Arthroscopic Lat Dorsi Transfer 2017
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Arthroscopically assisted latissimus dorsi transfer is a viable option for treatment of patients in their 50s to 70s, without arthritis of the glenohumeral joint, who suffer from massive postero-superior rotator cuff tears that are not amendable to primary repair or that have failed previous repair attempts.
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the common questions patients will ask once they have had a scan and a tear has been reported, particularly if they have had no injury of trauma, they ask what caused my tear. If I have a tear what can you do to fix it, it’s got to be fixed. How can I get better if it is not fixed. I have already had physiotherapy and that didn’t fix it so how will more physiotherapy. Some patients who are not keen on surgery, do I really need to have an operation. I have not had an injury.
there are multiple options thrown into the mix here which we need to consider for an individual patient.
The below illustration shows a very rough decision making tool that I would use in determining surgical or treatment options for particular patients.
A younger patient who has both pain and weakness with a massive cuff tear, if it is partially repairable a biological augment would be suitable.
If their predominant weakness is external rotation i.e. a positive Hornblower sign but good elevation, a lat dorsi tendon transfer.
For an older patient who has a predominant weakness but no significant pain, deltoid rehabilitation programme is indicated.
If they do have pain, a suprascapular nerve procedure such as an ablation would be beneficial.
For those that have significant pain and weakness with failed non-operative options, a reverse shoulder replacement would be the best option.
The balloon as we said, has a very limited place and this is for the older patient with slight loss of function and pain with higher demands.
For those that have more significant pain and elevation weakness, a superior capsular reconstruction would be my preferred option.
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Anterior shoulder Instability in the young athlete 2020 bostaa
This document discusses anterior glenohumeral joint instability in younger athletes. It notes that recurrence rates after non-operative treatment are high, between 70-100% in most studies. Arthroscopic stabilization also has high recurrence rates, particularly in those under age 16. The Latarjet procedure has shown good outcomes in both adolescent and adult populations with low recurrence rates and high rates of return to previous sport levels. For a semi-pro rugby player with anterior instability, surgery may be considered given the presence of major structural lesions, inability to continue playing, and pressures to return mid-season. The Latarjet procedure would be a good surgical option in this younger athlete population.
Superior Capsular Reconstruction Outcomes Wrightington 2020
Hariharan Mohan, Jagwant Singh, Michael Walton, Lennard Funk, Puneet Monga
Cautious optimism following SCR may be offered to this challenging subset of patients with symptomatic irreparable rotator cuff tears. It is likely that the relatively low re-operation rates can be further improved by considering the negative prognostic factors in defining indications for surgery. Further studies with longer term followup are recommended.
Shoulder Instability Sports - Decision Making
Lennard Funk presented on the clinical and radiological assessment of shoulder instability in athletes. He discussed evaluating anterior and posterior instability through physical examination tests in different positions and assessing glenoid and humeral bone loss on imaging studies like MRI arthrograms. Funk also covered management strategies and decision making, which involves considering factors related to the patient, their profession, the type and extent of pathology, and the treating physician.
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Isolated scapula pain is uncommon, but very difficult to diagnose and manage. In this presentation I run through the known causes and an approach to the diagnosis, in order to guide best treatment.
The Incidence of Traumatic Posterior and Combined Labral Tears in Patients Un...
Posterior and combined labral tears are more common than previously thought, especially in young active populations. The study reviewed 442 patients undergoing shoulder stabilization surgery and found that posterior and combined tears accounted for 47% of cases, compared to only 53% being isolated anterior tears. Rates of posterior and combined tears were even higher in sporting populations (52%) compared to non-sporting populations (32%). Rugby players in particular had a high rate of posterior and combined tears (53%). The study concludes that posterior and combined shoulder instability is more prevalent than reported, especially in contact sports.
Pectoralis major allograft reconstruction
Presentation at ISAKOS, 2019
We performed a total of 142 pectoralis major repairs over a ten year period, of which 19 required allograft reconstruction. Of these 19 patients, 11 were available for response. All 11 patients were male with a mean age of 38.3 years (21 to 48 years). The mean time between injury and surgery was 12.2 months (4 to 30 months). Ten patients (91%) were unable to perform their previous level of work pre-operatively, with all patients returning to pre-injury occupation levels post-operatively.
The main complaint prior to surgery was pain on pushing and moving the affected arm across the body, which improved in nine patients (82%), with no improvement reported in two patients. Strength improved significantly post-operatively, with only three patients reporting no improvement (paired t-test p=0.01). Six patients reported an improvement in cosmesis (50%).
What the surgeon wants from radiologist
The document discusses shoulder injuries in sports. It provides guidance on what information is important to understand from MRI reports for rotator cuff tears, including the size and location of the tear and the extent of muscle atrophy. It emphasizes the importance of collaboration between surgeons and radiologists for accurate diagnoses. The treatment approach for sports injuries depends on factors like the patient's age, type of sport played, and time since injury.
Rotator cuff tear management 2019
Rotator cuff tears do not always require surgical repair. The decision depends on factors like the patient's age and activity level as well as the size and chronicity of the tear. Smaller tears in younger, more active patients may heal with non-operative treatment or repair, while larger, chronic tears in older individuals often do not heal after repair. When repair is not indicated for massive, irreparable tears, options include tendon transfers, superior capsular reconstruction, augmented repairs, and InSpace balloon spacers. Ultrasound is useful for initial evaluation and post-operative monitoring but MRI may better assess tear size and tissue quality factors that predict repair outcomes.
Perioperative pain management toni hundle the arm clinic 2019
Peri-operative pain management from Anaesthetist, Dr Toni Hundle for The Arm Clinic at HCA The Wilmslow Hospital 2019
Hydrodistension outcomes 2017
Hydrodistention is a treatment for frozen shoulder (FS) that is gaining popularity again. However, no large, long-term outcome data has been published yet. Our aims were to evaluate hydrodistension for the treatment of primary frozen shoulder (FS) in a large cohort of patients with long follow-up period.
We present a case series of eighty-nine patients (36 males and 53 females) with a mean age of 52 years (33-73). Eleven (12.4%) had disease associations. We excluded post-operative secondary stiff shoulders. The mean volume injected was 33.7ml (16-66). 36/89 (40%) had capsular rupture. Six (6.7%) had adverse effects. The mean follow-up was 104.5 weeks (8-238).
Mean improvement in forward flexion was 165.4, abduction 111.6, external rotation was hand above head with elbow back (and internal rotation in extension to T12. Mean improvement in quickDASH score was 17.1 (p<0.001) and Constant Score was 70.0 (p<0.001). Mean improvement in VAS was 7.3 (p<0.001). No patients had night pain (p<0.001). Eighty-eight (99%) returned to their previous occupation. Seventy-six (85%) returned to their previous level of sport. Gender, previous intra-articular steroid injection, volume of the injectate, type of steroid used, capsular rupture and underlying aetiology had no impact on outcome.
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- 2. @thearmclinic Acknowledgements • LaFosse, 2002 • Grimberg, 2011 • Gerber• Gervasi
- 4. @thearmclinic Indication for tendon transfer • MRCT with Weakness • Functional strength loss +/- pain
- 5. @thearmclinic Pre-requisites of Transfer 1. Intact deltoid 2. Intact Subscapularis - maintain force-couple 3. No Pseudoparalysis 4. Good bone - fixation 5. Compliant patient (young active) 6. Teres Minor Intact
- 6. @thearmclinic Pre-Habilitation • shoulder therapist • Optimise Deltoid & function • Activity modifications • Re-assess before surgery
- 7. @thearmclinic Principles of the technique • Open: – Harvest Tendon – Mobilise tendon • Arthroscopy: – Prepare surfaces – Develop track – Transfer tendon – Fixation
- 10. @thearmclinic
- 11. @thearmclinic
- 12. @thearmclinic
- 13. @thearmclinic
- 15. @thearmclinic
- 24. @thearmclinic Post-Surgery • ER Brace - comfort only • Pain Management • Limit NSAIDs • Cold Compression • Wound Care • Early Rehab
- 25. @thearmclinic 4 Stage Rehab • Stage 1: • Pain & Wound management • Closed Chain Active-Assisted • Stage 2: • Wean off sling • Progress to Open Chain exercises • Stage 3: • Open Active - ‘hand over elbow’ training • Eccentric control • Stage 4: • Functional & Sports-specific training • Endurance Not Time-Based !!!