Specialists

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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 […]

Biceps Tendinitis

Biceps tendinitis has been partitioned into primary tendinitis versus secondary tendinitis. Primary tendinitis involves inflammation of the tendon within the bicipital groove. To be considered primary, no other pathological findings (such as impingement, bony abnormalities within the groove, or biceps subluxation) should be present. It is considered an uncommon condition and should be thought of […]

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 […]

Complete Tears

Complete rotator cuff tears are classified as follows: 1. A small complete tear such as a puncture wound.

2. A moderate tear that still encompasses only one of the rotator cuff tendons; the tear is usually less than 2 cm (0.8 in) in size, with no retraction of the torn ends.

3. Large complete tear […]

Partial Tears

In a cuff with smooth coverings of synovial and bursal tissue, the severity of a partial tear can be classified as follows:

1. Minimal superficial bursal or synovial irritation, or slight capsular fraying with a partial tear less than 1 cm (0.4 in) in size.

2. Actual fraying and failure of some rotator cuff fibers […]

Post-Traumatic Shoulder Stiffness

SYMPTOMS

There is gradual onset of diffuse pain or ache, and stiffness in the shoulder after previous trauma or immobilisation. Physiotherapy, after manipulation under anaesthesia and arthroscopic release, improves the condition dramatically. Secondary problems in the neck and upper back are almost inevitable and must be addressed.

AETIOLOGY

This disorder has similar symptoms to frozen […]

External Impingement

SYMPTOMS

There is gradual onset of pain in the shoulder on overhead activity involving internal rotation and abduction. Typically, the pain is worst in one specific position or during a certain movement but often the shoulder gradually stiffens up, restricting abduction and rotation. It is painful to sleep on that side and movement becomes […]

Subacromial Injection

Basics Shoulder injection sites: Subacromial area: Most common site Other potential sites include: Bicipital tendon sheath Glenohumeral joint Sternoclavicular joint AC joint To avoid confusion: Always refer to these injections by describing the anatomic location of the shot. Avoid describing any of these injections as a shoulder injection. Subacromial injection is reserved for pain […]

Shoulder/Glenohumeral Arthritis

Basics Description Progressive loss of glenohumeral joint space with thinning of articular cartilage, formation of osteophytes, and progressive deformity Epidemiology Females are more likely than males to have primary glenohumeral osteoarthritis. Patients >60 years old are more likely to have it than are younger patients. Incidence ~0.4% in the general population Can reach 4.6% […]

Shoulder Impingement Syndrome

Basics Description Shoulder pain with overhead activities is a common musculoskeletal complaint. Impingement syndrome: Inflammatory condition of the soft tissues of the subacromial space Most common cause of presentation for shoulder complaints to a physician’s office (>50% of all shoulder complaints) Represents a continuum, progressing from acute bursitis, to chronic bursitis, to partial-thickness tears […]