Post instability walton
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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.
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This document discusses the rehabilitation approach for patients following shoulder instability surgery. It focuses on principles such as analgesia, quality range of motion, muscle control, timing, strength goals, and patient-specific rehabilitation. The approach emphasizes avoiding immobilization to prevent deconditioning while also protecting the surgical repair site. Exercises target the rotator cuff and scapular muscles as well as proprioception and the kinetic chain. The rehabilitation progresses from an initial protection phase using range of motion and proprioceptive exercises to a functional phase incorporating strengthening, sports-specific exercises, and plyometrics.
Rc repair philosophy and technique microhand 2014
This document summarizes the philosophy and techniques for arthroscopic treatment of rotator cuff tears. It discusses restoring the balance between the functional demands on the shoulder and the capacity of the rotator cuff by lowering demands, increasing cuff capacity, or repairing tears. Various tear patterns such as partial, full thickness, crescent, U-shaped, and massive contracted tears are described. Surgical techniques including debridement, acromioplasty, margin convergence, and interval slides are outlined. Good results are reported for small and medium tears, and massive tears with less fatty infiltration, while irreparable tears may require tendon transfers or arthroplasty.
Rotator cuff 2008 final
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.
Serious games for upper limb rehabilitation following stroke
This document discusses the development of serious games for upper limb rehabilitation following stroke. The researchers at the University of Ulster created virtual reality and webcam-based games that can be played with inexpensive off-the-shelf hardware like the Nintendo Wii remote. Their goal was to develop engaging rehabilitation games that motivate patients and can be used at home or in clinical settings. An initial usability study found patients enjoyed the games and found the feedback and adaptivity to be effective. Further clinical studies are planned to evaluate the games' effects on motor function recovery.
Labral repairs 2013 lf
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.
SCJ instability athletes 2017
Sternoclavicular joint (SCJ) injuries are uncommon. A minority of patients with anterior dislocation progress to chronic instability associated with pain and a limitation of activities, and thus surgery should be considered. The technique is safe and effective for reconstructing chronic anterior SCJ dislocations. The all anterior approach for reconstruction of the SCJ reduces the risk to the structures posterior to the medial clavicle, manubrium sterni or first rib.
Diagnosing Instability in Rugby Players
Making the clinical diagnosis of direction of instability in contact athletes can be difficult and this research confirms this.
Rugby shoulder injuries 2013
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.
ACJ revision surgery 2017
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).
Revisions of failed Latarjet surgery 2015
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.
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
Low Grade Infection after Shoulder Surgery
Young male patients are at greatest risk for low-grade infections following arthroscopic and open non-arthroplasty shoulder surgery. Propionibacterium acnes was the most prevalent organism. Patients presented with classical post-operative frozen shoulder symptoms, resistant to usual treatments. 80% of patients with negative cultures improved with empirical treatment.
Understanding shoulder instability
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.
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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.
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This document discusses the assessment of unstable shoulders, including classification, biomechanics, anatomy, and physical examination tests. It provides details on classifying structural and non-structural instability, the static and dynamic biomechanical stabilizers of the shoulder, and the anatomy of bony structures. The document also reviews physical examination tests for assessing anterior, posterior, and inferior instability, providing the sensitivity and specificity of each test.
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This document discusses approaches to evaluating and diagnosing shoulder pain. It outlines that shoulder pain is commonly caused by stiffness, weakness, or instability. Three criteria can help determine the appropriate diagnosis and treatment: history of trauma, age, and the results of the shoulder external rotation test. Stiff and painful shoulders may indicate osteoarthritis, frozen shoulder, or a missed fracture/dislocation. Weak and painful shoulders may be due to rotator cuff tendinopathy or tears. Unstable shoulders could be from congenital instability or structural defects. Red flags should also be assessed to ensure the pain originates from the shoulder rather than the neck or below the elbow.
Muscle tear presentation
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.
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Cervical radiculopathy is pain in an arm caused by compression of a cervical nerve root. It is commonly caused by cervical spondylosis which results in decreased disc height and bone spurs around the vertebrae that can compress nerve roots. Physical exam findings may include pain and sensory changes in the arm corresponding to the affected nerve root level as well as weakness or reflex changes. Diagnosis is based on history, physical exam, and imaging such as MRI which is the most sensitive test for evaluating soft tissues like discs and nerves. Most cases improve over time but surgery may be needed if conservative treatment fails.
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The PowerPoint presentation on Physiotherapy Management of Spondylolisthesis has been successfully completed. This informative session explored the crucial role of physiotherapy in effectively managing spondylolisthesis, restoring spinal stability, and optimizing functional outcomes for patients.
The presentation covered various aspects of spondylolisthesis, including its definition, classification, common causes, and risk factors. Attendees gained insights into the clinical manifestations of the condition and the resulting limitations in daily activities.
The role of physiotherapy in the comprehensive management of spondylolisthesis was emphasized, highlighting the importance of collaboration between physiotherapists and healthcare professionals. The presentation discussed the comprehensive assessment techniques employed by physiotherapists to evaluate patients accurately.
Attendees learned about the goals of physiotherapy interventions, which included reducing pain and inflammation, restoring spinal stability, improving mobility and flexibility, and enhancing overall function. Evidence-based physiotherapy interventions such as therapeutic exercises, manual therapy techniques, postural education, and ergonomic modifications were showcased, providing practical knowledge for managing spondylolisthesis.
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The Incidence of Traumatic Posterior and Combined Labral Tears in Patients Un...
Posterior and combined labral tears are more common than previously thought, especially in young active populations. The study reviewed 442 patients undergoing shoulder stabilization surgery and found that posterior and combined tears accounted for 47% of cases, compared to only 53% being isolated anterior tears. Rates of posterior and combined tears were even higher in sporting populations (52%) compared to non-sporting populations (32%). Rugby players in particular had a high rate of posterior and combined tears (53%). The study concludes that posterior and combined shoulder instability is more prevalent than reported, especially in contact sports.
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Low frequency anteroposterior mobilization of the talus was found to be more effective at increasing ankle dorsiflexion range of motion than high frequency mobilization in healthy subjects. The low frequency technique allowed more time for plastic deformation of the connective tissues to occur, in line with their viscoelastic properties. Future studies should investigate these mobilization techniques in patients with acute, subacute, or chronic ankle conditions.
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.
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The document discusses the anatomy, function, pathology, clinical evaluation, and treatment of biceps pain. It notes that the biceps helps with elbow flexion, supination, and stability of the humeral head. Common pathologies include inflammation, instability from tears or subluxation, and trauma. Clinical tests evaluate for pain and instability. Treatment options depend on the pathology and include rest, injections, physical therapy, and surgery such as tenodesis or tenotomy. Tenodesis maintains length-tension but has more pain, while tenotomy has less pain but risks a cosmetic deformity. The best approach considers patient factors and functional demands.
Multidirectional shoulder instability
This document discusses multi-directional shoulder instability (MDI). MDI is characterized by subluxations or dislocations in at least two directions, usually anteriorly, posteriorly, or inferiorly. It is commonly seen in overhead athletes and is associated with capsular laxity. Clinical examination reveals laxity and translation in multiple directions. Treatment involves strengthening dynamic stabilizers through physical therapy initially, with surgery such as arthroscopic capsular plication considered if conservative measures fail. Post-operative rehabilitation is important for successful outcomes. Long-term, over half of untreated MDI patients experience pain and instability.
Proximal femoral fractures
This document discusses proximal femoral fractures, including their anatomy, classification, treatment goals and options. It covers fractures of the femoral head, neck, intertrochanteric region and subtrochanteric area. Treatment depends on factors like patient age, fracture type/stability and involves methods like closed/open reduction and internal fixation or arthroplasty. Complications include nonunion, osteonecrosis and implant failure.
cprs2
Clinical prediction rules (CPRs) are tools that use clinical findings to predict outcomes. This document summarizes several CPRs for orthopedic conditions seen in outpatient settings. It describes the Ottawa Ankle Rules and Ottawa Knee Rules, which use symptoms and physical exam findings to determine if imaging is needed for ankle or knee injuries. It also summarizes CPRs related to patellofemoral pain, hip osteoarthritis, benefit from manual therapy or exercise, and carpal tunnel syndrome. The document provides details on the clinical findings and validation levels for each CPR.
cprs2
Clinical prediction rules use combinations of clinical findings to predict the probability of a specific condition or outcome. This document summarizes several clinical prediction rules for orthopedic conditions seen in outpatient settings, including rules for ankle injuries, knee injuries, patellofemoral pain, hip osteoarthritis, and low back pain. It provides details on the clinical findings and validation levels for each rule. The document concludes by describing where to find more information on clinical prediction rules and validation studies.
Shoulder Impingement : The Surgeon's Approach
This document discusses the history and treatment of subacromial impingement. It describes Neer's theory of extrinsic impingement from the acromion and coracoacromial ligament. The standard open and arthroscopic approaches to subacromial decompression are outlined. Studies comparing surgery to exercise-based treatment show similar long-term outcomes, though surgery may provide better short-term relief. Factors predicting poorer outcomes include longer symptom duration, lack of social support, and non-compliance with rehabilitation. The role of the surgeon is to establish an accurate diagnosis and ensure adequate rehabilitation, as failure of non-surgical treatment may reflect systemic issues rather than patient factors alone.
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This meta-analysis reviewed randomized controlled trials comparing platelet-rich plasma (PRP) or platelet-rich fibrin (PRF) to controls in arthroscopic rotator cuff repair. It found that PRP, particularly leukocyte-poor PRP, significantly improved tendon healing rates and led to better postoperative outcomes compared to controls. PRF, however, provided no clinical benefits over controls. While the study supports the use of PRP, especially leukocyte-poor formulations, in rotator cuff repair, limitations included a lack of standardization in PRP preparations across trials.
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The document discusses the surgical technique of remplissage, which involves filling in a bony defect (Hill-Sachs lesion) on the humeral head that commonly results from shoulder dislocations. Remplissage is performed after a Bankart repair by freshening the Hill-Sachs lesion and capsule before securing the tissue to restore stability. Studies have found that remplissage provides improved outcomes over other procedures with low complication and recurrence rates and no loss of range of motion. However, patient factors like the degree of glenoid bone loss must be considered when determining if remplissage is an appropriate additional procedure.
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This document reviews evidence comparing volar locking plate (VLP) fixation versus K-wire fixation for Colles fractures of the distal radius. Several studies found no significant differences in functional outcomes or complications between the two methods at 1-2 years post-operatively. However, VLP was found to provide more stable and accurate fixation, earlier functional recovery, and fewer reoperations for complications compared to K-wiring or fragment-specific plating. Overall, current evidence suggests VLP and K-wiring have similar long-term outcomes, but VLP may have advantages in the early postoperative period and lower reoperation rates.
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The document provides an overview of assessing the rotator cuff, including:
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2) Numerous clinical tests used to assess each muscle are outlined, such as Jobb's test for supraspinatus and Gerber's lift-off test for subscapularis.
3) Assessment involves taking a history, inspecting for deformities, and performing special tests like Codman's drop arm sign and the external rotation lag sign to isolate weak muscles.
Calcific tendonitis
Calcific tendonitis is characterized by the deposition of calcium hydroxyapatite in tendons, most commonly in the shoulder. The exact pathogenesis is unclear but it involves a cell-mediated process with formative, calcific, resorptive, and reparative phases. Diagnosis is typically made based on x-ray or ultrasound findings of calcific deposits. Initial treatment involves rest, NSAIDs, physiotherapy, and steroid injections. If conservative treatment fails, extracorporeal shockwave therapy or surgical debridement may be considered to remove the calcium deposits.
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1) Os acromiale occurs when the acromion fails to fully fuse during development, leaving separate ossification centers. It has a reported incidence of 1.4-30% and is often asymptomatic.
2) Treatment options for symptomatic os acromiale include non-operative measures like physiotherapy, injections, or surgical excision or fixation of the fragments. Arthroscopic excision aims to preserve deltoid attachment with good reported outcomes.
3) Acromial fractures can occur from direct trauma or overuse. Indications for surgical fixation include symptomatic nonunion, impingement, or displacement over 1cm. Posterior plating techniques are commonly used.
Peripheral Nerve Injuries
Peripheral nerve injuries can be classified in several ways, including the Seddon and Sunderland systems. The Seddon system categorizes injuries as neurapraxia (transient block), axonotmesis (lesion in continuity), or neurotmesis (complete division). Sunderland further subclassifies injuries based on the anatomical structures involved. The document discusses various mechanisms of nerve injuries, principles of nerve surgery including neurolysis, repair, grafting and transfers. It also covers prognostic factors and options for reconstructing nerve defects like grafts and conduits.
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Mr. Kiran Kumar Naikoti's document describes Kienbock's disease, an idiopathic osteonecrosis of the lunate bone that commonly affects men aged 20-40. The disease is progressive and results from bone necrosis leading to fractures, sclerosis, and collapse of the lunate bone. This in turn causes decreased carpal height, proximal capitate migration, carpal instability, and degenerative wrist changes. The etiology is multifactorial and may involve trauma, anatomical factors like negative ulnar variance, vascular causes like single vessel lunate supply, and systemic diseases. Stages of the disease are described based on radiological findings from normal to severe lunate collapse. Treatment options discussed include
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The document traces the origins and development of shoulder arthroplasty implants from the late 19th century to modern designs. It discusses early pioneers like Jules Pean and Charles Neer who developed hemiarthroplasty and total shoulder replacement designs. Key advances included the introduction of modular components, inverted shoulder designs by Grammont to address rotator cuff deficiency, and trabecular metal and augmented glenoids to improve fixation and stability. The document outlines the progression from monoblock to anatomically designed implants to current reverse, anatomic, and resurfacing options to best address different clinical presentations.
Calcific tendonitis james wilson
Calcific tendonitis is characterized by the deposition of calcium hydroxyapatite in tendons, most commonly in the shoulder. The exact pathogenesis is unclear but it involves a cell-mediated process with formative, calcific, resorptive, and reparative phases. Diagnosis is typically made based on x-ray or ultrasound findings of calcific deposits. Initial treatment involves rest, NSAIDs, physiotherapy, and steroid injections. If conservative treatment fails, extracorporeal shockwave therapy or surgical debridement may be considered to remove the calcium deposits and relieve symptoms.
Addressing bone loss in shoulder instability lennard funk
This document discusses approaches to measuring and treating bone loss in the glenoid and humeral head that can contribute to shoulder instability. It addresses how to measure glenoid and Hill-Sachs lesions using various imaging modalities and arthroscopy. It presents studies examining the amount of glenoid and humeral head bone loss that significantly increases instability risk. The document also introduces the "glenoid track" and "Funky Pizza method" to assess if a Hill-Sachs lesion is engaging or non-engaging. It concludes with an overview of treatment approaches based on the size of glenoid and Hill-Sachs defects.
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Post instability walton
- 1. Arthroscopic Management of Posterior Instability Mike Walton @mrmikewalton mikewalton@shoulderdoc.co.uk Santander 2015
- 2. How Common is it? • Traditional estimates of posterior instability were 2-5% • Often discussed with atraumatic and MDI • Our practice seemed to be very different • High volume of athletes Am J Sports Med. 2011 Apr;39(4):874-86. doi: 10.1177/0363546510384232. Posterior instability of the shoulder: diagnosis and management. Provencher MT1, LeClere LE, King S, McDonald LS, Frank RM, Mologne TS, Ghodadra NS, Romeo AA
- 3. How Common is it? • 3 Surgeons, 3 years • 442 shoulder arthroscopic stabilisations • Specialist Shoulder practice • Mean age 26, 87% Male
- 4. How Common is it? • 75% Sporting Population (Recreational to Elite) • 48% Isolated Anterior, 17% Isolated Posterior • 35% Combined Lesions • Non-Sporting population older with 68.5% isolated anterior labral tear
- 5. How Common is it? • RUGBY (n=231) • 53% Posterior labral lesion (13% Posterior, 40% combined lesions) • If you treat these patient you MUST be able to treat this lesion.
- 7. Presentation • Anterior instability • Occasionally posterior dislocations • Subluxation episodes • WEAKNESS • CUFF PAIN
- 8. Assessment Lewis A, Kitmura T & Bayley JIL.The classification of shoulder instability: new light through old windows! Current Orthopaedics, 2004; 18(2):97-108.
- 10. Modified O’Briens Test • Forward Elevation to 90 • Adduction / Internal Rotation • Pain - SLAP • WEAKNESS - Post Instability
- 11. Modified O’Briens Test • Posterior Translation occurs in simulated Active Compression Test J Shoulder Elbow Surg. 2013 Mar;22(3):365-74. doi: 10.1016/j.jse.2012.02.003. Epub 2012 May 19. Glenohumeral contact pressure in a simulated active compression test using cadaveric shoulders. Lin T1, Javidan P, McGarry MH, Gonzalez-Lomas G, Limpisvasti O, Lee TQ.
- 12. Investigations • MR Arthrogram • Accurate for isolated anterior and posterior lesions (78.5%, 69%) • Accuracy ONLY 37% in combined lesions
- 14. Sitting or Spoons DONT FORGET THE EUA
- 20. If the angle is wrong..
- 21. Reverse HAGL
- 22. Reverse HAGL
- 23. Reverse HAGL
- 27. Rehabilitation • External Rotation brace 2 weeks • Highly specialist physiotherapy • More Atraumatic - More Physio • Kinetic Chain and Cuff Rehabiliation
- 28. Failures and Bone Loss
- 29. Failures and Bone Loss