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 shoulder Review common shoulder injuries requiring surgery

Four Joints: Glenohumeral Scapulothoracic Acromioclavicular Sternoclavicular

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

Rotator Cuff Muscles Anatomy S Supraspinatus I Infraspinatus T - Teres minor S- Supscapularis

Anatomy Rotator Cuff

Anatomy - Rotator Cuff

Shoulder Injuries Shoulder Instability SLAP Tear (Superior Labrum Anterior to Posterior) AC Joint Dislocation/Separation Rotator Cuff Tears Fractures + Fracture/Dislocation

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

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 4.25 : 1) Subluxations included Main cause = sports: Falls Collisions

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

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

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%

Open Bankart Stabilisation Procedure

Arthroscopic Bankart Procedure

Open Laterjet Procedure

SLAP Tear (Superior Labrum Anterior to Posterior)

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

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"

Arthroscopic SLAP Repair

AC Joint Dislocation AC Sprain / Separation Typically due to fall onto tip of shoulder (acromion) Treatment depends on type

AC Joint Dislocation/Separation

Rotator Cuff Tears Partial Thickness vs. Full Thickness Four classical tear patterns: Crescent-shaped U-shaped L-shaped Massive, contracted, immobile tears

Crescent-Shaped RC Tear

U-Shaped RC Tear

Acute L-shaped RC Tear

Chronic L-shaped RC Tear

Massive Contracted RC Tear

Arthroscopy + RC Repair Portals

Arthroscopy + Glenohumeral Portals

Arthroscopy + Subacromial Portals

Shoulder Arthroscopy Posterior Portal View

Type of Repair: Single vs. Double Row?

Fractures Around the Shoulder Clavicle Proximal Humerus Fracture -Dislocations

Clavicle Fractures Up to 5% of all fractures 60-80 % = mid-shaft clavicle 10 30% = lateral clavicle

Midshaft Clavicle Fractures

Lateral Clavicle Fractures

Proximal Humerus Fractures

Fracture Non-Union

Fracture Mal-Union

Fracture-Dislocation

One Year Post Op

Severe Mal-Union Post Fracture Resurfacing Hemiathroplasty

Massive Rotator Cuff Tear + OA

64yr Massive Rotator Cuff Tear

64 yr Partial Resurfacing Hemiarthroplasty

Severe Fracture Humerus

When You Thought You Have Seen It All

Thank You