Double row repair
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A 44-year-old overhead worker presented with pain and inability to raise his arm after a fall 30 days prior. An MRI revealed a complete tear of the supraspinatus tendon extending to the infraspinatus. The surgeon performed a double row rotator cuff repair using the technique of bursectomy, tendon debridement and mobilization, acromioplasty and tuberoplasty followed by medial and lateral row suture anchor insertion and knot tying to reattach the torn tendons. The repair was inspected from the glenohumeral joint before concluding the procedure.
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This document discusses rotator cuff tears, including their indications, treatment options, and results. It provides an overview of rotator cuff anatomy and function. It describes the various types and classifications of rotator cuff tears and discusses the history and evolution of rotator cuff repair techniques. Treatment options are discussed depending on factors like the patient's age, tear size and chronicity. Expected results are outlined based on the pre-operative tissue quality and repair achieved.
Bone defects thessal2010
This document discusses treatment options for bone defects in the glenoid and humeral head that can cause recurrent shoulder instability. It finds that humeral head (Hill-Sachs) defects occur in 65-93% of cases depending on the number of dislocations, while glenoid defects occur in 5-56% of cases. Treatment depends on the size and engagement of the defects. For large Hill-Sachs lesions, options include bone grafting, arthroplasty, or the remplissage procedure. For significant glenoid bone loss over 20-30%, options include soft tissue repair plus bone grafting or procedures like Bristow or Latarjet to add bone to the glenoid. The document advocates
Impingement syndromes
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
πρωτο εξάρθρημα
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.
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This document provides an overview of shoulder arthroscopy presented by Manos Antonogiannakis. It discusses shoulder anatomy, patient positioning, basic arthroscopic tools, and common arthroscopic procedures such as rotator cuff repair, biceps tenodesis/tenotomy, calcifying tendonitis repair, frozen shoulder treatment, and anterior instability procedures like Bankart repair. The presentation emphasizes proper portal placement, hemostasis, and having the necessary instrumentation prepared before beginning the arthroscopic procedure.
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Massive rotator cuff tears present unique challenges for repair. The document discusses techniques for arthroscopic repair based on tear pattern, including releases to improve mobility. For crescent tears, a double row fixation is recommended. L-shaped and U-shaped tears are repaired with side-to-side sutures converging the margin. Massive contracted immobile tears may require interval slides. Outcomes are generally good, though strength deficits can remain. Proper patient selection considering fatty degeneration and mobility is important for success.
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The document summarizes key points from a seminar on shoulder instability and scapular dyskinesis. It discusses the anatomy of the shoulder and factors contributing to instability, including traumatic injuries and muscular dysfunction. It presents classifications for different instability profiles and evaluates treatments based on the size of glenoid and humeral bone defects. The concepts of engaging versus non-engaging Hill-Sachs lesions are introduced, and the evolving model of on-track versus off-track lesions is described, which considers both glenoid track width and size of the Hill-Sachs interval. Remplissage is highlighted as an arthroscopic technique for engaging Hill-Sachs lesions.
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This document discusses arthroscopic rotator cuff repair. It begins with an overview of rotator cuff disease and the history of rotator cuff repair surgery. The document then outlines the goals and techniques of arthroscopic rotator cuff repair surgery, including preparation, visualization, tear evaluation and closure methods. Post-operative rehabilitation is also addressed. The document concludes with a discussion of studies showing high success rates for arthroscopic repair and comparisons of advantages and disadvantages to open surgical techniques.
αρθροσκόπηση ώμου μτχ παρακολούθηση
This document discusses shoulder arthroscopy and postoperative monitoring. It begins by outlining the range of motion and planes of movement in the shoulder joint, which make it prone to injuries. The history of shoulder arthroscopy is then reviewed, from the first cadaver procedure in 1931 to advances like arthroscopic rotator cuff repair in the 1980s. Diagnostic arthroscopy techniques are covered, including anesthesia, positioning, room setup, and basic tools. Therapeutic arthroscopy is then outlined for treating various shoulder issues like rotator cuff tears, instability, SLAP lesions, frozen shoulder, AC joint problems, and arthritis. Success rates for arthroscopic shoulder stabilization are reported to be over 90% in several studies.
εξελίξεις στην αρθροσκοπική χειρουργική της ακρωμιοκλειδικής
This document discusses advances in arthroscopy of the acromioclavicular (AC) joint. It describes the anatomy of the AC joint and common pathologies like osteolysis, arthritis, cysts, and dislocations that can be treated arthroscopically. Techniques for arthroscopic distal clavicle excision, AC joint reconstruction for dislocations using grafts or ligament transfers are presented. The author's preference is for open reduction and fixation for AC dislocations due to more precise reduction and residual scarring's effect on stability. Several case examples are provided.
καλαμάτα 2016 αρθρίτιδα ώμου
This document discusses shoulder arthritis and treatment options. It begins by describing the anatomy of the shoulder joint and causes of shoulder pain such as osteoarthritis, rotator cuff tears, and fractures. Symptoms of shoulder arthritis include pain, reduced range of motion, grinding, and stiffness. Diagnosis involves physical exams, imaging like x-rays and MRIs, and blood tests. Non-surgical treatments include medications, injections, physical therapy and lifestyle modifications. Surgical options include joint preserving procedures like arthroscopy and synovectomy for early arthritis or shoulder replacements like hemiarthroplasty, total shoulder replacement, and reverse total shoulder replacement for more severe arthritis. Outcomes of shoulder replacements are generally good with implant survival rates of
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This document provides an overview of shoulder arthroscopy procedures including patient positioning, room setup, skin marking of bony landmarks, creation of portals, and navigation of the glenohumeral joint and subacromial space. It discusses the lateral decubitus position as the preferred approach and describes skin marking for the basic posterior, anterior superior, anterior inferior, and posterior lateral portals. Key steps are outlined including insertion of the arthroscope through the posterior portal for initial visualization of the glenohumeral joint.
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This document discusses the management of traumatic anterior shoulder dislocations. It begins by describing the shoulder's anatomy and how its mobility makes it prone to instability. It then reviews the history and clinical examination findings that help determine appropriate treatment. Arthroscopic findings from studies of acute and chronic dislocations are presented, showing common lesions like Bankart tears. Treatment options are explored, including arthroscopic stabilization which can address all lesions with minimal morbidity. Arthroscopy allows accurate diagnosis and repair of injuries while facilitating early rehabilitation. The conclusion is that arthroscopy is now often the treatment of choice for traumatic shoulder dislocations.
Posterior instability
This document discusses posterior shoulder instability. It begins by outlining different types of posterior instability such as locked dislocation, traumatic unidirectional instability, and atraumatic instability. It emphasizes the importance of obtaining a thorough history and clinical examination to determine the mechanism of injury, position of apprehension, and ability to demonstrate instability. Imaging can help identify labral tears or bone abnormalities like glenoid dysplasia. Arthroscopic surgical techniques are recommended for treating traumatic unidirectional instability and involve repairing the labrum through posterior and accessory portals. Post-operative rehabilitation is outlined. Careful examination is key to properly diagnosing and treating posterior shoulder instability.
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Technique of Bursectomy involves using an arthroscope, shaver, and radio frequency device through two portals, posterior and lateral, to perform bursectomy. Initially the view is blurred but things soon become more clear as the procedure progresses.
Massive rct salonica 2106
1) Massive rotator cuff tears lower the functional capacity of the shoulder and can cause clinical symptoms when functional demands exceed capacity.
2) Treatment aims to restore equilibrium between demands and capacity by lowering demands, increasing capacity, repairing the cuff, or using tendon transfers or reverse shoulder arthroplasty.
3) Complete release of the torn tendons from surrounding structures is required to properly assess reparability before attempting repair without tension or considering alternative treatments.
Double row athlitiatriko 2008
This document discusses the history and techniques of double row arthroscopic rotator cuff repair. It provides details on the anatomy and function of the rotator cuff. Tears can range from partial to full thickness and increase in prevalence with age. Double row repair techniques aim to restore the footprint and increase fixation points compared to single row repair. While it provides stronger repair, double row is more time consuming and technically challenging. Factors like tear size and chronicity impact repair outcomes.
Mdi physiotherapists - nikos
This document discusses multi-directional shoulder instability (MDI). MDI is characterized by instability in at least two directions, usually anterior, posterior, or inferior. It is commonly caused by repetitive overhead motion stretching the shoulder capsule beyond its limits. Clinically, MDI presents with vague symptoms, laxity and translation in multiple directions on examination. Treatment involves strengthening dynamic stabilizers through physical therapy, with surgery such as arthroscopic capsular plication considered if conservative measures fail. Outcomes are generally good, though some residual pain and instability may remain long term.
Mri in corellation to surgery
The document summarizes a study on arthroscopic remplissage for recurrent anterior shoulder instability. 48 patients underwent remplissage in addition to Bankart repair, with a mean follow-up of 37 months. The failure rate was 6.3%, and 93.7% were satisfied without restrictions. Scores on the ASES, Rowe, and Oxford scales all significantly improved post-operatively without loss of range of motion. The study concludes remplissage enhances Bankart repair for managing instability, with good results and no effect on shoulder movement.
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This document discusses techniques for repairing rotator cuff tears arthroscopically. It begins by describing the classification of partial versus full thickness tears and massive tears involving two or more tendons. For massive contracted immobile tears, interval slides can be performed through the anterior and posterior intervals to regain mobility. Repair techniques depend on the tear pattern, such as side-to-side sutures for U-shaped tears or interval slides for massive immobile tears. Results of arthroscopic repair for massive tears show 84-94% excellent or good results according to several studies. The key is to match the repair technique to the tear morphology and mobility to minimize strain on the repair.
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Double row repair
- 1. Technique of double row rot cuff repair Manos Antonogiannakis Director Center for shoulder arthroscopy IASO General Hospital Athens, Greece
- 2. 44 year old Over head worker Pain after a fall 30 days ago Pain and inability to raise his arm MRI: complete tear of supraspinatus extending to infraspinatus
- 5. Bursa excision – Tendon mobilization
- 6. Tendon debridement- Tear morphology recognition
- 9. Checking the mobility and elasticity of the tendons
- 10. Acromioplasty
- 11. Mobilization of the Articular Part of the Rotator Cuff
- 12. Tuberoplasty
- 13. 1st Anchor Insertion – Medial Row
- 14. 1st suture passage- Medial row - mattress
- 15. 2nd suture passage- Medial row - mattress
- 16. 4rd suture passage- Medial row - mattress
- 17. 2nd Anchor Insertion – Medial Row
- 18. suture passage- Medial row – post. anchor
- 19. suture passage- Medial row – post. anchor
- 20. Suture inspection – medial row - mattress
- 21. Lateral Row 1st Anchor Insertion
- 22. Lateral Row Suture Passage
- 23. Lateral Row Suture Passage
- 24. Lateral Row 2nd Anchor Insertion
- 25. Lateral Row Suture Passage
- 26. Inspection of all the sutures
- 27. Knot Tying Lateral Row
- 28. Knot Tying Mattress Medial Row
- 29. Knot Tying Mattress Medial Row
- 30. Knot Tying Lateral Row
- 31. Knot Tying Lateral Row
- 32. Knot Tying Mattress Medial Row
- 33. Final Repair
- 34. Inspection from the Glenohumeral Joint
- 35. Thank you for your attention