Many Directions. Overview of the shoulder instabilities and of their patho anatomy. Four «basic contributors» And two joints

Size: px
Start display at page:

Download "Many Directions. Overview of the shoulder instabilities and of their patho anatomy. Four «basic contributors» And two joints"

Transcription

1 Overview of the shoulder instabilities and of their patho anatomy. Olivier GAGEY, MD, PhD Paris- South University Many Directions Antero inferior Posterior Antero superior Superior Multidirectional Voluntary the most frequent much less frequent the most unknown and rare it is a cuff problem only! motor control trouble, the less surgery, the best never propose surgery! Four «basic contributors» Bones Ligaments * Muscles Motor control system (including scapula) And two joints Scapulohumeral joint And Scapulothoracic joint * * Involved through motor control system troubles. Never forget it! 1

2 Regarding the ligaments Never forget that the ligaments play a double function : 1) primary passive stabilization AND 2) recruitment of muscles through the motor control system = a ligament doesn t work alone Bone only Glenoïd : At least 16 % of the surface of the glenoïd (E. Itoi). Notch of the head : Obvious in posterior instability. Much less clear in antero inferior. Large cuff tears create basically a superior instability! Muscle only Deltoïd palsy may lead to inferior instability Muscle only 2

3 Ligament only Traumatic antero inferior instability, without substantial bony lesion, may be explained by pure ligament lesion (post traumatic laxity). Motor Control only Motor control trouble is the base of MDI, of atraumatic dislocation and of voluntary dislocation. Single causes Motor Control Bone Muscle Ligament system A traumatic MDI Cuff tear Glenoid loss > 16% Anterior Head notch Deltoïd palsy Post traumatic laxity Or voluntary D (2 tendons) Anteroinferior Anteroinferior Posterior instability Any direction! Superior instability Inferior instability instability instability Single causes but not necessarily simple problems! But! Even in traumatic antero inferior instability, we all know patients with bilateral problems, and families with trend toward shoulder instability. We do consider (and fear) a multi factorial origin even in absence of evidence! 3

4 A constant factor R- 45 test The Inferior glenohumeral ligament laxity is constant in Antero Inferior instability! Study both MGHL and upper subscapularis A positive Hyperabduction test (> 90 ) is always present in anteroinferior instability Posterior capsule can t be tested alone! Posterior test This test involves posterior capsule AND external rotator muscles FuncZon of the ligaments of SHJ anatomical evidences Movement Lateral rotation R0 Passive abduction R 45 Retropulsion Restricted by Coracohumeral ligament alone Inferior glenohumeral ligament alone Both MGHL and Upper subscapularis Both posterior capsule and external rotators Ms. 4

5 What does sulcus sign mean? In cadaver the humeral head stays in its normal posizon. A_er opening the capsule the humeral head migrates inferiorly unzl 3 cm No ligaments are tensed in the reszng posizon What does sulcus sign mean? Sulcus doesn t demonstrate any ligaments laxity at all! Sulcus sign belongs to muscle paberning! Anteroinferior Instability Anterosuperior instability The importance of the Bankart lesion is highly variable. Experimental Bankart lesion doesn't provide any instability! This means that laity is the constant factor in anteroinferior instability. Rare and difficult to treat. Utility of the R 45 test that is always positive (> 15 ) 5

6 Antero superior instability The R 45 test asses both MGHL and upper part of the subscapularis Instead of a triangle (Stanmore).. (non structural) The arm is hold at 45 elevation in the scapular plane, then gently provide passive external rotation and then measure. I would propose a pyramid! (structural) The more the laxity the less the trauma! Antero inferior instability Antero inferior instability Antero inferior instability is the sum of post traumatic ligament laxity and of constitutional hyperlaxity and of other factor like trouble of motor control system. We still don t know where is the amount of associated hyperlaxity that leads to increased rate of failure after surgery. The more the constitutional hyperlaxity, the less the traumatism!? 6

7 Conclusion We have the logical and useful tools to asses both anteroinferior and anterosuperior instabilities. For other cases we lack of evidences for the clinical diagnosis. Take Home! Hyperabduction test normal : can t be an anteroinferior instability! R-45 test positive : look at the anterosuperior instability! Presence of constitutionnal hyperlaxity look at the scapula dysfunction! Thank You! London Interna+onal Shoulder Symposium 18 October 2014 Just look at the left arm position! 7

SHOULDER INSTABILITY IN PATIENTS WITH EDS

SHOULDER INSTABILITY IN PATIENTS WITH EDS EDNF 2012 CONFERENCE LIVING WITH EDS SHOULDER INSTABILITY IN PATIENTS WITH EDS Keith Kenter, MD Associate Professor Sports Medicine & Shoulder Reconstruction Director, Orthopaedic Residency Program Department

More information

Shoulder Injuries. Why Bother? QAS Injury Prevalence. Screening Injury 29.2% 12 month cumulative injury prevalence. Dr Simon Locke

Shoulder Injuries. Why Bother? QAS Injury Prevalence. Screening Injury 29.2% 12 month cumulative injury prevalence. Dr Simon Locke Shoulder Injuries Dr Simon Locke Why Bother? Are shoulder and upper limb injuries common? Some anatomy What, where, what sports? How do they happen? Treatment, advances? QAS Injury Prevalence Screening

More information

Chapter 5. The Shoulder Joint. The Shoulder Joint. Bones. Bones. Bones

Chapter 5. The Shoulder Joint. The Shoulder Joint. Bones. Bones. Bones Copyright The McGraw-Hill Companies, Inc. Reprinted by permission. Chapter 5 The Shoulder Joint Structural Kinesiology R.T. Floyd, Ed.D, ATC, CSCS Structural Kinesiology The Shoulder Joint 5-1 The Shoulder

More information

Rehabilitation Guidelines for Arthroscopic Capsular Shift

Rehabilitation Guidelines for Arthroscopic Capsular Shift Rehabilitation Guidelines for Arthroscopic Capsular Shift The anatomic configuration of the shoulder joint (glenohumeral joint) is often compared to a golf ball on a tee. This is because the articular

More information

Shoulder Instability. Fig 1: Intact labrum and biceps tendon

Shoulder Instability. Fig 1: Intact labrum and biceps tendon Shoulder Instability What is it? The shoulder joint is a ball and socket joint, with the humeral head (upper arm bone) as the ball and the glenoid as the socket. The glenoid (socket) is a shallow bone

More information

Bankart Repair using the Smith & Nephew BIORAPTOR 2.9 Suture Anchor

Bankart Repair using the Smith & Nephew BIORAPTOR 2.9 Suture Anchor Shoulder Series Technique Guide *smith&nephew BIORAPTOR 2.9 Suture Anchor Bankart Repair using the Smith & Nephew BIORAPTOR 2.9 Suture Anchor Gary M. Gartsman, M.D. Introduction Arthroscopic studies of

More information

Arthroscopic Shoulder Procedures. David C. Neuschwander MD. Shoulder Instability. Allegheny Health Network Orthopedic Associates of Pittsburgh

Arthroscopic Shoulder Procedures. David C. Neuschwander MD. Shoulder Instability. Allegheny Health Network Orthopedic Associates of Pittsburgh Arthroscopic Shoulder Procedures David C. Neuschwander MD Allegheny Health Network Orthopedic Associates of Pittsburgh Shoulder Instability Anterior Instability Posterior Instability Glenohumeral Joint

More information

The Shoulder Complex & Shoulder Girdle

The Shoulder Complex & Shoulder Girdle The Shoulder Complex & Shoulder Girdle The shoulder complex 4 articulations involving The sternum The clavicle The ribs The scapula and The humerus Bony Landmarks provide attachment points for muscles

More information

Rehabilitation Guidelines for Anterior Shoulder Reconstruction with Arthroscopic Bankart Repair

Rehabilitation Guidelines for Anterior Shoulder Reconstruction with Arthroscopic Bankart Repair Rehabilitation Guidelines for Anterior Shoulder Reconstruction with Arthroscopic Bankart Repair The anatomic configuration of the shoulder joint (glenohumeral joint) is often compared to a golf ball on

More information

Rotator Cuff Tears in Football

Rotator Cuff Tears in Football Disclosures Rotator Cuff Tears in Football Roger Ostrander, MD Consultant: Mitek Consultant: On-Q Research Support: Arthrex Research Support: Breg Research Support: Arthrosurface 2 Anatomy 4 major muscles:

More information

Shoulder Examination

Shoulder Examination Shoulder Examination Summary Inspection Palpation Movement Special Tests Neurological examination Introduction Shoulder disorders are can be broadly classified into the following types: Pain Stiffness

More information

Rotator Cuff Pathophysiology. treatment program that will effectively treat it. The tricky part about the shoulder is that it is a ball and

Rotator Cuff Pathophysiology. treatment program that will effectively treat it. The tricky part about the shoulder is that it is a ball and Rotator Cuff Pathophysiology Shoulder injuries occur to most people at least once in their life. This highly mobile and versatile joint is one of the most common reasons people visit their health care

More information

A Simplified Approach to Common Shoulder Problems

A Simplified Approach to Common Shoulder Problems A Simplified Approach to Common Shoulder Problems Objectives: Understand the basic categories of common shoulder problems. Understand the common patient symptoms. Understand the basic exam findings. Understand

More information

Rehabilitation Guidelines for Posterior Shoulder Reconstruction with or without Labral Repair

Rehabilitation Guidelines for Posterior Shoulder Reconstruction with or without Labral Repair Rehabilitation Guidelines for Posterior Shoulder Reconstruction with or without Labral Repair The anatomic configuration of the shoulder joint (glenohumeral joint) is often compared to a golf ball on a

More information

Ms. Ruth Delaney ROTATOR CUFF DISEASE Orthopaedic Surgeon, Shoulder Specialist

Ms. Ruth Delaney ROTATOR CUFF DISEASE Orthopaedic Surgeon, Shoulder Specialist WHAT DOES THE ROTATOR CUFF DO? WHAT DOES THE ROTATOR CUFF DO? WHO GETS ROTATOR CUFF TEARS? HOW DO I CLINICALLY DIAGNOSE A CUFF TEAR? WHO NEEDS AN MRI? DOES EVERY CUFF TEAR NEED TO BE FIXED? WHAT DOES ROTATOR

More information

More Joint & Bursa Injuries

More Joint & Bursa Injuries Unraveling the Mystery of Shoulder Pain: More Joint & Bursa Injuries Presented by Dr. Ben Benjamin Instructor: Ben Benjamin, Ph.D. Instructor: Ben Benjamin, Ph.D. ben@benbenjamin.com 1 Thank You DrBen@BenBenjamin.com

More information

Overhead Strength Training for the Shoulder: Guidelines for Injury Prevention and Performance Training Success

Overhead Strength Training for the Shoulder: Guidelines for Injury Prevention and Performance Training Success Overhead Strength Training for the Shoulder: Guidelines for Injury Prevention and Performance Training Success Robert Panariello MS, PT, ATC, CSCS Strength training is an important component in the overall

More information

Rehabilitation Guidelines For SLAP Lesion Repair

Rehabilitation Guidelines For SLAP Lesion Repair Rehabilitation Guidelines For SLAP Lesion Repair The anatomic configuration of the shoulder joint (glenohumeral joint) is often compared to a golf ball on a tee. This is because the articular surface of

More information

ACL plastik, erfarenheter av. tidig kirurgisk behandling. tidig kirurgisk behandling 6/12/2013

ACL plastik, erfarenheter av. tidig kirurgisk behandling. tidig kirurgisk behandling 6/12/2013 in sports Per Renström, MD, PhD Professor emeritus,,, Sweden Member ATP and ITF Sports Science and Medical Committees Physician Swedish Football Association Presentation at the IOC Advanced team physician

More information

THE SHOULDER JOINT T H E G L E N O H U M E R A L ( G H ) J O I N T

THE SHOULDER JOINT T H E G L E N O H U M E R A L ( G H ) J O I N T THE SHOULDER JOINT T H E G L E N O H U M E R A L ( G H ) J O I N T CLARIFICATION OF TERMS Shoulder girdle = scapula and clavicle Shoulder joint (glenohumeral joint) = scapula and humerus Lippert, p115

More information

A Patient s Guide to Shoulder Pain

A Patient s Guide to Shoulder Pain A Patient s Guide to Shoulder Pain Part 2 Evaluating the Patient James T. Mazzara, M.D. Shoulder and Elbow Surgery Sports Medicine Occupational Orthopedics Patient Education Disclaimer This presentation

More information

Chapter 4 The Shoulder Girdle

Chapter 4 The Shoulder Girdle Chapter 4 The Shoulder Girdle Key Manubrium Clavicle Coracoidprocess Acromionprocess bony landmarks Glenoid fossa Bones Lateral Inferior Medial border angle McGraw-Hill Higher Education. All rights reserved.

More information

Shoulder Injury Prevention and Rehabilitation for Health & Fitness Professionals

Shoulder Injury Prevention and Rehabilitation for Health & Fitness Professionals s EDUCATION WORKSHOPS Shoulder Injury Prevention and Rehabilitation for Health & Fitness Professionals with B.App.Sc (Physio), Dip.Ed (P.E.) CONTENTS Topic Page 1. Functional Anatomy 3 2. Scapulohumeral

More information

Anterior Capsular Repair Rehabilitation Program Methodist Sports Medicine Center, Indianapolis, IN Department of Physical Therapy

Anterior Capsular Repair Rehabilitation Program Methodist Sports Medicine Center, Indianapolis, IN Department of Physical Therapy Anterior Capsular Repair Rehabilitation Program Methodist Sports Medicine Center, Indianapolis, IN Department of Physical Therapy Anterior Capsule reconstruction is a surgical procedure utilized for anterior

More information

Refer to Specialist. The Diagnosis and Management of Shoulder Pain 1. SLAP lesions, types 1 through 4

Refer to Specialist. The Diagnosis and Management of Shoulder Pain 1. SLAP lesions, types 1 through 4 The Diagnosis Management of Shoulder Pain 1 Significant Hisry -Age -Extremity Dominance -Hisry of trauma, dislocation, subluxation -Weakness, numbness, paresthesias -Sports participation -Past medical

More information

CAPPAGH NATIONAL ORTHOPAEDIC HOSPITAL, FINGLAS, DUBLIN 11. The Sisters of Mercy. Rotator Cuff Repair

CAPPAGH NATIONAL ORTHOPAEDIC HOSPITAL, FINGLAS, DUBLIN 11. The Sisters of Mercy. Rotator Cuff Repair 1.0 Policy Statement... 2 2.0 Purpose... 2 3.0 Scope... 2 4.0 Health & Safety... 2 5.0 Responsibilities... 2 6.0 Definitions and Abbreviations... 3 7.0 Guideline... 3 7.1 Pre-Operative... 3 7.2 Post-Operative...

More information

Shoulder Dyslexia: The Alphabet Soup. Alison Nguyen 4/13/06

Shoulder Dyslexia: The Alphabet Soup. Alison Nguyen 4/13/06 Shoulder Dyslexia: The Alphabet Soup Alison Nguyen 4/13/06 Mystery Cases Case 1 Case 2 Case 3 Case 4 Shoulder Dyslexia: The Alphabet Soup Shoulder dyslexia: addressing the endless alphabet soup Ant-inf

More information

TOWN CENTER ORTHOPAEDIC ASSOCIATES P.C. Labral Tears

TOWN CENTER ORTHOPAEDIC ASSOCIATES P.C. Labral Tears Labral Tears The shoulder is your body s most flexible joint. It is designed to let the arm move in almost any direction. But this flexibility has a price, making the joint prone to injury. The shoulder

More information

SCAPULAR FRACTURES. Jai Relwani, Shoulder Fellow, Reading Shoulder Unit, Reading.

SCAPULAR FRACTURES. Jai Relwani, Shoulder Fellow, Reading Shoulder Unit, Reading. SCAPULAR FRACTURES Jai Relwani, Shoulder Fellow, Reading Shoulder Unit, Reading. Aims Anatomy Incidence/Importance Mechanism Classification Principles of treatment Specific variations Conclusion Anatomy

More information

X-Ray Rounds: (Plain) Radiographic Evaluation of the Shoulder

X-Ray Rounds: (Plain) Radiographic Evaluation of the Shoulder X-Ray Rounds: (Plain) Radiographic Evaluation of the Shoulder Anatomy 3 Bones Humerus Scapula Clavicle 3 Joints Glenohumeral Acromioclavicular Sternoclavicular 1 Articulation Scapulothoracic Anatomy Humerus

More information

Clarification of Terms

Clarification of Terms Shoulder Girdle Clarification of Terms Shoulder girdle = scapula and clavicle Shoulder joint (glenohumeral joint) = scapula and humerus What is the purpose (or function) of the shoulder and entire upper

More information

SHOULDER INSTABILITY. E. Edward Khalfayan, MD

SHOULDER INSTABILITY. E. Edward Khalfayan, MD SHOULDER INSTABILITY E. Edward Khalfayan, MD Instability of the shoulder can occur from a single injury or as the result of repetitive activity such as overhead sports. Dislocations of the shoulder are

More information

9/7/14. I do not have a financial relationship with any orthopedic manufacturing organization

9/7/14. I do not have a financial relationship with any orthopedic manufacturing organization I do not have a financial relationship with any orthopedic manufacturing organization Timothy M. Geib, MD Oklahoma Sports & Orthopedic Institute September 27, 2014 Despite what you may have heard, I am

More information

Shoulder MRI for Rotator Cuff Tears. Conor Kleweno,, Harvard Medical School Year III Gillian Lieberman, MD

Shoulder MRI for Rotator Cuff Tears. Conor Kleweno,, Harvard Medical School Year III Gillian Lieberman, MD Shoulder MRI for Rotator Cuff Tears Conor Kleweno,, Harvard Medical School Year III Goals of Presentation Shoulder anatomy Function of rotator cuff MRI approach to diagnose cuff tear Anatomy on MRI images

More information

Biceps Tenodesis Protocol

Biceps Tenodesis Protocol Department of Rehabilitation Services Physical Therapy The intent of this protocol is to provide the clinician with a guideline of the postoperative rehabilitation course of a patient that has undergone

More information

Rehabilitation Guidelines for Post-Operative Shoulder Instability Repair

Rehabilitation Guidelines for Post-Operative Shoulder Instability Repair Rehabilitation Guidelines for Post-Operative Shoulder Instability Repair Please note that this is advisory information only. Your experiences may differ from those described. A fully qualified Physiotherapist

More information

Shoulder. Clinical Assessment of the. The approach to a physical examination of the

Shoulder. Clinical Assessment of the. The approach to a physical examination of the Focus on CME at the University of British Columbia Clinical Assessment of the Shoulder When assessing shoulder pain, a structured physical examination, as directed by the patient s history, allows the

More information

Orthopaedic and Spine Institute 21 Spurs Lane, Suite 245, San Antonio, TX 78240 www.saspine.com Tel# 210-487-7463

Orthopaedic and Spine Institute 21 Spurs Lane, Suite 245, San Antonio, TX 78240 www.saspine.com Tel# 210-487-7463 Phase I Passive Range of Motion Phase (postop week 1-2) Minimize shoulder pain and inflammatory response Achieve gradual restoration of gentle active range of motion Enhance/ensure adequate scapular function

More information

Important rehabilitation management concepts to consider for a postoperative physical therapy rtsa program are:

Important rehabilitation management concepts to consider for a postoperative physical therapy rtsa program are: : General Information: Reverse or Inverse Total Shoulder Arthroplasty (rtsa) is designed specifically for the treatment of glenohumeral (GH) arthritis when it is associated with irreparable rotator cuff

More information

Arthroscopic Labrum Repair of the Shoulder (SLAP)

Arthroscopic Labrum Repair of the Shoulder (SLAP) Anatomy Arthroscopic Labrum Repair of the Shoulder (SLAP) The shoulder joint involves three bones: the scapula (shoulder blade), the clavicle (collarbone) and the humerus (upper arm bone). The humeral

More information

Level V Evidence. Minor Shoulder Instability. Alessandro Castagna, M.D., Ulf Nordenson, M.D., Raffaele Garofalo, M.D., and Jon Karlsson, M.D., Ph.D.

Level V Evidence. Minor Shoulder Instability. Alessandro Castagna, M.D., Ulf Nordenson, M.D., Raffaele Garofalo, M.D., and Jon Karlsson, M.D., Ph.D. Level V Evidence Minor Shoulder Instability Alessandro Castagna, M.D., Ulf Nordenson, M.D., Raffaele Garofalo, M.D., and Jon Karlsson, M.D., Ph.D. Abstract: The wide spectrum of shoulder instability is

More information

J F de Beer, K van Rooyen, D Bhatia. Rotator Cuff Tears

J F de Beer, K van Rooyen, D Bhatia. Rotator Cuff Tears 1 J F de Beer, K van Rooyen, D Bhatia Rotator Cuff Tears Anatomy The shoulder consists of a ball (humeral head) and a socket (glenoid). The muscles around the shoulder act to elevate the arm. The large

More information

Combined lesions of the glenoid labrum include labral

Combined lesions of the glenoid labrum include labral 9(1):10 14, 2008 Ó 2008 Lippincott Williams & Wilkins, Philadelphia T E C H N I Q U E Arthroscopic Repair of Combined Labral Lesions MAJ Brett D. Owens, MD, Bradley J. Nelson, MD, and COL Thomas M. DeBerardino,

More information

Internal Impingement in the Overhead Athlete: A Correlation of Findings on MRI and Arthroscopic Evaluation

Internal Impingement in the Overhead Athlete: A Correlation of Findings on MRI and Arthroscopic Evaluation Internal Impingement in the Overhead Athlete: A Correlation of Findings on MRI and Arthroscopic Evaluation Lee D Kaplan, MD J Towers, MD PJ McMahon, MD CH Harner,, MD RW Rodosky,, MD Thrower s shoulder

More information

Musculoskeletal Ultrasound Technical Guidelines. I. Shoulder

Musculoskeletal Ultrasound Technical Guidelines. I. Shoulder European Society of MusculoSkeletal Radiology Musculoskeletal Ultrasound Technical Guidelines I. Shoulder Ian Beggs, UK Stefano Bianchi, Switzerland Angel Bueno, Spain Michel Cohen, France Michel Court-Payen,

More information

BODY BODY PEDICLE PEDICLE TRANSVERSE TRANSVERSE PROCESS PROCESS

BODY BODY PEDICLE PEDICLE TRANSVERSE TRANSVERSE PROCESS PROCESS Learning Objective Radiology Anatomy of the Spine and Upper Extremity Identify anatomic structures of the spine and upper extremities on standard radiographic and cross-sectional images Timothy J. Mosher,

More information

Arthroscopic Management of Anterior Instability: Pearls, Pitfalls, and Lessons Learned

Arthroscopic Management of Anterior Instability: Pearls, Pitfalls, and Lessons Learned Arthroscopic Management of Anterior Instability: Pearls, Pitfalls, and Lessons Learned Matthew T. Provencher, MD a,b, *, Neil Ghodadra, MD c, Anthony A. Romeo, MD d,e KEYWORDS Anterior shoulder instability

More information

MRI shoulder: troubleshooting the cuff and instability. Phil Hughes Plymouth

MRI shoulder: troubleshooting the cuff and instability. Phil Hughes Plymouth MRI shoulder: troubleshooting the cuff and instability Phil Hughes Plymouth Shoulder Pathways Pain (subacromial/cuff) Stiffness (Frozen shoulder/oa) Weakness (Query cuff tear) Instability General Practice

More information

Sports Medicine. Assessing and Diagnosing Shoulder Injuries in Pediatric and Adolescent Patients

Sports Medicine. Assessing and Diagnosing Shoulder Injuries in Pediatric and Adolescent Patients Sports Medicine Assessing and Diagnosing Shoulder Injuries in Pediatric and Adolescent Patients Sports Medicine at Nationwide Children s Hospital Nationwide Children s Hospital Sports Medicine includes

More information

REVERSE SHOULDER ARTHROPLASTY

REVERSE SHOULDER ARTHROPLASTY William J. Robertson, MD UT Southwestern Orthopedics 1801 Inwood Rd. Dallas, TX 75390-8882 Office: (214) 645-3300 Fax: (214) 3301 billrobertsonmd.com REVERSE SHOULDER ARTHROPLASTY The shoulder is a ball

More information

Muscle Energy Technique. Applied to the Shoulder

Muscle Energy Technique. Applied to the Shoulder Muscle Energy Technique Applied to the Shoulder MUSCLE ENERGY Theory Muscle energy technique is a manual therapy procedure which involves the voluntary contraction of a muscle in a precisely controlled

More information

Post-operative rehabilitation guidelines Latissimus Dorsi Transfer to Posterosuperior Cuff

Post-operative rehabilitation guidelines Latissimus Dorsi Transfer to Posterosuperior Cuff Post-operative rehabilitation guidelines Latissimus Dorsi Transfer to Posterosuperior Cuff Please note that this is advisory information only. Your experiences may differ from those described. A fully

More information

Rehabilitation Protocol: SLAP Superior Labral Lesion Anterior to Posterior

Rehabilitation Protocol: SLAP Superior Labral Lesion Anterior to Posterior Rehabilitation Protocol: SLAP Superior Labral Lesion Anterior to Posterior Department of Orthopaedic Surgery Lahey Hospital & Medical Center, Burlington 781-744-8650 Lahey Outpatient Center, Lexington

More information

Abstract Objective: To review the mechanism, surgical procedures, and rehabilitation techniques used with an athlete suffering from chronic anterior

Abstract Objective: To review the mechanism, surgical procedures, and rehabilitation techniques used with an athlete suffering from chronic anterior Abstract Objective: To review the mechanism, surgical procedures, and rehabilitation techniques used with an athlete suffering from chronic anterior glenohumeral instability and glenoid labral tear. Background:

More information

SLAP repair. An information guide for patients. Delivering the best in care. UHB is a no smoking Trust

SLAP repair. An information guide for patients. Delivering the best in care. UHB is a no smoking Trust SLAP repair An information guide for patients Delivering the best in care UHB is a no smoking Trust To see all of our current patient information leaflets please visit www.uhb.nhs.uk/patient-information-leaflets.htm

More information

Review Article. Dislocation Of Shoulder Joint

Review Article. Dislocation Of Shoulder Joint Review Article Dislocation Of Shoulder Joint Hafizuddin Ahmed A. H. Introduction: Dislocation means complete loss of contact of the articular surfaces of bony components of a joint. Shoulder joint is the

More information

Upper limb injuries. Traumatology RHS 231 Dr. Einas Al-Eisa

Upper limb injuries. Traumatology RHS 231 Dr. Einas Al-Eisa Upper limb injuries Traumatology RHS 231 Dr. Einas Al-Eisa Pain in the limbs: May be classified under 4 headings: 1. Joint pain 2. Soft tissue pain 3. Neurogenic pain 4. Orthopaedic causes (fractures,

More information

Rotator cuff tears Acute or chronic? Mary Obele ANZSOM September 2012 Acknowledgement: ACC

Rotator cuff tears Acute or chronic? Mary Obele ANZSOM September 2012 Acknowledgement: ACC Rotator cuff tears Acute or chronic? Mary Obele ANZSOM September 2012 Acknowledgement: ACC Anatomy Epidemiology Asymptomatic rotator cuff tears: prevalence is 35% (5) 15% full thickness and 20% partial

More information

Shoulder Pain and Weakness

Shoulder Pain and Weakness Shoulder Pain and Weakness John D. Kelly IV, MD THE PHYSICIAN AND SPORTSMEDICINE - VOL 32 - NO. 11 - NOVEMBER 2004 For CME accreditation information, instructions and learning objectives, click here. A

More information

Imaging of Sports Injuries

Imaging of Sports Injuries Imaging of Sports Injuries Capable of tremendous mobility Paradox Must be loose enough to function but stable enough to prevent symptoms Shoulder injuries occur when the balance between stability & mobility

More information

Anterior Stabilization of the Shoulder: Latarjet Protocol

Anterior Stabilization of the Shoulder: Latarjet Protocol Department of Rehabilitation Services Physical Therapy Shoulder instability may be caused from congenital deformity, recurrent overuse activity, and/or traumatic dislocation. Surgical stabilization of

More information

28% have partial tear of the rotator cuff.

28% have partial tear of the rotator cuff. ROTATOR CUFF TENDON RUPTURE Anatomy: 1. Rotator cuff consists of: Subscapularis anteriorly, Supraspinatus superiorly and Infraspinatus and Teres minor posteriorly. 2 Biceps tendon is present in the rotator

More information

Dr. Benjamin Hewitt. Shoulder Stabilisation

Dr. Benjamin Hewitt. Shoulder Stabilisation Please contactmethroughthegoldcoasthospitaswityouhaveanyproblemsafteryoursurgery. Dr. Benjamin Hewitt Orthopaedic Surgeon Shoulder Stabilisation The shoulder is the most flexible joint in the body, allowing

More information

Rehabilitation Guidelines for Post-Operative Stiff Shoulder

Rehabilitation Guidelines for Post-Operative Stiff Shoulder Rehabilitation Guidelines for Post-Operative Stiff Shoulder Please note that this is advisory information only. Your experiences may differ from those described. A fully qualified Physiotherapist must

More information

5/7/2009 SHOULDER) CONDITIONS OF THE SHOULDER NOW IT TIME TO TEST YOU ICD-9 SKILLS: PLEASE APPEND THE APPROPRIATE DIAGNOSIS CODE FOR EACH:

5/7/2009 SHOULDER) CONDITIONS OF THE SHOULDER NOW IT TIME TO TEST YOU ICD-9 SKILLS: PLEASE APPEND THE APPROPRIATE DIAGNOSIS CODE FOR EACH: SHOULDER CONDITIONS OF THE SHOULDER AND THEIR TREATMENT Presented by Kevin Solinsky, CPC,CPC-I,CEDC, CEMC The is a major joint and plays a large part in daily life, particularly for athletes and those

More information

The arthroscopic treatment of unidirectional anterior

The arthroscopic treatment of unidirectional anterior Arthroscopic Treatment of Multidirectional Shoulder Instability With Minimum 270 Labral Repair: Minimum 2-Year Follow-up Joshua M. Alpert, M.D., Nikhil Verma, M.D., Robert Wysocki, M.D., Adam B. Yanke,

More information

Quantifying the Extent of a Type II SLAP Lesion Required to Cause Peel-Back of the Glenoid Labrum A Cadaveric Study

Quantifying the Extent of a Type II SLAP Lesion Required to Cause Peel-Back of the Glenoid Labrum A Cadaveric Study Quantifying the Extent of a II SLAP Lesion Required to Cause Peel-Back of the Glenoid Labrum A Cadaveric Study Aruna Seneviratne, M.D., Kenneth Montgomery, M.D., Babette Bevilacqua, P.A.C., and Bashir

More information

Rotator Cuff Repair and Rehabilitation

Rotator Cuff Repair and Rehabilitation 1 Rotator Cuff Repair and Rehabilitation Surgical Indications and Considerations Anatomical Considerations: The rotator cuff complex is comprised of four tendons from four muscles: supraspinatus, infraspinatus,

More information

10/1/2007. Philosophy. Pune Shoulder Rehabilitation Programme (PSRP) 9 th Annual TRAC meeting, Budapest. Principles -I. Design. Study-I.

10/1/2007. Philosophy. Pune Shoulder Rehabilitation Programme (PSRP) 9 th Annual TRAC meeting, Budapest. Principles -I. Design. Study-I. Dr. Ashish Babhulkar D.Orth., DNB(Orth.), MCh.Orth.(Liverpool,UK.),FRCS(Tr. & Orth.) Shoulder & Joint Replacement Surgeon Pune, India Pune Shoulder Rehabilitation Programme (PSRP) Philosophy Design an

More information

Rehabilitation Guidelines for Shoulder Arthroscopy

Rehabilitation Guidelines for Shoulder Arthroscopy Rehabilitation Guidelines for Shoulder Arthroscopy Front View Long head of bicep Acromion Figure 1 Shoulder anatomy Supraspinatus Image Copyright 2010 UW Health Sports Medicine Center. Short head of bicep

More information

Glenohumeral stability is provided by the integrity

Glenohumeral stability is provided by the integrity Technical Note Arthroscopic Thermal Capsulorrhaphy as Treatment for the Unstable Paralytic Shoulder Eric J. Strauss, M.D., Stephen Fealy, M.D., Michael Khazzam, M.D., Joshua S. Dines, M.D., and Edward

More information

THE SHOULDER. Shoulder Pain. Fractures. Instability and Dislocations of the Shoulder

THE SHOULDER. Shoulder Pain. Fractures. Instability and Dislocations of the Shoulder THE SHOULDER Shoulder Pain 1. Fractures 2. Sports injuries 3. Instability/Dislocations 4. Rotator Cuff Disease and Tears 5. Arthritis Fractures The shoulder is made up of three primary bones, the clavicle,

More information

SLAP Repair Protocol

SLAP Repair Protocol SLAP Repair Protocol Anatomy and Biomechanics The shoulder is a wonderfully complex joint that is made up of the ball and socket connection between the humerus (ball) and the glenoid portion of the scapula

More information

Shouldering the Burden

Shouldering the Burden Shouldering the Burden Wheelchair Athletes and Shoulder Injuries Dr. Julia Alleyne BHSc(PT) MD MScCH Dip Sport Med CMO, 2015 Parapan Games, Toronto Faculty/Presenter Disclosure Faculty: Dr. Julia Alleyne

More information

The Treatment of Traumatic Recurrent Anterior Shoulder Instability with Arthroscopic Bankart Repair

The Treatment of Traumatic Recurrent Anterior Shoulder Instability with Arthroscopic Bankart Repair J Med Sci 22;22(2):63-68 http://jms.ndmctsgh.edu.tw/22263.pdf Copyright 22 JMS Hsing-Ning Yu, et al. The Treatment of Traumatic Recurrent Anterior Shoulder Instability with Arthroscopic Bankart Repair

More information

Upper extremity Failed shoulder stabilization surgery: what to do?

Upper extremity Failed shoulder stabilization surgery: what to do? S P E C I A L F O C U S Upper extremity Failed shoulder stabilization surgery: what to do? Neil Ghodadra a, Robert Grumet a, Lance LeClere b and LCDR Matthew T. Provencher, MD MC USN b ABSTRACT Despite

More information

ROTATOR CUFF SYNDROME Arbejds- og Miljømedicinsk Årsmøde 2008 ROTATOR CUFF SYNDROME = SHOULDER PAIN Steen Bo Kalms, Shoulder- and Elbow Surgeon ROTATOR CUFF SYNDROME VERY COMMON DIAGNOSIS ON REFERRED PTT

More information

Arthroscopic Shoulder Stabilization With Suture Anchors: Technique, Technology, and Pitfalls

Arthroscopic Shoulder Stabilization With Suture Anchors: Technique, Technology, and Pitfalls CLINICAL ORTHOPAEDICS AND RELATED RESEARCH Number 390, pp. 17 30 2001 Lippincott Williams & Wilkins, Inc. Arthroscopic Shoulder Stabilization With Suture Anchors: Technique, Technology, and Pitfalls Brian

More information

Shoulder Arthropathies. Crystal Skovly, PA-C Orthopedic Institute Yankton, SD

Shoulder Arthropathies. Crystal Skovly, PA-C Orthopedic Institute Yankton, SD Shoulder Arthropathies Crystal Skovly, PA-C Orthopedic Institute Yankton, SD Covered Glenohumeral Arthritis Impingement Syndrome Rotator Cuff Tears Rupture of the Long Head Biceps Tendon Shoulder Instability

More information

Completing the Loop: Management of the Adolescent Sports Injury. Adam Thomas, PT, DPT, ATC

Completing the Loop: Management of the Adolescent Sports Injury. Adam Thomas, PT, DPT, ATC : Management of the Adolescent Sports Injury Adam Thomas, PT, DPT, ATC https://www.youtube.com/watch?v=vbufpo 8s3As On field assessment can be the most efficient when the health care provider has observed

More information

Aredundant or insufficient posterior capsule has

Aredundant or insufficient posterior capsule has Original Article With Video Illustration Kim s Lesion: An Incomplete and Concealed Avulsion of the Posteroinferior Labrum in Posterior or Multidirectional Posteroinferior Instability of the Shoulder Seung-Ho

More information

Thermal Capsulorrhaphy as a Treatment of Joint Instability. Original Policy Date

Thermal Capsulorrhaphy as a Treatment of Joint Instability. Original Policy Date MP 7.01.65 Thermal Capsulorrhaphy as a Treatment of Joint Instability Medical Policy Section Surgery Issue 12/2013 Original Policy Date 12/2013 Last Review Status/Date Reviewed with literature search/12/2013

More information

.org. Shoulder Pain and Common Shoulder Problems. Anatomy. Cause

.org. Shoulder Pain and Common Shoulder Problems. Anatomy. Cause Shoulder Pain and Common Shoulder Problems Page ( 1 ) What most people call the shoulder is really several joints that combine with tendons and muscles to allow a wide range of motion in the arm from scratching

More information

Anterosuperior impingement of the shoulder as a result of pulley lesions: A prospective arthroscopic study

Anterosuperior impingement of the shoulder as a result of pulley lesions: A prospective arthroscopic study Anterosuperior impingement of the shoulder as a result of pulley lesions: A prospective arthroscopic study Peter Habermeyer, MD, a Petra Magosch, MD, a Maria Pritsch, PhD, b Markus Thomas Scheibel, MD,

More information

LOURDES MEDICAL ASSOCIATES PROFESSIONAL ORTHOPAEDICS SPORTS MEDICINE & ARTHROSCOPY

LOURDES MEDICAL ASSOCIATES PROFESSIONAL ORTHOPAEDICS SPORTS MEDICINE & ARTHROSCOPY LOURDES MEDICAL ASSOCIATES PROFESSIONAL ORTHOPAEDICS SPORTS MEDICINE & ARTHROSCOPY Sean Mc Millan, DO Director of Orthopaedic Sports Medicine & Arthroscopy 2103 Burlington-Mount Holly Rd Burlington, NJ

More information

Knee Injuries What are the ligaments of the knee?

Knee Injuries What are the ligaments of the knee? As sporting participants or observers, we often hear a variety of terms used to describe sport-related injuries. Terms such as sprains, strains and tears are used to describe our aches and pains following

More information

THE REVERSE SHOULDER REPLACEMENT

THE REVERSE SHOULDER REPLACEMENT THE REVERSE SHOULDER REPLACEMENT The Reverse Shoulder Replacement is a newly approved implant that has been used successfully for over ten years in Europe. It was approved by the FDA for use in the U.S.A.

More information

ARTHROSCOPIC STAPLING FOR DETACHED SUPERIOR GLENOID LABRUM

ARTHROSCOPIC STAPLING FOR DETACHED SUPERIOR GLENOID LABRUM ARTHROSCOPIC STAPLING FOR DETACHED SUPERIOR GLENOID LABRUM MINORU YONEDA, ATSUSHI HIROOKA, SUSUMU SAITO, TOMIO YAMAMOTO, TAKAHIRO OCHI, KONSEI SHINO From the Osaka Kohseinenkin Hospital and Sumitomo Hospital,

More information

Posterior Shoulder Stability

Posterior Shoulder Stability Diagnosis and Arthroscopic Management of Posterior Shoulder Instability Adam Blair Yanke, MD; Geoffrey S. Van Thiel, MD, MBA; Lance E. LeClere, MD; Daniel J. Solomon, MD; Bernard R. Bach, Jr, MD; Matthew

More information

Injuries to Upper Limb

Injuries to Upper Limb Injuries to Upper Limb 1 The following is a list of common sporting conditions and injuries. The severity of each condition may lead to different treatment protocols and certainly varying levels of intervention.

More information

10/16/2012. Marc J Breslow, MD Illinois Bone and Joint Institute Morton Grove, Des Plaines

10/16/2012. Marc J Breslow, MD Illinois Bone and Joint Institute Morton Grove, Des Plaines Orthopaedic Management of Shoulder Pathology Marc J Breslow, MD Illinois Bone and Joint Institute Morton Grove, Des Plaines Opening Statements IBJI Began fall 2007 9000 Waukegan Rd, Morton Grove 900 Rand

More information

Upper Extremity Special Tests. Cervical Tests. TMJ Dysfunction

Upper Extremity Special Tests. Cervical Tests. TMJ Dysfunction Upper Extremity Special Tests Cervical Tests Vertebral Artery Test: used to test for vertebral artery occlusion or insufficiency. The subject lies supine on the plinth with the examiner seated behind with

More information

Rotator Cuff Repair Protocol

Rotator Cuff Repair Protocol Rotator Cuff Repair Protocol Anatomy and Biomechanics The shoulder is a wonderfully complex joint that is made up of the ball and socket connection between the humerus (ball) and the glenoid portion of

More information

Total Knee Arthroplasty. TKA - Indications. Technical Goals - TKA. Prosthesis parallel to Floor/Stance. Mechanical Axis/Center of Joint

Total Knee Arthroplasty. TKA - Indications. Technical Goals - TKA. Prosthesis parallel to Floor/Stance. Mechanical Axis/Center of Joint Total Knee Arthroplasty TKA - Indications Osteoarthritis Rheumatoid Arthritis Post Traumatic Arthritis Osteonecrosis Tumor Technical Goals - TKA Prosthesis parallel to Floor/Stance Mechanical Axis/Center

More information

Knotilus TM. Anchor Instability Repair. Technique Guide

Knotilus TM. Anchor Instability Repair. Technique Guide Knotilus TM Anchor Instability Repair Technique Guide Instability Repair Using the Knotilus TM Anchor Introduction While the shoulder has more mobility than any other joint in the body, it is also the

More information

Portal Placement for Shoulder Arthroscopy: Basic to Advanced William B. Stetson, MD

Portal Placement for Shoulder Arthroscopy: Basic to Advanced William B. Stetson, MD Portal Placement for Shoulder Arthroscopy: Basic to Advanced William B. Stetson, MD 1. Cannulas Smooth Ribbed Lipped Partial Threaded Fully Threaded Flexible 5.75 mm, 6 mm, 7 mm & 8.25 mm x 7cm or 9 cm

More information

Good morning, everyone! I m Sue Banta, a coding consultant for Amphion Medical. ambulatory knee and shoulder procedures.

Good morning, everyone! I m Sue Banta, a coding consultant for Amphion Medical. ambulatory knee and shoulder procedures. Copyright 2013 by the American Health Information Management Association. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or

More information

Rehabilitation Guidelines for Type I and Type II Rotator Cuff Repair and Isolated Subscapularis Repair

Rehabilitation Guidelines for Type I and Type II Rotator Cuff Repair and Isolated Subscapularis Repair UW Health SpoRTS Rehabilitation Rehabilitation Guidelines for Type I and Type II Rotator Cuff Repair and Isolated Subscapularis Repair The anatomic configuration of the shoulder joint (glenohumeral joint)

More information

The Pilates Studio of Los Angeles / PilatesCertificationOnline.com

The Pilates Studio of Los Angeles / PilatesCertificationOnline.com Anatomy Review Part I Anatomical Terminology and Review Questions (through pg. 80) Define the following: 1. Sagittal Plane 2. Frontal or Coronal Plane 3. Horizontal Plane 4. Superior 5. Inferior 6. Anterior

More information

Functional Anatomy of the Shoulder Complex

Functional Anatomy of the Shoulder Complex Functional Anatomy of the Shoulder Complex MALCOLM PEAT The shoulder complex, together with other joint and muscle mechanisms of the upper limb, primarily is concerned with the ability to place and control

More information