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.
Hoffa's Fracture: Diagnosis, management & New Classification System by BAGARI...Vaibhav Bagaria
Hoffa's Fracture - coronal split fracture of distal femur, its diagnosis, management strategy, a new classification and tips and tricks of management. First described Hoffa, a new classification system by Bagaria et al helps plan the surgery for these tricky fracture. The most crucial step is not to miss these fractures in ER.
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/
The art of medial release in varus knee during total knee replacementVaibhav Bagaria
Medial Release in Varus knee is key to balancing the knee right. When done optimally, it reduces reliance on excessive boney cuts and improves patients outcomes.
The presentation includes new insight to rotator cuff anatomy, rotator cable, concept of force couple, different classifications of rotator cuff tear, signs and symptoms, special tests, non operative and operative management of rotator cuff tear, comparison of recent surgical modalities, management of irreparable cuff tears, post operative rehabilitation protocols, SLAP lesion, Parsonage Turner Syndrome
Rotator cuff tear is a very common orthopedic condition, which causes shoulder pain and stiffness. The slides are on rotator cuff tears and its management by open repair, mini open repair & by arthroscopy
Hoffa's Fracture: Diagnosis, management & New Classification System by BAGARI...Vaibhav Bagaria
Hoffa's Fracture - coronal split fracture of distal femur, its diagnosis, management strategy, a new classification and tips and tricks of management. First described Hoffa, a new classification system by Bagaria et al helps plan the surgery for these tricky fracture. The most crucial step is not to miss these fractures in ER.
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/
The art of medial release in varus knee during total knee replacementVaibhav Bagaria
Medial Release in Varus knee is key to balancing the knee right. When done optimally, it reduces reliance on excessive boney cuts and improves patients outcomes.
The presentation includes new insight to rotator cuff anatomy, rotator cable, concept of force couple, different classifications of rotator cuff tear, signs and symptoms, special tests, non operative and operative management of rotator cuff tear, comparison of recent surgical modalities, management of irreparable cuff tears, post operative rehabilitation protocols, SLAP lesion, Parsonage Turner Syndrome
Rotator cuff tear is a very common orthopedic condition, which causes shoulder pain and stiffness. The slides are on rotator cuff tears and its management by open repair, mini open repair & by arthroscopy
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/
Arthroscopically assisted latissimus dorsi transfer is a viable option for treatment of patients in their 50s to 70s, without arthritis of the glenohumeral joint, who suffer from massive postero-superior rotator cuff tears that are not amendable to primary repair or that have failed previous repair attempts.
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.
ROTATOR CUFF TEAR SHOULDER PAIN ATHRITIS ARTHROSCOPY KEYHOLE SURGERY I Dr.RAJAT JANGIR JAIPUR
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#allinsideacl #internalbrace #drrajatjangir #bestaclsurgeon #aclexpert #bestkneesurgeon
To Know more about ACL Injury, Click the links below:
1. ACL surgery 7 different Techniques we do at our center - "Not single technique best for all"
https://youtu.be/oWkIr8IXvr8
2. Everything about ACL Injury tear surgery in Hindi I
https://youtu.be/bqpjkAkwZ14
3. Best Screw for ACL tear surgery in Hindi
https://youtu.be/1LGpU1NHiIs
4. ACL Injury Tear Surgery Recovery : All your questions & queries solved by Dr.Rajat Jangir
https://youtu.be/SIAPWiMbOqs
5. Partial ACL Tear Surgery or not ! ACL आधा टूटा हो तो क्या करें ?
https://youtu.be/NEJRPKskJTI
6. 5 Symptoms of ACL Injury tear इंजरी के पांच लक्षण ?
https://youtu.be/EXpgy19Jxzw
7. PRP injection therapy in Partial ACL TEARs
https://youtu.be/qyG1EYgS87E
Dr.RAJAT JANGIR(Asso Prof.)
Senior Consultant Arthroscopy and Joint Replacement
(Specialist in Shoulder Knee Hip Surgery)
Ligament and Joints Clinic
67/34 Mansarovar Jaipur
Whatsapp: shorturl.at/gnAEP
Appointment: +91 8104855900
Email: ligamentsurgeon@gmail.com
Google Page: https://g.page/KNEE-Shoulder-SURGERY?...
Facebook: https://www.facebook.com/Ligamentandj...
* Vast experience and specialisation in the field of Arthroscopy and sports surgery.
* M.S. orthopaedics from BJ Medical College, Civil hospital, Ahmedabad
* Fellowship in Arthroscopy and Sports injury with Prof Joon Ho Wang at Samsung Medical Center, South Korea
* Diploma in Sports Medicine from InternationaI Olympic Committee
* Invited as Athlete Medical Doctor at Rio Olympic 2016
* Done Rajasthan's first "All Inside Physeal Preserving ACL reconstruction" in 13 year old Athlete
Dr.Rajat is rated as one of the best orthopedic surgeon with with excellence in Knee Shoulder Arthroscopy surgeries as replacements'
Total Shoulder Arthroplasty | Reverse Shoulder Replacement | South Windsor, R...James Mazzara
https://hartfordsportsorthopedics.com/
In this presentation, Dr. Mazzara discusses the pathology, surgical techniques, and potential complications during a total shoulder replacement and a reverse total shoulder replacement.
To learn more about shoulder replacements, please visit: https://hartfordsportsorthopedics.com/total-shoulder-replacement-arthroplasty-south-windsor-rocky-hill-glastonbury-ct/
its a presentation done in AIIMS rishikesh on pediatric fracture around elbow
includes supracondylar humerus fracture, lateral and medial condyle fracture monteggia fracture, neglected monteggia fracture pulled elbow, TRASH lesions around elbow
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
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
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
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
2. Rotator Cuff Function
1. Dynamic stabilizer of the shoulder
2. Contributes strength to the arm
(50% of the abduction strength is generated by
supraspinatus)
3. Couple forces stabilize and regulate the
motion of the shoulder
www.shoulder.gr
3. Rotator Cuff disease
Rotator cuff disease is a wide spectrum
of clinical conditions, which range
from asymptomatic partial
thickness tears to symptomatic rotator cuff
arthropathy
www.shoulder.gr
4. First Successful RC Repair
Codman EA. Rupture of the supraspinatus
tendon Boston Medical & Surgical
Journal 1911 Vol
clxiv (2) 708-10
McLaughlin HL. Lesions of the musculotendinous
cuff of the shoulder: the
exposure and repair of tears
with retraction. J Bone Joint Surg 1944;26:31-51.
First Description of RC tears
Smith JG. London. Med Gaz, 1834,14:280
Pathological appearances of seven cases
of injury of the shoulder joint, with
remarks. EA Codman
HL McLaughlin
The History of Rotator Cuff Repair
www.shoulder.gr
5. • In 1972 Neer defined the concept of
subacromial impingement
• Open Surgery
• Mini Open Surgery
• In the 90s’ the arthroscope changed the
treatment
www.shoulder.gr
The History of Rotator Cuff Repair
6. Tears’ Definitions
• Partial Thickness Tears =
absence of communication between the
glenohumeral joint and the subacromial
bursa.
• Full Thickness Tears =
communication between the glenohumeral
joint and the subacromial bursa.
• Massive Tear =
Involving 2 or 3 tendons [Gerbers]
or bigger than 5cm [Cofield]
www.shoulder.gr
7. Partial Thickness Tear
• Bursal side tears
• Articular side tears
• Intratendinus tears
Partial tear classification by Ellman
• Grade I <3mm deep
• Grade II 3-6mm deep
• Grade III >6mm deep (i.e. >50% thickness)
www.shoulder.gr
8. How frequent are RC Tears?
• Rotator Cuff Frequency:
30% of population
• Significant correlation with
age [Sher JS, Arthroscopy 1995]
www.shoulder.gr
9. Full Thickness Tear
Age Frequency
40-60 4-13%
60-70 20%
70-80 50%
>80 80%
Partial Thickness Tear
Age Frequency
<40 4%
>60 25%
[Tempelhof S, JSES, 1999]
How Frequent are RC Tears?
www.shoulder.gr
10. Bilateral RC Tears
• Rotator Cuff Disease is not only age related,
but also bilateral
• >51% of patients with a previously asymptomatic
rotator cuff tear and a contralateral symptomatic tear
will develop symptoms in the non-symptomatic tear at
the next 2.8 years.
[Yamaguchi K., JSES, 2001]
www.shoulder.gr
11. Rot cuff disease etiology and
pathogenesis
1. Tendon degeneration
2. Vascular factors
3. Impingement
• Type of acromion as identified by Bigliani
• Acromial angle devised by Toivonen .
• Type I. Angle 0-12
• Type II. Angle 13-27
• Type III. Angle > 27 Popularized by Neer
4. Secondary impingement popularized by Jobe
5. Instability overload of the cuff - secondary superior migration
6. Trauma
7. Glenohumeral instability
8. Scapulothoracic dysfunction
www.shoulder.gr
12. Natural History of a Tear
• Tears DO NOT HEAL. Some but NOT ALL of them will
progress
• Rot cuff arthropathy is the end stage (4%)
• 50% of newly symptomatic tears will progress in size
• 20% of asymptomatic tears will progress.
• No Tear seem to decrease in size.
• 80% of partial tears progress in size or become full
thickness at 2 years
[Yamaguchi K., 2006, Nice Shoulder Course]
www.shoulder.gr
13. Current Knowledge
• RC tears DO NOT behave the same
in different patients
• Patients PROFILE plays
the most important role
• Size and Location of the tear
DOES MATTER
www.shoulder.gr
14. RC Treatment
Patient Profile
Size & Location
Symptoms
Tissue Quality
Other Lesions
MAKE YOURMAKE YOUR
DECISIONDECISION
www.shoulder.gr
15. Patients <25 years
Aggressive athletics, high impact
accident, heavy labor
Common history repetitive
overhead sport or work with
repetitive overhead lifting
Symptoms during overhead
activity respond to rest and are
aggravated as the patient resumes
activity
Probably
partial
articular
side tear
www.shoulder.gr
16. Chronic overuse due to
work related overhead
activity
Common history repetitive
overhead sport or work with
repetitive overhead lifting
Acute trauma on chronic
overuse is common
Patients 25 - 45 years
Usually small
to medium
tears are not
retracted
www.shoulder.gr
17. Subacromial impingement is
common
Acute tears on chronic
Chronic pain. Night pain
Patients 45 - 65 years
In the more severe cases weak
or impossible elevation external
rotation
www.shoulder.gr
Usually Full
Thickness
Tear.
Good Tissue
Quality
18. Rot cuff tears common
Limited activities make severe
rotator cuff tears tolerable
Chronic aching or acute
exaberation of symptoms after
minor trauma
Patients >65 years
Debilitating symptoms in rotator
cuff arthropathy
www.shoulder.gr
Usually Large
or Massive
Tear
Goutallier
Stage 3 or 4
Retracted
Tendons
20. RC Treatment Options
Non-Operative
• 45-80% Satisfactory
Results
BUT
• Symptom resolution ???
• Tear progression ???
• Fatty degeneration ???
• Progression to rot cuff
arthropathy ???
Operative
90% Good to Excellent
Results at 10 years
[Iannotti Wolf]
www.shoulder.gr
21. Risk to Benefit Ratio
• Rot cuff tears DO NOT heal spontaneously
• Tear repairability
• Think of Size, Elasticity and Chronicity
• Fatty infiltration is not fully reversible
www.shoulder.gr
Operative Treatment
22. Grouping the Patients
Group I: patients with minimal risk of
progression to irreversible changes
to the rotator cuff
Group II: patients with high risk of
progression
Group III: patients who have progressed
already
[Yamaguchi K., 2006, Nice Shoulder Course]
www.shoulder.gr
23. Group I patients
• About 50 years with tendinosis or partial tears
degenerative in nature Articular side
• They respond very well to
non operative treatment
(about 50-60% resolution of the symptoms)
• The risk of progression is very low but they need
observation
Non operative treatment
www.shoulder.gr
24. Group II patients
• Younger than 65 years with
– Small or medium size tears
– Acute tears of any size
– Tears with recent acute loss of function
• Patients non responsive to conservative
treatment
• Acute tears or overuse tears in athletes
Early surgical repair to avoid irreversible changes
www.shoulder.gr
25. Group III patients
• Older than 70 years
– with large or massive tears and
– irreversible damage to the rot cuff
They can benefit from rotator cuff repair,
even a partial repair
www.shoulder.gr
[Yamaguchi K., 2006, Nice Shoulder Course]
[Burkhart, 2007, Arthroscopy]
26. Partial Tears Treatment
• By far the most common partial tears are
Articular-side, vascular or age relateted
Traditionally partial tears classifications
are based to 50%
BUT
“How healthy is the remaining,
intact tissue?”
www.shoulder.gr
27. Partial Tears Treatment Options
1. Debride partial tear only
2. In-situ Repair
3. Convert to full thickness, Debride, Repair
Etiology makes the decision!!!
• Because most tears are degenerative, option 3
should be the best for most cases
• Trauma or young athletes are candidates for in-situ
repair
• If partial tear causes significant pain then
debridement alone
[Yamaguch K, 2006 Nice Shoulder Course]
www.shoulder.gr
28. RC Tear Classification
Acute, Chronic, Acute on chronic
Tear Age Tissue Quality
1. Partial <40 Good
2. Complete <40 Good
3. Complete 40-65 Good
4. Complete 40-65 Bad
5. Complete >65 Good
6. Complete >65 Bad
www.shoulder.gr
33. RC Arthroscopic Repair
1. Recognition, of the type of the tear
2. Retraction and releases
3. Repair Options:
Anchors: metallic or absorbable
Type of stitch: Mason-Allen,
Mc Stitch,
Mattress sutures,
Horizontal mattress,
Simple sutures
Restoration of footprint: Double row or
Single row www.shoulder.gr
36. What kind of Repair is
NECESSARY?
• An anatomically deficient RC could be biomechanically
intact rot cuff
[Burkhart]
• Conservative treatment of chronic painful rot cuff tears
will result in a successful outcome in about 50% of
patients
[Cofield]
• Cuff tear arthropathy will develop in 4% of patients with
complete rot cuff tears
[Neer]]
www.shoulder.gr
37. What can we Repair?
• UP to 50% of cuff repairs had a postoperative defect
• This didn’t affected patient satisfaction or pain relief
• But it did affected shoulder strength
[Harryman et all J. B.J.S 1991]
www.shoulder.gr
38. Factors that affect RC Healing
• Age
• Sex
• Activity
• Size
• Location
• Tissue quality and
elasticity
• Muscle fat
degeneration
• Chronicity of the tear
• Concomitant lesions
• Smoking
• Family history
• Rehabilitation
Protocol
• NSAID
• Surgical Technique
www.shoulder.gr
39. Today’s Knowledge
• Rot cuff has some degree of reserve that affords
functional use of the arm in cases of limited tendon
deficiency.
• Location rather that size of a tear maybe more important
in the development of symptoms.
• Type of activities plays an important factor in the
development of symptoms
www.shoulder.gr
40. Goutallier fatty degeneration of
muscles
• Stage 0 Normal muscle – no fatty streaming
• Stage 1 Occasional fatty streaming
• Stage 2 Fat<50% of cross sectioned area
Fat < Muscle
• Stage 3 Fat=50% of cross sectioned area
Fat = Muscle
• Stage 4 Fat>50% of cross sectioned area
Fat > Muscle
www.shoulder.gr
41. What to do???
• Patients with grade 3 or 4 fatty degeneration
DO NOT improve with rot cuff repair
[Goutallier]
Vs.
• Patients with grade 3 or 4 fatty degeneration
improved significant at 86% of cases after
arthroscopic repair
[Burkhart]
www.shoulder.gr
42. The quality of Functional results
depends on:
1. The size of the persistent defect
2. Associated atrophy of the muscles
3. Integrity of the deltoid and the
coracoacromial arch
4. Functional demands of the patient
www.shoulder.gr
43. Non-Operative Treatment
Best candidates for non-operative are:
• patients with chronic attritional RC tears
• limited to one tendon
• the onset not associated with significant trauma
• over the age of 60 and less active
[Iannotti J.P.Disorders of the shoulder]
www.shoulder.gr
44. Treatment of
Irreparable Massive RC Tears
• Pts >70 years with massive tear and major complaint
pain, can function reasonably well
Criteria of Irreparability:
• Profound weakness of external rotation with ext.rot lag or
internal rotation lag when the subscapularis is involved
• Superior displacement of the humeral head and contact
with the acromion
www.shoulder.gr
46. How to convert a Symptomatic tear
to an Asymptomatic re-tear
• Subacromial decompression and
debridmeut
• Biseps tenotomy
• Partial repair and healing of the rot cuff
• Adequate post-op rehabilitation
www.shoulder.gr
47. Early failure
of arthroscopic rot cuff repair
1. Failure of tendon-suture interface
2. Suture-anchor failure
3. Suture failure
www.shoulder.gr
48. RC Repair Results
• The rate of structural failure after open repair varies
from 20% to more 50%, while it is greater for
arthroscopic repairs
• First report of DOUBLE ROW repair:
Fealy S, Kingham TP, Altchek DW, Arthoscopy July 2002
Mini-open Rot cuff repair using a two row fixation technique
www.shoulder.gr
49. Results - what to expect
• Pts between 50-75 years old with
• pain
• loss of external rotation (positive lag sign) and
• inability to keep the hand externally rotated age
• MRI findings: Goutallier III or IV
Arthroscopic findings:
massive posterosuperior tear,
retracted tendons of bad quality
www.shoulder.gr
50. Results - what to expect
• Arthroscopic partial repair or
medialized repair
•Resolution of pain but not restoration of
external rotation
www.shoulder.gr
51. Results what to expect
• Patients aged 50-60 years old with
painless loss of external rotation
• MRI findings: Goutallier III or IV
Arthroscopic findings:
massive posterosuperior tear,
retracted tendons of bad quality
www.shoulder.gr
52. Results what to expect
Arthroscopic partial repair or
medialized repair
Inability to restore external rotation
Tendon transfer more appropriate
in young active patients
www.shoulder.gr
53. Results - what to expect
• Pts with
• acute exaberration of symptoms after minor trauma
• mainly pain
• loss of strength of abduction and ext rotation
• age >60 years old
• no or minimal symptoms before trauma
• MRI findings: Goutallier II or III
Arthroscopic findings:
large or massive posterosuperior tear
retracted tendons of bad quality
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54. Results - what to expect
Arthroscopic partial repair or
medialized repair
•Resolution of pain
•near normal restoration of strength of
abduction and external rotation
•some loss of strength remaining
•slow restoration of function
•pts plateaus after more than a year
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55. Results what to expect
• Pts with
• loss of function
• pain after acute trauma1-3 months before
• normal function before trauma
• MRI findings: Goutallier I or II
Arthroscopic findings:
large or massive posterosuperior tear with
good quality of tissues repair
with no tension
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56. Results - what to expect
Complete resolution of symptoms
normal function
restoration of strength
Excellent Results independent of age
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57. Results - what to expect
• Young patients, athletes
• or overhead workers age 20-40 years old with:
• pain
• loss of function or
• inability to perform athletics in the same level
• MRI findings: partial or complete tear of supraspinatus
Arthroscopic Findings:
partial articular side or
complete tear of suprafpinatus
Double row repair:
complete resolution of symptoms
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58. Results - what to expect
• Pts more than 60 years old with
• pain
• inability to raise the hand
• Symptoms of long duration
• MRI findings: Goutallier III or IV complete tear and
retracted tendons
• X-Ray findings: superior migration of the head and
contact with the undersurface of the anterolateral
acromion
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59. Results - what to expect
No improvement
with arthroscopic treatment
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60. Results - what to expect
• Pts >50 years old with
• minimal symptoms
• Chronic symptoms
• MRI findings: Small to medium tear of supraspinatus
• Pts willing to accept slight restrictions of overhead
activities
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61. Results - what to expect
Conservative treatment
may be successful
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62. Conclusions
• Rot Cuf is extremely significant for the normal function of
the shoulder
• Rot Cuf tears can be asymptomatic
• Symptoms Produced by a tear depend on:
– Size
– Location
– Functional demands of the patient
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63. Conclusions
• An anatomically deficient but biomechanical intact cuff is
possible
• Biomechanical intact cuff is the cuff that restores the
equilibrium of the force couples
• A cuff tear does not heal conservative
• A cuff tear after operative repair may yet not heal
• Partial healing may restore sufficient power to the cuff to
equilibrate the force couples
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64. Conclusions
• Non-operative treatment strives to optimize the function
of the remaining cuff
• Rehabilitation after surgery strives to optimize the
function of the partially or completely healed cuff
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65. ..so when we treat a RC tear…
We must try to:
• Optimize the anatomic integrity of the cuff by a repair
with minimal morbidity to the healthy tissues (mainly
deltoid)
THEN
• Rehabilitate vigorously the patient, to optimize the total
function of the shoulder
THEN
We can expect a majority of
satisfied patients
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69. • Older patients
• Chronic symptoms
• Minimal loss of function
(strength-mobility)
• Less active
Non-Operative Treatment for:
•Older patients
•Massive tear
•Superior migration of the
humeral head
•Fatty infiltration of the muscles
•Retraction of the tendons
Trial of Non-Operative Treatment
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