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An Owners Guide to Shoulders

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1. Shoulder Anatomy and Function Overview
2. Exercises for Healthy Shoulders
3. Good vs. Bad Pain
4. Overview of Common Sources of Shoulder Pain and Debility
5. Cutting Edge Treatments
6. Frozen Shoulder
- Causes and Treatment options

7. Unstable Shoulder
- Advances in Treatment

8. Rotator Cuff Tears -
Best Surgical Options Today
- Surgery Not Always Best Option

9. Shoulder Arthritis
- Many types of new surgeries
more at https://www.TheShoulderCenter.com/


Published in: Health & Medicine
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An Owners Guide to Shoulders

  1. 1. Attention Athletes of All Ages An Owners Guide to Shoulders Vivek Agrawal, MD Director The Shoulder Center
  2. 2. Owners’ Guide to Shoulders • Shoulder Anatomy and Function Overview • Exercises for Healthy Shoulders? • Good vs. Bad Pain • Overview of Common Sources of Shoulder Pain and Debility • Cutting Edge Treatments • Frozen Shoulder – Causes and Treatment options • Unstable Shoulder – Advances in Treatment • Rotator Cuff Tears – Best Surgical Options Today – Surgery Not Always Best Option • Shoulder Arthritis – Many types of new surgeries
  3. 3. Shoulder Anatomy and Function
  4. 4. Shoulder Anatomy and Function
  5. 5. The Shoulder • Most mobile joint in body • Very little inherent stability • Human joints are marvels of engineering – Provide “cushion” and “lubricity” – Highly “slick” coefficient of friction 0.01-0.004 – Teflon 0.05 – BAM (new ceramic with Boron, Al, Mg) 0.02 • Second hardest material after diamond
  6. 6. The Shoulder • Flat socket (glenoid) means that soft tissues (labrum, capsule, ligaments, muscles) provide most of the support
  7. 7. The Shoulder • A delicate balance of all these tissues keeps the shoulder balanced and stable • Injury, overuse, or compensation can disrupt this balance.
  8. 8. The Shoulder
  9. 9. Shoulder Arthroscopy • Ability to diagnose and treat a greater spectrum of concurrent shoulder pathology • Much lower risk of infection and stiffness • Earlier functional recovery • Avoid injury to normal tissues • Minimal scar
  10. 10. Acromioplasty
  11. 11. Acromioplasty
  12. 12. Frozen Shoulder
  13. 13. Unstable Shoulder Wispy (Thin) Capsule No Bumper Cushion
  14. 14. Arthroscopic Repair • The best repairs are much more than just a labrum repair. • Balance to the entire shoulder must be restored. Restore Bumper Cushion
  15. 15. Unstable Shoulder Bumper Cushion Circle Concept
  16. 16. Circle Concept
  17. 17. Unstable Shoulder First Dislocation Age Risk of Ongoing Instability
  18. 18. Unstable Shoulder • The risk of developing arthritis increases with the number of episodes of dislocation or subluxation.
  19. 19. Arthroscopic Repair • State of the Art Repair requires sutures and tying knots • Avoid thermal probes and knotless anchors • 5:1 failure rate knotless: knot
  20. 20. Complications • Catastrophic Chondrolysis – Intraarticular pain pumps • Local anesthetic toxic to cartilage – Knotless Suture Anchors • Five fold failure rate for instability (4.9% vs. 23.8%) • Windshield wiper phenomenon shears cartilage – Thermal Shrinkage • High failure rates • Nerve, Capsule, and Cartilage Injury/Damage
  21. 21. Suprascapular Nerve
  22. 22. Suprascapular Nerve
  23. 23. Rotator Cuff Repair
  24. 24. Subscapularis Repair Present in 27-35% of cases. Frequently missed.
  25. 25. State of the Art • Improving Healing Rates and Outcomes for Rotator Cuff Tears with Graft Augmentation • More than doubles the healing rates for complex tears.
  26. 26. Healed Rotator Cuff Repair
  27. 27. • 14 patients • MRI at 16.8 months avg. • 86% intact (12/14) • 14% < 1cm discontinuity (2/14) • Strength:1.73 kg to 7.52 kg (p=0.006)
  28. 28. • Barber et al, Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 28, No 1 (January), 2012: pp 8-15 • 22 Patients in GRAFTJACKET arm – 30-60 minutes additional operative time • 20 Patients in Control arm • 24 month mean follow-up • MRIs at 12 months minimum • 85% healing in GRAFTJACKET • 40% healing in Control • Dr. Barber-"This multi-center clinical study supported the hypothesis that augmentation with GRAFTJACKET® Matrix resulted in improved repair healing for large rotator cuff tears and provided statistically better functional outcome scores." FIGURE 5. Once in place, the augmenting graft is secured by tying each short-tailed interference knot to the corresponding suture. © Dr. F. Alan Barber.
  29. 29. Rotator Cuff Outcome
  30. 30. Shoulder Arthritis Normal Joint Space Arthritis and Rotator Cuff Tear
  31. 31. Shoulder Arthritis
  32. 32. Shoulder Arthritis Total Shoulder with Rotator Cuff Tear Partial Replacement with Rotator Cuff Tear
  33. 33. Total Shoulder Replacement Total Shoulder Reverse Total Shoulder
  34. 34. Reverse Total Shoulder
  35. 35. RSA for Fracture
  36. 36. Thank You www.TheShoulderCenter.com

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