shoulder injuries surgical consideration john f. meyers, m.d
TRANSCRIPT
Shoulder InjuriesSurgical Consideration
Shoulder InjuriesSurgical Consideration
John F. Meyers, M.D.John F. Meyers, M.D.
Clavicle FracturesClavicle Fractures
• Surgical Indications Rare
• Tenting or Breaking Skin
• Marked Comminution
• Surgical Indications Rare
• Tenting or Breaking Skin
• Marked Comminution
Acromioclavicular Seperations
Acromioclavicular Seperations
• Grade 1
• Grade 2
• Grade 3
• Grade 4
• Grade 1
• Grade 2
• Grade 3
• Grade 4
Definition – NeerDefinition – Neer
A Spectrum of Diseases the result from an impingement of the Rotator Cuff, the
overlying Subacromial Bursa, and occasionally the Tendon of the Biceps
against the anterior edge of the Acromion and it’s associated
Coracoacromial Arch
A Spectrum of Diseases the result from an impingement of the Rotator Cuff, the
overlying Subacromial Bursa, and occasionally the Tendon of the Biceps
against the anterior edge of the Acromion and it’s associated
Coracoacromial Arch
Impingement PositionsImpingement Positions
• Functional position is forward flexion not Abduction (Neer)
• Forward Flexion with Internal Rotation -> Greater Tuberosity rotates under Coracoacromial Arch
• Repetitive Adduction -> Coracoid Process Impingement
• Functional position is forward flexion not Abduction (Neer)
• Forward Flexion with Internal Rotation -> Greater Tuberosity rotates under Coracoacromial Arch
• Repetitive Adduction -> Coracoid Process Impingement
Classic Impingement LesionNeer
JBJS – 1972
Classic Impingement LesionNeer
JBJS – 1972
• Stage 1– Less than age 25– Edema & Hemorrhage
• Stage 2– Age 25 – 40– Fibrosis & Tendinitis
• Stage 3– Greater Than Age 40– Bone Spurs & Tendon Rupture
• Stage 1– Less than age 25– Edema & Hemorrhage
• Stage 2– Age 25 – 40– Fibrosis & Tendinitis
• Stage 3– Greater Than Age 40– Bone Spurs & Tendon Rupture
Acromial MorphologyBigliani, et al – 1983
Acromial MorphologyBigliani, et al – 1983
• Type 1 (Flat) – 0% Cuff Tears
• Type 2 (Curved) – 20% Cuff Tears
• Type 3 (Hooked) – 80% Cuff Tears
• Type 1 (Flat) – 0% Cuff Tears
• Type 2 (Curved) – 20% Cuff Tears
• Type 3 (Hooked) – 80% Cuff Tears
Classification of Rotator Cuff Pathology
Classification of Rotator Cuff Pathology
• Compressive Failure• Tensile Failure• Acute Traumatic Tears• Calcific Tendinitis
• Compressive Failure• Tensile Failure• Acute Traumatic Tears• Calcific Tendinitis
Acute Traumatic TearsMechanisms of Injury
Acute Traumatic TearsMechanisms of Injury
• Active Abduction Against Resistance
• Forced Adduction
• Acute Traumatic Dislocation
• Active Abduction Against Resistance
• Forced Adduction
• Acute Traumatic Dislocation
* May have predisposing impingement or tensile rotator cuff disease
Tensile FailureTensile Failure
• Failure during eccentric contracture
• Undersurface Tear (inside -> Outside)
• Common in throwing athletes
• Often no Subacromial Impingement at Surgery
• Failure during eccentric contracture
• Undersurface Tear (inside -> Outside)
• Common in throwing athletes
• Often no Subacromial Impingement at Surgery
Surgical TreatmentSurgical Treatment
• Arthroscopic Debridement Alone
• Arthroscopic Debridement & Acromioplasty
• Arthroscopic Acromioplasty & Mini-Open Repair
• Classic Open Repair
• Arthroscopic Debridement Alone
• Arthroscopic Debridement & Acromioplasty
• Arthroscopic Acromioplasty & Mini-Open Repair
• Classic Open Repair
Arthroscopic DebridementArthroscopic Debridement
• Incomplete Tears Without Impingement
• Calcific Rotator Cuff Tendinitis Without Impingement
• Incomplete Tears Without Impingement
• Calcific Rotator Cuff Tendinitis Without Impingement
Arthroscopic Debridement & Acromioplasty
Arthroscopic Debridement & Acromioplasty
• Incomplete Rotator Cuff Tear & Impingement
• Complete Rotator Cuff Tears & Impingement
(Primary Goal is Pain Relief)
• Incomplete Rotator Cuff Tear & Impingement
• Complete Rotator Cuff Tears & Impingement
(Primary Goal is Pain Relief)
Arthroscopic Acromioplasty & Mini-Open Repair
Arthroscopic Acromioplasty & Mini-Open Repair
Small, Complete, Easily Repairable Lesion
Physically Activew Patient with Symptomatic Weakness
Small, Complete, Easily Repairable Lesion
Physically Activew Patient with Symptomatic Weakness
Classic Open RepairClassic Open Repair
Acute Traumatic Tears
Failed Arthroscopic Debridement
Acute Traumatic Tears
Failed Arthroscopic Debridement