night pain is common and sleep difficult Stiffness trouble
Augmented Glenoid Component for Bone Deficiency in Shoulder Arthroplasty
Clin Orthop Relat Res (2008) 466:579 583 DOI 10.1007/s11999-007-0104-4 SYMPOSIUM: NEW APPROACHES TO SHOULDER SURGERY Augmented Glenoid Component for Bone Deficiency in Shoulder Arthroplasty Robert S. Rice
Shoulder and Elbow ORTHOPAEDIC SYPMPOSIUM APRIL 8, 2017 DANIEL DOTY MD
Shoulder and Elbow ORTHOPAEDIC SYPMPOSIUM APRIL 8, 2017 DANIEL DOTY MD Shoulder Articulations Glenohumeral Joint 2/3 total arc of motion Shallow Ball and Socket Joint Allows for excellent ROM Requires
Conflicts of Interest Consulting (C), Royalty (R)
Principles of Anatomic Total Shoulder Arthroplasty Joseph P. Iannotti MD, PhD Maynard Madden Professor and Chairman Orthopaedic and Rheumatologic Institute Cleveland Clinic Conflicts of Interest Consulting
D Degenerative joint disease, rotator cuff deficiency with, 149 Deltopectoral approach component removal with, 128
Index A Abduction exercise, outpatient with, 193, 194 Acromioclavicular arthritis, with, 80 Acromiohumeral articulation, with, 149 Acromio-humeral interval (AHI), physical examination with, 9, 10 Active
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
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
The Irreparable Rotator Cuff Tear:
The Irreparable Rotator Cuff Tear: Trauma 101: Shoulder Session #2 Brian Grawe, MD Assistant Professor Orthopaedics & Sports Medicine 5/10/2018 Brian Grawe, MD Assistant Professor Phone Number: 513-558-4516
Not relevant to this presentation.
Nolan R. May, MD Kearney, NE Heartland Surgery Center, Kearney NE Not relevant to this presentation. 1 What are the indications for total shoulder arthroplasty? What are the differences between total shoulder
How they begin 8/18/15. Arthroscopic Management of Complex RCT. Disclosures in AAOS Database
Arthroscopic Management of Complex RCT Brian J. Cole, MD, MBA Professor and Vice-Chairman, Department of Orthopedics Chairman, Department of Surgery, Rush OPH Team Physician, Chicago Whites Sox and Bulls
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
Index. B Backslap technique depth assessment, 82, 83 diaphysis distal trocar, 82 83
Index A Acromial impingement, 75, 76 Aequalis intramedullary locking avascular necrosis, 95 central humeral head, 78, 80 clinical and functional outcomes, 95, 96 design, 77, 79 perioperative complications,
06/Μαρ/2013 FUNCTION OF THE ROTATOR CUFF. ARTHROSCOPIC ROTATOR CUFF REPAIR Primarily to stabilize and centralize the humeral head GENERAL GUIDE LINES
FUNCTION OF THE ROTATOR CUFF ARTHROSCOPIC ROTATOR CUFF REPAIR Primarily to stabilize and centralize the humeral head GENERAL GUIDE LINES Achieved by balancing the force couples in coronal and transverse
Shoulder 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
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
ANATOMIC TOTAL SHOULDER REPLACEMENT:
The Shoulder Replacement A total shoulder arthroplasty (TSA) is a surgery to replace the damaged parts of the ball and socket shoulder joint with an artificial prosthesis. The damage to the shoulder can
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,
Anatomic Total Shoulder Arthroplasty: Optimizing Outcomes and Avoiding Complications
Anatomic Total Shoulder Arthroplasty: Optimizing Outcomes and Avoiding Complications Dr. Ryan T. Bicknell, MD, MSc, FRCSC Associate Professor Division of Orthopaedic Surgery, Departments of Surgery, Mechanical
Massive Rotator Cuff Tears. Rafael M. Williams, MD
Massive Rotator Cuff Tears Rafael M. Williams, MD Rotator Cuff MRI MRI Small / Partial Thickness Medium Tear Arthroscopic View Massive Tear Fatty Atrophy Arthroscopic View MassiveTears Tear is > 5cm
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
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
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,
Index. ESSKA 2018 G. Milano et al. (eds.), Management of Failed Shoulder Surgery,
A Acromial fractures, 186 Acromioclavicular joint (ACJ) instability, 55, 97 case study, 98 100 classification, 85 clinical relevant situations, 86 dislocation, 97 98 insufficient fixation, 87 88 operative
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
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
Options for the Irreparable RCT 3/9/2018. Your Patient has an Irreparable RC Tear: What Now? Asheesh Bedi, MD
Your Patient has an Irreparable RC Tear: What Now? Asheesh Bedi, MD Harold and Helen W. Gehring Professor Chief, Sports Medicine & Shoulder Surgery MedSport, Department of Orthopedic Surgery Head Team
)19( COPYRIGHT 2019 BY THE ARCHIVES OF BONE AND JOINT SURGERY
)19( COPYRIGHT 2019 BY THE ARCHIVES OF BONE AND JOINT SURGERY RESEARCH ARTICLE Failure of Anatomic Total Shoulder Arthroplasty with Revision to Another Anatomic Total Shoulder Arthroplasty Mihir Sheth,
11/13/2017. Disclosures: The Irreparable Rotator Cuff. I am a consultant for Arhtrex, Inc and Endo Pharmaceuticals.
Massive Rotator Cuff Tears without Arthritis THE CASE FOR SUPERIOR CAPSULAR RECONSTRUCTION MICHAEL GARCIA, MD NOVEMBER 4, 2017 FLORIDA ORTHOPAEDIC INSTITUTE Disclosures: I am a consultant for Arhtrex,
Use of a partial humeral head resurfacing system for management of an osseous mechanic... Page 1 of 12 Int J Shoulder Surg. 2011 Jan-Mar; 5(1): 17 20. doi: 10.4103/0973-6042.80465. PMCID: PMC3109768 Copyright
Les séquelles traumatiques. Ph. Valenti, J. Kany, D. Katz
Indications et Techniques Les séquelles traumatiques Ph. Valenti, J. Kany, D. Katz Paris Shoulder Unit Clinique Bizet (Paris, France) Disclosures Arthroplasty Consultant : FH orthopaedics receive royalties
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
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:
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
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
The Shoulder. By Patrick Ryan, Bobby Law, Jack Beaty, Alex Newhouse and Chuck Nelson
The Shoulder By Patrick Ryan, Bobby Law, Jack Beaty, Alex Newhouse and Chuck Nelson Learning Objectives/Agenda Review the anatomy of the shoulder Describe the main diseases of the shoulder Describe the
Clinical Outcomes and Complications during the Learning Curve for Reverse Total Shoulder Arthroplasty: An Analysis of the First 40 Cases
Original Article Clinics in Orthopedic Surgery 2017;9:213-217 https://doi.org/10.4055/cios.2017.9.2.213 Clinical Outcomes and Complications during the Learning Curve for Reverse Total Shoulder Arthroplasty:
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,
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.
Natural History of RTC Disease Is Non Op Treatment OK in a Young Person? Leesa M. Galatz, MD COI Disclosure Information Leesa M.
Natural History of RTC Disease Is Non Op Treatment OK in a Young Person? Leesa M. Galatz, MD Mount Sinai Professor of Orthopedics Leni and Peter May Department of Orthopedic Surgery Icahn School of Medicine
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
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
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
Strategies 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:
ICL 2: Cartilage Early Osteoarthritis & Cartilage Repair Pathogenesis Diagnosis: Imaging/Bio-marker Treatment Alignment
Preliminary Program TOSSM 2019 (Sheraton Hua Hin. Thursday 25- Saturday 27 May 2019) Thursday.25 July 2019 08.00-09.00 ICL 1: Knee Getting good results in ACL reconstruction Patient selection and graft
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
Shoulder 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
SHOULDER ANATOMY AND FUNCTION. Disclosure. Case. Learning Objectives MRI. Plan? 3/23/2017 5
Disclosure Doc, My Shoulder Keeps me Up at Night! Evaluation and Treatment of Atraumatic Shoulder Pain Matthew F. Dilisio, MD Shoulder and Elbow Surgery, CHI Health Orthopedics Assistant Professor, Creighton
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
Common Shoulder Problems and Treatment Options. Benjamin W. Szerlip D.O. Austin Shoulder Institute
Common Shoulder Problems and Treatment Options Benjamin W. Szerlip D.O. Austin Shoulder Institute Speaker Disclosure Dr. Szerlip has disclosed that he has no actual or potential conflict of interest in
Shoulder hemiarthroplasty in the management of humeral head fractures
Acta Orthop. Belg., 2004, 70, 214-218 ORIGINAL STUDY Shoulder hemiarthroplasty in the management of humeral head fractures Joseph J. CHRISTOFORAKIS, George M. KONTAKIS, Pavlos G. KATONIS, Konstantinos
1. 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
Conversion of Anatomic TSA to RSA
Conversion of Anatomic TSA to RSA Joseph A. Abboud, M.D. Professor of Shoulder and Elbow Surgery Senior Vice-President at the Rothman Institute Philadelphia, PA Disclosures Joseph A. Abboud, MD Depuy Synthes
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,
Fracture complexe ESH Que choisir? Hémi ou Inversée Ph Valenti Paris
Fracture complexe ESH Que choisir? Hémi ou Inversée Ph Valenti Paris Proximal Complex fracture of the humerus Surgeon is not always happy!!!! Reduction is not anatomical!!!! Great tuberosity is not reduced!!!
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
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.
Convertibilité. Ph. Valenti. Paris Shoulder Unit Clinique Bizet (Paris, France)
Convertibilité Ph. Valenti Paris Shoulder Unit Clinique Bizet (Paris, France) Disclosures Arthroplasty Consultant : FH orthopaedics receive royalties Arthroscopy Consultant : Zimmer Biomet Arthrex In Last
Rotator Cuff Repair Outcomes. Patrick Birmingham, MD
Rotator Cuff Repair Outcomes Patrick Birmingham, MD Outline Arthroscopic Vs. Mini-open Subjective Outcomes Objective Outcomes Timing Arthroscopic Vs. Mini-open Sauerbrey Arthroscopy 2005 Twenty-six patients
"Stability and Instability of RTSA"
Orthopedics Update «Reverse Total Shoulder Arthroplasty» Stability and Instability of RTSA A. LÄDERMANN Orthopaedics and Traumatology, La Tour Hospital, Meyrin, Switzerland Orthopaedics and Traumatology,
2nd madrid. shoulder course. msc. MADRID - October 18-19, Chairmen: Samuel Antuña Emilio Calvo Fernando Marco
2nd Chairmen: Samuel Antuña Emilio Calvo Fernando Marco www..com 2 2nd Index General Information 04 Faculty 05 Scientific Program Thursday October 18th 06 Friday October 19th 10 Traducción simultánea Inglés
Shoulder Arthroplasty
Shoulder Arthroplasty Nathan G. Everding, MD Specializing in Hand, Wrist, Elbow & Shoulder Surgery Syracuse Orthopedic Specialists SJH Family Practice Refresher course 3/8/19 Shoulder Arthroplasty Rate
WEEKEND 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
Reverse Total Shoulder. Dr. Minoo Patel
Reverse Total Shoulder Dr. Minoo Patel AOA VIC, Lorne, 2011 The role of the rotator cuff Depress and humeral head (against the force of the deltoid) Keep the humeral head co-apted in the glenoid Initiate
Index. A Abduction arm motion, 170 dislocation in, 109
Index A Abduction arm motion, 170 dislocation in, 109 internal rotation standing plyometrics in neutral, 132 isometric shoulder, 83 prone, 84 shoulder position, 101, 119 Acromioplasty, 121 Active/passive
Management of Glenoid and Humeral Bone Loss in Shoulder Instability
Short Stem and Long Stem Professor, Department of Orthopedics Head, Section of Shoulder and Elbow Surgery Team Physician, Chicago White Sox and Bulls Chief Medical Editor, Orthopaedics Today Short Stem
Shoulder 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
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
Total Shoulder Arthroplasty
1 Total Shoulder Arthroplasty Surgical indications and contraindications Anatomical Considerations: Total shoulder arthroplasty surgery involves the replacement of the humeral head and the glenoid articulating
Current Controversies in Shoulder Surgery:
Current Controversies in Shoulder Surgery: Shoulder Instability Rotator Cuff Injury and Repair Reverse Shoulder Arthroplasty Brian Feeley, MD UC San Francisco Sports Medicine and Shoulder Surgery Disclosures
2nd madrid. shoulder course. msc. MADRID - October 18-19, Chairmen: Samuel Antuña Emilio Calvo Fernando Marco
Chairmen: Samuel Antuña Emilio Calvo Fernando Marco www..com 2 Index General Information 04 Faculty 05 Scientific Program Thursday October 18th 06 Friday October 19th 10 3 General information Dates October
Dr. 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
Operative skills have advanced sufficiently so that. Arthroscopic Treatment of Multidirectional Glenohumeral Instability: 2- to 5-Year Follow-up
Arthroscopic Treatment of Multidirectional Glenohumeral Instability: 2- to 5-Year Follow-up Gary M. Gartsman, M.D., Toni S. Roddey, Ph.D., P.T., O.C.S., and Steven M. Hammerman, M.D. Purpose: We present
MSK Covered Services. Musculoskeletal: Joint Metal-on-metal total hip resurfacing, including acetabular and femoral components
CPT CODE S2118 MSK Covered Services Musculoskeletal: Joint Metal-on-metal total hip resurfacing, including acetabular and femoral components 23000 Removal of subdeltoid calcareous deposits, open 23020
ARTICLE COVER SHEET. LWW TECHNIQUES FLA, SF, LTE and Case Study & Review
ARTICLE COVER SHEET LWW TECHNIQUES FLA, SF, LTE and Case Study & Review Article : BTE20100 Creator : dj44 Date : 4/2/2008 Time : 11:1 Article Title : Number of Pages (including this page) : 8 Template
The use of the Lima reverse shoulder arthroplasty for the treatment of fracture sequelae of the proximal humerus
J Orthop Sci (2012) 17:141 147 DOI 10.1007/s00776-011-0185-5 ORIGINAL ARTICLE The use of the Lima reverse shoulder arthroplasty for the treatment of fracture sequelae of the proximal humerus Angel Antonio
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
Degenerative joint disease of the shoulder, while
Arthroscopic Debridement of the Shoulder for Osteoarthritis David M. Weinstein, M.D., John S. Bucchieri, M.D., Roger G. Pollock, M.D., Evan L. Flatow, M.D., and Louis U. Bigliani, M.D. Summary: Twenty-five
Instability After Reverse Total Shoulder Arthroplasty: Which Patients Dislocate?
An Original Study Instability After Reverse Total Shoulder Arthroplasty: Which Patients Dislocate? Eric M. Padegimas, MD, Benjamin Zmistowski, MD, Camilo Restrepo, MD, Joseph A. Abboud, MD, Mark D. Lazarus,
Technique. Aequalis Resurfacing Humeral Head
S u r g i c a l Technique Aequalis Resurfacing Humeral Head 1 The Aequalis Resurfacing Humeral Head has been developed in conjunction with Drew Miller, MD - Atlanta, GA. The Aequalis Resurfacing Humeral
)532( COPYRIGHT 2018 BY THE ARCHIVES OF BONE AND JOINT SURGERY
)532( COPYRIGHT 2018 BY THE ARCHIVES OF BONE AND JOINT SURGERY RESEARCH ARTICLE The Midterm Results of the Delta Xtend Reverse Shoulder System: A Five-Year Outcome Study John G. Horneff, MD; Thema A. Nicholson,
Asymptomatic acromioclavicular joint arthritis in arthroscopic rotator cuff tendon repair: a prospective randomized comparison study
Arch Orthop Trauma Surg (2011) 131:363 369 DOI 10.1007/s00402-010-1216-y ARTHROSCOPY AND SPORTS MEDICINE Asymptomatic acromioclavicular joint arthritis in arthroscopic rotator cuff tendon repair: a prospective
Boomeritis: The Shoulder
Boomeritis: The Shoulder James T. Mazzara, M.D. Connecticut Center for Orthopedic Surgery Manchester / Wethersfield Manchester Memorial Hospital / Hartford Hospital Patient Education Disclaimer This presentation
I (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)
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