Specialists

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Open Capsular Release for Adhesive Capsulitis

Open surgical release of the glenohumeral capsule was more commonly utilized to treat patients with severe and refractory adhesive capsulitis prior to the advancement of arthroscopic techniques to treat this difficult patient population. Although the peri-operative morbidity of this open approach to treatment is now accepted to be somewhat greater than its arthroscopic counterpart, use […]

Arthroscopic Capsular Release for Adhesive Capsulitis

Because adhesive capsulitis of the shoulder, by definition, is due only to a tight and thickened glenohumeral capsule, arthroscopic surgery seems ideal for the treatment of this problem. The capsule is best viewed, and more directly surgically addressed, by an intra-articular approach rather than an extra-articular, open surgical approach. Arthroscopy allows circumferential capsular release as […]

Operative Treatment for Adhesive Capsulitis

Manipulation Under Anesthesia

Manipulation under anesthesia (MUA) has been used to treat adhesive capsulitis for many years. This treatment has commonly been described to prospective patients as “stretching the tight capsule” or “breaking up adhesions” within the shoulder joint. Arthroscopic visualization of the glenohumeral joint after this procedure, however, reveals that a MUA does not […]

Small Tears Less Than 1 Centimeter

Smaller tears are easily missed as patients present with findings and symptoms consistent with impingement. Occasionally weakness is present, but even following the Neer test, significant weakness may not be detected.

These tears usually involve the supraspinatus tendon insertion, and pain is the primary presenting complaint. Examination usually reveals normal motion and strength.

After the […]

Partial Thickness Rotator Cuff Tears: Treatment

It is important to understand that not all full thickness rotator cuff tears are alike, and that some complete tears are compatible with excellent function and minimal discomfort. Armed with biomechanical models, basic engineering principles, and kinematic studies of patients with known rotator cuff tears, Burkhart defined the “functional rotator cuff tear.”

His reasoning was […]

Partial Thickness Rotator Cuff Tears: Treatment

Partial thickness rotator cuff tears can result from intrinsic cuff degeneration and tendinopathy absent an injury or impingement. The lack of uniformity of collagen bundles and the paucity of vascular supply contributes to weakness, especially along the articular aspect of the rotator cuff. These degenerative tears often exit the articular surface and can be well […]

Humeral Bone Deficiency

Humeral head defects are commonly present in patients with shoulder instability. The defects are usually small and carry the eponym Hill-Sachs lesion when secondary to anterior instability and reverse Hill-Sachs lesions when secondary to posterior instability.

Although quite ubiquitous in recurrent anterior shoulder instability, the management of large Hill-Sachs defects remains controversial especially in […]

Physical Findings

A systematic evaluation includes observation for abnormal motion patterns and atrophy, palpation to localize painful areas, assessment of both active and passive range of motion, measurement of strength of the rotator cuff, deltoid and scapular stabilizer muscles, neurovascular examination, and finally provocative testing maneuvers for instability. It is important to examine the opposite shoulder for […]

Capsular Lesions

Traumatic intra-substance injury of the joint capsule is commonly associated with anterior dislocation. Depending on the magnitude of the anterior shear force, either plastic deformation or a complete tear of the joint capsule can occur.

The recognition of a concomitant posttraumatic capsular laxity or rupture and a Bankart lesion is essential in order to select […]

Dynamic Stability Factors

Glenohumeral stability is mainly achieved through dynamic factors. Active contraction of the rotator cuff contributes to joint stabilization by coordinated muscular activity and by secondary tightening of the ligamentous constraints. This effect works in combination with the concavity-compression mechanism, in which muscle contraction causes compression of nearly congruent articular surfaces into one another.

The rotator […]