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.
Short Term Analysis of Clinical, Functional Radiological Outcome of Total Kne...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Arthrolatarjet (Arthroscopic Latarjet Proc) Dr Sujit Jos keralaSujit Jos
Arthroscopic Latarjet procedure is gaining popularity in every part of the world as it combines the strength of Latarjet procedure while retaining the advantages of Arthroscopy. It is most useful shoulder recurrent dislocation associated with bone loss in the glenoid (Bony Bankart) or humeral head (Hill Sach's defect).
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.
Short Term Analysis of Clinical, Functional Radiological Outcome of Total Kne...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Arthrolatarjet (Arthroscopic Latarjet Proc) Dr Sujit Jos keralaSujit Jos
Arthroscopic Latarjet procedure is gaining popularity in every part of the world as it combines the strength of Latarjet procedure while retaining the advantages of Arthroscopy. It is most useful shoulder recurrent dislocation associated with bone loss in the glenoid (Bony Bankart) or humeral head (Hill Sach's defect).
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.
Robotic spine surgery is on the cutting edge of medicine, allowing our surgeons to exercise an incredible level of precision, well beyond standard capabilities.
Percutaneous fixation of bilateral anterior column acetabular fracturesApollo Hospitals
The treatment of displaced acetabular fractures with open
reduction and internal fixation has gained general acceptance. This is done either by anterior, posterior or combined approaches depending on the location of these fractures. These procedures may be associated with various complications like significant blood loss, infection, lengthy operative times, heterotopic ossification and neurovascular complications.
One test can save your life. Know what a CT Scan Cervical Spine (Neck) is, why you should have it, who should get it, and where can you get tested as well as get your results fast. If you want to read more about CT Scan Cervical Spine (Neck), just click the link below.
Visit: https://www.labfinder.com/labexams/ct-scan-of-back-cervical-spine-neck/ and get tested now!
Ligamentotaxis in the Intraarticular and Juxta Articular Fracture of Wristiosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
This study was presented at the 2019 AANA annual meeting by Dr Adnan Saithna, expert in ACL reconstruction, Overland Park, Kansas. It is the largest published series specifically evaluating ramp lesions (a specific type of meniscal tear) in ACL injured knees. This important work allowed identification of the incidence of this injury and an evaluation of re-operation rates after repair
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.
Robotic spine surgery is on the cutting edge of medicine, allowing our surgeons to exercise an incredible level of precision, well beyond standard capabilities.
Percutaneous fixation of bilateral anterior column acetabular fracturesApollo Hospitals
The treatment of displaced acetabular fractures with open
reduction and internal fixation has gained general acceptance. This is done either by anterior, posterior or combined approaches depending on the location of these fractures. These procedures may be associated with various complications like significant blood loss, infection, lengthy operative times, heterotopic ossification and neurovascular complications.
One test can save your life. Know what a CT Scan Cervical Spine (Neck) is, why you should have it, who should get it, and where can you get tested as well as get your results fast. If you want to read more about CT Scan Cervical Spine (Neck), just click the link below.
Visit: https://www.labfinder.com/labexams/ct-scan-of-back-cervical-spine-neck/ and get tested now!
Ligamentotaxis in the Intraarticular and Juxta Articular Fracture of Wristiosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
This study was presented at the 2019 AANA annual meeting by Dr Adnan Saithna, expert in ACL reconstruction, Overland Park, Kansas. It is the largest published series specifically evaluating ramp lesions (a specific type of meniscal tear) in ACL injured knees. This important work allowed identification of the incidence of this injury and an evaluation of re-operation rates after repair
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.
Presentations from Professor Adnan Saithna at the North West Upper Limb Group Meeting January 2018, focusing on current concepts in the diagnosis and management of long head of biceps tendon pathology, with an emphasis on the young, active patient with anterior shoulder pain
Predictors of Patients’ Functional Outcome after Motor Nerve Transfers in Man...Professor M. A. Imam
To maximize outcome in nerve transfers:
1- The recipient nerve reinnervated close to the target muscle.
2- Direct repair without intervening grafts.
3- Similarly behaving neuromuscular units (agonistic donors and recipients)
This study demonstrates that 3D-MRI is able to evaluate the anterolateral ligament fully in all normal knees. The classification system for injury to the ALL described shows high inter- and intra-observer reliability
Study of current pattern of Cervical Spondylotic Myelopathy and to evaluate t...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
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Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
1. Manos Antonogiannakis
O r t h o p a e d i c S u r g e o n
Director Center for Shoulder Arthroscopy
IASO General Hospital
Athens, Greece
www.shoulder.gr
9. Demonstrate the extent and the configuration of rot cuff abnormalities
Suggest mechanical imbalance of the cuff
Document abnormalities of the adjacent muscles.
With the use of the pre-operative MRI the surgeon is able to predict the rotator cuff tear pattern, the appropriate
method for repairing and the prognosis .
10. Field strength : High field strength 1, 1.5, 3 Tesla
Low field strength 0.5 Tesla
Low field strength : longer time to generate images
High signal to noise ratio
Surface coils (transmitter and receiver of radiofrequency pulses) that generate
Pulse sequences
T1-weighted sequence (fat bright,- water , muscle intermediate – fibrous, calcioum
dark)
T2-weighted sequence(water ,fat bright-muscle intermediete-fibrous, calcioum dark
Proton density
Gradient echo
Fat saturation techniques (supress the signal from fat so that pathology to be more
obvious)
MRI nomenclature
The patient is placed into a magnetic field created by a strong
magnet
12. Partial tears are better imaged by MR direct
arthrography
High(fluid) signal intensity due to Gadolinioum through a portion of the tendon
Common in young athletes in combination with SLAP tears
13. Many classification systems have been described
But we use the 2-dimensional classification system described by S. Burkhart that links
preoperative MRI imaging to operative treatment and prognosis
14. Measure L (medial to lateral length)
Blunt
Taper
ed
Wisp
y
Measure from here
Measure W (anterior to posterior length)
Measurment in two dimensions Length medial to lateral. Width anterior to posterior
Good quality T2 weighted fat suppressed coronal
oblique and sagital oblique MRI images are used for the
calculations
15. Type Description Preoperative MRI Findings Treatment Prognosis
1 Crescent Short and wide tear
End-to-bone
repair
Good to excellent
2
Longitudinal
(L or U)
Long and narrow tear
Margin
convergence
Good to excellent
3
Massive
contracted
Long and wide
> (2 x 2 cm)
Interval
slides or
partial repair
Fair to good
4
Cuff tear
arthropathy
Cuff tear arthropathy Arthroplasty Fair to good.
16. Type Description Preoperative MRI Findings Treatment Prognosis
1 Crescent
Short and wide tear
L < W
End-to-bone
repair
Good to
excellent
18. Type Description Preoperative MRI Findings Treatment Prognosis
2
Longitudinal
(L or U)
Long and narrow tear
L > W
Margin
convergence
Good to
excellent
19.
20. Type Description Preoperative MRI Findings Treatment Prognosis
3
Massive
contracted
Long and wide
> (2 x 2 cm)
Interval slides
or partial repair
Fair to good
21.
22.
23. Preoperative estimation of fatty infiltration of
infraspinatus and supraspinatus muscle bellies
affects the prognosis
26. Arthroscopic repair of massive rot cuff tears with stage 3 and 4
fatty degenaration
S.S. Burkhart et al Arthroscopy 2007
22 patients,
Mean age 66.5
Massive 2 and 3 tendon tears
Mean F.U. 39 months
Mean UCLA score; pre-op 12.3 post-op 29.5
Mean active FF: preoperative 103.2° and postoperatively: 156.9°).
Mean active ext rot: preoperative 35.7° and postoperative: 54.8°
Better results in patients with 50-75% Fatty degeneration of infraspinatus than in
more than 75%
Fair to good prognosis
27. 2 years (January 2011– December 2012)
28 patients with an average age of 66 years
Chronic tears: 57% - Acute on chronic tears: 43%
Tangent sign positive: 82%
Repair: Complete - 68%, Medialized – 20% - Partial 12%
Following these guidelines and classification system
We had similar results
28. Mean VAS: from 7 pre-op to 0.3 post-op
From preoperatively to One year postoperatively
Mean active FF: from 141 to 171 degrees
Mean active ER in 0 degrees abduction: from 54 to 69 degrees
Mean active IR: from L3 to Th11
Mean Constant Score: from 35 to 73
Mean ASES: from 48 to 93
Mean Power in ER: from 1.6 to 6
29. Important is that by preoperative MRI imaging we can
plan the operation and have a fairly accurate
prediction of the outcome
32. Thickened coracohumeral ligament
Thickening of soft tissue in the rotator interval
Thickened inferior glenohumeral ligament
33. The diagnosis of frozen shoulder is clinical
Be aware of MRI reports of tendinosis or partial thickness
rot cuff tears or narrow subacromial space in a clinically
diagnosed frozen shoulder
They are misleading and can drive the surgeon to wrong decisions regarding the
best treatment
The signs of frozen shoulder in MRI are subtle but very obvious in clinical
examination
And remember the radiologist has not examined the patient and usually has very litle
information about the clinical condition of the patient
34. There is no need for evaluating with MRI in order to be detected
even though the accuracy of MRI for finding calcification is more than 95%.
Only an x-ray of the shoulder is needed for the diagnosis of calcific tendonitis
especially in the acute face
35. Interpreting MR images of the post-operative shoulder can be daunting
because of the artifacts from implants that often make the study harder to
evaluate.
36.
37. Conventional MRI provides a good
overview of shoulder lesions and anatomy,
particularly the soft-tissue structures.
However, it is less accurate than MR
arthrography for depiction of small
labroligamentous lesions associated with
shoulder dislocation.
MR arthrography is the imaging modality of
choice to evaluate the labrum. It has the
highest sensitivity and specificity of all
available modalities.
But it is invasive and inconvenient for the
patient
38. Differences in the type of soft tissue lesions have little influence
to the planning of the operation ,but significant bone loss either
of the glenoid or the humeral head has
39. Traumatic Glenohumeral bone defects and Their
relationship to failure of arthroscopic Bankart repairs:
Significance of the inverted-pear glenoid and the
humeral engaging Hill-Sachs lesion
S.S. Burkhart and J. F. De Beer, M.D.
Arthroscopy,October 2000
40. Total group: 194 patients
173 pt without significant bone defects :
7 pt sustained a recurrence (4%)
21 pt with significant bone defects:
14 pt developed rec instability (67%)
41. The inferior 2/3 of the glenoid is nearly a perfect
circle with avg diameter 24mm
Huysman et al. JSES 2006
43. Loss of 8.6mm of anterior radius of glenoid at the level
of the bare spot corresponds to 35% of the normal
anteroposterior width
Lo, Burkhart Arthroscopy 2004
44. >25 – 30% bone loss
6.5 – 8.6mm AP width
Inverted pear appearance
Bone block procedures
Piasecki et al. AAOS J17 (8): 482. (2009)
45. Although a bony bankart and glenoid and
humeral bone defects are being depicted on
MRI at present CT-scans are better for the
quantification of the defects
46. Glenoid Index in 3D CT scan of both shoulders
Critical Limit Glenoid index 0.75
SS Burkhart Arthroscopy: Vol 24, No 4 (April), 2008: pp 376-382
47. Taverna et al. Pico Method 2D CT – measurement of
glenoid surface Critical Limit 25% loss of glenoid
surface
48. Our practice
The percentage of the glenoid defect was evaluated on the en face reconstructed
view with the humeral head eliminated
Sugaya et al (2005) Joint Surg Am
49. Glenoid Bone Loss >25-30%
Arthroscopic or open Latarjet procedure
L. Lafosse
Arthroscopic shoulder stabilization with a bone
block
E. Taverna
53. Engaging Hill-Sachs-glenoid bone loss
Hill- Sachs Remplisage: An arthroscopic surgical
solution for the engaging Hill-Sachs
E.M. Wolf
54. OOF
SHOULDER1
2 Midterm outcomes of arthroscopic remplissage
3 for the management of recurrent anterior shoulder instability
4 Emmanouil Brilakis • Elias Mataragas •
5 Anastasios Deligeorgis • Vasilios Maniatis •
6 Emmanouil Antonogiannakis
7 Received: 14 April 2013/Accepted: 12 January 2014
8 Ó Springer-Verlag Berlin Heidelberg 2014
9 Abstract 27returned to their previous everyday activities while 70.8 %
Knee Surg Sports Traumatol Arthrosc
DOI 10.1007/s00167-014-2848-1
AuthorProof
55. 4 years (January 2007– December 2010)
48 patients with an average age of 28.9 ± 7.8 years
Positive apprehension sign pre-operatively
79% of these patients were involved in sport activities
of different levels.
Mean follow-up period: 37.2 ± 9.9 months
UNCO
RRECTED
PRO
O
F
SHOUL DER1
2 M idter m outcomes of ar thr oscopic r emplissage
3 for the management of r ecur r ent anter ior shoulder instability
4 Emmanouil Br ilakis • Elias M atar agas •
5 Anastasios Deligeor gis • Vasilios M aniatis •
6 Emmanouil Antonogiannakis
7 Received: 14 April 2013 / Accepted: 12 January 2014
8 Ó Springer-Verlag Berlin Heidelberg 2014
9 Abstr act
10 Purpose The purpose of the study was to present midterm
11 results concerning the management of recurrent anterior
12 shoulder instability with the remplissage technique in
13 addition to the classic Bankart repair, in patients with
14 engaging Hill–Sachs lesions.
15 Methods During a time period of 4 years (January 2007–
16 December 2010), 48 patients with an average age of
17 28.9 ± 7.8 years were operated on in our department.
18 They all had a positive apprehension sign pre-operatively
19 and satisfied the inclusion criteria of this study. Seventy-
20 nine per cent of these patients were involved in sport
21 activities of different levels. The mean follow-up period
22 was 37.2 ± 9.9 months.
23 Results Three patients (6.3 %) had suffered a new dis-
24 location: one of them after a low-energy trauma and the
25 two other after a high-energy trauma. The rest of the
26 patients (93.7 %) were satisfied with the surgical result and
27returned to their previous everyday activities while 70.8 %
28continued to participate in sporting activities without
29restrictions. The ASES score increased from 67.7 ± 21.5
30points pre-operatively to 90.8 ± 21.7 points post-opera-
31tively (p 0.01), the modified Rowe score from 38 ± 17.3
32to 93.8 ± 14.5 (p 0.001) and the Oxford Instability score
33from 27.6 ± 11.1 to 45.1 ± 8.3 (p 0.001). No signifi-
34cant restriction in shoulder range of motion was
35documented.
36Conclusions The outcome of the enhancement of the
37classic Bankart repair with tenodesis of the infraspinatus
38and posterior capsular plication is very good as far as the
39management of recurrent anterior shoulder instability is
40concerned, without significantly influencing the range of
41motion of the shoulder.
42Level of evidence Therapeutic study—case series with no
43comparison group, Level IV. 44
45K eywor ds Arthroscopy Shoulder Remplissage
46Recurrent anterior shoulder instability Engaging Hill–
47Sachs lesion
48I ntr oduction
49Arthroscopic Bankart repair is nowadays widely accepted
50as the treatment of choice for the management of patients
51with traumatic unidirectional anterior shoulder instability.
52However, when a marked glenoid defect is discovered, the
53Bristow, the Latarjet or other bone grafting procedures are
54indicated. On the other hand, when large Hill–Sachs
55lesions exist, the optimal treatment is controversial.
56According to Burkhart and De Beer [2], large osseous
57defects of the postero-superior aspect of the humeral head
58can engage the glenoid rim and cause recurrent instability
A1 E. Brilakis (& ) E. Mataragas A. Deligeorgis
A2 E. Antonogiannakis
A3 2nd Orthopaedic Department, Shoulder Arthroscopy and Surgery
A4 Center, IASO General Hospital, 44-46 Str. Sevastopoulou,
A5 115 24 Athens, Greece
A6 e-mail: emmanuel.brilakis@gmail.com
A7 E. Mataragas
A8 e-mail: eliasmataragas@gmail.com
A9 A. Deligeorgis
A10 e-mail: delitasos@hotmail.com
A11 E. Antonogiannakis
A12 e-mail: manosanton@gmail.com
A13 V. Maniatis
A14 Department of Radiology, IASO General Hospital, Athens,
A15 Greece
A16 e-mail: vmaniatis67@gmail.com
123
Journal : L ar ge 167 Dispatch : 23-1-2014 Pages : 8
Article No. : 2848 h LE h TYPESET
MS Code : K SST-D-13-00348 h CP h DISK4 4
Knee Surg Sports Traumatol Arthrosc
DOI 10.1007/s00167-014-2848-1
AuthorProof
56. Failure rate: 6.3 %
93.7 % satisfied with the surgical result and returned to their previous
everyday activities
70.8 % continued to participate in sporting activities without restrictions.
ASES score: increased from 67.7 ± 21.5 29 to 90.8 ± 21.7 points (p<0.01),
Modified Rowe score increased from 38 ± 17.3 to 93.8 ± 14.5 (p<0.001)
Oxford Instability score increased from 27.6 ± 11.1 to 45.1 ± 8.3 (p<0.001).
No significant restriction in shoulder range of motion
UNCO
RRECTED
PRO
O
F
SHOUL DER1
2 M idter m outcomes of ar thr oscopic r emplissage
3 for the management of r ecur r ent anter ior shoulder instability
4 Emmanouil Br ilakis • Elias M atar agas •
5 Anastasios Deligeor gis • Vasilios M aniatis •
6 Emmanouil Antonogiannakis
7 Received: 14 April 2013 / Accepted: 12 January 2014
8 Ó Springer-Verlag Berlin Heidelberg 2014
9 Abstr act
10 Purpose The purpose of the study was to present midterm
11 results concerning the management of recurrent anterior
12 shoulder instability with the remplissage technique in
13 addition to the classic Bankart repair, in patients with
14 engaging Hill–Sachs lesions.
15 Methods During a time period of 4 years (January 2007–
16 December 2010), 48 patients with an average age of
17 28.9 ± 7.8 years were operated on in our department.
18 They all had a positive apprehension sign pre-operatively
19 and satisfied the inclusion criteria of this study. Seventy-
20 nine per cent of these patients were involved in sport
21 activities of different levels. The mean follow-up period
22 was 37.2 ± 9.9 months.
23 Results Three patients (6.3 %) had suffered a new dis-
24 location: one of them after a low-energy trauma and the
25 two other after a high-energy trauma. The rest of the
26 patients (93.7 %) were satisfied with the surgical result and
27returned to their previous everyday activities while 70.8 %
28continued to participate in sporting activities without
29restrictions. The ASES score increased from 67.7 ± 21.5
30points pre-operatively to 90.8 ± 21.7 points post-opera-
31tively (p 0.01), the modified Rowe score from 38 ± 17.3
32to 93.8 ± 14.5 (p 0.001) and the Oxford Instability score
33from 27.6 ± 11.1 to 45.1 ± 8.3 (p 0.001). No signifi-
34cant restriction in shoulder range of motion was
35documented.
36Conclusions The outcome of the enhancement of the
37classic Bankart repair with tenodesis of the infraspinatus
38and posterior capsular plication is very good as far as the
39management of recurrent anterior shoulder instability is
40concerned, without significantly influencing the range of
41motion of the shoulder.
42Level of evidence Therapeutic study—case series with no
43comparison group, Level IV. 44
45K eywor ds Arthroscopy Shoulder Remplissage
46Recurrent anterior shoulder instability Engaging Hill–
47Sachs lesion
48I ntr oduction
49Arthroscopic Bankart repair is nowadays widely accepted
50as the treatment of choice for the management of patients
51with traumatic unidirectional anterior shoulder instability.
52However, when a marked glenoid defect is discovered, the
53Bristow, the Latarjet or other bone grafting procedures are
54indicated. On the other hand, when large Hill–Sachs
55lesions exist, the optimal treatment is controversial.
56According to Burkhart and De Beer [2], large osseous
57defects of the postero-superior aspect of the humeral head
58can engage the glenoid rim and cause recurrent instability
A1 E. Brilakis (& ) E. Mataragas A. Deligeorgis
A2 E. Antonogiannakis
A3 2nd Orthopaedic Department, Shoulder Arthroscopy and Surgery
A4 Center, IASO General Hospital, 44-46 Str. Sevastopoulou,
A5 115 24 Athens, Greece
A6 e-mail: emmanuel.brilakis@gmail.com
A7 E. Mataragas
A8 e-mail: eliasmataragas@gmail.com
A9 A. Deligeorgis
A10 e-mail: delitasos@hotmail.com
A11 E. Antonogiannakis
A12 e-mail: manosanton@gmail.com
A13 V. Maniatis
A14 Department of Radiology, IASO General Hospital, Athens,
A15 Greece
A16 e-mail: vmaniatis67@gmail.com
123
Journal : L ar ge 167 Dispatch : 23-1-2014 Pages : 8
Article No. : 2848 h LE h TYPESET
MS Code : K SST-D-13-00348 h CP h DISK4 4
Knee Surg Sports Traumatol Arthrosc
DOI 10.1007/s00167-014-2848-1
AuthorProof
57. Evolving Concept of Bipolar Bone Loss and
the Hill-Sachs Lesion:
From “Engaging/Non-Engaging” Lesion to “On-
Track/Off-Track” Lesion
Giovanni Di Giacomo, Eiji Itoi, Stephen S. Burkhart
Or when to perform a soft tissue Bankart repair only
Or in combination with Remplisage or a Latarget procedure
58. Evolving Concept of Bipolar Bone Loss and the Hill-Sachs Lesion:
From “Engaging/Non-Engaging” Lesion to “On-Track/Off-Track” Lesion
Giovanni Di Giacomo, Eiji Itoi, Stephen S. Burkhart
Three-dimensional CT scan with en face view of a normal glenoid, with
subtraction of the humeral head
The width of the glenoid track without a glenoid defect is 83% of the glenoid width.
Glenoid track= the width
of the posterior lateral
part of the humeral that
is in contact with the
glenoid in abduction –
ext rotation
59. Evolving Concept of Bipolar Bone Loss and the Hill-Sachs Lesion:
From “Engaging/Non-Engaging” Lesion to “On-Track/Off-Track” Lesion
Giovanni Di Giacomo, Eiji Itoi, Stephen S. Burkhart
A. 3D CT scan with en face view of a glenoid with bone loss of width d.
In such a case with glenoid bone loss, the glenoid track will be 83% of the normal
glenoid width minus d.
.
60. Evolving Concept of Bipolar Bone Loss and the Hill-Sachs Lesion:
From “Engaging/Non-Engaging” Lesion to “On-Track/Off-Track” Lesion
Giovanni Di Giacomo, Eiji Itoi, Stephen S. Burkhart
The width of the glenoid track of the humeral head
bigger than the Hill-Sachs= non engaging ,on track
61. Evolving Concept of Bipolar Bone Loss and the Hill-Sachs Lesion:
From “Engaging/Non-Engaging” Lesion to “On-Track/Off-Track” Lesion
Giovanni Di Giacomo, Eiji Itoi, Stephen S. Burkhart
The width of the glenoid track of the humeral head
smaller than the Hill-Sachs= engaging ,off track
62. Off track = Engaging Hill-Sachs
Evaluation during arthroscopy
Engagement of the Hill-Sachs can be evaluated
preoperatively
63. Evolving Concept of Bipolar Bone Loss and the Hill-Sachs Lesion:
From “Engaging/Non-Engaging” Lesion to “On-Track/Off-Track” Lesion
Giovanni Di Giacomo, Eiji Itoi, Stephen S. Burkhart
Group Glenoid Defect Hill-Sachs Lesion Recommended Treatment
1 <25% On track Arthroscopic Bankart repair
2 <25% Off track Arthroscopic Bankart repair plus remplissage
3 >25% On track Latarjet procedure
4 >25% Off track Latarjet procedure with or without humeral-sided
procedure (humeral bone graft or remplissage),
depending on engagement of Hill-Sachs lesion
after Latarjet procedure
and the operation planned accordingly
At present we are evaluating the preoperative calculation with direct arthoscopic
confirmation of engagement but the results are promising
64. Benign tumors around the shoulder
Primary and metastatic malignant tumors
Subtle fractures of the upper part of the humerous or
the scapula
Sinovial diseases ( osteochondromatosis , PVS)
Neuropathies of the peripheral nerves that innervate
the muscles of the scapula and the shoulder
Be especially suspicious when the clinical presentation is not
familiar
65.
66.
67. 1. MRI is helpful in Rot Cuff tears
depicting not only the existence but also the size, morphology,
condition of the rot cuff muscles and prognosis
2.In frozen shoulder the diagnosis may be missed
beware of reports of supraspinatus tendinosis or calcifications
of the supraspinatus in a clinical diagnosed frozen shoulder
3. Partial rot cuff tears and labral tears especially in young
overhead athletes are best depicted with MR Arthrogram
4. Although Glenoid bone loss and Hill-Sachs lesions are depicted
with MRI, are better quantitated at present by a 3D CT-scan
5.Unfamiliar clinical presentations need further imaging