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

Similar documents
MRI SHOULDER WHAT TO SEE

SHOULDER INSTABILITY

ROTATOR CUFF DISORDERS/IMPINGEMENT

Management of Anterior Shoulder Instability

SHOULDER PROBLEMS & ARTHROSCOPIC MANAGEMENT

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

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

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

Chronic Shoulder Disorders


Common Surgical Shoulder Injury Repairs

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

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

Shoulder Joint Examination. Shoulder Joint Examination. Inspection. Inspection Palpation Movement. Look Feel Move

11/13/2017. Disclosures: The Irreparable Rotator Cuff. I am a consultant for Arhtrex, Inc and Endo Pharmaceuticals.

Acute Orthopaedic Injuries Developing a Diagnostic Approach to the Shoulder

2015 OPSC Annual Convention. syllabus. February 4-8, 2015 Hyatt Regency Mission Bay San Diego, California

SHOULDER ANATOMY AND FUNCTION. Disclosure. Case. Learning Objectives MRI. Plan? 3/23/2017 5

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

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

Shoulder examination. P Sripathi Rao Arthroscopy & Sports Injuries Unit Dean, Kasturba Medical College

RECURRENT SHOULDER DISLOCATIONS WITH ABSENT LABRUM

Diagnostic and Management Approach to the Painful Shoulder

Pearson Education Limited Edinburgh Gate Harlow Essex CM20 2JE England and Associated Companies throughout the world

Review shoulder anatomy Review the physical exam of the shoulder Discuss some common causes of acute shoulder pain Discuss some common causes of

POSTERIOR INSTABILITY OF THE SHOULDER Vasu Pai

Management of Massive/Revision Rotator Cuff Tears

Stefan C Muzin, MD PM&R Attending Physician, Beth Israel Deaconess Medical Center, Harvard Medical School Onsite Physiatrist, GE Aviation, Lynn, MA

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

Massive Rotator Cuff Tears. Rafael M. Williams, MD

The Shoulder. Jill Inouye Primary Care Sports Medicine Family Medicine Resident School February 26, 2014

Considerations 3/9/2018. Asheesh Bedi, MD. I have no disclosures or conflicts of interest related to the content of this presentation.

Evaluating shoulder injuries in primary care Bethany Reed, MSn, AGPCNP-BC One Medical Group

2/19/2014. Things I love. What s new in shoulder surgery? What s new in medicine? Outline. Focus on problem-based learning for medical school

Current Controversies in Shoulder Surgery:

MRI of Shoulder Instabilities

US finding of the shoulder (with live demonstration) 인제의대상계백병원 안재기

Page 1. Shoulder Injuries in Sports.

Physical Examination of the Shoulder

DK7215-Levine-ch12_R2_211106

Recurrent Shoulder Dislocation.

The Shoulder. Jennifer R Marks, MD

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

Diagnosis: Significant atrophy of supraspinatus FATTY INFILTRATION AND CUFF ATROPHY

DISTINGUISHING BETWEEN ACUTE AND CHRONIC ROTATOR CUFF INJURIES IN WORKERS COMPENSATION PATIENTS

EVALUATION OF ACUTE SHOULDER INJURIES. Douglas J. Moran, MD Orthopaedic Sports Medicine

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

Shoulder joint Assessment and General View

Patient Presentation. Prevalence of Rotator Cu Tears. By Derek S. Shia, M.D.

Shoulder Anatomy and a preface on the Shoulder Arthroscopy.

Ultrasound of Shoulder Pathology and Intervention 서울대학교병원재활의학과 김기원

Shoulder Ultrasonography as a Diagnostic Tool for Rotator Cuff Disease

Shoulder Instability and Tendon Injuries

Shoulder Arthroscopy Lab Manual

WEEKEND 2 Shoulder. Shoulder Active Range of Motion Assessment

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

Glenohumeral Joint Instability: An Athlete s Perspective

Shoulder Injuries. Glenoid labrum injuries. SLAP Lesions

Glenohumeral Capsule Tears in Baseball Pitchers

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

Shoulder Instability

The Shoulder. Systematically scanning the shoulder provides extremely useful diagnostic information. The Shoulder

Anterior shoulder instability: Evaluation using MR arthrography.

Rotator Cuff Tendinopathy

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

Shoulder Pain

SSSR. 1. Nov Shoulder Prosthesis. Postoperative Imaging. Florian M. Buck, MD

Burwood Road, Concord 160 Belmore Road, Randwick

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

Shoulder Arthroscopy Portals

Natural History of RTC Disease Is Non Op Treatment OK in a Young Person? Leesa M. Galatz, MD COI Disclosure Information Leesa M.

Shoulder Injury Evaluation.

Lawrence Gulotta Gillian Lieberman, MD October Gillian Lieberman, MD. Shoulder Imaging. Lawrence V. Gulotta, HMS IV 10/16/02

ANTERIOR SHOULDER STABILIZATION CLINICAL PRACTICE GUIDELINE

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

UPPER EXTREMITY INJURIES. Recognizing common injuries to the upper extremity

Mastering the Musculoskeletal Exam UCSF Essentials of Women s Health July 7, 2016 Carlin Senter, M.D. Henry Crevensten, M.D.

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

Subacromial Impingement (diagnostic methods )

SLAP Lesions Assessment & Treatment

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

Gregory P. Nicholson, M.D. Disclosures. Indications for Open RCR. Open RC Repairs 2015 and Role of Tendon Transfers. Associate Professor

EBP- An Examination of Special Tests for the Shoulder Module 4 Questions

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

SHOULDERS MADE DR DR CHRIS MILNE SPORTS PHYSICIAN

WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 2134/16

Shoulder Pain: Diagnosis and Management

SHOULDER INSTABILITY

Management of arthritis of the shoulder. Omar Haddo Consultant Orthopaedic Surgeon

The Shoulder. By Patrick Ryan, Bobby Law, Jack Beaty, Alex Newhouse and Chuck Nelson

AMSER Case of the Month January 2019

The examination of the painful knee. Maja K Artandi, MD, FACP Clinical Associate Professor of Medicine Stanford University

Shoulder arthroscopy. Mohammad nasir Naderi, MD Fellowship in shoulder and arthroscopic surgery

Shoulder Case Studies

P V S MEMORIAL HOSPITAL LTD.

Acromioplasty. Surgical Indications and Considerations

APPROPRIATE USE GUIDELINES

OCCUPATIONAL SHOULDER DISORDERS

Timothy S. Ackerman, D.O. Arlington Orthopedics Harrisburg, PA

Transcription:

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 Volontary

Traumatic anterior instability Incidence: 1,7% annually Recurrence rate: 90% <20 yrs Recurrence rate: 60% 20-40yrs Recurrence rate: <10% >40 yrs

Pathoanatomy Capsulolabral avulsion (Bankart) Capsular redundancy Bony defect (Hill Sachs/Glenoid)

Physical examination Generalized ligamentous laxity? Load and Shift test Apprehension Relocation Sulcus sign Posterior apprehension?

Imaging X ray (AP, scapular AP, axillary, West Point, Stryker notch) CT (bony defect) MRI (soft tissue,labrum, HAGL)

Surgical indications Failure of conservative treatment Patiënts < 25 yrs High demand sports Bony defect Rotator cuff tears

Treatment algorithm

Contra indications arthroscopic stabilization Engaging Hill-Sachs Bony defect > 20% anteroinferior glenoid Inverted pear

Engaging Hill-Sachs lesion

Open Bankart/Latarjet Young patients. Overhead, Collision sports Low recurrence rate Bony defect Engaging Hill-Sachs Inverted pear (>20% glenoid bone loss)

Arthroscopy: Set Up Beach chair Lateral decubitus

Arthroscopy Normal anatomy

Bankart repair

Bankart repair

Bankart repair

Surgical complications Recurrence Stiffness/Overtightening Subscapularis failure Anchor pull out Nervous injury (axillary nerve)

Postoperative clinical failures Failure to rule out concomitant cuff injury Failure to anatomically reconstruct anteroinferior labrum of IGHL Failure to recognize bony defects Inadequate capsular shift Inadequate retensioning IGHL

Rotator Cuff Tear Prevalence (full thicknes): 7-40% Increase with patient age Enlargement painfull cuff tears in time > 80 yr: up to 50%: asymptomatic Partial thickness: progression in size and symptoms

Anatomy Rotator Cuff

Anatomy Rotator Cuff

Rotator cuff

Pathoanatomy Intrinsic: changes collagen,proteoglycan, watercontent, vascularity Age dependant/degeneration Extrinsic: mechanical etiology/coracoacromial arch)

History <40 yrs: acute traumatic onset 50-60 yrs: traumatic/atraumatic >60 yrs: atraumatic

Classification Acute (< 3 months) Chronic (> 3 months) Acute on chronic (enlargement small tear) Full/Partial thickness Small, Medium, Large, Massive tears 1, 2 or 3 tendon involvement Partial (bursal, articular, < or> 50% thickness)

Physical Examination (1) Muscle atrophy Palpation (GT,AC,biceps,coracoid) Acive/Passive ROM Neer and Hawkins test Empty can and Jobe Lift-off test

Lift-off test

Physical examination (2) Resisted elevation test (supraspinatus) External rotation test (infraspinatus/teres m) External rotation lag sign (infraspinatus) Hornblower (teres minor) Lift-off/Abdominal compression (subscap) Deltoid integrity

Imaging X ray (true AP, acromiohumeral interval) X ray (external/internal rotation) Supraspinatus outlet (acromion morphology) Axillary view MRI (gold standard) Ultrasonography (accurate, operator dependant)

Imaging - Xray

Imaging - Ultrasound

Imaging: MRI MRI coronal T2 image MRI saggital oblique, retraction, atrophy, fatty infiltration

Imaging - MRI

Treatment (non surgical) Avoidance provocative moments Ice application NSAID s Physical therapy, deltoid strengthening Subacromial corticosteroid infiltration Elderly patients (degenerative tear)

Treatment (surgical) Failure of non-surgical treatment Acute traumatic tear (young patient) Acute loss of strength (any age) Good quality muscle No glenohumeral degeneration

Contra indication surgical repair Chronic infection Glenohumeral arthritis Retracted tendon Fatty infiltration Significant muscle atrophy Fixed proximal migration (AH interval < 7 mm) Deltoid/Axillary nerve dysfunction Bad prognostic factors (smoking, DM, high age, comorbidity

Literature J Shoulder Elbow Surg. 2015 Aug;24(8):1274-81. doi: 10.1016/j.jse.2015.05.040. Comparing surgical repair with conservative treatment for degenerative rotator cuff tears: a randomized controlled trial. Lambers Heerspink FO 1, van Raay JJ 2, Koorevaar RC 3, van Eerden PJ 4, Westerbeek RE 5, van 't Riet E 3, van den Akker-Scheek I 6, Diercks RL 6. CONCLUSION: In our population of patients with degenerative rotator cuff tears who were randomly treated by surgery or conservative protocol, we did not observe differences in functional outcome as measured with the CMS 1 year after treatment. However, significant differences in pain and disabilities were observed in favor of surgical treatment. The best outcomes in function and pain were seen in patients with an intact rotator cuff postoperatively.

Surgical repair Arthroscopic repair Mini-open repair (small and medium tears) Open repair (all sizes)

Rotator cuff repar constructs Single row repair (simple suture/mattress) Double row repair (medial and lateral based anchors) Transosseous equivalent

Complications Infection (Proprionibact acnes) Deltoid dehiscence Recurrent tear Iatrogenic injury suprascap nerve Stiffness (cave low grade infection) Missed other pathologic conditions (biceps, AC, instability, arthritis, cervical/neurological pathology)

Arthroscopic repair

Arthroscopic repair

Arthroscopic repair

Traumatic Shoulder Instability Take Home: 4 times a row Recurrency dependant on age Repair Capsulolabral avulsion Repair/Correct Capsular redundancy Recognition significant bony defects

Rotator cuff tear Take Home Partial tears progress in size and symptoms MRI (sagittal): retraction,atrophy Older patients do well with non-surgical treatment Maintain integrity CA ligament Rule out bad prognostic factors

2024 © healthdocbox.com Privacy Policy | Terms of Service | Feedback