Specialists

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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 […]

Techniques-Open Anatomic Repair

The classic open Bankart repair, Neer capsular shift, and multiple subsequent modifications have been reported for many years In the appropriate patient population and while adhering to meticulous surgical technique, the results are consistently very good. With Rowe et al.

It reporting 97% and 95% success rates respectively with open anterior stabilization, it is not […]

Open Surgery

Open surgery for instability remains an acceptable method of treatment when the surgeon lacks the equipment, experience, or technical expertise to perform an arthroscopic repair. Furthermore, open surgery is indicated in situations where current arthroscopic methods are likely to fail—namely, in the setting of large bone or soft tissue deficiencies or in the context of […]

Rotator Interval Closure

If after repair of the labrum and IGHL and MGHLs, the shoulder shows persistent inferior or inferoposterior translation, rotator interval closure is performed. The authors close the rotator interval in all patients with MDI and posterior instability.

The arthroscope is inserted posteriorly to visualize the rotator interval. The arm should be placed in external rotation […]

Inferior Glenohumeral Ligament

The IGHL functions as the primary restraint to anterior, posterior, and inferior glenohumeral translation between 45 degree and 90 degree elevation of the arm. The IGHL originates from the inferior half of the glenoid neck or the anterior-inferior labrum, to insert inferior to the MGHL on the lesser tuberosity.

The IGHL forms a hammocklike […]

Imaging Evaluation

X-ray films are an integral part of the work up and necessary to gain additional information. The views that are the most valuable are anterior-posterior (AP) view, supraspinatous outlet view, and axillary lateral. A 15-degree cephalic view of the AC joint, and an AP view with humeral internal rotation can also be helpful.

It is […]

Long Head of the Biceps

The long head of the biceps tendon has a variable origin, with 30% to 40% originating at the supraglenoid tubercle, 45% to 60% directly from the labrum, and 25% to 30% from both. It travels obliquely within the shoulder joint, then turns sharply to exit inferiorly beneath the transverse humeral ligament along the bicipital groove. […]

Middle Glenohumeral Ligament

The MGHL originates on the supraglenoid tubercle or anterosuperior labrum, and it inserts on the lesser tuberosity running obliquely to the SGHL and the CHL. It is present between 60% and 80% of individuals as a discrete band or thickening of the anterior capsule confluent with the IGHL.

The MGHL becomes taut at 45 degrees […]

Managment-Operative Management

Surgical decision making is first dependent on whether a cyst is causing suprascapular nerve compression. If a ganglion cyst is present, then the cyst is a result of intra-articular pathology; in athletes, this frequently is because of a labral tear. The natural history of ganglion cysts about the shoulder is not known; however, it commonly […]

PASSIVE TESTS-Passive flexion

Positioning.

The subject lies relaxed in the supine position. The examiner stands level with the hip. Procedure.

Both hands lift the knee upwards towards the subject’s chest until the movement stops. Meanwhile a slight axial pressure is applied on the femur.

Common mistakes:

• Moving the thigh too much laterally towards the shoulder. • Carrying […]