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/
Shoulder instability current concepts mike waltonLennard Funk
The document discusses shoulder instability, beginning with how humans evolved the ability to throw through modifications to the shoulder including a lengthened clavicle and increased external rotation of the glenohumeral joint. It then notes that the glenohumeral joint is inherently unstable, and anterior dislocation is the most common type, usually occurring with combined external rotation and abduction. Assessment of instability involves understanding the mechanism of injury, performing apprehension tests, and obtaining imaging like MR arthrogram. Bone loss and engaging Hill-Sachs lesions are predictors of failure following surgery.
The HAGL lesion involves an avulsion of the inferior glenohumeral ligament from its humeral insertion, which is a rare cause of shoulder instability comprising less than 10% of cases. It often occurs with a traumatic mechanism of hyperabduction and external rotation. MRI arthrography is the best imaging modality to diagnose a HAGL lesion. Surgical repair is usually recommended and case series have reported good outcomes with no recurrent instability after repair.
This document discusses shoulder instability, including the normal anatomy, causes of instability, classifications, clinical evaluation, radiographic evaluation, and treatment options. The glenohumeral joint has the highest mobility of any joint but lacks stability. Instability can be caused by excessive ligament laxity, bone defects, or trauma. Clinical exams include special tests like the apprehension and relocation tests. Treatment may involve arthroscopic or open stabilization surgery like Bankart repair, with post-op rehabilitation progressing from immobilization to strengthening and return to activity.
Reverse shoulder arthroplasty is a procedure used to treat shoulder arthritis and rotator cuff tears. It works by reversing the natural ball-and-socket anatomy of the shoulder joint. Early results showed improved shoulder function and pain relief. However, complications can include scapular notching, instability, infection, and loosening. Modifications to implant design, including increased prosthetic overhang, have helped reduce scapular notching. While reverse shoulder arthroplasty can improve shoulder function in patients with rotator cuff dysfunction, long-term outcomes remain variable and reoperations are sometimes required to address complications.
The document discusses reverse total shoulder arthroplasty (rTSA), including:
- The procedure reverses the ball and socket of the shoulder joint.
- It was approved for use in the US in 2004.
- The new design moves the center of rotation medially and inferiorly, increasing deltoid tension and function as the primary shoulder elevator.
- Indications include severe rotator cuff deficiency or previous TSA failure. Contraindications include infection or inadequate bone stock. Potential complications range from minor issues like stiffness or hematoma to more serious problems like prosthesis loosening or nerve damage.
The Latarjet procedure is effective for treating traumatic anterior shoulder instability, especially when there is significant bone loss. It works by increasing the effective glenoid track and addressing humeral and glenoid bone deficits. Studies show the Latarjet procedure results in excellent stability, range of motion, function, and return to sports. While it has a slightly higher risk of complications than the Bankart repair, the Latarjet procedure is superior in addressing the underlying bone pathology and has lower recurrence rates, making it the preferred option for many patients with traumatic anterior instability.
Arthroscopic Stablization Cherry Blossom Final 2009haydenmac
1. Arthroscopic stabilization has become the standard treatment for anterior shoulder instability with indications including post-traumatic unidirectional instability with a discrete Bankart lesion and good tissue quality.
2. Contraindications for arthroscopic stabilization include HAGL lesions, poor quality capsulolabral tissue, intra-capsular IGHL rupture, revision surgery, significant glenoid or bony Bankart pathology, engaging Hill-Sachs lesions, and involvement in contact/collision sports.
3. Multiple studies have shown arthroscopic Bankart repair can achieve recurrence rates of 3-10% with mean follow-ups of 2-5 years, though higher recurrence rates of 25-29% were
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/
Shoulder instability current concepts mike waltonLennard Funk
The document discusses shoulder instability, beginning with how humans evolved the ability to throw through modifications to the shoulder including a lengthened clavicle and increased external rotation of the glenohumeral joint. It then notes that the glenohumeral joint is inherently unstable, and anterior dislocation is the most common type, usually occurring with combined external rotation and abduction. Assessment of instability involves understanding the mechanism of injury, performing apprehension tests, and obtaining imaging like MR arthrogram. Bone loss and engaging Hill-Sachs lesions are predictors of failure following surgery.
The HAGL lesion involves an avulsion of the inferior glenohumeral ligament from its humeral insertion, which is a rare cause of shoulder instability comprising less than 10% of cases. It often occurs with a traumatic mechanism of hyperabduction and external rotation. MRI arthrography is the best imaging modality to diagnose a HAGL lesion. Surgical repair is usually recommended and case series have reported good outcomes with no recurrent instability after repair.
This document discusses shoulder instability, including the normal anatomy, causes of instability, classifications, clinical evaluation, radiographic evaluation, and treatment options. The glenohumeral joint has the highest mobility of any joint but lacks stability. Instability can be caused by excessive ligament laxity, bone defects, or trauma. Clinical exams include special tests like the apprehension and relocation tests. Treatment may involve arthroscopic or open stabilization surgery like Bankart repair, with post-op rehabilitation progressing from immobilization to strengthening and return to activity.
Reverse shoulder arthroplasty is a procedure used to treat shoulder arthritis and rotator cuff tears. It works by reversing the natural ball-and-socket anatomy of the shoulder joint. Early results showed improved shoulder function and pain relief. However, complications can include scapular notching, instability, infection, and loosening. Modifications to implant design, including increased prosthetic overhang, have helped reduce scapular notching. While reverse shoulder arthroplasty can improve shoulder function in patients with rotator cuff dysfunction, long-term outcomes remain variable and reoperations are sometimes required to address complications.
The document discusses reverse total shoulder arthroplasty (rTSA), including:
- The procedure reverses the ball and socket of the shoulder joint.
- It was approved for use in the US in 2004.
- The new design moves the center of rotation medially and inferiorly, increasing deltoid tension and function as the primary shoulder elevator.
- Indications include severe rotator cuff deficiency or previous TSA failure. Contraindications include infection or inadequate bone stock. Potential complications range from minor issues like stiffness or hematoma to more serious problems like prosthesis loosening or nerve damage.
The Latarjet procedure is effective for treating traumatic anterior shoulder instability, especially when there is significant bone loss. It works by increasing the effective glenoid track and addressing humeral and glenoid bone deficits. Studies show the Latarjet procedure results in excellent stability, range of motion, function, and return to sports. While it has a slightly higher risk of complications than the Bankart repair, the Latarjet procedure is superior in addressing the underlying bone pathology and has lower recurrence rates, making it the preferred option for many patients with traumatic anterior instability.
Arthroscopic Stablization Cherry Blossom Final 2009haydenmac
1. Arthroscopic stabilization has become the standard treatment for anterior shoulder instability with indications including post-traumatic unidirectional instability with a discrete Bankart lesion and good tissue quality.
2. Contraindications for arthroscopic stabilization include HAGL lesions, poor quality capsulolabral tissue, intra-capsular IGHL rupture, revision surgery, significant glenoid or bony Bankart pathology, engaging Hill-Sachs lesions, and involvement in contact/collision sports.
3. Multiple studies have shown arthroscopic Bankart repair can achieve recurrence rates of 3-10% with mean follow-ups of 2-5 years, though higher recurrence rates of 25-29% were
This document discusses reconstructive surgery of the glenohumeral joint, including reverse total shoulder arthroplasty. It provides an anatomical overview of the glenohumeral joint and describes the indications, surgical procedure, components, and complications of reverse total shoulder arthroplasty. Reverse total shoulder arthroplasty involves replacing the normal ball and socket articulation with a convex glenoid component and concave humeral cup to improve function and range of motion, especially for conditions involving rotator cuff dysfunction.
This document discusses shoulder instability. It defines instability as the inability to maintain the humeral head in the glenoid fossa, and describes different types including dislocation, subluxation, and laxity. Static factors like bony anatomy and dynamic factors like muscles contribute to stability. The glenoid fossa has a pear shape with retroversion and tilt. Classification systems for instability are mentioned. Surgical procedures to address instability and lesions are briefly outlined. Multi-directional instability is also referenced.
Current concepts in the management of shoulder instabilityPonnilavan Ponz
This document discusses the current concepts in the management of shoulder instability. It covers the causes, classifications, investigations, and treatment options for shoulder instability. For treatment, it emphasizes the importance of a systematic approach that considers the patient's age, activity level, and nature of the soft tissue and bony injuries. Non-operative treatments include physiotherapy, while operative options depend on the specific injuries and may include arthroscopic bankart repair, open latarjet procedure, remplissage, or capsular shift procedures. The goal of treatment and rehabilitation is to return the patient to their prior level of function and activity.
Bankart and SLAP lesions are injuries to the shoulder labrum that can cause instability. Bankart lesions involve detachment of the labrum from the glenoid while SLAP lesions involve tears of the superior labrum and biceps tendon. Surgical repair reattaches the labrum while rehabilitation focuses on protecting the repair initially and gradually restoring range of motion, strength, and functional activities over 6-12 months. Non-operative rehabilitation also aims to restore stability, strength, and function over 6 months through stretching, strengthening, and proprioceptive exercises. Return to overhead sports requires a gradual throwing progression over multiple phases to ensure safe return to full activities.
This is a short presentation on shoulder instability, biomechanics, pathology, diagnostic modalities, clinical picture and treatment methods available.
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.
This document discusses shoulder instability, including definitions, anatomy, evaluation, and treatment. It defines instability as the inability to maintain the humeral head in the glenoid fossa, ranging from dislocation to laxity. Static stabilizers include the labrum and ligaments, while dynamic stabilizers are the rotator cuff and scapulothoracic muscles. Evaluation involves history, exam, and imaging to classify instability by direction, degree, and etiology. Treatment depends on classification but may include immobilization, rehabilitation, or surgical repair of labral tears or bone defects.
Shoulder sports injury overview and instability basicsPuneet Monga
This document discusses shoulder injuries in sports. It covers categories of shoulder injuries including contact, overhead, combat, and riding injuries. It focuses on shoulder instability, describing the static and dynamic stabilizers of the shoulder joint. It discusses classifications of instability and assessments including clinical exams and imaging studies. The management of traumatic dislocations and surgical options for instability are outlined.
1) Reverse shoulder arthroplasty designs impact joint biomechanics by altering the deltoid moment arm and tension through variations in glenosphere medialization/lateralization and humeral component design.
2) Medializing the glenosphere increases the deltoid moment arm but can increase scapular notching and instability risks, while lateralizing the glenosphere reduces these risks but decreases deltoid efficiency.
3) Lateralizing the humeral component improves deltoid wrapping and compression at the joint while maintaining deltoid efficiency compared to more medial designs.
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.
This document discusses shoulder instability, including definitions, causes, classifications, assessments, and treatments. It defines types of instability like dislocation, subluxation, and laxity. Static and dynamic factors that contribute to instability are identified. Common injuries associated with instability like Bankart lesions are described. Evaluation involves history, physical exam, imaging studies like x-rays and MRI. Surgical procedures to address different types of instability are outlined, including Bankart repair and Latarjet procedure. Post-operative rehabilitation protocols are also summarized.
Pre op planning for shoulder arthroplastyPuneet Monga
This document provides an overview of the pre-operative planning process for shoulder arthroplasty. It discusses 4 key steps: 1) clinical assessment using a cluster approach including history, exam, and investigations; 2) assessment of bone stock using x-rays, CT scans, and the Walch classification system; 3) assessment of rotator cuff status using CT, ultrasound, and MRIs; and 4) choosing the correct implant based on the individual patient's anatomy and bone loss classification. Advanced techniques discussed include 3D printing, patient-specific instrumentation, and custom implants to best address individual patient factors.
The document discusses anterior glenohumeral instability, including epidemiology, pathoanatomy, diagnosis, and management options. It notes that anterior dislocations are most common in athletes under age 25, with the primary pathology being a Bankart lesion. Diagnosis involves history, physical exam including tests like the apprehension test, and imaging like x-rays and MRI. Treatment depends on factors like number of dislocations, age, and physical exam findings, ranging from rehabilitation to surgical procedures.
Total shoulder arthroplasty and reverse TSA - Hussain AlgawahmedHussainAlgawahmedMBB
This document discusses shoulder arthritis and treatment options including total shoulder arthroplasty (TSA) and reverse total shoulder arthroplasty (rTSA). It provides details on patient cases, anatomy, biomechanics, types of arthritis, and principles of TSA and rTSA. For a 50-year-old patient with shoulder pain, options could include TSA if the rotator cuff and glenoid are intact. An rTSA may be considered for a patient with a massive rotator cuff tear or pseudoparalysis. The document reviews indications, surgical techniques, and complications for both procedures.
Rehabilitation following a reversed total shoulder arthroplasty nwulg 28.2.12Lennard Funk
This document discusses the rehabilitation of reverse total shoulder replacements (rTSR). It notes that rTSR rehabilitation differs from traditional shoulder replacements by focusing initially on stability and deltoid rehabilitation, addressing scapular control, and emphasizing restoration of external rotation. Key points include immobilizing the shoulder initially, progressing to active-assisted then active range of motion, addressing movement deficits, and advancing to functional exercises while monitoring for complications like scapular notching. The goal is improved pain relief and movement, though some patients may have poor outcomes requiring additional support strategies.
1. Shoulder injuries are common in sports and can be acute or chronic. They range from mild sprains to traumatic dislocations and are often painful and mobility-restricting.
2. MRI and CT scans are important imaging modalities to diagnose shoulder injuries and assess soft tissue damage, bone defects, and other pathology like tumors or fractures. MR arthrography provides high accuracy for labral tears.
3. Common acute injuries include dislocations, rotator cuff tears, and injuries to the biceps tendon. Chronic overload can also cause tendinopathy and impingement. The size and chronicity of rotator cuff tears affects prognosis.
Rehabilitation Of Anterior Shoulder DislocationCoachBlake
- Younger patients under age 20 who experience an anterior shoulder dislocation have recurrent dislocation rates as high as 90% in athletic populations, while rates decrease with age to lower than 50% for those ages 20-25 and even lower for those over age 40.
- Rehabilitation following a shoulder dislocation or repair focuses first on restoring range of motion and strengthening the rotator cuff and parascapular muscles, with protocols varying based on surgical versus non-surgical treatment and generally taking 4-6 months to return to full activity.
- While overhead lifting and deep pressing motions carry risk of reinjury, year-round training of the shoulder girdle including sports-specific drills is important to prevent future instability
Reversing the Trend- Newer Types of Shoulder Replacementcoreinstitute
Recently, there has been much discussion about a relatively new type of shoulder replacement, which offers patients the prospects of pain relief and better shoulder function. View this presentation to learn more about this shoulder replacement surgery.
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.
This document discusses treatment options for bone defects in the glenoid and humeral head that can cause recurrent shoulder instability. It finds that humeral head (Hill-Sachs) defects occur in 65-93% of cases depending on the number of dislocations, while glenoid defects occur in 5-56% of cases. Treatment depends on the size and engagement of the defects. For large Hill-Sachs lesions, options include bone grafting, arthroplasty, or the remplissage procedure. For significant glenoid bone loss over 20-30%, options include soft tissue repair plus bone grafting or procedures like Bristow or Latarjet to add bone to the glenoid. The document advocates
This document discusses reconstructive surgery of the glenohumeral joint, including reverse total shoulder arthroplasty. It provides an anatomical overview of the glenohumeral joint and describes the indications, surgical procedure, components, and complications of reverse total shoulder arthroplasty. Reverse total shoulder arthroplasty involves replacing the normal ball and socket articulation with a convex glenoid component and concave humeral cup to improve function and range of motion, especially for conditions involving rotator cuff dysfunction.
This document discusses shoulder instability. It defines instability as the inability to maintain the humeral head in the glenoid fossa, and describes different types including dislocation, subluxation, and laxity. Static factors like bony anatomy and dynamic factors like muscles contribute to stability. The glenoid fossa has a pear shape with retroversion and tilt. Classification systems for instability are mentioned. Surgical procedures to address instability and lesions are briefly outlined. Multi-directional instability is also referenced.
Current concepts in the management of shoulder instabilityPonnilavan Ponz
This document discusses the current concepts in the management of shoulder instability. It covers the causes, classifications, investigations, and treatment options for shoulder instability. For treatment, it emphasizes the importance of a systematic approach that considers the patient's age, activity level, and nature of the soft tissue and bony injuries. Non-operative treatments include physiotherapy, while operative options depend on the specific injuries and may include arthroscopic bankart repair, open latarjet procedure, remplissage, or capsular shift procedures. The goal of treatment and rehabilitation is to return the patient to their prior level of function and activity.
Bankart and SLAP lesions are injuries to the shoulder labrum that can cause instability. Bankart lesions involve detachment of the labrum from the glenoid while SLAP lesions involve tears of the superior labrum and biceps tendon. Surgical repair reattaches the labrum while rehabilitation focuses on protecting the repair initially and gradually restoring range of motion, strength, and functional activities over 6-12 months. Non-operative rehabilitation also aims to restore stability, strength, and function over 6 months through stretching, strengthening, and proprioceptive exercises. Return to overhead sports requires a gradual throwing progression over multiple phases to ensure safe return to full activities.
This is a short presentation on shoulder instability, biomechanics, pathology, diagnostic modalities, clinical picture and treatment methods available.
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.
This document discusses shoulder instability, including definitions, anatomy, evaluation, and treatment. It defines instability as the inability to maintain the humeral head in the glenoid fossa, ranging from dislocation to laxity. Static stabilizers include the labrum and ligaments, while dynamic stabilizers are the rotator cuff and scapulothoracic muscles. Evaluation involves history, exam, and imaging to classify instability by direction, degree, and etiology. Treatment depends on classification but may include immobilization, rehabilitation, or surgical repair of labral tears or bone defects.
Shoulder sports injury overview and instability basicsPuneet Monga
This document discusses shoulder injuries in sports. It covers categories of shoulder injuries including contact, overhead, combat, and riding injuries. It focuses on shoulder instability, describing the static and dynamic stabilizers of the shoulder joint. It discusses classifications of instability and assessments including clinical exams and imaging studies. The management of traumatic dislocations and surgical options for instability are outlined.
1) Reverse shoulder arthroplasty designs impact joint biomechanics by altering the deltoid moment arm and tension through variations in glenosphere medialization/lateralization and humeral component design.
2) Medializing the glenosphere increases the deltoid moment arm but can increase scapular notching and instability risks, while lateralizing the glenosphere reduces these risks but decreases deltoid efficiency.
3) Lateralizing the humeral component improves deltoid wrapping and compression at the joint while maintaining deltoid efficiency compared to more medial designs.
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.
This document discusses shoulder instability, including definitions, causes, classifications, assessments, and treatments. It defines types of instability like dislocation, subluxation, and laxity. Static and dynamic factors that contribute to instability are identified. Common injuries associated with instability like Bankart lesions are described. Evaluation involves history, physical exam, imaging studies like x-rays and MRI. Surgical procedures to address different types of instability are outlined, including Bankart repair and Latarjet procedure. Post-operative rehabilitation protocols are also summarized.
Pre op planning for shoulder arthroplastyPuneet Monga
This document provides an overview of the pre-operative planning process for shoulder arthroplasty. It discusses 4 key steps: 1) clinical assessment using a cluster approach including history, exam, and investigations; 2) assessment of bone stock using x-rays, CT scans, and the Walch classification system; 3) assessment of rotator cuff status using CT, ultrasound, and MRIs; and 4) choosing the correct implant based on the individual patient's anatomy and bone loss classification. Advanced techniques discussed include 3D printing, patient-specific instrumentation, and custom implants to best address individual patient factors.
The document discusses anterior glenohumeral instability, including epidemiology, pathoanatomy, diagnosis, and management options. It notes that anterior dislocations are most common in athletes under age 25, with the primary pathology being a Bankart lesion. Diagnosis involves history, physical exam including tests like the apprehension test, and imaging like x-rays and MRI. Treatment depends on factors like number of dislocations, age, and physical exam findings, ranging from rehabilitation to surgical procedures.
Total shoulder arthroplasty and reverse TSA - Hussain AlgawahmedHussainAlgawahmedMBB
This document discusses shoulder arthritis and treatment options including total shoulder arthroplasty (TSA) and reverse total shoulder arthroplasty (rTSA). It provides details on patient cases, anatomy, biomechanics, types of arthritis, and principles of TSA and rTSA. For a 50-year-old patient with shoulder pain, options could include TSA if the rotator cuff and glenoid are intact. An rTSA may be considered for a patient with a massive rotator cuff tear or pseudoparalysis. The document reviews indications, surgical techniques, and complications for both procedures.
Rehabilitation following a reversed total shoulder arthroplasty nwulg 28.2.12Lennard Funk
This document discusses the rehabilitation of reverse total shoulder replacements (rTSR). It notes that rTSR rehabilitation differs from traditional shoulder replacements by focusing initially on stability and deltoid rehabilitation, addressing scapular control, and emphasizing restoration of external rotation. Key points include immobilizing the shoulder initially, progressing to active-assisted then active range of motion, addressing movement deficits, and advancing to functional exercises while monitoring for complications like scapular notching. The goal is improved pain relief and movement, though some patients may have poor outcomes requiring additional support strategies.
1. Shoulder injuries are common in sports and can be acute or chronic. They range from mild sprains to traumatic dislocations and are often painful and mobility-restricting.
2. MRI and CT scans are important imaging modalities to diagnose shoulder injuries and assess soft tissue damage, bone defects, and other pathology like tumors or fractures. MR arthrography provides high accuracy for labral tears.
3. Common acute injuries include dislocations, rotator cuff tears, and injuries to the biceps tendon. Chronic overload can also cause tendinopathy and impingement. The size and chronicity of rotator cuff tears affects prognosis.
Rehabilitation Of Anterior Shoulder DislocationCoachBlake
- Younger patients under age 20 who experience an anterior shoulder dislocation have recurrent dislocation rates as high as 90% in athletic populations, while rates decrease with age to lower than 50% for those ages 20-25 and even lower for those over age 40.
- Rehabilitation following a shoulder dislocation or repair focuses first on restoring range of motion and strengthening the rotator cuff and parascapular muscles, with protocols varying based on surgical versus non-surgical treatment and generally taking 4-6 months to return to full activity.
- While overhead lifting and deep pressing motions carry risk of reinjury, year-round training of the shoulder girdle including sports-specific drills is important to prevent future instability
Reversing the Trend- Newer Types of Shoulder Replacementcoreinstitute
Recently, there has been much discussion about a relatively new type of shoulder replacement, which offers patients the prospects of pain relief and better shoulder function. View this presentation to learn more about this shoulder replacement surgery.
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.
This document discusses treatment options for bone defects in the glenoid and humeral head that can cause recurrent shoulder instability. It finds that humeral head (Hill-Sachs) defects occur in 65-93% of cases depending on the number of dislocations, while glenoid defects occur in 5-56% of cases. Treatment depends on the size and engagement of the defects. For large Hill-Sachs lesions, options include bone grafting, arthroplasty, or the remplissage procedure. For significant glenoid bone loss over 20-30%, options include soft tissue repair plus bone grafting or procedures like Bristow or Latarjet to add bone to the glenoid. The document advocates
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/
This document discusses shoulder injuries in rugby players. It provides statistics showing that rugby has a high risk of shoulder injuries, which are often recurrent. Common shoulder injuries in rugby players include labral injuries, AC joint sprains, rotator cuff tears, and glenohumeral arthritis. Video analysis has shown that tackles are a major cause of shoulder injuries in rugby. The document outlines the forces involved in rugby tackles and compares them to car crash forces. It then discusses approaches to diagnosing and treating shoulder injuries in rugby players, including rehabilitation protocols and return to play timeframes following arthroscopic stabilization surgery.
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.
Revisions of failed Latarjet surgery 2015Lennard Funk
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.
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.
Surgery for shoulder instability len funkLennard 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.
InSpace balloon for massive rotator cuff tears 2017Lennard Funk
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.
This document discusses shoulder instability, including traumatic and atraumatic causes. It presents three case studies to demonstrate different types of instability: 1) a rugby player with recurrent anterior dislocations requiring surgical repair for bony lesions; 2) a drama student with recurrent posterior subluxations and normal imaging, indicating a motor control issue; and 3) a gymnast with multidirectional instability and hyperlaxity who may benefit from capsular plication. The document outlines the Stanmore classification system for shoulder instability (Polar types I-III) and factors to consider in surgical versus rehabilitation management depending on the specific instability pattern.
Assessing bone loss in instability lf 2016Lennard Funk
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.
Rc repair philosophy and technique microhand 2014Shoulder Library
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.
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.
Medial patellofemoral ligament reconstruction ---- an update on techniques used. This lecture was taken by me at Trinity Arthroscopy Course, Chandigarh.
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
Evolution of tunnel placement in ACL reconstructionDhananjaya Sabat
One of my talks at Delhi Arthroscopy Club....... this presentation provides a insight regarding the conceptual evolution in tunnel placement during ACL reconstruction.
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.
Discoid meniscus is a congenital abnormality of the lateral compartment of the knee and not only a big meniscus
The leading cause of non traumatic snapping and extension deficit in children and adolescents
Clinical examination is more sensitive and specific for diagnosis
MRI is a good tool for diagnosis
Meniscal preserving surgeries are recommended to avoid degenerative arthritis
Long-term follow-up studies are needed to determine the effects of meniscal Saucerization and repair on the risk of OA.
1) Proximal humerus fractures are common in elderly patients and can be classified using the AO or Neer systems.
2) Nondisplaced fractures are usually treated non-operatively while displaced fractures may require surgical intervention such as open reduction internal fixation, hemiarthroplasty, or reverse total shoulder arthroplasty.
3) Surgical treatment aims to restore anatomy and stability but can increase risks of complications compared to nonoperative treatment. The optimal management of displaced proximal humerus fractures remains controversial.
This document discusses multi-directional shoulder instability (MDI). MDI is characterized by instability in at least two directions, usually anterior, posterior, or inferior. It is commonly caused by repetitive overhead motion stretching the shoulder capsule beyond its limits. Clinically, MDI presents with vague symptoms, laxity and translation in multiple directions on examination. Treatment involves strengthening dynamic stabilizers through physical therapy, with surgery such as arthroscopic capsular plication considered if conservative measures fail. Outcomes are generally good, though some residual pain and instability may remain long term.
This document discusses multi-directional shoulder instability (MDI). MDI is characterized by subluxations or dislocations in at least two directions, usually anteriorly, posteriorly, or inferiorly. It is commonly seen in overhead athletes and is associated with capsular laxity. Clinical examination reveals laxity and translation in multiple directions. Treatment involves strengthening dynamic stabilizers through physical therapy initially, with surgery such as arthroscopic capsular plication considered if conservative measures fail. Post-operative rehabilitation is important for successful outcomes. Long-term, over half of untreated MDI patients experience pain and instability.
1. The document discusses the approach to evaluating and diagnosing spinal trauma, with a focus on cervical spine injuries. It covers spinal anatomy, epidemiology, mechanisms of injury, clinical evaluation, and diagnostic imaging.
2. Key points discussed include the NEXUS and Canadian C-Spine Rules for determining when cervical spine radiography is necessary, how to read cervical spine x-rays, and challenges in clearing the cervical spine in unconscious or intubated patients.
3. CT scanning and MRI are more sensitive than plain films for detecting injuries, but have limitations. Clinical examination is important but impossible in unconscious patients, who require continued spinal precautions until fully conscious.
This document discusses the epidemiology, diagnosis, prevention and management of osteoporotic fractures in the elderly. It covers common fracture types including the femur, hip, ankle and proximal humerus. For each fracture, it discusses epidemiology, classification systems, radiographic evaluation, treatment options and outcomes. Surgical treatment is often recommended but fixation can be challenging due to osteopenia. The goal is to restore pre-injury function and mobility through prompt treatment and rehabilitation.
Cervical spine clearance lecture given to 1st-year emergency medicine residents at Duke University. Covers indications for applying cervical collar, types of collars, types of imaging of the spine, and when to remove the collar.
Bilateral hip fractures are rare and usually result from high-energy trauma. This case report describes a 40-year old male who sustained simultaneous bilateral intertrochanteric hip fractures after his lower body was crushed in a motor vehicle accident. He underwent staged surgical fixation of the fractures with dynamic hip screws. Postoperative recovery was uncomplicated. While bilateral hip fractures pose risks, early surgical treatment and careful monitoring can lead to good functional outcomes even in active patients.
Management of Shoulder dislocations and shoulder instability in sports BhaskarBorgohain4
acute shoulder dislocation is one of the most common sports injuries especially in contact sports. recurrent dislocations are quite common after anterior dislocation of shoulder especially in young athletes who are engaged in sports with lots of overhead activities during their games. Bankarts lesion, Hill sachs lesion are common predisposing factors for recurrence. Simple acute first time dislocations may be reduced on the field by a trained person but further referral is must for detail evaluation. recurrent dislocation can be reduced on field too by less trained. complicated dislocations, neurovascular deficits, fracture dislocation are to be referred to hospital immediately. Practical scientific algorithms are presented for their appropriate management here.
1. The functional outcomes of shoulder fracture surgery can be unpredictable due to the complex anatomy of the shoulder.
2. Key factors that guide the choice of treatment for proximal humeral fractures include patient characteristics and the nature of the fracture.
3. Rotator cuff tears in overhead athletes are often due to tensile overload and impingement, and may present as acute partial or complete tears.
This document discusses options for treating neck and back pain without surgery or drugs. It introduces Drs. Samir Haddad and Brian Self, who have experience in neurology and chiropractic. Poor posture from sitting, technology use, and weight are significant contributors to back pain. Surgery often does not provide lasting relief and may lead to further issues. A new treatment called cervical extension traction therapy is introduced to restore the cervical curve and address the root causes of pain. Case studies demonstrate its effectiveness in resolving symptoms and improving spinal structure.
This document discusses shoulder and ankle injuries. Regarding shoulders, it describes the anatomy and stabilizers of the shoulder joint. It discusses classifications for shoulder instability and common associated lesions like Bankart and Hill-Sachs lesions. For ankles, it outlines the prevalence and classifications of ankle sprains and fractures. It provides guidance on clinical examination, imaging and management considerations for various ankle injuries.
A mangled extremity refers to severe limb injury where viability is questionable. Emergent management prioritizes life-saving care. The decision to salvage or amputate is complex, considering scoring systems, nerve function, bone/joint integrity, and patient factors. If salvaged, options include debridement, fixation, flaps, and bone reconstruction. Amputation may provide better function than some salvaged limbs, especially with vascular/major injuries. The child's growth is also a key consideration.
This document provides information on spinal injuries, including epidemiology, mechanisms of injury, clinical assessment, radiographic evaluation, and management. Some key points:
- Spinal injuries most commonly occur in the cervical region in individuals ages 16-30. Mortality is 40-50%.
- Clinical assessment includes inspection, palpation, and neurological examination to evaluate for tenderness, deficits, and classify the level of injury.
- The NEXUS and Canadian C-Spine rules can help determine which patients require radiographic imaging based on factors like mechanism of injury, neurological status, and range of motion.
- Management involves immobilization, monitoring ABCs, ruling out other injuries, pain control,
it comprises of the anatomy, epidemiology, mechanism of injury and management options.
there is also the fracture classifications
management was grouped into operative and conservative
there is also a section for children.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
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TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Kat...rightmanforbloodline
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Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
3. Why is an Unstable Shoulder so
common?
• Flat socket
(glenoid) means
that soft tissues
(labrum, capsule,
ligaments,
muscles) provide
most of the support
4. Unstable Shoulder
• A delicate balance of
all these tissues
keeps the shoulder
balanced and stable
• Injury, overuse, or
compensation can
disrupt this balance.
7. What is Shoulder Instability?
• Wide variation in diagnostic
and treatment criteria even
among shoulder surgeons.
– Chahal, J., Clin. J. Sports Med
• With the advances in modern
arthroscopic diagnosis and
treatment this may reflect a
gradual transition from an
etiology based diagnosis and
treatment methodology to one
that is based on the anatomic
sites of pathology.
8. What is posterior instability?
• Spectrum of disorders and pathology
– Acute only 5% of all dislocations
• Trauma, Seizure, Electrical
Shock
• Nearly 50% missed initially
– Voluntary
• Psychogenic
• Learned Behavior
– Acquired
• Largest group includes
multiple etiologies
• Circle Concept of Instability
• Multiple sites of concurrent
pathology
– Glenoid Dysplasia
9. Diagnosis
• Difficult
– Pain often the only complaint
• Primarily with activity or positional
• Flexion, adduction, internal rotation
– Instability and Neurological Complaints
• More common with underlying laxity/MDI
– Spectrum of anatomic lesions
• Historically articles have focused on a small subset
of this spectrum.
10. Diagnosis
• No single test reliable
– Jerk
– Load and Shift
– Sulcus
– Biceps/SLAP related
Tests
– Rotator Cuff
– Anterior Instability
Tests
16. Why Arthroscopic Repair?
• Allows global
evaluation, treatment,
and flexibility
• Instability is a
Spectrum
• Broad array of
coexistent pathology
• Modern techniques
offer excellent results
17. Complications
• Catastrophic Chondrolysis
– Intraarticular pain pumps
• Local anesthetic toxic to cartilage
– Knotless Suture Anchors
• Five fold failure rate for instability (4.9% vs. 23.8%)
• Windshield wiper phenomenon shears cartilage
– Thermal Shrinkage
• High failure rates
• Nerve, Capsule, and Cartilage Injury/Damage
21. Arthroscopic Repair
• The best repairs
are much more
than just a labrum
repair.
• Balance to the
entire shoulder
must be restored.
Restore Bumper Cushion
22. Arthroscopic Repair
• State of the Art
Repair requires
sutures and tying
knots
• Avoid thermal
probes and
knotless anchors
• 5:1 failure rate
knotless:knot