Rudolf Hoellrich, MD

Total Page：16

File Type：pdf, Size：1020Kb

Rudolf G. Hoellrich, MD 25th Annual Orthopedics & Sports Medicine Update December 2, 2017 Disclosure Information Presenter Rudolf G. Hoellrich, MD, has nothing to disclose Shoulder Instability: Case 1 HPI Physical Exam 16 year old male football Normal ROM player Normal strength Anterior dislocation Positive anterior shoulder during daily apprehension & doubles relocation test 2 subluxations since then Frequent “dead-arm” episodes Wants to play next year Imaging studies X-rays – instability series • AP • Axillary • Westpoint • Stryker notch MR arthrogram Preferred study for labral pathology Bankart lesion is found Treatment Options Nonsurgical • Physical therapy • Activity modification • Shoulder Harness • Injection? Surgical Arthroscopic Bankart repair Open Bankart repair Bankart Repair Shoulder Instability: Case 2 HPI Physical Exam 27 y/o male mill worker Reveals marked Traumatic dislocation apprehension and guarding Approximately 12 instability episodes Self-limited ROM since Normal strength and Reports hx of instability neuro exam in sleep and simple ADLs Failed PT Shoulder Instability: Case 2 Complex shoulder instability… CT scan with 3D reconstruction Glenoid and humeral bone loss Options? Shoulder Instability: Case 2 Surgery must address: Soft tissue injury Bone deficiency Surgical options: Coracoid transfer Iliac crest bone graft Osteochondral graft Case 3: Acute rotator cuff injury HPI Physical Exam 49 y/o right-hand Normal ROM dominant female + Impingement test Acute injury lifting Obvious weakness of compost 6 weeks ago rotator cuff on empty Pain at night can test Pain with reaching and repetitive ADLs Right arms feels “weak” Xrays Standard series: True AP Axillary SSOV MR Imaging Non-contrast MRI ordered Acute rotator cuff tear Recommended treatment: Rotator cuff repair Alternative options: NSAIDs Cortisone injection PT Case 4: Chronic cuff tear HPI Physical Exam 74 y/o male Popeye deformity Pain for 3 yrs Decreased AROM No specific injury Subacromial crepitus Global cuff weakness Imaging Xray shows superior migration of humeral head MRI shows massive cuff tear with atrophy Chronic cuff tear Non-repairable cuff tear Non-op treatment NSAIDs Cortisone injection PT Reverse TSA Case 5: low grade AC sprain HPI Physical Exam 19 y/o make Localized superior snowboarder shoulder pain and Fall onto shoulder swelling Normal strength and ROM Treatment Rest, ice, NSAIDS Sling for comfort Activity modification x 6 weeks PT program Injection? Case 6: High-Grade AC injury 47 year old female Prior grade 3 AC treated non-operatively Now has new fall injury Marked deformity, pain Grade 5 AC separation High grade AC injury Renders the shoulder complex unstable Pain Weakness Impingement Deformity AC Reconstruction Questions?.

Copy Link

Recommended publications

Bony Bankart Lesions and Shoulder Dislocations
Shoulder Dislocations and Bony Bankart Lesions The shoulder is the most mobile and the most commonly dislocated large joint in the body. Dislocation means that the joint is moved out of position, such that the joint surfaces at the ends of the bones are no longer in contact. In the shoulder, most dislocations are anterior (moving forward from the body); however, they can occur in several directions. When a dislocation occurs, the soft tissues that stabilize the shoulder can be torn, and the bone that forms the socket also can be broken at the same time. Traumatic dislocations of the shoulder can result in a Bankart lesion (tear). The head of the humerus (ball of upper arm bone) is stabilized against the glenoid (socket of the shoulder joint) using a combination of muscles, labrum, and ligaments. Ligaments run from the glenoid to the humeral head, and they blend with fibrous tissue called the capsule that encloses the entire joint. When the humeral head is forced forward in a dislocation, the soft tissues stretch or tear, and in some cases, bone is fractured off the glenoid rim, resulting in a bony Bankart lesion. X-ray of a patient with a bony Bankart facture of 3-D scan of the same patient more clearly the glenoid (socket), secondary to shoulder recreating the fracture. dislocation. Orthopaedic Surgery & Sports Medicine 630-324-0402 ⚫ [email protected] Teaching & Research Foundation stevenchudikmd.com otrfund.org Schedule online now © 2018 Steven Chudik MD Shoulder, Knee & Sports Medicine. All rights reserved. Frequent Signs and
[Show full text]
34Th Annual Meeting of the Japan Shoulder Society
34TH ANNUAL MEETING OF THE JAPAN SHOULDER SOCIETY 1 F Wave Monitoring After Arthroscopic Shoulder Surgery gers may be used to evaluate the functions of the shoulder joint. It is IWATA Yoshio, Department of Orthopaedics, Uji Takeda Hospital also believed that people can perform approximately half of the ac- MORIHARA Toru, HAYASHIDA Tatsurou, OGURA Akiko, KUBO tions even if the diseased hand is on their dominant side. Toshikazu, Department of Orthopaedics, Kyoto Prefectural Univer- sity of Medicine, Graduate School of Medical Science HORII Motoyuki, Department of Orthopaedic Surgery, Kyoto Inter- 3 The Shoulder Function of Congenital Clavicle Anomalies disciplinary Institute Hospital of Community Medicine KENMOKU Tomonori, Department of Orthopaedics Surgery, Chiba KUROKAWA Masao, Department of Orthopaedic Surgery, Saisei- Univercity Graduate School of Medicine kai Suita Hospital SAISU Takashi, KAMEGAYA Makoto, Division of Orthopaedics Sur- The purpose of this study was to evaluate the modulation of excit- gery, Chiba Children’s Hospital ability of spinal motor neuron function. We investigated F waves af- MIKASA Motohiko, Matsudo Orthopaedic Hospital ter arthroscopic shoulder surgery. We evaluated 7 subjects who There was no report on the shoulder function of congenital clav- underwent an arthroscopic shoulder surgery. There were 5 men icle anomalies. Our purpose was to clarify the role of the clavicle, and 2 women; the mean age at the time of surgery was 33.6 years investigating the shoulder function in patients with clavicle defect old. In our study, F waves were recorded from the abductor pollicis or pseudoarthrosis. muscle after transcutaneous median nerve stimulation at bilateral Thirteen shoulders of 9 patients with congenital clavicle anoma- wrists.
[Show full text]
Presentations
7/4/2019 30th Brucosport Football Medicine: What’s New 2017 Bruges, Belgium 11 March 2017 Aspetar Orthopaedic and Sports Medicine Hospital 1 Dr. Scott Gillogly Chief Medical Officer 26 February 2017 2 1 7/4/2019 Articular Cartilage Injuries in the Knee: Evaluation and Surgical Treatment Options based on Return to Play Scott D. Gillogly, MD 34th FIMS World Sports Medicine Congress Ljubljana, Slovenia 29 September - 2 October 2016 Aspetar Orthopaedic and Sports Medicine Hospital 3 ICRS Annual Meeting 29 September 2016 Aspetar Orthopaedics and Sorrento, Italy Sports Medicine Hospital 4 2 7/4/2019 Articular Cartilage Injuries in the Knee: Evaluation and Surgical Treatment Options based on Return to Play Scott D. Gillogly, MD AFC Team Physiotherapist Sports Medicine Course Doha, Qatar 13-15 June 2016 Aspetar Orthopaedic and Sports Medicine Hospital 5 Cartilage Defects in Athletes: Return To Play (RTP) Scott D. Gillogly, MD 1st GCC Sports Medicine Conference Doha, Qatar 23 April 2016 Aspetar Orthopaedic and Sports Medicine Hospital 6 3 7/4/2019 AAOS Articular Cartilage Restoration: The Modern Frontier 1 April 2016 Aspetar Orthopaedics and Sports Medicine Hospital Chicago, Illinois 7 AAOS Articular Cartilage Restoration: The Modern Frontier 2 April 2016 Aspetar Orthopaedics and Chicago, Illinois Sports Medicine Hospital 8 4 7/4/2019 8 April 2016 Aspetar Orthopaedics and Washington, D.C. Sports Medicine Hospital 9 8 April 2016 Aspetar Orthopaedics and Washington, D.C. Sports Medicine Hospital 10 5 7/4/2019 Return to Play (RTP) After Cartilage Repair of the Knee Scott D. Gillogly, MD Challenges in Football Injuries Doha, Qatar 11‐12 February, 2016 Aspetar Orthopaedic and Sports Medicine Hospital 11 Partial Osteochondral Fractures of the Condyles (Osteochondral Defects) Scott D.
[Show full text]
An Overview of Common Injuries and Imaging Findings
SPORTS RADIOLOGY SHOULDER DISLOCATION AMONG ATHLETES AN OVERVIEW OF COMMON INJURIES AND IMAGING FINDINGS – Written by Nima Hafezi–Nejad, Shadpour Demehri and John A Carrino, USA The Glenohumeral (GH) joint has a mobility is often termed hyperlaxity, a during sports activities. Second, SD may arise large range of motion that leaves it prone common feature among many athletes. as a result of chronic injuries, mostly in the to shoulder instability, ranging from Hyperlaxity may help athletes by enhancing form of recurrent microtrauma and overuse. subluxation to frank shoulder dislocation their range of motion. However, this may Secondary forms of impingement and (SD). Due to the shallow depth of the glenoid’s become a problem when it is accompanied injury to the dynamic soft tissue stabilisers osseous structure, shoulder stability is by a functional deficit and pathological may arise from recurrent microtrauma as achieved through a number of additional symptoms. Typical symptoms include well2. soft tissue stabilisers (including the glenoid pain and a subjective feeling of instability labrum). Rotator cuff muscles are the most or apprehension. While instability and ADVANCED IMAGING FINDINGS – AN important dynamic stabilisers of the GH hyperlaxity are two distinct phenomena, OVERVIEW joint. Other muscles that cross the GH joint, they frequently occur together in athletes Radiography remains the primary such as pectoralis major and latissimus dorsi, suffering from SD1. modality of choice when SD is suspected may potentially act as stabilisers as well. SD While purely atraumatic causes may (Figure 1). However, advanced imaging may arise from abnormal function of either account for a number of SDs among athletes, modalities including computed tomo- osseous (glenoid fossa and coracoacromial there are two main etiologies, behind athlete graphy (CT) and magnetic resonance arch) or soft tissue (glenoid labrum, articular SD.
[Show full text]
ESR-Endorsed ESSR DIPLOMA CORRECT ANSWERS (In Bold)
ESR-endorsed ESSR DIPLOMA Examination Session at ESSR 2015 York, June 19, 2015 CORRECT ANSWERS (in bold) 1. In the Erdheim-Chester disease, which of the following statements is true: a) it is a frequent disease in Western Europe b) is a Langerhans cell histiocytosis c) bone involvement is almost universal d) it essentially affects the axial skeleton and only rarely the long bones 2. In the POEMS syndrome, which of the following statements is false: a) affected patients are older than patients with standard multiple myeloma b) sclerotic bone lesions are found in the majority of the patients c) sclerotic bone lesions can be mistaken for bone islands d) as a consequence of treatment response, sclerotic bone lesions may to decrease in size 3) Taking into account ankle sprains, the highest incidence of injury can be found in the: a) calcaneofibular ligament b) posterior talofibular ligament c) anterior talofibular ligament d) tibiocalcaneal ligament 4) HIV-positive patients have a higher incidence of: a) bacillary angiomatosis b) thoracic cage tuberculosis c) reiter’s syndrome d) all of the previous entities 5) On MRI, the structures of the rotator cuff interval can be best evaluated on: a) oblique sagittal and oblique coronal images b) axial and oblique coronal images. c) oblique sagittal and axial images d) ABER position. 6) Which structure does not belong to the rotator cuff interval? a) coraco-acromial ligament b) long head of the biceps tendon c) coracohumeral ligament d) superior glenohumeral ligament 7) Most people under the age of
[Show full text]
High-Yield Shoulder & Elbow Topics
HIGH-YIELD SHOULDER & ELBOW TOPICS Dragomir Mijic, DO 1. Rotator Cuff Tears Epidemiology Rotator cuff repair age >60: 28% have full-thickness tear acute or chronic full-thickness tears age >70: 65% have full-thickness tear bursal-sided tears >3 mm (>25%) in depth Risk factors: age, smoking, hypercholesterolemia, family history partial articular-side tears>50%. Acute SIT tears: > 40 with shoulder PASTA with >7mm of exposed bony dislocation footprint between the articular surface and intact tendon late cocking/early represents significant (>50%) cuff acceleration>internal tear impingement>PASTA rate-limiting step for recovery is MRI biologic healing of RTC tendon to Overview of Physical Exam of Rotator Cuff sagittal images: muscle atrophy greater tuberosity: 8-12 weeks Cuff Muscle Special Tests Supraspinatus o Drop arm test medial biceps subluxation: subscap WC: higher postop disability and o Pain with Jobe test tear lower satisfaction Infraspinatus o ER lag sign Teres minor o Hornblowers tangent sign: line between spine and Subscapularis o Excessive passive ER coracoid: SS grade III atrophy o Belly press o Lift off o IR lag sign 55% of asymptomatic pt 60+ will have RCT on MRI https://www.orthobullets.com/shoulder-and-elbow/3043/rotator-cuff-tears https://www.pagepress.org/journals/index.php/rr/article/view/rr.2010.e1/1907 Rotator Cuff Tears Tendon Transfers Complications Pectoralis (subscap) Repair Failure under the conjoined tendon failure of cuff tendon healing and suture pullout from tissue Latissimus Dorsi (post/sup RC) Risk Factors Thoracodorsal N. (C6-C8) age >65 young laborer large tear >5cm brace in 45º abd and 30º ext rotation muscle atrophy radial nerve at risk (3cm medial to tendon insertion on humerus) DM, tobacco Lower Trapezius (post/sup RC) tear retraction medial to glenoid Spinal Accessory N.
[Show full text]
History of Surgical Intervention of Anterior Shoulder Instability
J Shoulder Elbow Surg (2016) 25, e139–e150 www.elsevier.com/locate/ymse History of surgical intervention of anterior shoulder instability David M. Levy,MD*, Brian J. Cole, MD, MBA, Bernard R. Bach Jr, MD Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA Background: Anterior glenohumeral instability most commonly affects younger patients and has shown high recurrence rates with nonoperative management. The treatment of anterior glenohumeral instability has undergone significant evolution over the 20th and 21 centuries. Methods: This article presents a retrospective comprehensive review of the history of different operative techniques for shoulder stabilization. Results: Bankart first described an anatomic suture repair of the inferior glenohumeral ligament and anteroinferior labrum in 1923. Multiple surgeons have since described anatomic and nonanatomic repairs, and many of the early principles of shoulder stabilization have remained even as the techniques have changed. Some methods, such as the Magnusson-Stack procedure, Putti-Platt procedure, arthroscopic stapling, and transosseous suture fixation, have been almost completely abandoned. Other strategies, such as the Bankart repair, capsular shift, and remplissage, have persisted for decades and have been adapted for arthroscopic use. Discussion: The future of anterior shoulder stabilization will continue to evolve with even newer prac- tices, such as the arthroscopic Latarjet transfer. Further research and clinical experience will dictate which future innovations are ultimately embraced. Level of evidence: Review Article © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Keywords: Anterior glenohumeral instability; dislocation; subluxation; shoulder stabilization; arthroscopic; Bankart Because of its relative lack of bony limitations and ex- Hovelius et al60 in a prospective study of 229 primary dis- tensive range of motion, the shoulder is the most commonly locations treated nonoperatively.
[Show full text]
Imaging of the Shoulder Bankart Lesion and Its Variants
REVIEW ARTICLE https://doi.org/10.3126/njr.v9i1.24816 Imaging of the Shoulder Bankart Lesion and its Variants Leow KS1, Low SF2, PehWCG1 1Department of Diagnostic Radiology, Khoo Teck Puat Hospital, Yishun Central, Singapore, Republic of Singapore 2Department of Radiology, Kuala Lumpur Sports Medicine Centre, Jalan Dungun, Bukit Damansara, Kuala Lumpur, Malaysia Received: March 08, 2019 Accepted: April 15, 2019 Published: June 30, 2019 Cite this paper: Leow KS, Low SF, PehWCG. Imaging of the Shoulder Bankart Lesion and its Variants. Nepalese Journal of Radiology 2019;9(13):33-39. https://doi.org/10.3126/njr.v9i1.24816 ABSTRACT The glenoid labrum is an important soft tissue structure that provides stability to the shoulder joint. When the labrum is injured, affected patients may present with chronic shoulder instability and future recurrent dislocation. The Bankart lesion is the most common labral injury, and is often accompanied by a Hill-Sachs lesion of the humerus. Various imaging techniques are available for detection of the Bankart lesion and its variants, such as anterior labroligamentous periosteal sleeve avulsion and Perthes lesion. Direct magnetic resonance (MR) arthrography is currently the imaging modality of choice for evaluation of the various types of labral tears. As normal anatomical variants of glenoid labrum are not uncommonly encountered, familiarity with appearances of this potential pitfall helps avoid misdiagnosis. Key words: Anterior Labroligamentous Periosteal Sleeve Avulsion, Glenohumeral Joint Dislocation, Hill-Sachs Lesion, MR Arthrography, Perthes Lesion, Shoulder Dislocation INTRODUCTION The shoulder joint is one of the more commonly injured joints in the body, with its inherently large range of mobility predisposing it to risk of dislocation and development of chronic instability.
[Show full text]
Surgical Technique
ARTHROSCOPIC B A NK art L esio N repair Using the 3.5mm LactoScrew® Suture Anchor Surgical Technique Diagnostic Arthroscopy • Standard posterior portal (Figure 1) • Anterior/superior rotator interval portal placed just off anterior edge of acromion (more superior than usual) • Assess for . • Bankart lesion • Integrity of anterior / inferior ligaments (MGHL, IGHL, inferior pouch) – May be seen best with scope in anterior/superior portal – Intrasubstance tearing – HAGL • Hill-Sachs lesion or other articular injury • SLAP lesion • Biceps tendon integrity / stability • Articular surface rotator cuff tear Figure 1 Establish Anterior Bankart Lesion Trans-Subscapularis Portal View from Anterior Cannula • Be aware of axillary nerve position at medial / inferior border of subscapularis (Figure 2) • 2mm guide pin through muscular portion of subscapularis (below superior subscapularis tendon, mid-substance) • 7mm cannulated obturator +7mm cannula placed over guide pin Figure 2 Surgical Technique Anterior/Inferior Labral Debridement/ Bony Preparation (Figure 3) • Place 30° scope in anterior/superior portal or 70° scope in posterior portal to maximize visualization • Contour edges of torn labrum (conservative debridement) • Small, curved shaver (3.5mm) to debride anterior/inferior glenoid bone • Small burr (3.5mm) to decorticate anterior/inferior glenoid bone • Avoid deep trough • Avoid glenoid articular cartilage injury Placement of Suture Anchors Figure 3 • If utilizing 30° scope, place in anterior/superior portal to enable placement of suture anchor(s)
[Show full text]
Shoulder Anterior Bankart Tear
Anterior Shoulder Instability Anterior shoulder instability typically results from a dislocation injury to the shoulder joint when the humeral head (ball) of the humerus (upper arm bone) is displaced from its normal position in the center of the glenoid (socket) and the joint surfaces no longer touch each other. The most common dislocation is anterior (more than 90 percent), where the humeral head dislocates in front and below the glenoid. X-ray of anterior shoulder dislocation Because the shoulder has more motion than any other large joint in the body, it is the most commonly dislocated large joint. The shoulder is like a golf ball on a golf tee. Many structures contribute to shoulder stability and include bony contours of the humeral head (ball) and glenoid (socket), the soft-tissue bumper of the labrum which surrounds the rim of the socket, the capsule and ligaments that attach the humeral head to the labrum of the glenoid, and the muscles of the rotator cuff which surround the deep shoulder joint. When a shoulder is dislocated from its glenoid (socket), all these stabilizing structures may be injured to different degrees, including the humeral and glenoid bone, the labrum, the capsule and ligaments, and the rotator cuff muscles. When a younger active patient dislocates his or her shoulder, he or she may injure all these structures but typically tear the labrum off the glenoid (socket) along with the attached stabilizing capsule and ligaments, called a Bankart lesion. 630-324-0402 [email protected] Orthopaedic Surgery & Sports Medicine Teaching & Research Foundation stevenchudikmd.com otrfund.org Schedule online now © 2018 Steven Chudik MD Shoulder, Knee & Sports Medicine.
[Show full text]
Bankart Labrum Repair Protocol
Bankart Labrum Repair Protocol Salomone is welcoming and arch underground as unhyphenated Brad upheld resinously and jitterbug lowlily. Meatal and exceptionable Sal stigmatizing almost wearily, though Pinchas lunging his sleave subsoils. Megaphonic and representative Shaun designate while caterpillar Claire browbeating her sorceress transversely and laicises relentlessly. Hip ir with dr dewanjee for labrum repair helps pinpoint truly personalized care We perform shoulder actually goes to achieve maximum range of labrum repair is typically the arm jerked during a sharp pop or overuse and shoulder joint gently forward in hospital. Schedule an appointment with a labrum repair protocol has no aggressive er by sanford health care for labrum, tear there is delivered through this. Does Bankart tear or surgery? The share the labrum is stretched or torn the more unstable the shoulder becomes The item may pop out his joint so frequently that it tears. Arthroscopic Bankart Repair Shoulder Clinic. Shoulder Rehabilitation Protocols Bankart Repair with or leaf a capsular shift Phase 1 First 3 weeks Wound cover as outlined. Arthroscopic Anterior Stabilization Protocol Boston Shoulder. Bankart Repair Northwestern Medical Center. Physical Therapy Protocols for Arthroscopic Bankart Repair. Below two the physical therapy protocols that family doctor recommends. Arthroscopic Anterior Capsulolabral Repair of reverse Shoulder. Hip Labral Repair Protocol Physical Therapy protocols provided by Dr LaFrance of Hamilton Orthopedic Spine Sports Medicine. Slap and labrum and then return to protocol as bankart labrum repair protocol has been stretched or drink anything with your pain completely off the. Rehab Protocols Premier Bone & Joint Centers. SUPERIOR LABRAL REPAIR REHABILITATION PROTOCOL COPYRIGHT 2014 CRC BRIAN J COLE.
[Show full text]
MRI of the Small Joints and Extremities/ Illustrative Cases
1/20/2014 Utility of MR Magnetic Resonance Imaging of In Musculoskeletal Imaging Minor Trauma: January 2014 • Noninvasive • Multiplanar capabilities • No ionizing radiation Mark I. Robbins, M.D. • High sensitivity with Musculoskeletal Radiology excellent spatial Rye, New Hampshire USA resolution=early detection How Does MRI Form A Picture? A Paradox • Fat and Water in the • "Simplicity, simplicity, simplicity! I say, let Human body have an your affairs be as two or three, and not a abundance of hundred or a thousand; instead of a million protons count half a dozen, and keep your accounts on • They resonate in a your thumbnail." HD Thoreau, Walden, random frequency "Where I Lived and What I Lived For" (1854) and orientation • “Simplify, but don’t oversimplify” A. Einstein • For today, we’re going with the Concordian Basics Imaging of All Three Planes The Musculoskeletal System • Radiographs are insensitive to non- displaced fractures, infiltrative processes and marrow edema states • Think of Radiographs as the “sed rate” of imaging 1 1/20/2014 MRI Appearance CT based on Hounsfield Units- Cortical bone & tendons Attenution Coefficient CT defines cortical margins, small avulsions and CT Imaging fracture planes, but some processes are CT occult CT versus MRI OSSEOUS TRAUMA • Insensitive to occult bone marrow edema • CASE STUDIES • Can be useful to define fracture planes, avulsions • Beneficial for incomplete or non-union, due to Shortcut to march05- april 05 191.jpg.lnk “edge enhancement” • Can show small osseous bodies, define osteoid matrices
[Show full text]