Rotator cuff the future 2015
•
1 like•1,180 views
The document discusses potential future directions for rotator cuff repair surgery. It describes 4 possibilities - 1) biological repairs that enhance healing using growth factors, 2) augmentation devices to reinforce repairs, 3) gene therapy and nano-surgery approaches for prevention and treatment, and 4) algorithms to better determine who needs surgery versus non-operative treatment based on age, genetics, and other factors. The future may include enhanced sutures that promote angiogenesis, balloon devices to support tissue, gene therapies administered through self-monitoring techniques, and remotely-controlled nano-instruments.
Report
Share
Report
Share
Download to read offline
Recommended
Orogen vet t(rf)
The document discusses advances in regenerative medicine and a company called OroGen Biosciences. It describes how information technologies have enabled sharing of medical information and how the body's cells have an innate ability to heal itself. OroGen Biosciences develops tissue regenerative biomatrix products that intensify the body's own regenerative factors to support wound healing and regeneration. The document provides several case studies showing applications of OroGen's products in aiding fracture repair, wound healing, and other conditions in canines and other animals.
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.
InSpace balloon for massive rotator cuff tears 2017
This document summarizes the results and experience of a study comparing the InSpace Balloon procedure to rotator cuff repair for massive rotator cuff tears. The interim analysis of the first 20 subjects in the randomized controlled trial showed no difference in outcomes between the two procedures at 6 months follow-up. The study is ongoing and being conducted by principal investigators across the United States to further compare the efficacy of InSpace Balloon versus repair for massive rotator cuff tears.
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.
An Owners Guide to Shoulders
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/
Surgery for shoulder instability len funk
A 24-year old semi-pro rugby player suffered a shoulder injury during a tackle and has since experienced recurring dislocations. MRI arthrogram revealed a bony Bankart lesion and HAGL tear. Surgery including Bankart repair and bony reconstructions was recommended due to the structural nature and recurrence of the injury. The timing of surgery was mid-season so recovery and return to play was discussed. Rehab is sport-specific and focuses on regaining stability before strengthening to ensure a safe return at the previous level of competition.
Impingement modern approach 2016
This document discusses the approach to subacromial impingement syndrome. It provides a brief history of the understanding and treatment of impingement. It describes Neer's 1982 description of impingement syndrome and extrinsic theory. For treatment, it advocates excluding secondary causes, a trial of non-operative treatment including rehabilitation for 18 months, and considering surgery only if rehabilitation and injections are unsuccessful or if a structural cause such as a rotator cuff tear is identified. The document emphasizes treating the underlying cause rather than simply performing acromioplasty.
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.
Recommended
Orogen vet t(rf)
The document discusses advances in regenerative medicine and a company called OroGen Biosciences. It describes how information technologies have enabled sharing of medical information and how the body's cells have an innate ability to heal itself. OroGen Biosciences develops tissue regenerative biomatrix products that intensify the body's own regenerative factors to support wound healing and regeneration. The document provides several case studies showing applications of OroGen's products in aiding fracture repair, wound healing, and other conditions in canines and other animals.
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.
InSpace balloon for massive rotator cuff tears 2017
This document summarizes the results and experience of a study comparing the InSpace Balloon procedure to rotator cuff repair for massive rotator cuff tears. The interim analysis of the first 20 subjects in the randomized controlled trial showed no difference in outcomes between the two procedures at 6 months follow-up. The study is ongoing and being conducted by principal investigators across the United States to further compare the efficacy of InSpace Balloon versus repair for massive rotator cuff tears.
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.
An Owners Guide to Shoulders
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/
Surgery for shoulder instability len funk
A 24-year old semi-pro rugby player suffered a shoulder injury during a tackle and has since experienced recurring dislocations. MRI arthrogram revealed a bony Bankart lesion and HAGL tear. Surgery including Bankart repair and bony reconstructions was recommended due to the structural nature and recurrence of the injury. The timing of surgery was mid-season so recovery and return to play was discussed. Rehab is sport-specific and focuses on regaining stability before strengthening to ensure a safe return at the previous level of competition.
Impingement modern approach 2016
This document discusses the approach to subacromial impingement syndrome. It provides a brief history of the understanding and treatment of impingement. It describes Neer's 1982 description of impingement syndrome and extrinsic theory. For treatment, it advocates excluding secondary causes, a trial of non-operative treatment including rehabilitation for 18 months, and considering surgery only if rehabilitation and injections are unsuccessful or if a structural cause such as a rotator cuff tear is identified. The document emphasizes treating the underlying cause rather than simply performing acromioplasty.
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.
Unstable Shoulder
Unstable Shoulder. A more detailed definition of these slides and concepts can be found at: https://www.theshouldercenter.com/resources/
Operative management of grade iii acj injuries olivia flannery
This document discusses the operative management of grade III acromioclavicular joint (ACJ) injuries. It reviews the evidence for surgery versus non-surgical treatment, noting that early studies found non-surgical treatment had better outcomes. However, more recent studies using newer surgical techniques like the Ligament Augmentation and Reconstruction System (LARS) ligament and tightrope fixation have reported good to excellent results in 87.5-93.3% of surgical patients, compared to 58.8-0% of non-surgical patients. The document concludes that with advances in surgical techniques, surgery is now the better option for treating type III ACJ injuries.
Return to swimming after Shoulder Surgery or Injury
This document provides guidelines and a phased return to swimming program for swimmers recovering from shoulder surgery or injury. The guidelines include using a pain scale to monitor pain levels, avoiding kickboards, paddles and bottom hand pulls initially. The return to swimming program has three phases starting with 100-300 meters and progressing to 300-600 meters and then 600-1000 meters. Swimmers must complete each phase three times without pain before advancing. The focus is on proper technique and pacing with one stroke introduced at a time.
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.
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).
Diagnosing Instability in Rugby Players
Making the clinical diagnosis of direction of instability in contact athletes can be difficult and this research confirms this.
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.
Acj injury
This document provides information on acromioclavicular (AC) joint injuries. It discusses the anatomy and biomechanics of the AC joint. It also outlines the epidemiology, mechanisms of injury, clinical evaluation, classification systems and treatment options for different grades of AC joint separation. For acute injuries under 4 weeks, treatment options discussed include conservative management or surgical stabilization techniques like hook plates, tightropes or ligament reconstruction. For chronic injuries, options include AC joint excision or reconstruction of the coracoclavicular ligaments.
Congenital vertical talus UG lecture
This document discusses congenital convex pes valgus (CVT), a rare rigid flatfoot condition present at birth. CVT is caused by genetic syndromes or abnormal muscle fibers/tendon contractures. Clinically, it presents as a rigid flatfoot with the talus medially displaced. Imaging can classify the deformity and assess reducibility. Nonoperative treatment with casting is rarely effective. The preferred surgical treatment is a single-stage correction using approaches like Cincinnati to release tissues and reduce/fix the talonavicular joint. Complications include recurrence, stiffness, and avascular necrosis of the talus. Later presentations may require more extensive fusions.
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.
Arthroscopic Lat Dorsi Transfer 2017
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.
πρωτο εξάρθρημα
This document discusses the treatment of first-time shoulder dislocations. It finds that arthroscopic stabilization has lower recurrence rates compared to conservative treatment, especially for young athletes. Arthroscopy allows visualization and repair of common lesions like Bankart tears and Hill-Sachs defects. Studies show arthroscopic stabilization reduces recurrence to 16% versus 47% for conservative care. Arthroscopy provides excellent outcomes with minimal pain and quick return to previous activity levels. It is the recommended approach for young, active patients to prevent future dislocations and allow continued athletic participation.
Impingement syndromes
This document discusses various types of shoulder impingement syndromes. It begins with a brief history, noting that while Meyer first described the process in 1931, Neer classified and named shoulder impingement syndrome in 1972. It then describes current classifications, including primary and secondary subacromial impingement, coracohumeral impingement, glenoid (internal) impingement, ASI (AnteroSuperior Impingement), and PSGI (PosteroSuperior Glenoid Impingement). The bulk of the document focuses on describing these various impingement syndromes in more detail, including causes, presentations, treatments, and relevant anatomy. It provides an overview of imaging and clinical exams for
Late stage rehab tanya mackenzie
This document discusses essential elements for the functional/final stage of shoulder rehabilitation, including proprioceptive awareness, kinetic chain neuromuscular control, glenohumeral joint dynamic stability provided by compressive forces, and scapular mobility and stability. It emphasizes retraining muscle synergy between agonist and antagonist groups to control adverse humeral head translation at the glenoid. Clinical applications include using symptom modification to guide targeted muscle group rehabilitation in controlled vulnerable positions, and positioning the glenoid to support the humeral head in functional positions for each patient. The goal of late-stage rehabilitation is to achieve optimal biomechanical function and return to sport or work activities through integrated techniques built upon endurance and strength foundations while maintaining
Hydrodilation for frozen shoulder Does capsular rupture matter
This document summarizes a study examining the outcomes of hydrodilatation for frozen shoulder and whether capsular rupture during the procedure matters. The study found:
1) Patients experienced significant improvements in pain, range of motion, Constant-Murley scores, and Oxford Shoulder scores following hydrodilatation.
2) When comparing patients who experienced capsular rupture to those who did not, there were no significant differences in baseline characteristics or magnitudes of improvement between the groups.
3) Hydrodilatation resulted in meaningful pain relief and functional improvement for frozen shoulder patients, and capsular rupture during the procedure did not influence outcomes.
Shoulder rehab early julia walton
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.
Assessing bone loss in instability lf 2016
This document discusses various methods for assessing bone loss in the glenoid and humeral head in shoulder instability. It finds that while CT may be the most reliable method, there is no consensus on measurement techniques and what constitutes a clinically significant lesion. Methods like MRI and arthroscopy have not been sufficiently validated. Plain radiography is not accurate enough for pre-operative planning. The glenoid track and engagement formulas attempt to combine glenoid and humeral head measurements but also have limitations and have not been fully validated. Overall, the document concludes there is still uncertainty around accurately assessing and defining the critical amount of bone loss that increases recurrence risk in shoulder instability.
Evolution of tunnel placement in ACL reconstruction
One of my talks at Delhi Arthroscopy Club....... this presentation provides a insight regarding the conceptual evolution in tunnel placement during ACL reconstruction.
Ultrasound of the shoulder 2012
This document discusses the use of ultrasound scanning for evaluating shoulder conditions. It provides background on the history of medical ultrasound and its use for shoulder exams. Key points covered include what ultrasound can visualize in the shoulder, its benefits for being cheap, quick, and avoiding radiation compared to other imaging. Common shoulder issues it can diagnose are described, along with limitations and when it should not be used. The document emphasizes how ultrasound is changing practice by enabling rapid office-based evaluations, diagnoses, and treatment planning for patients with shoulder pain and injuries.
The moveable feast: converging technologies and our dinner table
The moveable feast: converging technologies and our dinner tableCalifornia State University Monterey Bay
The Moveable Feast: Legal, Ethical and Social Implications of Converging Technologies On Our Dinner Tables.
From genetically modified crops to nanoparticles in our food, converging technologies will likely change the way we eat. By converging technologies, I am referring to the convergence of Nanotechnology, Biotechnology, Information Technologies, and Cognitive Sciences (NBIC ). With GMOs already part of the legal landscape (Monsanto v. Geertson), and nutraceuticals that claim to boost brain power already available at your local health food store, nanotechnology and information technology promises to deliver such things as InVitro meat. What does the future hold with regards to new foodstuff and what, as lawyers and ethicists can expect to contemplate? Will the old law suffice or will new laws be needed? Articular cartilage injuries
The document provides an overview of articular cartilage injuries and treatment methods. It discusses the composition and limited self-repair ability of cartilage. Imaging can detect cartilage defects and bone marrow edema. Treatment methods include non-invasive platelet rich plasma and bone marrow concentrate injections as well as surgical options like microfracture, mosaicplasty/OATS, and autologous chondrocyte implantation. Mosaicplasty has shown good long-term outcomes for small to medium defects while autologous chondrocyte implantation improves large defects, though both generate fibrocartilage. Future advances may include tissue engineering and 3D bioprinting of cartilage.
More Related Content
Viewers also liked
Unstable Shoulder
Unstable Shoulder. A more detailed definition of these slides and concepts can be found at: https://www.theshouldercenter.com/resources/
Operative management of grade iii acj injuries olivia flannery
This document discusses the operative management of grade III acromioclavicular joint (ACJ) injuries. It reviews the evidence for surgery versus non-surgical treatment, noting that early studies found non-surgical treatment had better outcomes. However, more recent studies using newer surgical techniques like the Ligament Augmentation and Reconstruction System (LARS) ligament and tightrope fixation have reported good to excellent results in 87.5-93.3% of surgical patients, compared to 58.8-0% of non-surgical patients. The document concludes that with advances in surgical techniques, surgery is now the better option for treating type III ACJ injuries.
Return to swimming after Shoulder Surgery or Injury
This document provides guidelines and a phased return to swimming program for swimmers recovering from shoulder surgery or injury. The guidelines include using a pain scale to monitor pain levels, avoiding kickboards, paddles and bottom hand pulls initially. The return to swimming program has three phases starting with 100-300 meters and progressing to 300-600 meters and then 600-1000 meters. Swimmers must complete each phase three times without pain before advancing. The focus is on proper technique and pacing with one stroke introduced at a time.
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.
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).
Diagnosing Instability in Rugby Players
Making the clinical diagnosis of direction of instability in contact athletes can be difficult and this research confirms this.
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.
Acj injury
This document provides information on acromioclavicular (AC) joint injuries. It discusses the anatomy and biomechanics of the AC joint. It also outlines the epidemiology, mechanisms of injury, clinical evaluation, classification systems and treatment options for different grades of AC joint separation. For acute injuries under 4 weeks, treatment options discussed include conservative management or surgical stabilization techniques like hook plates, tightropes or ligament reconstruction. For chronic injuries, options include AC joint excision or reconstruction of the coracoclavicular ligaments.
Congenital vertical talus UG lecture
This document discusses congenital convex pes valgus (CVT), a rare rigid flatfoot condition present at birth. CVT is caused by genetic syndromes or abnormal muscle fibers/tendon contractures. Clinically, it presents as a rigid flatfoot with the talus medially displaced. Imaging can classify the deformity and assess reducibility. Nonoperative treatment with casting is rarely effective. The preferred surgical treatment is a single-stage correction using approaches like Cincinnati to release tissues and reduce/fix the talonavicular joint. Complications include recurrence, stiffness, and avascular necrosis of the talus. Later presentations may require more extensive fusions.
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.
Arthroscopic Lat Dorsi Transfer 2017
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.
πρωτο εξάρθρημα
This document discusses the treatment of first-time shoulder dislocations. It finds that arthroscopic stabilization has lower recurrence rates compared to conservative treatment, especially for young athletes. Arthroscopy allows visualization and repair of common lesions like Bankart tears and Hill-Sachs defects. Studies show arthroscopic stabilization reduces recurrence to 16% versus 47% for conservative care. Arthroscopy provides excellent outcomes with minimal pain and quick return to previous activity levels. It is the recommended approach for young, active patients to prevent future dislocations and allow continued athletic participation.
Impingement syndromes
This document discusses various types of shoulder impingement syndromes. It begins with a brief history, noting that while Meyer first described the process in 1931, Neer classified and named shoulder impingement syndrome in 1972. It then describes current classifications, including primary and secondary subacromial impingement, coracohumeral impingement, glenoid (internal) impingement, ASI (AnteroSuperior Impingement), and PSGI (PosteroSuperior Glenoid Impingement). The bulk of the document focuses on describing these various impingement syndromes in more detail, including causes, presentations, treatments, and relevant anatomy. It provides an overview of imaging and clinical exams for
Late stage rehab tanya mackenzie
This document discusses essential elements for the functional/final stage of shoulder rehabilitation, including proprioceptive awareness, kinetic chain neuromuscular control, glenohumeral joint dynamic stability provided by compressive forces, and scapular mobility and stability. It emphasizes retraining muscle synergy between agonist and antagonist groups to control adverse humeral head translation at the glenoid. Clinical applications include using symptom modification to guide targeted muscle group rehabilitation in controlled vulnerable positions, and positioning the glenoid to support the humeral head in functional positions for each patient. The goal of late-stage rehabilitation is to achieve optimal biomechanical function and return to sport or work activities through integrated techniques built upon endurance and strength foundations while maintaining
Hydrodilation for frozen shoulder Does capsular rupture matter
This document summarizes a study examining the outcomes of hydrodilatation for frozen shoulder and whether capsular rupture during the procedure matters. The study found:
1) Patients experienced significant improvements in pain, range of motion, Constant-Murley scores, and Oxford Shoulder scores following hydrodilatation.
2) When comparing patients who experienced capsular rupture to those who did not, there were no significant differences in baseline characteristics or magnitudes of improvement between the groups.
3) Hydrodilatation resulted in meaningful pain relief and functional improvement for frozen shoulder patients, and capsular rupture during the procedure did not influence outcomes.
Shoulder rehab early julia walton
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.
Assessing bone loss in instability lf 2016
This document discusses various methods for assessing bone loss in the glenoid and humeral head in shoulder instability. It finds that while CT may be the most reliable method, there is no consensus on measurement techniques and what constitutes a clinically significant lesion. Methods like MRI and arthroscopy have not been sufficiently validated. Plain radiography is not accurate enough for pre-operative planning. The glenoid track and engagement formulas attempt to combine glenoid and humeral head measurements but also have limitations and have not been fully validated. Overall, the document concludes there is still uncertainty around accurately assessing and defining the critical amount of bone loss that increases recurrence risk in shoulder instability.
Evolution of tunnel placement in ACL reconstruction
One of my talks at Delhi Arthroscopy Club....... this presentation provides a insight regarding the conceptual evolution in tunnel placement during ACL reconstruction.
Ultrasound of the shoulder 2012
This document discusses the use of ultrasound scanning for evaluating shoulder conditions. It provides background on the history of medical ultrasound and its use for shoulder exams. Key points covered include what ultrasound can visualize in the shoulder, its benefits for being cheap, quick, and avoiding radiation compared to other imaging. Common shoulder issues it can diagnose are described, along with limitations and when it should not be used. The document emphasizes how ultrasound is changing practice by enabling rapid office-based evaluations, diagnoses, and treatment planning for patients with shoulder pain and injuries.
Viewers also liked (20)
Operative management of grade iii acj injuries olivia flannery
Operative management of grade iii acj injuries olivia flannery
Return to swimming after Shoulder Surgery or Injury
Return to swimming after Shoulder Surgery or Injury
Serious games for upper limb rehabilitation following stroke
Serious games for upper limb rehabilitation following stroke
Hydrodilation for frozen shoulder Does capsular rupture matter
Hydrodilation for frozen shoulder Does capsular rupture matter
Evolution of tunnel placement in ACL reconstruction
Evolution of tunnel placement in ACL reconstruction
Similar to Rotator cuff the future 2015
The moveable feast: converging technologies and our dinner table
The moveable feast: converging technologies and our dinner tableCalifornia State University Monterey Bay
The Moveable Feast: Legal, Ethical and Social Implications of Converging Technologies On Our Dinner Tables.
From genetically modified crops to nanoparticles in our food, converging technologies will likely change the way we eat. By converging technologies, I am referring to the convergence of Nanotechnology, Biotechnology, Information Technologies, and Cognitive Sciences (NBIC ). With GMOs already part of the legal landscape (Monsanto v. Geertson), and nutraceuticals that claim to boost brain power already available at your local health food store, nanotechnology and information technology promises to deliver such things as InVitro meat. What does the future hold with regards to new foodstuff and what, as lawyers and ethicists can expect to contemplate? Will the old law suffice or will new laws be needed? Articular cartilage injuries
The document provides an overview of articular cartilage injuries and treatment methods. It discusses the composition and limited self-repair ability of cartilage. Imaging can detect cartilage defects and bone marrow edema. Treatment methods include non-invasive platelet rich plasma and bone marrow concentrate injections as well as surgical options like microfracture, mosaicplasty/OATS, and autologous chondrocyte implantation. Mosaicplasty has shown good long-term outcomes for small to medium defects while autologous chondrocyte implantation improves large defects, though both generate fibrocartilage. Future advances may include tissue engineering and 3D bioprinting of cartilage.
Medical devices 2004
This document summarizes the medical device industry in British Columbia. It notes that the industry employs over 3,000 people at around 200 companies and generates $270 million annually. The industry has strengths in specialty niche products, strong research infrastructure, and government support. The document discusses how technologies are converging, with examples of devices that combine areas like biotechnology, advanced materials, and wireless capabilities. It predicts future convergence involving nanotechnology, micro fuel cells, brain-computer interfaces, and advanced power sources. The key takeaway is that the medical device field is advancing through convergence of technologies.
Tendons in ten minutes
Overuse injuries are common in professional ballet dancers, with the foot/ankle being the most injured area. Maintaining in-house medical staff can help decrease injury rates and save money. Tendinopathy is a core issue in dance medicine. Puberty is a critical period for collagen synthesis in tendons. New ultrasound tissue characterization technology provides objective data on tendon health and links to research. Treatment involves intelligent loading programs and potentially injections or surgery.
PRINCIPLES OF FUNCTIONAL APPLIANCES
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Nigel Ten Fleming | Adventura Capital | THE MICROBIOME, GENETICS, BIG DATA A...
A healthcare revolution is emerging driven by advances in genomics, microbiology, and mobile technology. Radically new diagnostics and therapeutics based on a person's DNA, epigenetics, and microbiome will transform medicine over the next decade. However, the enormous amount of complex biological data being generated far outpaces our ability to apply this new knowledge clinically. Both healthcare providers and patients need intuitive apps and algorithms to help interpret genetic and microbial information and develop personalized treatment plans. This unmet need represents a major business opportunity to develop user-friendly big data analytics tools that can simplify decision making and optimize patient care.
The Extreme Future of Health Care 2014
Radical trends in health care and medicine will change business and society. This presentation fresh from Dr. James Canton's New Keynote Presentation and from his upcoming new book looks at the trends in biotech, synthetic biology, digital health, genomics, wellness and regenerative medicine that will shape the near future of our world and health. Find out what's next and how to prepare today. For more info see http://globalfuturist.com
Moving Telehealth from the future to the present
This is a program delivered on 19 March 2012 by Glen Hiemstra to the 2012 Future of Telemedicine Conference put on by the Northwest Regional Telehealth Resource Center, in Billings, Montana. Glen Hiemstra is the Founder of Futurist.com and the Curator of DoTheFuture.com
Peri implantitis
Peri-implantitis is a chronic inflammatory disease affecting the bone and gum tissue around implants. As the number of implants being placed increases and subjected to inflammatory and occlusal demands the incidence of problems associated with Peri-implantitis will also increase. It is essential for practitioners to understand the etiology of Peri-implantitis and their role in preventing, treating and maintaining this growing problem.
Cybernetic theory of craniofacial /certified fixed orthodontic courses by Ind...
Cybernetic theory of craniofacial /certified fixed orthodontic courses by Ind...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
The future of Larkin Community Hospital
The document discusses challenges with the current state of medical care in the United States, including overemphasis on subspecialization, high costs due to unnecessary diagnostic testing and interventions, poor quality of care according to several studies, geographic variation in care, and influence of the pharmaceutical industry. It notes upcoming shortages of primary care physicians and specialists. Opportunities for collaboration between institutions via educational programs are highlighted.
Distraction osteogenesis
Distraction osteogenesis is a biological process used to treat craniofacial deformities. It involves separating bone segments gradually through incremental traction to stimulate new bone formation. Historically, it has been used since the early 1900s to lengthen limbs, and was first applied to the craniofacial skeleton in the 1980s. The process involves osteotomy, latency, distraction, consolidation, and remodeling phases. Both internal and external devices can be used uni-directionally or multi-directionally. Factors like age, site of surgery, rate and rhythm of distraction influence outcomes. The orthodontist plays a key role in planning distraction vectors and post-treatment orthodontics.
The present, the past and the futue of Longevity Research
These slides are presented on 5th Octiber Sunday at International Online Longevity Day Conference 2014 by Dr. Ilia Stambler
Measuring Force in Single Heart Cells
Traditional shortening experiments utilizing isolated myocytes have provided scientists a valuable functional assay. These studies, however, have been limited to techniques that could not replicate the mechanical environment of the heart. New technology now provides investigators the ability to reliably attach myocytes, mechanically stretch them, make direct force measurements and control cell length intelligently. This webinar reviews best-practices and techniques for attaching, stretching, and studying isolated cells.
During this exclusive webinar sponsored by IonOptix, presenters Ben Prosser and Michiel Helmes discuss methodology, best-practices, and show attendees how to attach isolated myocytes to ensure accurate force measurements. In addition, Ben Prosser reviews an application of myocyte stretching and loading. Michiel Helmes discusses the importance of both mechanical loading and measuring force, and how controlling myocyte length to regulate force development enables generation of work loops and a host of mechanical studies.
Key Topics:
Why it is important to mechanically load single myocytes and how to do master the technique
The value of measuring force in single cell applications of cardiac function research
Why it is important to control myocyte length
The value of combining force measurements with other indices of contraction and cellular function
Presenters:
Benjamin L. Prosser, PhD
Department of Physiology
Perelman School of Medicine
University of Pennsylvania
Michiel Helmes, PhD
Department of Physiology
VU University Medical Center Amsterdam & IonOptix
Bone union and advances
There are three phases of fracture healing: reactive, reparative, and remodeling. The reparative phase involves cartilage callus formation and lamellar bone deposition. Recent advances to enhance fracture healing include the use of bone grafts, bone marrow aspirate, growth factors, and platelet rich plasma to stimulate cell proliferation and new bone formation. Monitoring serum markers can help evaluate the bone formation process during healing. Other techniques like pulsed electromagnetic fields, low-intensity ultrasound, and vertebroplasty have also been used to promote healing.
SMi Group's 6th annual BioBanking 2016 conference
This document provides information about the 6th annual BioBanking conference taking place on June 20-21, 2016 in London. It will discuss topics such as biobanking regulations, data protection laws, biomarker identification, and creating biobanking networks. The event will feature keynote speakers from organizations like the European Commission, UK Biobank, and pharmaceutical companies. Participants can learn about building sustainable biobanks, sample management, and the role of biobanks in drug development. The conference aims to address challenges in biobanking compliance, harmonization, and integrating bioresources in precision medicine.
Non union of fractures dr mohamed ashraf,HOD orthopaedics,govt TD medical col...
presentation about pathophysiology and pathmechanics of delayed and non union of fractures.it shows how to manage different types of bone non union. presentation is by Dr Mohamed ashraf professor and head of orthopaedics,govt TD medical college, alleppey,kerala,india
Chapter 7 Other emerging technologies.pptx
The document discusses several emerging technologies including nanotechnology, biotechnology, blockchain technology, cloud computing, quantum computing, and their applications. Nanotechnology involves control of matter at the nanoscale of 1-1000 nanometers. Biotechnology uses techniques and science to modify living things or their components. Blockchain technology is a distributed digital ledger that maintains a chronological chain of transaction records. Cloud computing provides on-demand access to computing resources without ownership, while quantum computing uses quantum bits that can represent 0s and 1s simultaneously. These technologies offer benefits but also ethical issues requiring consideration.
Food 2040 project overview
This document outlines a discussion on the future of food in 2040. It presents a hypothesis that global wealth creation will drive demand for functional foods that align with consumer health and wellness strategies. The objective is to define opportunities arising from convergence of multiple interacting factors in the food system. Outcomes will include stakeholders activating action plans incorporating this new vision of how they can benefit from advances in food. The discussion will cover topics like emerging technologies, consumer trends in Asia, the competitive landscape, infrastructure changes, and environmental impacts of global growth.
Similar to Rotator cuff the future 2015 (20)
The moveable feast: converging technologies and our dinner table
The moveable feast: converging technologies and our dinner table
Nigel Ten Fleming | Adventura Capital | THE MICROBIOME, GENETICS, BIG DATA A...
Nigel Ten Fleming | Adventura Capital | THE MICROBIOME, GENETICS, BIG DATA A...
Cybernetic theory of craniofacial /certified fixed orthodontic courses by Ind...
Cybernetic theory of craniofacial /certified fixed orthodontic courses by Ind...
Introduction to Principles of Periodontal Surgery.pptx
Introduction to Principles of Periodontal Surgery.pptx
The present, the past and the futue of Longevity Research
The present, the past and the futue of Longevity Research
Non union of fractures dr mohamed ashraf,HOD orthopaedics,govt TD medical col...
Non union of fractures dr mohamed ashraf,HOD orthopaedics,govt TD medical col...
More from Lennard Funk
ACJ Disloc Management 2022.pdf
This document discusses the management of AC joint dislocations. It notes that while literature indicates surgery for type 4, 5, and 6 dislocations, classification using radiographs is unreliable. Further, clinical results are comparable between operative and non-operative treatment, but complications are more common with surgery. The author's indications for surgery are for those who cannot cope functionally or with work/social demands, such as overhead athletes. His experience using the LARS ligament for AC joint reconstruction is described along with postoperative rehabilitation phases and results showing a mean 15% reduction in displacement and low complication rates. Revision procedures for failed reconstructions also have good results.
Clavicle Fractures Pro Cyclists 2021.pdf
Clavicle fractures in pro cyclists are unique injuries that require careful management. Operative treatment with plate and screws results in improved healing times, higher union rates, and an earlier return to competition compared to non-operative treatment. The decision to return to cycling depends on fracture healing as well as an assessment of risk versus benefit by a multidisciplinary team in consultation with the patient.
ACJ Osteolysis.pdf
This document summarizes a study evaluating the clinical outcomes of direct arthroscopic acromioclavicular (AC) joint excision for osteolysis. Osteolysis of the AC joint is caused by excessive overhead motions and is commonly seen in weightlifters and rugby players, causing pain and limited shoulder range of motion. The study retrospectively reviewed 16 patients who underwent direct arthroscopic AC joint excision over a 2 year period. Patients showed significant improvements in their Constant Shoulder Score and QuickDASH score between pre-op and post-op assessments at a mean follow-up of 21 months. Patients also reported high satisfaction ratings. The study concluded that direct arthroscopic AC joint excision is an effective treatment for osteolysis with significant
Chronic Pectoralis Major Injuries Len Funk 2020
This document discusses chronic injuries to the pectoralis major muscle and surgical techniques for repairing them. It provides details on indications for surgery, including factors that make for good and poor surgical candidates. Surgical techniques described include preparing and attaching an allograft tendon to the pec major footprint using suture anchors. Post-op rehabilitation is outlined in phases focusing initially on range of motion and later on strengthening. Ultrasound imaging is used post-operatively to monitor healing. Outcomes of surgeries performed are also mentioned.
Rotator Cuff Augment 2018.pdf
This document discusses rotator cuff augmentation, which involves adding graft material to reinforce rotator cuff repairs. There are several types of grafts, including autografts from the patient's own tissue, allografts from human donors, xenografts from animals, and synthetic grafts. The evidence for whether augmentation improves outcomes comes from a limited number of randomized controlled trials and observational studies of varying quality. While allograft augmentation seemed to produce better results than controls in some studies, the overall evidence is inconclusive due to the low quality and small size of available studies. More research is still needed to determine whether and when augmentation provides meaningful benefits over standard rotator cuff repair without grafting.
Rotator Cuff Update 2022 for Medbelle Len Funk.pptx
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.
Should We Repair Rotator Cuff Tears OPN 2017.pdf
Lennard Funk & Puneet Monga
Prepared for Orthopaedic Product News, 2017
Rotator cuff disease is very common. There is as much enthusiastic discussion and debate on its management as there was 80 years ago when Codman (1937) first described the pathology and surgical management. There is great variation amongst surgeons as to the management of rotator cuff tears biased by experience and their understanding of the literature, skills levels and regional variations. There has been a lot of research done on the pathology, non-operative and operative treatments over the last two decades. Also, over the last decade there have been massive strides in the development of new surgical techniques and technologies. However, despite these advances there is as much discussion and debate!
Anterior shoulder instability st4-6
This document discusses the evolution and current approaches to shoulder instability surgery. It begins with a brief history of instability surgery techniques from Hippocrates to modern arthroscopic and open surgical procedures. It then covers classification of instability, pathological lesions, management decisions, and surgical procedure principles. Key points discussed include the Stanmore classification system, types of soft tissue lesions like Bankart tears and bone defects like bony Bankart fractures and Hill-Sachs lesions. Decision factors for open versus arthroscopic surgery are outlined. Surgical techniques like Bankart repair, capsular plication, bone graft procedures for glenoid deficiency, and remplissage for large Hill-Sachs lesions are summarized.
ACJ revision surgery for failed reconstructions and excisions
This document discusses ACJ revision surgery. It provides information on the functional anatomy of the AC joint, causes of failed ACJ excision or reconstruction, and describes a technique for ACJ revision surgery. The technique involves removing scar tissue from previous procedures, taking micro samples, performing an anatomical reconstruction of the CC and AC ligaments using LARS ligaments and a biceps flip or CAL transfer, and performing a delto-trapezial reefing. Results from 23 revision cases over 7 years showed improved Constant scores, low rates of re-displacement and infection, and no need for further revision after a mean follow up of 37 months.
Pectoralis Major Injuries for BESS 2020
This document discusses pectoralis major injuries, including anatomy, diagnosis, treatment options, and outcomes. It provides an overview of the author's experience treating tears in athletes from various sports. Diagnosis involves clinical exam and imaging like ultrasound or MRI. Treatment can be non-operative with strength loss, or operative with surgical repair which often provides best results, especially for distal tears. Post-operative rehabilitation is outlined in phases focusing first on range of motion and later on strengthening. Reported outcomes include patients regaining 90% of strength on average and returning to sports within 6 months.
Anterior shoulder Instability in the young athlete 2020 bostaa
This document discusses anterior glenohumeral joint instability in younger athletes. It notes that recurrence rates after non-operative treatment are high, between 70-100% in most studies. Arthroscopic stabilization also has high recurrence rates, particularly in those under age 16. The Latarjet procedure has shown good outcomes in both adolescent and adult populations with low recurrence rates and high rates of return to previous sport levels. For a semi-pro rugby player with anterior instability, surgery may be considered given the presence of major structural lesions, inability to continue playing, and pressures to return mid-season. The Latarjet procedure would be a good surgical option in this younger athlete population.
Superior Capsular Reconstruction Outcomes Wrightington 2020
Hariharan Mohan, Jagwant Singh, Michael Walton, Lennard Funk, Puneet Monga
Cautious optimism following SCR may be offered to this challenging subset of patients with symptomatic irreparable rotator cuff tears. It is likely that the relatively low re-operation rates can be further improved by considering the negative prognostic factors in defining indications for surgery. Further studies with longer term followup are recommended.
Shoulder Instability Sports - Decision Making
Lennard Funk presented on the clinical and radiological assessment of shoulder instability in athletes. He discussed evaluating anterior and posterior instability through physical examination tests in different positions and assessing glenoid and humeral bone loss on imaging studies like MRI arthrograms. Funk also covered management strategies and decision making, which involves considering factors related to the patient, their profession, the type and extent of pathology, and the treating physician.
Scapula Pain
Isolated scapula pain is uncommon, but very difficult to diagnose and manage. In this presentation I run through the known causes and an approach to the diagnosis, in order to guide best treatment.
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.
Pectoralis major allograft reconstruction
Presentation at ISAKOS, 2019
We performed a total of 142 pectoralis major repairs over a ten year period, of which 19 required allograft reconstruction. Of these 19 patients, 11 were available for response. All 11 patients were male with a mean age of 38.3 years (21 to 48 years). The mean time between injury and surgery was 12.2 months (4 to 30 months). Ten patients (91%) were unable to perform their previous level of work pre-operatively, with all patients returning to pre-injury occupation levels post-operatively.
The main complaint prior to surgery was pain on pushing and moving the affected arm across the body, which improved in nine patients (82%), with no improvement reported in two patients. Strength improved significantly post-operatively, with only three patients reporting no improvement (paired t-test p=0.01). Six patients reported an improvement in cosmesis (50%).
What the surgeon wants from radiologist
The document discusses shoulder injuries in sports. It provides guidance on what information is important to understand from MRI reports for rotator cuff tears, including the size and location of the tear and the extent of muscle atrophy. It emphasizes the importance of collaboration between surgeons and radiologists for accurate diagnoses. The treatment approach for sports injuries depends on factors like the patient's age, type of sport played, and time since injury.
Rotator cuff tear management 2019
Rotator cuff tears do not always require surgical repair. The decision depends on factors like the patient's age and activity level as well as the size and chronicity of the tear. Smaller tears in younger, more active patients may heal with non-operative treatment or repair, while larger, chronic tears in older individuals often do not heal after repair. When repair is not indicated for massive, irreparable tears, options include tendon transfers, superior capsular reconstruction, augmented repairs, and InSpace balloon spacers. Ultrasound is useful for initial evaluation and post-operative monitoring but MRI may better assess tear size and tissue quality factors that predict repair outcomes.
Perioperative pain management toni hundle the arm clinic 2019
Peri-operative pain management from Anaesthetist, Dr Toni Hundle for The Arm Clinic at HCA The Wilmslow Hospital 2019
Hydrodistension outcomes 2017
Hydrodistention is a treatment for frozen shoulder (FS) that is gaining popularity again. However, no large, long-term outcome data has been published yet. Our aims were to evaluate hydrodistension for the treatment of primary frozen shoulder (FS) in a large cohort of patients with long follow-up period.
We present a case series of eighty-nine patients (36 males and 53 females) with a mean age of 52 years (33-73). Eleven (12.4%) had disease associations. We excluded post-operative secondary stiff shoulders. The mean volume injected was 33.7ml (16-66). 36/89 (40%) had capsular rupture. Six (6.7%) had adverse effects. The mean follow-up was 104.5 weeks (8-238).
Mean improvement in forward flexion was 165.4, abduction 111.6, external rotation was hand above head with elbow back (and internal rotation in extension to T12. Mean improvement in quickDASH score was 17.1 (p<0.001) and Constant Score was 70.0 (p<0.001). Mean improvement in VAS was 7.3 (p<0.001). No patients had night pain (p<0.001). Eighty-eight (99%) returned to their previous occupation. Seventy-six (85%) returned to their previous level of sport. Gender, previous intra-articular steroid injection, volume of the injectate, type of steroid used, capsular rupture and underlying aetiology had no impact on outcome.
More from Lennard Funk (20)
Rotator Cuff Update 2022 for Medbelle Len Funk.pptx
Rotator Cuff Update 2022 for Medbelle Len Funk.pptx
ACJ revision surgery for failed reconstructions and excisions
ACJ revision surgery for failed reconstructions and excisions
Anterior shoulder Instability in the young athlete 2020 bostaa
Anterior shoulder Instability in the young athlete 2020 bostaa
Superior Capsular Reconstruction Outcomes Wrightington 2020
Superior Capsular Reconstruction Outcomes Wrightington 2020
The Incidence of Traumatic Posterior and Combined Labral Tears in Patients Un...
The Incidence of Traumatic Posterior and Combined Labral Tears in Patients Un...
Perioperative pain management toni hundle the arm clinic 2019
Perioperative pain management toni hundle the arm clinic 2019
Recently uploaded
Foundation of Yoga, YCB Level-3, Unit-1
Unit -1 of Yoga certification board, level 3, all topics covered. An exam conducted by ministry of Ayush for yoga enthusiastic students.
Pollen and Fungal allergy: aeroallergy.pdf
Pollen and Fungal allergy: aeroallergy.pdfChulalongkorn Allergy and Clinical Immunology Research Group
Pollen and Fungal allergy
Presented by Chaloemchai Chumsaengchotsakul, MD.
June 14, 2024NARCOTICS- POLICY AND PROCEDURES FOR ITS USE
This document outlines policies and procedures for handling narcotic and controlled drugs in NABH accredited hospitals.
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdf
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdfOsvaldo Bernardo Muchanga
GASTROINTESTINAL INFECTIONS AND GASTRITIS
Osvaldo Bernardo Muchanga
Gastrointestinal Infections
GASTROINTESTINAL INFECTIONS result from the ingestion of pathogens that cause infections at the level of this tract, generally being transmitted by food, water and hands contaminated by microorganisms such as E. coli, Salmonella, Shigella, Vibrio cholerae, Campylobacter, Staphylococcus, Rotavirus among others that are generally contained in feces, thus configuring a FECAL-ORAL type of transmission.
Among the factors that lead to the occurrence of gastrointestinal infections are the hygienic and sanitary deficiencies that characterize our markets and other places where raw or cooked food is sold, poor environmental sanitation in communities, deficiencies in water treatment (or in the process of its plumbing), risky hygienic-sanitary habits (not washing hands after major and/or minor needs), among others.
These are generally consequences (signs and symptoms) resulting from gastrointestinal infections: diarrhea, vomiting, fever and malaise, among others.
The treatment consists of replacing lost liquids and electrolytes (drinking drinking water and other recommended liquids, including consumption of juicy fruits such as papayas, apples, pears, among others that contain water in their composition).
To prevent this, it is necessary to promote health education, improve the hygienic-sanitary conditions of markets and communities in general as a way of promoting, preserving and prolonging PUBLIC HEALTH.
Gastritis and Gastric Health
Gastric Health is one of the most relevant concerns in human health, with gastrointestinal infections being among the main illnesses that affect humans.
Among gastric problems, we have GASTRITIS AND GASTRIC ULCERS as the main public health problems. Gastritis and gastric ulcers normally result from inflammation and corrosion of the walls of the stomach (gastric mucosa) and are generally associated (caused) by the bacterium Helicobacter pylor, which, according to the literature, this bacterium settles on these walls (of the stomach) and starts to release urease that ends up altering the normal pH of the stomach (acid), which leads to inflammation and corrosion of the mucous membranes and consequent gastritis or ulcers, respectively.
In addition to bacterial infections, gastritis and gastric ulcers are associated with several factors, with emphasis on prolonged fasting, chemical substances including drugs, alcohol, foods with strong seasonings including chilli, which ends up causing inflammation of the stomach walls and/or corrosion. of the same, resulting in the appearance of wounds and consequent gastritis or ulcers, respectively.
Among patients with gastritis and/or ulcers, one of the dilemmas is associated with the foods to consume in order to minimize the sensation of pain and discomfort. Full Handwritten notes of RA by Ayush Kumar M pharm - Al ameen college of pha...
Full Handwritten notes of RA by Ayush Kumar M pharm - Al ameen college of pha...ayushrajshrivastava7
Regulatory Affairs
Full hand written notes
M.pharm - 1st year .PGx Analysis in VarSeq: A User’s Perspective
Since our release of the PGx capabilities in VarSeq, we’ve had a few months to gather some insights from various use cases. Some users approach PGx workflows by means of array genotyping or what seems to be a growing trend of adding the star allele calling to the existing NGS pipeline for whole genome data. Luckily, both approaches are supported with the VarSeq software platform. The genotyping method being used will also dictate what the scope of the tertiary analysis will be. For example, are your PGx reports a standalone pipeline or would your lab’s goal be to handle a dual-purpose workflow and report on PGx + Diagnostic findings.
The purpose of this webcast is to:
Discuss and demonstrate the approaches with array and NGS genotyping methods for star allele calling to prep for downstream analysis.
Following genotyping, explore alternative tertiary workflow concepts in VarSeq to handle PGx reporting.
Moreover, we will include insights users will need to consider when validating their PGx workflow for all possible star alleles and options you have for automating your PGx analysis for large number of samples. Please join us for a session dedicated to the application of star allele genotyping and subsequent PGx workflows in our VarSeq software.
Breast cancer: Post menopausal endocrine therapy
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
Travel Clinic Cardiff: Health Advice for International Travelers
Travel Clinic Cardiff offers comprehensive travel health services, including vaccinations, travel advice, and preventive care for international travelers. Our expert team ensures you are well-prepared and protected for your journey, providing personalized consultations tailored to your destination. Conveniently located in Cardiff, we help you travel with confidence and peace of mind. Visit us: www.nxhealthcare.co.uk
Know the difference between Endodontics and Orthodontics.
Your smile is beautiful.
Let’s be honest. Maintaining that beautiful smile is not an easy task. It is more than brushing and flossing. Sometimes, you might encounter dental issues that need special dental care. These issues can range anywhere from misalignment of the jaw to pain in the root of teeth.
June 2024 Oncology Cartoons By Dr Kanhu Charan Patro
une 2024 Oncology Cartoons By Dr Kanhu Charan Patro
SENSORY NEEDS B.SC. NURSING SEMESTER II.
Sensation is the neurological process by which we become aware of surrounding environment.
Pharmacology of 5-hydroxytryptamine and Antagonist
5-hydroxytryptamine or 5-HT or Serotonin is a neurotransmitter that serves a range of roles in the human body. It is sometimes referred to as the happy chemical since it promotes overall well-being and happiness.
It is mostly found in the brain, intestines, and blood platelets.
5-HT is utilised to transport messages between nerve cells, is known to be involved in smooth muscle contraction, and adds to overall well-being and pleasure, among other benefits. 5-HT regulates the body's sleep-wake cycles and internal clock by acting as a precursor to melatonin.
It is hypothesised to regulate hunger, emotions, motor, cognitive, and autonomic processes.
Skin Diseases That Happen During Summer.
Summer is a time for fun in the sun, but the heat and humidity can also wreak havoc on your skin. From itchy rashes to unwanted pigmentation, several skin conditions become more prevalent during these warmer months.
biomechanics of running. Dr.dhwani.pptx
The biomechanics of running involves the study of the mechanical principles underlying running movements. It includes the analysis of the running gait cycle, which consists of the stance phase (foot contact to push-off) and the swing phase (foot lift-off to next contact). Key aspects include kinematics (joint angles and movements, stride length and frequency) and kinetics (forces involved in running, including ground reaction and muscle forces). Understanding these factors helps in improving running performance, optimizing technique, and preventing injuries.
Top Travel Vaccinations in Manchester
Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
Giloy in Ayurveda - Classical Categorization and Synonyms
Giloy, also known as Guduchi or Amrita in classical Ayurvedic texts, is a revered herb renowned for its myriad health benefits. It is categorized as a Rasayana, meaning it has rejuvenating properties that enhance vitality and longevity. Giloy is celebrated for its ability to boost the immune system, detoxify the body, and promote overall wellness. Its anti-inflammatory, antipyretic, and antioxidant properties make it a staple in managing conditions like fever, diabetes, and stress. The versatility and efficacy of Giloy in supporting health naturally highlight its importance in Ayurveda. At Planet Ayurveda, we provide a comprehensive range of health services and 100% herbal supplements that harness the power of natural ingredients like Giloy. Our products are globally available and affordable, ensuring that everyone can benefit from the ancient wisdom of Ayurveda. If you or your loved ones are dealing with health issues, contact Planet Ayurveda at 01725214040 to book an online video consultation with our professional doctors. Let us help you achieve optimal health and wellness naturally.
Recently uploaded (20)
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdf
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdf
Full Handwritten notes of RA by Ayush Kumar M pharm - Al ameen college of pha...
Full Handwritten notes of RA by Ayush Kumar M pharm - Al ameen college of pha...
Travel Clinic Cardiff: Health Advice for International Travelers
Travel Clinic Cardiff: Health Advice for International Travelers
Know the difference between Endodontics and Orthodontics.
Know the difference between Endodontics and Orthodontics.
June 2024 Oncology Cartoons By Dr Kanhu Charan Patro
June 2024 Oncology Cartoons By Dr Kanhu Charan Patro
Pharmacology of 5-hydroxytryptamine and Antagonist
Pharmacology of 5-hydroxytryptamine and Antagonist
Giloy in Ayurveda - Classical Categorization and Synonyms
Giloy in Ayurveda - Classical Categorization and Synonyms
Rotator cuff the future 2015
- 1. ROTATOR CUFF REPAIRS - THE FUTURE? •Lennard Funk •Shoulder Surgeon, Wrightington, Wigan and Leigh NHS Foundation Trust
- 2. The past is full of sutures & anchors
- 3. The future of rotator cuff repairs is NOT rotator cuff repairs The future…
- 4. Possibilities • Future 1: Biological repairs • Future 2: Augmentation devices • Future 4: Gene therapy prevention & Nano-surgery
- 5. Cuff Pathology • Changes with age: • Microvascularity • Collagen • Cellular • Genetics • Overuse effects
- 6. Tendon Clock
- 7. Future: • Clearer understanding of those that need repair & those that can be treated non-operatively • Algorithms • Age • Genetics • Fatty Infiltration • Micro-vascularity • Size • Cellular markers
- 8. Enhancing technologies Growth Factors ◦Timed Release ◦on the Suture ◦Anchor Reservoir ◦In the Tissue
- 9. Future 1 • Early repairs • Biological enhancement • BMP • Growth Factors • Vascular sutures http://www.google.com.ar/patents/US20100040662
- 11. Future 3 • Late repairs • Augmentation devices • SCR • InSpace Balloon
- 14. InSpace Balloon
- 15. Future 4 • Gene therapy based on genetic markers & self- monitoring • Self-administered • Nanosurgery • Injection • Remotely controlled
- 16. Nano-Instruments "Nanoelectrode Scanning Probes from Fluorocarbon-Coated Single-Walled Carbon Nanotubes" Maria J. Esplandiu, Vern G. Bittner, Konstantinos P. Giapis, C. Patrick Collier. Nano Lett.; 2004; ASAP Web Release Date 19-Aug-2004
- 18. The future of rotator cuff repairs is NOT rotator cuff repairs •Lennard Funk •Shoulder Surgeon, Wrightington, Wigan and Leigh NHS Foundation Trust
- 19. But… Is the future gonna be as much fun?