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/

1. Attention Athletes of All Ages
An Owners Guide to Shoulders
Vivek Agrawal, MD
Director
The Shoulder Center

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. Shoulder Anatomy and Function

4. Shoulder Anatomy and Function

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. The Shoulder
• Flat socket
(glenoid) means
that soft tissues
(labrum, capsule,
ligaments,
muscles) provide
most of the support

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. The Shoulder

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. Acromioplasty

11. Acromioplasty

12. Frozen Shoulder

13. Unstable Shoulder
Wispy (Thin) Capsule No Bumper Cushion

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. Unstable Shoulder
Bumper Cushion Circle Concept

16. Circle Concept

17. Unstable Shoulder
First Dislocation Age Risk of Ongoing Instability

18. Unstable Shoulder
• The risk of developing
arthritis increases with the
number of episodes of
dislocation or subluxation.

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. 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. Suprascapular Nerve

22. Suprascapular Nerve

23. Rotator Cuff Repair

24. Subscapularis Repair
Present in 27-35% of cases. Frequently missed.

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. Healed Rotator Cuff Repair

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. • 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. Rotator Cuff Outcome

30. Shoulder Arthritis
Normal Joint Space Arthritis and Rotator Cuff Tear

31. Shoulder Arthritis

32. Shoulder Arthritis
Total Shoulder with Rotator Cuff
Tear
Partial Replacement with Rotator
Cuff Tear

33. Total Shoulder Replacement
Total Shoulder Reverse Total Shoulder

34. Reverse Total Shoulder

35. RSA for Fracture

36. Thank You
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