new technique in shoulder surgery for sports injury dennis crawford md, phd assistant professor...
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New Technique in Shoulder New Technique in Shoulder Surgery for Sports InjurySurgery for Sports Injury
Dennis Crawford MD, PhDDennis Crawford MD, PhD
Assistant ProfessorAssistant Professor
Surgical Director, Sports Medicine ProgramSurgical Director, Sports Medicine Program
Department of Orthopedics & RehabilitationDepartment of Orthopedics & Rehabilitation
Oregon Health Sciences UniversityOregon Health Sciences University
Center for Health & Healing Center for Health & Healing
Portland OregonPortland Oregon
Shoulder Surgery: State of the Shoulder Surgery: State of the Art ‘07Art ‘07• All ArthroscopicAll Arthroscopic
– Stabilization for Stabilization for dislocationdislocation
– Stabilization for Stabilization for instabilityinstability
– Rotator cuff repairsRotator cuff repairs– SLAP repairsSLAP repairs– Biceps tendon repairBiceps tendon repair– Capsular releaseCapsular release
• Internal Rotation Internal Rotation contracturecontracture
• Frozen ShoulderFrozen Shoulder
• OpenOpen– Clavicle fixationClavicle fixation
• Improved outcomesImproved outcomes
DefinitionsDefinitions• InstabilityInstability
– Failure of the dynamic Failure of the dynamic and static mechanisms and static mechanisms of joint biomechanics to of joint biomechanics to maintain a functional maintain a functional position of two position of two articulating surfacesarticulating surfaces
• SubluxationSubluxation– Partial, transient loss of Partial, transient loss of
articulating congruencyarticulating congruency
• DislocationDislocation– Complete loss of Complete loss of
articulating congruencyarticulating congruency
Shoulder DislocationsShoulder Dislocations
• First time dislocatorsFirst time dislocators– < 20 yrs < 20 yrs
• > 75% redislocation rate> 75% redislocation rate
– 20-30 yrs20-30 yrs• 30-50% redislocation rate30-50% redislocation rate
• Arthroscopic repairArthroscopic repair– Out-patientOut-patient– Reduce re-dislocation rate Reduce re-dislocation rate
• <2-5%<2-5%
– Return to SportsReturn to Sports• 3-6 months3-6 months
Type of Instability> Surgical Type of Instability> Surgical TimingTiming• Traumatic InjuryTraumatic Injury
– Most commonly Most commonly • anterior dislocationanterior dislocation
– Anatomic InjuryAnatomic Injury• ““Bankart” LesionBankart” Lesion
– Labral TearLabral Tear
• Acquired laxity Acquired laxity – Swimmers/GymnastsSwimmers/Gymnasts
• multidirectionmultidirection
• Subtle capsular injuriesSubtle capsular injuries– Globally “stretched”Globally “stretched”
Fundamental Shoulder ArthroscopyFundamental Shoulder Arthroscopy
Arthroscopic Exam of ShoulderArthroscopic Exam of Shoulder
Arthroscopic Exam: SLAP ? & BicepsArthroscopic Exam: SLAP ? & Biceps
Arthroscopic Exam: Bankart lesionArthroscopic Exam: Bankart lesion
Arthroscopic Bankart Repair: 1Arthroscopic Bankart Repair: 1
Arthroscopic Bankart Repair: 2Arthroscopic Bankart Repair: 2
Arthroscopic Bankart Repair: 3Arthroscopic Bankart Repair: 3
Arthroscopic Bankart Repair: 4Arthroscopic Bankart Repair: 4
Return to Sports after Scope BankartReturn to Sports after Scope Bankart • Sling for 4-6 weeksSling for 4-6 weeks
– ImmediateImmediate• Rhomboid strengtheningRhomboid strengthening• Core & conditioningCore & conditioning
• Weeks 4-10Weeks 4-10– Restore normal ROMRestore normal ROM
• Weeks 8-16Weeks 8-16– Restore Rotator Cuff strengthRestore Rotator Cuff strength– Restore Scapulo-thoracic kineticsRestore Scapulo-thoracic kinetics
• Weeks 12-20Weeks 12-20– Return to sportsReturn to sports– Throwing/overhead athletesThrowing/overhead athletes
• Graded increase in stressGraded increase in stress– Throwing programsThrowing programs
• 6 months 6 months – Unrestricted activity Unrestricted activity
• Assuming full strength and ROMAssuming full strength and ROM
Thank youThank you
Dennis C. Crawford, MD. PhDDennis C. Crawford, MD. PhDAssistant ProfessorAssistant Professor
Director, Sports & Arthroscopic SurgeryDirector, Sports & Arthroscopic Surgery
Department of Orthopedics Department of Orthopedics
Oregon Health & Science UniversityOregon Health & Science University