Revisions of failed Latarjet surgery 2015Lennard Funk
This study reviewed outcomes of revision procedures for failed Latarjet surgery in 16 patients over 5 years. The most common direction of recurrent instability was anterior (11 cases). Common causes of failure included coracoid non-union (7 cases) and capsular laxity (8 cases). Revision procedures included Eden-Hybinette (5 cases), arthroscopic stabilization (8 cases), and remplissage (1 case). Complications occurred in 4 revisions. Most patients (12/16) and professionals (9/11) returned to their pre-injury level of sport following revision. Capsular laxity and posterior lesions were implicated in recurrent multi-directional and posterior instability cases.
Rotator cuff Repair in Rugby 2015 funkLennard Funk
1) Arthroscopic rotator cuff repair was performed on 11 elite rugby players with significant rotator cuff injuries.
2) The tears ranged in size from small (<1cm) to massive (>5cm), with a mean size of 1.8cm. Post-operative ultrasound scans showed the repairs to be intact in all 9 cases that were checked.
3) All players but one returned to play at the same level, with the mean time to return to full match play being 4.8 months. The study concludes that rotator cuff tears are not uncommon in rugby players and arthroscopic repair can enable players to return to play.
This document discusses elbow tendinopathy and various treatment options. It begins by explaining common types of elbow tendinopathy and risk factors. Non-surgical treatments like eccentric exercises, corticosteroid injections, platelet-rich plasma injections, and autologous cell implantation are reviewed. Surgical options like arthroscopic and open tennis elbow release are also summarized. The document concludes by discussing the current state of research and the need for further well-designed clinical trials to evaluate the efficacy of emerging non-surgical treatments.
ACJ revision surgery for failed reconstructions and excisionsLennard Funk
This document discusses ACJ revision surgery. It provides information on the functional anatomy of the AC joint, causes of failed ACJ excision or reconstruction, and describes a technique for ACJ revision surgery. The technique involves removing scar tissue from previous procedures, taking micro samples, performing an anatomical reconstruction of the CC and AC ligaments using LARS ligaments and a biceps flip or CAL transfer, and performing a delto-trapezial reefing. Results from 23 revision cases over 7 years showed improved Constant scores, low rates of re-displacement and infection, and no need for further revision after a mean follow up of 37 months.
Rotator Cuff Update 2022 for Medbelle Len Funk.pptxLennard Funk
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.
The Latarjet procedure is effective for treating traumatic anterior shoulder instability, especially when there is significant bone loss. It works by increasing the effective glenoid track and addressing humeral and glenoid bone deficits. Studies show the Latarjet procedure results in excellent stability, range of motion, function, and return to sports. While it has a slightly higher risk of complications than the Bankart repair, the Latarjet procedure is superior in addressing the underlying bone pathology and has lower recurrence rates, making it the preferred option for many patients with traumatic anterior instability.
Pectoralis Major Injuries for BESS 2020Lennard Funk
This document discusses pectoralis major injuries, including anatomy, diagnosis, treatment options, and outcomes. It provides an overview of the author's experience treating tears in athletes from various sports. Diagnosis involves clinical exam and imaging like ultrasound or MRI. Treatment can be non-operative with strength loss, or operative with surgical repair which often provides best results, especially for distal tears. Post-operative rehabilitation is outlined in phases focusing first on range of motion and later on strengthening. Reported outcomes include patients regaining 90% of strength on average and returning to sports within 6 months.
Overuse injuries to the elbow in the throwing athlete are frequent. Ulnar collateral ligament reconstruction (UCLR), commonly known as Tommy John surgery, is performed on athletes from all levels of competition.
The purpose of this study is to review all ulnar collateral ligament reconstructions performed at a single institution between January 2004 – July 2014. The study reported patient demographics, clinical outcomes, return to sport rate and complications.
Revisions of failed Latarjet surgery 2015Lennard Funk
This study reviewed outcomes of revision procedures for failed Latarjet surgery in 16 patients over 5 years. The most common direction of recurrent instability was anterior (11 cases). Common causes of failure included coracoid non-union (7 cases) and capsular laxity (8 cases). Revision procedures included Eden-Hybinette (5 cases), arthroscopic stabilization (8 cases), and remplissage (1 case). Complications occurred in 4 revisions. Most patients (12/16) and professionals (9/11) returned to their pre-injury level of sport following revision. Capsular laxity and posterior lesions were implicated in recurrent multi-directional and posterior instability cases.
Rotator cuff Repair in Rugby 2015 funkLennard Funk
1) Arthroscopic rotator cuff repair was performed on 11 elite rugby players with significant rotator cuff injuries.
2) The tears ranged in size from small (<1cm) to massive (>5cm), with a mean size of 1.8cm. Post-operative ultrasound scans showed the repairs to be intact in all 9 cases that were checked.
3) All players but one returned to play at the same level, with the mean time to return to full match play being 4.8 months. The study concludes that rotator cuff tears are not uncommon in rugby players and arthroscopic repair can enable players to return to play.
This document discusses elbow tendinopathy and various treatment options. It begins by explaining common types of elbow tendinopathy and risk factors. Non-surgical treatments like eccentric exercises, corticosteroid injections, platelet-rich plasma injections, and autologous cell implantation are reviewed. Surgical options like arthroscopic and open tennis elbow release are also summarized. The document concludes by discussing the current state of research and the need for further well-designed clinical trials to evaluate the efficacy of emerging non-surgical treatments.
ACJ revision surgery for failed reconstructions and excisionsLennard Funk
This document discusses ACJ revision surgery. It provides information on the functional anatomy of the AC joint, causes of failed ACJ excision or reconstruction, and describes a technique for ACJ revision surgery. The technique involves removing scar tissue from previous procedures, taking micro samples, performing an anatomical reconstruction of the CC and AC ligaments using LARS ligaments and a biceps flip or CAL transfer, and performing a delto-trapezial reefing. Results from 23 revision cases over 7 years showed improved Constant scores, low rates of re-displacement and infection, and no need for further revision after a mean follow up of 37 months.
Rotator Cuff Update 2022 for Medbelle Len Funk.pptxLennard Funk
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.
The Latarjet procedure is effective for treating traumatic anterior shoulder instability, especially when there is significant bone loss. It works by increasing the effective glenoid track and addressing humeral and glenoid bone deficits. Studies show the Latarjet procedure results in excellent stability, range of motion, function, and return to sports. While it has a slightly higher risk of complications than the Bankart repair, the Latarjet procedure is superior in addressing the underlying bone pathology and has lower recurrence rates, making it the preferred option for many patients with traumatic anterior instability.
Pectoralis Major Injuries for BESS 2020Lennard Funk
This document discusses pectoralis major injuries, including anatomy, diagnosis, treatment options, and outcomes. It provides an overview of the author's experience treating tears in athletes from various sports. Diagnosis involves clinical exam and imaging like ultrasound or MRI. Treatment can be non-operative with strength loss, or operative with surgical repair which often provides best results, especially for distal tears. Post-operative rehabilitation is outlined in phases focusing first on range of motion and later on strengthening. Reported outcomes include patients regaining 90% of strength on average and returning to sports within 6 months.
Overuse injuries to the elbow in the throwing athlete are frequent. Ulnar collateral ligament reconstruction (UCLR), commonly known as Tommy John surgery, is performed on athletes from all levels of competition.
The purpose of this study is to review all ulnar collateral ligament reconstructions performed at a single institution between January 2004 – July 2014. The study reported patient demographics, clinical outcomes, return to sport rate and complications.
Management of Primary Traumatic Shoulder Instabilitywashingtonortho
This document discusses the management of primary traumatic shoulder instability through a presentation by Dr. J.R. Rudzki. Some key points discussed include:
- Age is a primary risk factor for recurrence, with rates of 100% in patients <10 years old and 79% in patients aged 20-30 years old.
- Surgical stabilization may have better outcomes than conservative treatment for young, active patients based on data from randomized controlled trials.
- For first-time dislocators, arthroscopic Bankart repair reduces the risk of recurrent instability by 76-82% compared to non-operative management.
- Factors like glenoid bone loss, large Hill-Sachs lesions, and capsular
Anotomic-Biological Reconstruction of Acromio-Clavicular Joint Injuries-Dr. U...TheRightDoctors
This study evaluated 11 patients who underwent an anatomic reconstruction of the acromio-clavicular joint using a semitendinosus graft. At a minimum follow-up of 6 months, 8 patients had excellent outcomes, 2 had good outcomes, and 1 had a satisfactory outcome based on Constant and ASES scores. Complications included minimal loss of reduction in 1 patient and wound edge necrosis in another. The technique aims to anatomically reconstruct the coracoclavicular and acromioclavicular ligaments. The authors concluded the technique provides stable reconstruction with low complication rates. However, they noted limitations including the small sample size and need for longer-term studies.
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.
Relationship between extrinsic factors and the acromio humeral distance (1)The Arm Clinic
This study investigated the relationship between various extrinsic factors and acromio-humeral distance (AHD) in male control and elite athlete shoulders. Measurements were taken of scapular rotation, shoulder range of motion, pectoralis minor length, thoracic curve, and AHD in neutral and 60° abduction. Correlations between the factors and AHD were determined, with some significant but weak relationships found. Multiple linear regression showed that combinations of factors accounted for up to 36% of the variance in AHD. The study supports that extrinsic factors influence AHD in a multi-factorial and population-specific manner.
This audit summarizes the first 100 consecutive shoulder arthroplasties performed by a single surgeon between 2013-2016. It found:
1) The majority of procedures were for osteoarthritis or cuff tear arthropathy. The proportion of revisions is increasing.
2) Outcomes were comparable to national joint registry data, with reverse replacements being more common than anatomical replacements.
3) Complication rates were lower than literature reports, with 3 periprosthetic fractures, 2 dislocations, and 1 acromial stress fracture being the main surgical complications.
Ulnar Collateral Ligament Injury in AthletesDikshaTaani
Ulnar collateral ligament or medial collateral ligament injuries are most common in players: baseball pitchers, gymnasts, javelin throwers etc.
It mainly occurs with repetitive throwing motion which causes strain on medial collateral ligament and is known as Thrower's elbow.
Injury can be of two types: overuse & traumatic injury in which overuse ligament injuries are the commonest of all.
Due to muscular imbalance & faulty technique injury occurs.
Common complains are pain, bruising, tenderness over the medial side of elbow and felt during movement.
This document summarizes a presentation on AC joint and distal clavicle injuries. It discusses the classification of AC joint injuries, controversies around treatment of type III injuries, surgical techniques for repair and reconstruction, and recent biomechanical studies. While the literature is limited, current evidence suggests conservative treatment may be adequate for many type III injuries, with surgical intervention favored for more active patients or overhead athletes. Surgical techniques like the tightrope and anatomic reconstruction show promise but further research is still needed.
Atraumatic Shoulder Instability ManagementThe Arm Clinic
This document discusses atraumatic shoulder instability and treatment options. It presents the Stanmore classification system for shoulder instability, which categorizes types of instability as traumatic structural (Polar I), atraumatic structural (Polar II), or motor control (Polar III). For atraumatic structural instability (Polar II), options include small lesion repair, capsular plications, or large lesion repair/reconstruction along with rehabilitation. The document outlines a proposed randomized controlled trial to determine whether surgical stabilization plus physiotherapy improves outcomes for atraumatic instability compared to physiotherapy alone.
Acromioclavicular joint injury Andrew Gardner NWULGLennard Funk
This document discusses the conservative rehabilitation and post-operative rehabilitation of AC joint injuries. It provides information on the causes, diagnosis, classification, aims of physiotherapy management, rehabilitation protocols, return to sport considerations, prognosis, and complications for both conservative and post-operative treatment of AC joint injuries. Research on the outcomes of conservative versus surgical management is also reviewed, finding similar results between the two approaches.
This document provides an overview of rotator cuff disorders and evidence related to diagnosis and management. Key points include:
- Rotator cuff tears can be caused by mechanical or degenerative factors and progress from tendinosis to partial or full thickness tears.
- Physical exams have low diagnostic accuracy for tears but clusters of tests may help. Investigations like ultrasound and MRI can better identify soft tissue pathology.
- Factors like age, tear size, tendon retraction and fatty infiltration affect outcomes, with larger/retracted tears and more fatty changes correlating to poorer prognosis.
- Initial management focuses on rest, analgesics and physiotherapy, with surgery for failed non-operative treatment. Surgical techniques like
This document discusses the anatomy, classification, diagnosis, and treatment of acromioclavicular joint injuries. It begins with an overview of the anatomy of the AC joint and its ligaments. It then describes the Rockwood classification system for AC joint injuries, which ranges from Type I to Type VI injuries with increasing severity. For mild Type I and II injuries, nonsurgical treatment with immobilization is recommended. For more severe Type III injuries, the literature is reviewed and there is a trend toward initial nonsurgical treatment. For severe Types IV-VI injuries that are displaced, surgical treatment is generally recommended.
This document provides information on acromioclavicular (AC) joint injuries. It discusses the anatomy and biomechanics of the AC joint. It also outlines the epidemiology, mechanisms of injury, clinical evaluation, classification systems and treatment options for different grades of AC joint separation. For acute injuries under 4 weeks, treatment options discussed include conservative management or surgical stabilization techniques like hook plates, tightropes or ligament reconstruction. For chronic injuries, options include AC joint excision or reconstruction of the coracoclavicular ligaments.
There is no “gold standard” technique for the surgical stabilization of Acromioclavicular joint (ACJ) disruptions and each of the described techniques has a failure rate. The management of failed ACJ stabilizations is a difficult problem and salvage procedures may often be constrained by the original procedure and the resultant anatomy. Reliable anatomical and biomechanically robust revision procedures for failed ACJ stabilization are therefore required. We describe a technique for revision stabilization of the ACJ that utilises a synthetic ligament in combination with augmentation from the coracoacromial ligament and biceps short head aponeurosis (‘biceps flip’ procedure).
The direct anterior approach (DAA) for hip replacement surgery has been described since the late 19th century but saw limited use until more recent decades. Proponents argue the DAA has advantages over other approaches like less soft tissue damage, faster recovery, and lower dislocation rates. Studies have found the DAA results in less muscle damage, lower inflammatory marker levels, and shorter hospital stays compared to posterior approaches. While specialized tables have been used, the DAA can also be performed on a standard operating table. Overall, the available evidence and experiences of surgeons indicate the DAA may offer benefits for patients undergoing hip replacement.
MRI Study of Anterolateral Ligament and Its Association with Knee Injury-Dr. ...TheRightDoctors
This study used 161 knee MRI scans to examine the anterolateral ligament (ALL) and its association with knee injuries. The ALL was clearly visible on all scans using specific imaging sequences. 21% of scans showed a torn ALL. Of those with a torn ACL, 40% also had a torn ALL, suggesting the two ligaments may work together to stabilize the knee. While the ALL's role requires more research, this study demonstrated the ALL can be identified on MRI and may be involved in controlling internal knee rotation and the pivot shift mechanism.
This document summarizes research on hip dislocation rates following total hip arthroplasty depending on surgical approach. It finds that the risk of dislocation is greatest in the first 3 months post-operation, and varies based on surgical approach and risk factors like age and joint condition. Specifically, it reports that posterior approaches have the lowest dislocation rates when soft tissue repair is performed, ranging from 0.49-1.01%, while rates are higher without repair. Anterior-lateral approaches have dislocation rates of 0.7%. The document concludes that more studies are needed but there may be no increased dislocation risk for anterior approaches without precautions.
Presentation on the Anterolateral Ligament (ALL) with information on diagnosis with ultrasound and treatment using an ultrasound guided, percutaneous, reconstruction and an internal brace
This document summarizes a study on AC joint separations and associated intra-articular shoulder pathology. The study reviewed 18 patients with AC separations requiring repair and found that 61% had some form of intra-articular pathology like SLAP tears, partial RCT tears, or full RCT tears. The conclusion is that AC separations have a high rate of concurrent intra-articular injuries, so MRI or arthroscopy before AC joint repair is recommended to identify any additional pathology.
A 78-year-old Thai man presented to the hospital with right shoulder pain for 5 days. He fell off his bicycle and landed on his right shoulder. On examination, he had deformity and tenderness of the right shoulder with limited abduction due to pain. Radiographs showed injury to the right acromioclavicular joint. The patient was diagnosed with a Rockwood type III acromioclavicular joint separation. He was initially treated conservatively with a sling and pain medications. A follow up appointment was scheduled in 9 days to assess response to conservative treatment.
This document discusses the use of ultrasound scanning for evaluating shoulder conditions. It provides background on the history of medical ultrasound and its use for shoulder exams. Key points covered include what ultrasound can visualize in the shoulder, its benefits for being cheap, quick, and avoiding radiation compared to other imaging. Common shoulder issues it can diagnose are described, along with limitations and when it should not be used. The document emphasizes how ultrasound is changing practice by enabling rapid office-based evaluations, diagnoses, and treatment planning for patients with shoulder pain and injuries.
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/
Management of Primary Traumatic Shoulder Instabilitywashingtonortho
This document discusses the management of primary traumatic shoulder instability through a presentation by Dr. J.R. Rudzki. Some key points discussed include:
- Age is a primary risk factor for recurrence, with rates of 100% in patients <10 years old and 79% in patients aged 20-30 years old.
- Surgical stabilization may have better outcomes than conservative treatment for young, active patients based on data from randomized controlled trials.
- For first-time dislocators, arthroscopic Bankart repair reduces the risk of recurrent instability by 76-82% compared to non-operative management.
- Factors like glenoid bone loss, large Hill-Sachs lesions, and capsular
Anotomic-Biological Reconstruction of Acromio-Clavicular Joint Injuries-Dr. U...TheRightDoctors
This study evaluated 11 patients who underwent an anatomic reconstruction of the acromio-clavicular joint using a semitendinosus graft. At a minimum follow-up of 6 months, 8 patients had excellent outcomes, 2 had good outcomes, and 1 had a satisfactory outcome based on Constant and ASES scores. Complications included minimal loss of reduction in 1 patient and wound edge necrosis in another. The technique aims to anatomically reconstruct the coracoclavicular and acromioclavicular ligaments. The authors concluded the technique provides stable reconstruction with low complication rates. However, they noted limitations including the small sample size and need for longer-term studies.
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.
Relationship between extrinsic factors and the acromio humeral distance (1)The Arm Clinic
This study investigated the relationship between various extrinsic factors and acromio-humeral distance (AHD) in male control and elite athlete shoulders. Measurements were taken of scapular rotation, shoulder range of motion, pectoralis minor length, thoracic curve, and AHD in neutral and 60° abduction. Correlations between the factors and AHD were determined, with some significant but weak relationships found. Multiple linear regression showed that combinations of factors accounted for up to 36% of the variance in AHD. The study supports that extrinsic factors influence AHD in a multi-factorial and population-specific manner.
This audit summarizes the first 100 consecutive shoulder arthroplasties performed by a single surgeon between 2013-2016. It found:
1) The majority of procedures were for osteoarthritis or cuff tear arthropathy. The proportion of revisions is increasing.
2) Outcomes were comparable to national joint registry data, with reverse replacements being more common than anatomical replacements.
3) Complication rates were lower than literature reports, with 3 periprosthetic fractures, 2 dislocations, and 1 acromial stress fracture being the main surgical complications.
Ulnar Collateral Ligament Injury in AthletesDikshaTaani
Ulnar collateral ligament or medial collateral ligament injuries are most common in players: baseball pitchers, gymnasts, javelin throwers etc.
It mainly occurs with repetitive throwing motion which causes strain on medial collateral ligament and is known as Thrower's elbow.
Injury can be of two types: overuse & traumatic injury in which overuse ligament injuries are the commonest of all.
Due to muscular imbalance & faulty technique injury occurs.
Common complains are pain, bruising, tenderness over the medial side of elbow and felt during movement.
This document summarizes a presentation on AC joint and distal clavicle injuries. It discusses the classification of AC joint injuries, controversies around treatment of type III injuries, surgical techniques for repair and reconstruction, and recent biomechanical studies. While the literature is limited, current evidence suggests conservative treatment may be adequate for many type III injuries, with surgical intervention favored for more active patients or overhead athletes. Surgical techniques like the tightrope and anatomic reconstruction show promise but further research is still needed.
Atraumatic Shoulder Instability ManagementThe Arm Clinic
This document discusses atraumatic shoulder instability and treatment options. It presents the Stanmore classification system for shoulder instability, which categorizes types of instability as traumatic structural (Polar I), atraumatic structural (Polar II), or motor control (Polar III). For atraumatic structural instability (Polar II), options include small lesion repair, capsular plications, or large lesion repair/reconstruction along with rehabilitation. The document outlines a proposed randomized controlled trial to determine whether surgical stabilization plus physiotherapy improves outcomes for atraumatic instability compared to physiotherapy alone.
Acromioclavicular joint injury Andrew Gardner NWULGLennard Funk
This document discusses the conservative rehabilitation and post-operative rehabilitation of AC joint injuries. It provides information on the causes, diagnosis, classification, aims of physiotherapy management, rehabilitation protocols, return to sport considerations, prognosis, and complications for both conservative and post-operative treatment of AC joint injuries. Research on the outcomes of conservative versus surgical management is also reviewed, finding similar results between the two approaches.
This document provides an overview of rotator cuff disorders and evidence related to diagnosis and management. Key points include:
- Rotator cuff tears can be caused by mechanical or degenerative factors and progress from tendinosis to partial or full thickness tears.
- Physical exams have low diagnostic accuracy for tears but clusters of tests may help. Investigations like ultrasound and MRI can better identify soft tissue pathology.
- Factors like age, tear size, tendon retraction and fatty infiltration affect outcomes, with larger/retracted tears and more fatty changes correlating to poorer prognosis.
- Initial management focuses on rest, analgesics and physiotherapy, with surgery for failed non-operative treatment. Surgical techniques like
This document discusses the anatomy, classification, diagnosis, and treatment of acromioclavicular joint injuries. It begins with an overview of the anatomy of the AC joint and its ligaments. It then describes the Rockwood classification system for AC joint injuries, which ranges from Type I to Type VI injuries with increasing severity. For mild Type I and II injuries, nonsurgical treatment with immobilization is recommended. For more severe Type III injuries, the literature is reviewed and there is a trend toward initial nonsurgical treatment. For severe Types IV-VI injuries that are displaced, surgical treatment is generally recommended.
This document provides information on acromioclavicular (AC) joint injuries. It discusses the anatomy and biomechanics of the AC joint. It also outlines the epidemiology, mechanisms of injury, clinical evaluation, classification systems and treatment options for different grades of AC joint separation. For acute injuries under 4 weeks, treatment options discussed include conservative management or surgical stabilization techniques like hook plates, tightropes or ligament reconstruction. For chronic injuries, options include AC joint excision or reconstruction of the coracoclavicular ligaments.
There is no “gold standard” technique for the surgical stabilization of Acromioclavicular joint (ACJ) disruptions and each of the described techniques has a failure rate. The management of failed ACJ stabilizations is a difficult problem and salvage procedures may often be constrained by the original procedure and the resultant anatomy. Reliable anatomical and biomechanically robust revision procedures for failed ACJ stabilization are therefore required. We describe a technique for revision stabilization of the ACJ that utilises a synthetic ligament in combination with augmentation from the coracoacromial ligament and biceps short head aponeurosis (‘biceps flip’ procedure).
The direct anterior approach (DAA) for hip replacement surgery has been described since the late 19th century but saw limited use until more recent decades. Proponents argue the DAA has advantages over other approaches like less soft tissue damage, faster recovery, and lower dislocation rates. Studies have found the DAA results in less muscle damage, lower inflammatory marker levels, and shorter hospital stays compared to posterior approaches. While specialized tables have been used, the DAA can also be performed on a standard operating table. Overall, the available evidence and experiences of surgeons indicate the DAA may offer benefits for patients undergoing hip replacement.
MRI Study of Anterolateral Ligament and Its Association with Knee Injury-Dr. ...TheRightDoctors
This study used 161 knee MRI scans to examine the anterolateral ligament (ALL) and its association with knee injuries. The ALL was clearly visible on all scans using specific imaging sequences. 21% of scans showed a torn ALL. Of those with a torn ACL, 40% also had a torn ALL, suggesting the two ligaments may work together to stabilize the knee. While the ALL's role requires more research, this study demonstrated the ALL can be identified on MRI and may be involved in controlling internal knee rotation and the pivot shift mechanism.
This document summarizes research on hip dislocation rates following total hip arthroplasty depending on surgical approach. It finds that the risk of dislocation is greatest in the first 3 months post-operation, and varies based on surgical approach and risk factors like age and joint condition. Specifically, it reports that posterior approaches have the lowest dislocation rates when soft tissue repair is performed, ranging from 0.49-1.01%, while rates are higher without repair. Anterior-lateral approaches have dislocation rates of 0.7%. The document concludes that more studies are needed but there may be no increased dislocation risk for anterior approaches without precautions.
Presentation on the Anterolateral Ligament (ALL) with information on diagnosis with ultrasound and treatment using an ultrasound guided, percutaneous, reconstruction and an internal brace
This document summarizes a study on AC joint separations and associated intra-articular shoulder pathology. The study reviewed 18 patients with AC separations requiring repair and found that 61% had some form of intra-articular pathology like SLAP tears, partial RCT tears, or full RCT tears. The conclusion is that AC separations have a high rate of concurrent intra-articular injuries, so MRI or arthroscopy before AC joint repair is recommended to identify any additional pathology.
A 78-year-old Thai man presented to the hospital with right shoulder pain for 5 days. He fell off his bicycle and landed on his right shoulder. On examination, he had deformity and tenderness of the right shoulder with limited abduction due to pain. Radiographs showed injury to the right acromioclavicular joint. The patient was diagnosed with a Rockwood type III acromioclavicular joint separation. He was initially treated conservatively with a sling and pain medications. A follow up appointment was scheduled in 9 days to assess response to conservative treatment.
This document discusses the use of ultrasound scanning for evaluating shoulder conditions. It provides background on the history of medical ultrasound and its use for shoulder exams. Key points covered include what ultrasound can visualize in the shoulder, its benefits for being cheap, quick, and avoiding radiation compared to other imaging. Common shoulder issues it can diagnose are described, along with limitations and when it should not be used. The document emphasizes how ultrasound is changing practice by enabling rapid office-based evaluations, diagnoses, and treatment planning for patients with shoulder pain and injuries.
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/
This document discusses labral repair techniques and tips. It begins by defining common types of labral tears such as Bankart tears and SLAP tears. It then discusses surgical techniques for anterior and posterior labral repairs including recommended portals and tools such as curved osteoraptors. Potential complications are also mentioned such as paralabral cysts and osteolysis from biodegradable implants.
This document discusses shoulder injuries in rugby players. It provides statistics showing that rugby has a high risk of shoulder injuries, which are often recurrent. Common shoulder injuries in rugby players include labral injuries, AC joint sprains, rotator cuff tears, and glenohumeral arthritis. Video analysis has shown that tackles are a major cause of shoulder injuries in rugby. The document outlines the forces involved in rugby tackles and compares them to car crash forces. It then discusses approaches to diagnosing and treating shoulder injuries in rugby players, including rehabilitation protocols and return to play timeframes following arthroscopic stabilization surgery.
Rotator cuff Repair - New Techniques and ChallengesShoulderPain
This presentation reviews the current challenges and advances in state of the art rotator cuff repair. Learn more at https://www.theshouldercenter.com/
This document discusses shoulder instability, including traumatic and atraumatic causes. It presents three case studies to demonstrate different types of instability: 1) a rugby player with recurrent anterior dislocations requiring surgical repair for bony lesions; 2) a drama student with recurrent posterior subluxations and normal imaging, indicating a motor control issue; and 3) a gymnast with multidirectional instability and hyperlaxity who may benefit from capsular plication. The document outlines the Stanmore classification system for shoulder instability (Polar types I-III) and factors to consider in surgical versus rehabilitation management depending on the specific instability pattern.
InSpace balloon for massive rotator cuff tears 2017Lennard Funk
This document summarizes the results and experience of a study comparing the InSpace Balloon procedure to rotator cuff repair for massive rotator cuff tears. The interim analysis of the first 20 subjects in the randomized controlled trial showed no difference in outcomes between the two procedures at 6 months follow-up. The study is ongoing and being conducted by principal investigators across the United States to further compare the efficacy of InSpace Balloon versus repair for massive rotator cuff tears.
Medial patellofemoral ligament reconstruction ---- an update on techniques used. This lecture was taken by me at Trinity Arthroscopy Course, Chandigarh.
This document discusses essential elements for the functional/final stage of shoulder rehabilitation, including proprioceptive awareness, kinetic chain neuromuscular control, glenohumeral joint dynamic stability provided by compressive forces, and scapular mobility and stability. It emphasizes retraining muscle synergy between agonist and antagonist groups to control adverse humeral head translation at the glenoid. Clinical applications include using symptom modification to guide targeted muscle group rehabilitation in controlled vulnerable positions, and positioning the glenoid to support the humeral head in functional positions for each patient. The goal of late-stage rehabilitation is to achieve optimal biomechanical function and return to sport or work activities through integrated techniques built upon endurance and strength foundations while maintaining
This document discusses the treatment of first-time shoulder dislocations. It finds that arthroscopic stabilization has lower recurrence rates compared to conservative treatment, especially for young athletes. Arthroscopy allows visualization and repair of common lesions like Bankart tears and Hill-Sachs defects. Studies show arthroscopic stabilization reduces recurrence to 16% versus 47% for conservative care. Arthroscopy provides excellent outcomes with minimal pain and quick return to previous activity levels. It is the recommended approach for young, active patients to prevent future dislocations and allow continued athletic participation.
Evolution of tunnel placement in ACL reconstructionDhananjaya Sabat
One of my talks at Delhi Arthroscopy Club....... this presentation provides a insight regarding the conceptual evolution in tunnel placement during ACL reconstruction.
This document discusses different techniques for infrapectoral biceps tenodesis. It notes that tenodesis may not be functionally superior to tenotomy based on literature. However, tenodesis is preferred to avoid potential muscle cramps experienced by some patients after tenotomy. The document recommends an optimal technique of open subpectoral biceps tenodesis using direct visualization and fixation of the interosseous tendon with an interference screw for a strong construct allowing early mobilization without stress on the diaphysis. Post-operative rehabilitation is described as allowing elbow range of motion as comfort permits, with no strengthening for 6 weeks and no weight training for 3 months.
The document discusses potential complications from ACL reconstruction surgery, noting that surgical technical errors during graft harvest, tunnel preparation, or fixation are most common causes of failure. Five possible causes of reconstruction failure are identified as graft discontinuity, inappropriate tunnel positioning, hardware failure, infection, or arthrofibrosis. Proper surgical technique and avoidance of tunnel malpositioning are emphasized to prevent complications.
This document discusses congenital convex pes valgus (CVT), a rare rigid flatfoot condition present at birth. CVT is caused by genetic syndromes or abnormal muscle fibers/tendon contractures. Clinically, it presents as a rigid flatfoot with the talus medially displaced. Imaging can classify the deformity and assess reducibility. Nonoperative treatment with casting is rarely effective. The preferred surgical treatment is a single-stage correction using approaches like Cincinnati to release tissues and reduce/fix the talonavicular joint. Complications include recurrence, stiffness, and avascular necrosis of the talus. Later presentations may require more extensive fusions.
This document discusses various types of shoulder impingement syndromes. It begins with a brief history, noting that while Meyer first described the process in 1931, Neer classified and named shoulder impingement syndrome in 1972. It then describes current classifications, including primary and secondary subacromial impingement, coracohumeral impingement, glenoid (internal) impingement, ASI (AnteroSuperior Impingement), and PSGI (PosteroSuperior Glenoid Impingement). The bulk of the document focuses on describing these various impingement syndromes in more detail, including causes, presentations, treatments, and relevant anatomy. It provides an overview of imaging and clinical exams for
This document discusses the arthroscopic management of posterior shoulder instability. It finds that posterior instability is more common than traditionally estimated, occurring in 17-35% of shoulder stabilization surgeries especially among contact athletes like rugby players. Posterior instability often presents with anterior instability symptoms, weakness, or cuff pain. Assessment involves special tests like the modified O'Brien's test. MR arthrogram can diagnose isolated anterior or posterior labral tears but has lower accuracy for combined lesions. Key steps of arthroscopic management include utilizing proper portal placement and angles, addressing reverse Hill-Sachs lesions, and specialized post-op rehabilitation involving the kinetic chain and rotator cuff. Bone loss increases risk of failure so it must also be addressed.
Hydrodilation for frozen shoulder Does capsular rupture matterLennard Funk
This document summarizes a study examining the outcomes of hydrodilatation for frozen shoulder and whether capsular rupture during the procedure matters. The study found:
1) Patients experienced significant improvements in pain, range of motion, Constant-Murley scores, and Oxford Shoulder scores following hydrodilatation.
2) When comparing patients who experienced capsular rupture to those who did not, there were no significant differences in baseline characteristics or magnitudes of improvement between the groups.
3) Hydrodilatation resulted in meaningful pain relief and functional improvement for frozen shoulder patients, and capsular rupture during the procedure did not influence outcomes.
Shoulder instability current concepts mike waltonLennard Funk
The document discusses shoulder instability, beginning with how humans evolved the ability to throw through modifications to the shoulder including a lengthened clavicle and increased external rotation of the glenohumeral joint. It then notes that the glenohumeral joint is inherently unstable, and anterior dislocation is the most common type, usually occurring with combined external rotation and abduction. Assessment of instability involves understanding the mechanism of injury, performing apprehension tests, and obtaining imaging like MR arthrogram. Bone loss and engaging Hill-Sachs lesions are predictors of failure following surgery.
The document discusses potential future directions for rotator cuff repair surgery. It describes 4 possibilities - 1) biological repairs that enhance healing using growth factors, 2) augmentation devices to reinforce repairs, 3) gene therapy and nano-surgery approaches for prevention and treatment, and 4) algorithms to better determine who needs surgery versus non-operative treatment based on age, genetics, and other factors. The future may include enhanced sutures that promote angiogenesis, balloon devices to support tissue, gene therapies administered through self-monitoring techniques, and remotely-controlled nano-instruments.
The Incidence of Traumatic Posterior and Combined Labral Tears in Patients Un...Lennard Funk
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.
This systematic review identified five prospective studies that examined risk factors for recurrent hamstring injuries. The studies reported recurrence rates ranging from 13.9% to 63.3% within two years of the initial injury. There was limited evidence that athletes with a larger volume of initial injury seen on MRI, a Grade 1 initial injury, or a previous ACL reconstruction were at increased risk of recurrent hamstring injury. There was also limited evidence that rehabilitation programs focusing on agility/stabilization exercises rather than stretching/strengthening reduced the risk of re-injury. No significant relationships were found for other factors like age, muscle involved, or functional tests at return to sport. Evidence on the relationship between cross-sectional area of initial injury and
Muscle tears are extremely common and are often recurrent. They are not as simple as we used to think and the advent of better imaging has proven that the site, size and location of the tear, together with the presence or otherwise of the tendon is crucial information especially for elite or professional athletes, who need accurate information about return to play. Traditional treatments of electrotherapy are simply placebos. The challenge ahead is to optimise treatments for the various diagnostic categories.
This study compared the effectiveness of two rehabilitation programs for acute hamstring strains. Twenty-four athletes with hamstring strains were randomly assigned to either a static stretching, isolated strengthening, and icing program (STST group) or a progressive agility, trunk stabilization, and icing program (PATS group). The PATS group had a significantly shorter average time to return to sports (22.2 days vs 37.4 days) and lower reinjury rates both within 2 weeks of returning (0% vs 54.5%) and within 1 year (7.7% vs 70%) compared to the STST group. A rehabilitation program including progressive agility and trunk stabilization exercises was found to be more effective for returning athletes to
This document summarizes a presentation on concussions and cervical injuries. It discusses how concussions are caused by rotational forces on the brain and shares similarities in symptoms with cervical injuries, which result from neck muscle strains. Tests are presented to differentiate between concussion and cervical injury. The risk of lower extremity injuries in the 6 months following a concussion is significantly higher than in non-concussed athletes, with the knee and ankle being most commonly injured. Ongoing balance and strength training is recommended for several months after concussion recovery to prevent future injuries.
This case series describes the conservative treatment of 6 collegiate athletes (4 males, 2 females aged 19-22) diagnosed with a sports hernia, or athletic pubalgia. A sports hernia is an injury involving weakness of the posterior inguinal wall without a hernia, causing severe groin pain with exertion. The athletes were evaluated for 5 key findings of sports hernia and treated with physical therapy including manual therapy, exercises, for a mean of 7.7 sessions. 3 athletes improved with conservative care alone while the other 3 improved after additional surgical repair and a mean of 6.7 sessions of post-surgical physical therapy. Conservative management including manual therapy appears to be a viable initial treatment option for sports hern
This document discusses hamstring strain injuries, which are common in sports requiring sprinting. It notes that about one-third of hamstring injuries will recur within two weeks of returning to sport, suggesting rehabilitation programs may be inadequate. The injuries typically occur during the late swing phase of running when the hamstrings absorb energy. Rehabilitation aims to address weakness, inflexibility and movement impairments from the injury. Future research should develop more individualized rehabilitation based on injury location and measures of reinjury risk.
This study examined the reliability of classifications derived from Cyriax's resisted testing in subjects with painful shoulders and knees. Two physical therapists evaluated subjects' shoulder and knee motions under maximal isometric resistance twice. They rated contractions as strong or weak and noted any pain. Intrarater reliability for the knee was generally acceptable but not for the shoulder. Interrater reliability was generally not acceptable for either. More training and standardized resistance may improve reliability.
This document contains summaries of 4 research studies:
1. A randomized controlled trial that found suprascapular nerve blocks were no more effective than saline injections for treating subacute adhesive capsulitis.
2. A study that found intra-articular injections of hyaluronic acid plus dextrose for knee osteoarthritis resulted in greater improvements in physical function and pain reduction compared to hyaluronic acid plus saline.
3. A randomized controlled trial that demonstrated alendronate effectively prevented bone loss in the hip in men during the first year after a traumatic spinal cord injury.
4. A study that found patients with acquired brain injuries who had contractures required more intensive rehabilitation therapy, longer
This document provides an overview of balloon kyphoplasty as an orthopaedic treatment for vertebral compression fractures. It describes how balloon kyphoplasty can stabilize fractures and correct spinal deformity by using an inflatable balloon to restore height to a fractured vertebra before injecting bone cement. Clinical studies discussed show that balloon kyphoplasty provides significant pain reduction, mobility improvements, and a low complication rate compared to alternative treatments like vertebroplasty.
ACL Injury Hacks covers the entire physiology, etiology,pathology, diagnosis, recent advancements in diagnosis of ACL and focus on how an early and accurate diagnosis can contribute to a better treatment and rehabilitation as well as early return to sport of an athlete.
This document contains 18 multiple choice questions related to orthopaedic surgery. Each question is followed by the preferred response and recommended reading materials. The questions cover topics such as compression of the median nerve at the elbow, congenital muscular torticollis exercises, preventing failure after fixation of an intertrochanteric fracture, osteoblast function, treatment for hip arthroplasty instability, and contraindications for hyperbaric oxygen therapy.
Some Mechanisms of the Noncontact Anterior Cruciate Ligament (ACL) Injury among Male Sport Activities by
Kasbparast Mehdi in Examines in Physical Medicine & Rehabilitation
Pitching biomechanics place high stresses on the shoulder and elbow joints that can lead to injury. During pitching, the lag between upper body and arm rotation forces the shoulder into excessive horizontal abduction and external rotation. This places tension on anterior shoulder structures and compresses posterior rotator cuff and labrum. Extreme external rotation also increases tension on the biceps-labrum complex, potentially causing SLAP lesions. Additionally, shoulder movement creates high valgus moments at the elbow, stressing medial elbow structures and increasing injury risk. Evidence links pitching mechanics to increased joint loading and certain pitching techniques to reports of pain and injury.
This study examined the intertester reliability of using James Cyriax's system for assessing patients with shoulder pain. Two experienced physical therapists independently evaluated 21 cases of painful shoulders using Cyriax's evaluation method. They classified the cases into specific shoulder lesions or indicated that the case did not fit the Cyriax model. The therapists agreed on the classification for 19 of the 21 cases, showing 90.5% agreement. Statistical analysis found "almost perfect" agreement between the therapists. Both therapists also agreed on the same 4 cases that did not fit the Cyriax model. The results demonstrate that Cyriax's evaluation can be a highly reliable method for assessing patients with shoulder pain.
Hip Muscle Strength Predicts Non-contact ACL Injury in Male and Female Athlet...Rachel Straub
Background: Prospective studies have reported that abnormal movement patterns at the trunk, hip, and knee are associated with non-contact ACL injuries. Impaired hip strength may underlie these abnormal movement patterns, suggesting that diminished hip strength may increase the risk of non-contact ACL injury.
Purpose: To determine if baseline hip strength predicts future non-contact ACL injury in athletes.
Study Design: Prospective cohort study.
Methods: Prior to the start of the competitive season, isometric hip strength (external rotator and abductor) was measured bilaterally using a hand-held dynamometer in 501 competitive athletes (138 females and 363 males) participating in various sports. During the sport seasons, ACL injury status was recorded, and injured athletes were further classified based on the mechanism of injury (non-contact vs. contact). Postseason, logistic regression was used to determine whether baseline hip strength predicted future non-contact ACL injury. Receiver operating characteristic (ROC) curves were constructed independently for each strength measure to determine the clinical cut-off value to distinguish between a high-risk and low-risk outcome.
Results: A total of 15 non-contact ACL injuries were confirmed (6 female, 9 male), for an overall annual incidence of 3.0% (2.5% for males and 4.3% for females). Baseline hip strength measures (external rotator and abductor) were significantly lower in injured athletes compared to non-injured athletes (p = 0.003 and p < 0.001, respectively). Separate logistic regression models indicated impaired hip strength increased future injury risk [external rotator: OR = 1.23 (95% CI: 1.08, 1.39), p = 0.001; abductor: OR = 1.12 (95% CI: 1.05, 1.20), p = 0.001]. Clinical cutoffs to define high risk were established as external rotator strength ≤ 20.3% body weight (BW) or abductor strength ≤ 35.4% BW.
Conclusion: Measures of preseason isometric hip abductor and external rotator strength independently predicted future non-contact ACL injury status in competitive athletes. Our data suggest that screening procedures to assess ACL injury risk should include an assessment of isometric hip abductor and/or external rotator strength.
Presentation by Dr Adnan Saithna, Professor of Orthopedic Surgery, Kansas City University, delivered at American Academy of Orthopedic Surgeons Annual Meeting 2020. This presentation reports that professional athletes are at higher risk of septic arthritis after ACL reconstruction than recreational athletes
ΠΡΟΓΡΑΜΜΑ ΠΡΟΛΗΨΗΣ ΤΡΑΥΜΑΤΙΣΜΩΝ ΣΕ ΕΠΑΓΓΕΛΜΑΤΙΕΣ ΑΘΛΗΤΕΣ. Π.Α.Ε ΟΛΥΜΠΙΑΚΟΣ- Α...STAVROS ALEVROGIANNIS
This document summarizes the results of an injury prevention program for the U20 and U17 football teams of Olympiacos F.C. The program assessed players' biomechanics using scans of their feet, nervous systems, and muscles. Scans found high rates of pronation among players and improvements in nervous system dysfunction between initial and follow-up scans. Severe nervous system dysfunction was more common in offensive players and correlated with higher injury risks like ACL tears and ankle sprains. The program aimed to restore normal weight distribution and improve neuromuscular function to help prevent injuries.
Similar to Diagnosing Instability in Rugby Players (20)
This document discusses the management of AC joint dislocations. It notes that while literature indicates surgery for type 4, 5, and 6 dislocations, classification using radiographs is unreliable. Further, clinical results are comparable between operative and non-operative treatment, but complications are more common with surgery. The author's indications for surgery are for those who cannot cope functionally or with work/social demands, such as overhead athletes. His experience using the LARS ligament for AC joint reconstruction is described along with postoperative rehabilitation phases and results showing a mean 15% reduction in displacement and low complication rates. Revision procedures for failed reconstructions also have good results.
Clavicle Fractures Pro Cyclists 2021.pdfLennard Funk
Clavicle fractures in pro cyclists are unique injuries that require careful management. Operative treatment with plate and screws results in improved healing times, higher union rates, and an earlier return to competition compared to non-operative treatment. The decision to return to cycling depends on fracture healing as well as an assessment of risk versus benefit by a multidisciplinary team in consultation with the patient.
This document summarizes a study evaluating the clinical outcomes of direct arthroscopic acromioclavicular (AC) joint excision for osteolysis. Osteolysis of the AC joint is caused by excessive overhead motions and is commonly seen in weightlifters and rugby players, causing pain and limited shoulder range of motion. The study retrospectively reviewed 16 patients who underwent direct arthroscopic AC joint excision over a 2 year period. Patients showed significant improvements in their Constant Shoulder Score and QuickDASH score between pre-op and post-op assessments at a mean follow-up of 21 months. Patients also reported high satisfaction ratings. The study concluded that direct arthroscopic AC joint excision is an effective treatment for osteolysis with significant
Chronic Pectoralis Major Injuries Len Funk 2020Lennard Funk
This document discusses chronic injuries to the pectoralis major muscle and surgical techniques for repairing them. It provides details on indications for surgery, including factors that make for good and poor surgical candidates. Surgical techniques described include preparing and attaching an allograft tendon to the pec major footprint using suture anchors. Post-op rehabilitation is outlined in phases focusing initially on range of motion and later on strengthening. Ultrasound imaging is used post-operatively to monitor healing. Outcomes of surgeries performed are also mentioned.
This document discusses rotator cuff augmentation, which involves adding graft material to reinforce rotator cuff repairs. There are several types of grafts, including autografts from the patient's own tissue, allografts from human donors, xenografts from animals, and synthetic grafts. The evidence for whether augmentation improves outcomes comes from a limited number of randomized controlled trials and observational studies of varying quality. While allograft augmentation seemed to produce better results than controls in some studies, the overall evidence is inconclusive due to the low quality and small size of available studies. More research is still needed to determine whether and when augmentation provides meaningful benefits over standard rotator cuff repair without grafting.
Should We Repair Rotator Cuff Tears OPN 2017.pdfLennard Funk
Lennard Funk & Puneet Monga
Prepared for Orthopaedic Product News, 2017
Rotator cuff disease is very common. There is as much enthusiastic discussion and debate on its management as there was 80 years ago when Codman (1937) first described the pathology and surgical management. There is great variation amongst surgeons as to the management of rotator cuff tears biased by experience and their understanding of the literature, skills levels and regional variations. There has been a lot of research done on the pathology, non-operative and operative treatments over the last two decades. Also, over the last decade there have been massive strides in the development of new surgical techniques and technologies. However, despite these advances there is as much discussion and debate!
This document discusses the evolution and current approaches to shoulder instability surgery. It begins with a brief history of instability surgery techniques from Hippocrates to modern arthroscopic and open surgical procedures. It then covers classification of instability, pathological lesions, management decisions, and surgical procedure principles. Key points discussed include the Stanmore classification system, types of soft tissue lesions like Bankart tears and bone defects like bony Bankart fractures and Hill-Sachs lesions. Decision factors for open versus arthroscopic surgery are outlined. Surgical techniques like Bankart repair, capsular plication, bone graft procedures for glenoid deficiency, and remplissage for large Hill-Sachs lesions are summarized.
Anterior shoulder Instability in the young athlete 2020 bostaaLennard Funk
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 2020Lennard Funk
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.
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.
Pectoralis major allograft reconstructionLennard Funk
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 radiologistLennard Funk
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 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.
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.
Clinical predictors hydrodilatation in idiopathic fs 2017Lennard Funk
Clinical predictors of poor outcomes for hydrodilatation include female gender, high pain scores, short length of symptoms, previous contralateral FS, inability to reach the waist in internal rotation and external rotation less than one degree. This information is useful in the treatment decision making process for idiopathic FS.
Hydrodilation technique - Does it matter 2018Lennard Funk
No difference was noted in the outcome of hydrodilatation procedure whether administered via X-ray or ultrasound guidance. The capsule rupture occurrence had no effect on outcome. Hydrodilatation procedures where the injectate was ≤30ml had 1.86 times risk of a subsequent ACR.
Traumatic shoulder instability is common in adolescent contact athletes. The document summarizes epidemiological data showing that shoulder instability accounts for around 10-20% of cases in those under age 20. Rugby is the most common cause of instability injuries in adolescents, accounting for around 85% of cases in some studies. Recurrence rates after surgery are high, especially in those under age 16 who have a 2.5 times higher risk of recurrence compared to those 16-18 years old. Surgical treatment can successfully treat instability in adolescents, but outcomes may be improved by considering physeal injuries in younger teens and the potential role of bone block procedures like Latarjet.
Bone Response to Suture Anchor Classification Training DocumentLennard Funk
This document outlines a proposed grading system for evaluating suture anchors used in shoulder surgery. It describes 5 grades (0-4) based on MRI imaging, where grade 0 is normal healing, grade 1 shows minimal bone changes, grade 2 mild bone edema, grade 3 bone edema and cysts, and grade 4 larger low signal areas and fluid around the anchor, indicating potential instability. Examples of each grade are provided to demonstrate the system.
Suture anchor Bone Response Validation StudyLennard Funk
1. This study validated a novel 5-point grading system to assess bone response around suture anchors following shoulder labral reconstruction using MRI scans.
2. The validation study found moderate to substantial interrater and intrarater reliability among musculoskeletal radiologists and shoulder surgeons when using the grading system.
3. The results suggest the grading system is feasible for clinical use and the next steps are to provide rater training and validate the system in other medical centers to further improve reliability.
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Kat...rightmanforbloodline
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central19various
Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa CentralClinic ^%[+27633867063*Abortion Pills For Sale In Tembisa CentralClinic ^%[+27633867063*Abortion Pills For Sale In Tembisa CentralClinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Vestibulocochlear Nerve by Dr. Rabia Inam Gandapore.pptx
Diagnosing Instability in Rugby Players
1. Diagnosing the Direction of Shoulder
Instability in Rugby Players
Dr Ciaran Clarke
Dr Emma Torrance
Prof Lennard Funk
The Wilmslow Hospital
2. Background
Shoulder injuries responsible for 9-11% of all injuries in elite
rugby 1
A dislocations/instability injury leads to an average of 81 days
absence from sport 2
High rates of recurrence reported (62-79%) with greater
morbidity
Literature suggests that well-muscled athletes offer a unique
challenge for identifying the direction of instability 5
3. Aim
Review the accuracy of clinical examination in
diagnosing the direction of shoulder instability
in rugby players
4. Materials and Method
Data analysed retrospectively for 300
patients over a 55 month period.
Must participate in regular, competitive
rugby and have received a shoulder
stabilisation procedure.
Excluded if participated in any other
sport.
All participants consented for their data
to be used for research purposes.
Data collected
Demographics
Results of Special Tests
Clinical Direction of Instability
Surgical Direction of Instability*
Analysis
2x2 tables
5. Results
Overall - Direction of instability correctly identified from physical
examination in 42% of cases (n=300)
Anterior
n = 150
Anterior
n = 114
75.4% (n = 86)
None
n = 30
Posterior
n = 23
Combined
n = 11
8. Conclusion
Direction of instability is challenging to diagnose
in rugby players
Anterior apprehension test less sensitive and
poorer NPV than in normal subjects
High sensitivity of WPIT, Kim test and Thrower’s
in posterior instability
9. References
• 1. Headey J, Brooks JHM, Kemp SPT. The epidemiology of shoulder injuries
in English professional rugby union. Am J Sports Med. 2007;35(9):1537–
43.
• 2. Brooks JHM. Epidemiology of injuries in English professional rugby
union: part 1 match injuries. Br J Sports Med. 2005;39(10):757–66.
• 3. Larrain MV, Montenegro HJ, Mauas DM, Collazo CC, Pavón F.
Arthroscopic management of traumatic anterior shoulder instability in
collision athletes: analysis of 204 cases with a 4- to 9-year follow-up and
results with the suture anchor technique. Arthroscopy. 2006
Dec;22(12):1283-9.
• 4. Bohu Y, Klouche S, Lefevre N, Peyrin J-C, Dusfour B, Hager J-P, et al. The
epidemiology of 1345 shoulder dislocations and subluxations in French
Rugby Union players: a five-season prospective study from 2008 to 2013.
Br J Sports Med. 2015;49:1535–40.
• 5. Funk L. Treatment of glenohumeral instability in rugby players. Knee
Surgery, Sport Traumatol Arthrosc. Springer Berlin Heidelberg;
2016;24(2):430–9.
Editor's Notes
Good morning, my name is Ciaran Clarke and I am Foundation Year 1 Doctor at Royal Bolton Hospital
My presentation today regards the diagnosis of shoulder instability in rugby players and was undertaken at The Wilmslow Hospital under the supervision of Dr Emma Torrance and Prof Lennard Funk
As well all know, rugby is a high impact, collision sport.
Epidemiological studies of elite rugby injuries have demonstrated that shoulder injuries overall are responsible for 9-11% of all injuries.
Shoulder dislocations and instability carry a particularly high morbidity, with an average of 81 days absence from the sport following injury.
Shoulder instability injuries also carry a high rate of recurrence following initial injury.
Furthermore, these recurrences carry an even greater level morbidity with a 2007 study by Headley et al. demonstrating that recurrences carry a mean 115 days lost from participation.
it has recently been suggested that the well-muscled anatomy of rugby players and their characteristically high tolerance for pain results in a unique challenge for the clinician in identifying the direction of shoulder instability on clinical examination.
Therefore, the aim of this study was to review the accuracy of clinical examination for diagnosing the direction of shoulder instability in rugby players.
To achieve our aim, we retrospectively analysed data for 300 patients over a 55 month period in a single specialist upper limb unit.
To be included in the study the patients had to participate in regular, competitive rugby league or union and must have received a shoulder stabilisation procedure as part of their care.
We excluded any patient who reported participating in more than one sport.
In particular, we collected demographic data, the results of clinical examination and orthopaedic special tests. The direction of instability recorded from the clinical examination findings was recorded as the clinical direction of instability. The direction of shouder instability recorded in the operation note was recorded as the surgical direction of instability. This final measure was taken as the gold standard for the direction of shoulder instability. Utilising the gold standard, we were able to construct 2x2 tables with statstics on the sensitivity, specificity, negative and positive predictive values of individual special tests.
All of our participants consented for their data to be used for research purposes.
The sample consisted of 300 patients, 296 of whom were male. The mean age was 22.6 years.
Overall, the results suggest that it is diagnosing the direction of shoulder instability in rugby players is challenging. Overall, the direction of shoulder instability was correctly diagnosed in just 42% of cases.
Anterior shoulder instability was diagnosed in 114 patients from clinical examination and 75% of these went on to have isolated anterior instability at surgery, which sounds relatively reasonable.
However, 64 patients who were clinically diagnosed with other forms of instability went on to have isolated anterior instability at surgery. This included 30 patients who were not diagnosed with any form on instability
The hypothesised challenge posed by rugby players in the literature is that they are characteristically well-muscled, which enables them to compensate for instability as well as having a high pain tolerance.
20% of the patients with surgical anterior instability were diagnosed as having no instability from clinical examination
This may be somewhat explained by the lower than previously reported sensitivity and negative predictive value of the anterior apprehension test in our sample. In studies of thousands of patients, Hegedus et al. and Jia both reported sensitivities of over 65%. But in our study, the sensitivity was just 53% which
In terms of diagnosing posterior instability, all three of the special tests analysed in our study had high sensitivity. Therefore a positive result had a high probability of isolated posterior instability. However, none of the tests had a specificity above 50%, so ruling out posterior instability remains challenging.
This is illustrated further as we follow through the 119 patients diagnosed with posterior instability from clinical examination. Whilst only 30.2% went on have posterior instability, only 5 patients went on to have posterior instability who were not originally diagnosed with it from clinical examination
Overall, this study demonstrates the challenge which rugby players offer us as clinicians trying to determine the direction of shoulder instability.
The study highlights the lower sensitivity and negative predictive value of the anterior apprehension test in rugby players compared to the normal population.
Finally, this study suggests that the WPIT, Kim test and Throwers test are all useful tools for diagnosing posterior instability of the shoulder as a positive test is highly suggestive of posterior instability.