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The Rotator Cuff

Rotator Cuff

Rotator Cuff

Key Points

The majority of symptomatic rotator cuff disease patients respond to a nonoperative program emphasizing the restoration of normal biomechanics, unrestricted motion, and functional force couples. Early surgical management should be considered for acute rotator cuff tears in physiologically young and very active individuals. The ability to recognize the complex layered […]

A Patient’s Guide to Osteonecrosis of the Humeral Head

Osteonecrosis Humeral Head

Osteonecrosis Humeral Head


Osteonecrosis of the humeral head is a condition where a portion of the bone of the humeral head (the top of the humerus or upper arm bone) loses its blood supply, dies and collapses. Another term used for osteonecrosis is avascular necrosis. The term avascular means that a loss […]

A Patient’s Guide to Shoulder Arthroscopy

Shoulder Arthroscopy

Shoulder Arthroscopy


The use of arthroscopy (arthro means joint and scopy means look) has revolutionized many different types of orthopedic surgery. During a shoulder arthroscopy, a small video camera attached to a fiber-optic lens is inserted into the shoulder joint to allow a surgeon to see without making a large incision. Today […]

Anatomy and Biomechanics of the Glenohumeral Capsule

The shoulder is an inherently loose articulation permitting a wide range of motion. The glenohumeral capsule remains lax throughout mid-range motion where stability is conferred by the dynamic action of the rotator cuff and the conforming articulation of the humeral head and the glenolabral surface. The capsuloligamentous structures about the glenohumeral joint act as passive […]

Complications and Special Considerations

Fracture of the proximal humerus presents a therapeutic challenge. Numerous complications have been reported. Most common complications include AVN, malunion, neurovascular injury, and adhesive capsulitis (frozen shoulder). Hardware failure, infection, and nonunion are less common.

AVN is a common complication following three- and four-part fractures. The incidence of AVN of the humeral head ranges from […]

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 […]

Basic Science-Anatomy and Biomechanics

The humerus is the largest bone of upper extremity. The proximal humerus is composed of the humeral head, the greater and lesser tuberosities, the anatomic and surgical necks of the humerus. The humeral head is the most proximal, ball-like region of the humerus that is retroverted (28 to 40 degrees) and articulates with the glenoid […]

Allograft Tissues

Allograft tissues have been employed to reconstruct a variety of joint surfaces, and the humerus is certainly no different. The use of smaller focal defects, however, is not extensively described in the literature with the exception of a few case series. In one study, Gerber et al.It employed a large segmental humeral head allograft to […]

Autologous Tissues

The use of autologous tissues about the knee has been commonplace for several years, and has included the transplantation of local tissue, transfer of remote tissue, and finally the genetic production of cloned tissue from knee cartilage cells .

A technique that has been used in the knee is transfer of autologous tissue from other […]

Diagnosis of Cartilage Lesions

Much effort has been directed at the development of imaging techniques that effectively diagnose cartilage lesions in the shoulder. The thrust of the research has employed a variety of magnetic resonance imaging techniques to delineate not only the actual lesions, but also something about their physiology.

It is well established that cartilage functions as the […]