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 […]

Massive Rotator Cuff Tears

These tears usually exceed 4 to 5 cm in dimension, but can be deceiving. Clearly a tear retracted in a lateral to medial direction of 5 cm presents as a very challenging repair whereas a tear extending 5 cm in an anterior to posterior direction without significant retraction is a much easier surgical problem to […]

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 […]

Impingement: Primary

Impingement of the tendinous portion of the rotator cuff as it passes under the coracoacromial arch is a classic cause of rotator cuff injury. The impingement syndrome, as originally described by Neer, encompasses a spectrum of pathologic changes involving the rotator cuff and associated bony changes within the coracoacromial arch, affecting primarily those 40 years […]

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 […]