Specialists

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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 […]

Clinical Evaluation-Radiographic Evaluation

Accurate radiographic evaluation of the fracture of the proximal humerus is essential for diagnosis and treatment. The trauma series is still the standard initial method for evaluating proximal humeral fracture. This consists of anteroposterior (AP) view of the scapula, a lateral, Y-view of the scapula, and axillary view. This series allows evaluation of the fracture […]

Impact of Cartilage Lesions

The spectrum of pathology includes a gradation in the severity of cartilage damage beginning with simple delamination of a small area and ending with complete degeneration of the articular surfaces, i.e., osteoarthritis.

Although the glenohumeral joint surface geometry historically has been considered less of a stabilizing factor as a result of the smaller surface area […]

The Bio-Tenodesis Screw System

We perform all arthroscopic shoulder procedures in the lateral decubitis position under general anesthesia. Five to 10 pounds of balanced suspension are used with the arm in 20 degrees to 30 degrees of abduction and 20 degrees of forward flexion (Star Sleeve Traction System, Arthrex, Inc., Naples, FL). Diagnostic glenohumeral arthroscopy is performed through a […]

Technique

Operative intervention for biceps pathology begins with arthroscopic inspection and debridement. The proximal biceps tendon is easily visualized during standard glenohumeral arthroscopy. The tendon is first visualized thoroughly from the posterior portal. The tendon should be inspected from its origin on the superior glenoid tubercle and/or superior labrum all the way into the bicipital sheath. […]

Biomechanics

Few would dispute the critical role of the biceps brachii at the elbow joint and its function has been well documented at this position. It is with the LHB’s role at the shoulder where the arguments intensify. Many authors have suggested that the LHB has a role in humeral head depression—particularly with shoulder external rotation […]

Impingement: Secondary

Individuals with shoulder instability or other underlying pathology can develop significant abnormal mechanics that can lead to rotator cuff functional disability, eventual fatigue and loss of humeral head containment. When this occurs, rather than the coracoacromial arch moving toward the cuff, the cuff migrates cephalad as containment is compromised.

In addition to articular-sided internal impingement-type […]

Open Nonanatomic Repairs

Latarjet was the first to describe the technique of using a portion of the coracoid transferred to the anterior glenoid as a buttress to anterior humeral translation in 1958. In this procedure, the transfer includes a portion of the coracoacromial ligament that is sutured to the capsular tissue through a short horizontal incision made in […]

Contraindications for Open Instability Surgery

In cases of concomitant severe arthritis, open instability repair may not be effective. Depending on the status of the osseous glenoid and surrounding rotator cuff, arthroplasty or arthrodesis may be better options.

Paralysis may also be associated with chronic instability and in such cases arthrodesis may be more successful in eliminating pain. Relative contraindications […]

Absolute Indications for Open Surgery

Absolute indications for open stabilization procedures include significant degrees of glenoid or humeral bone loss, capsular deficiencies, or irreparable rotator cuff tears, particularly those of the subscapularis. In individuals with significant anterior glenoid erosion, an osseous reconstruction should be performed.

In the rare case where a large humeral head defect (Hill-Sachs lesion) plays a […]