Specialists

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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 […]

Clinical Evaluation-Physical Findings

Distinguishing anterior shoulder pain caused by biceps tendon disorders as opposed to subacromial impingement can be difficult, as these two entities usually co-exist. Although there are some exam maneuvers, which attempt to isolate the biceps tendon, there is still a fair amount of overlap and the definitive diagnosis of isolated biceps tendon pathology is extremely […]

Pathophysiology

Multiple classification schemes have been developed to describe disorders of the LHB tendon. These divisions have been only marginally useful in regards to diagnosis and treatment decisions. More important is to understand the various pathological processes involving the biceps tendon and how to treat each process accordingly. The three biceps tendon pathologies that we will […]

Complications and Pitfalls-Recurrence

Recurrence is the most frequently reported complication after open and arthroscopic surgery for anterior instability. Recurrence may be secondary to new trauma or to atraumatic events.Patients with traumatic recurrence of their instability usually have better post-operative results after revision surgery than patients with atraumatic recurrence. The recurrence rate is related to the number of prior […]

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 […]

Relative Indications for Open Surgery

Despite advancements in surgical technique and implants, certain clinical scenarios are prone to failure by arthroscopic methods. These include HAGL lesions and capsular ruptures. Other relative indications for open surgery include failed prior arthroscopic or open repairs. In the setting of failed thermal capsulorrhaphy, the surgeon is often faced with residual casulolabral tissue that is […]

Technique-SLAP Surgical Techniques

Surgical treatment of symptomatic SLAP lesions consists of shoulder arthroscopy, which frequently demonstrates a positive “drive-through” sign, a displaceable biceps vertex and, in up to 60% of cases, associated rotator cuff pathology, mostly partial-thickness undersurface tears.

If the biceps-labral anchor is avulsed, it is partially debrided and secured back to the glenoid with suture anchors […]

Physical Findings-Nonoperative SLAP treatment

Treatment of SLAP lesions is typically conservative at first, as many patients respond to rest and rehabilitation in the acute period. However, after the inflammation has subsided, and if patient has completed course of rehabilitation and is still unable to resume athletic activities, serious consideration must be made for surgical intervention.

Hill-Sachs Lesions

The most common bony lesion associated with traumatic glenohumeral instability is a compression fracture at the posterolateral margin of the humeral head Commonly known as a Hill-Sachs lesion, this fracture occurs as the humeral head impacts the glenoid edge during dislocation.

The lesion is present in 80% of anterior dislocations, 25% of anterior subluxations, […]

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 […]