DOCSLIB.ORG

2011 Newsletter – Winter (919

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
2011 Newsletter – Winter (919 NEWS ISSUE 05 I WINTER 2011 Welcome Message Winter is here and with that comes a long line of winter sports. The cold weather and early snow O RTHOSPORTS LOcATIONS brings skiing and snowboarding to mind, to prepare for the ski season Drs Sher and Bruce gave > concord 02 9744 2666 lectures to the ski patrol in readiness for the busy season of snow sport injuries. > Hurstville 02 9580 6066 Winter also means Rugby, Netball, Hockey, AFL, Soccer and many other sports that bring with > Olympic Park 02 9735 3637 them a vast array of knee, ankle, shoulder, foot, hip and general orthopaedic traumas. > Penrith 02 4721 1865 Leading on from the completion of our knee examination series, we commence our shoulder > Randwick 02 9399 5333 examination series on page 3. > Sydney 02 9735 3637 We hope you enjoy this issue of Orthosports News. The Team at Orthosports Or visit our website www.orthosports.com.au The Young Patient who Dislocates their WhO arE WE? Orthosports is a professional Shoulder for the First Time association of Orthopaedic Surgeons based in Sydney. This is one of the most controversial topics in orthopaedics. The literature has established We specialise in joint replacement, that the younger the patient, the higher the risk arthroscopic and reconstructive of recurrence (up to 90% in persons under 20 surgery. years). With each instability episode, increasing Orthosports also includes a team damage is done to the articular cartilage and of Sport & Exercise Medicine other structures of the shoulder. One can Physicians who are dedicated to extrapolate from that, that the more frequent Fig 3. X-ray showing Fig 4. MRI showing promoting excellence in the treatment the number of dislocations, the higher the risk bony Bankart lesion torn anterior labrum of musculoskeletal disorders in of developing Glenohumeral arthritis. and Hill Sachs lesion both adults and children. When a patient dislocates the shoulder the Our team of surgeons has particular labrum can tear (a bankart lesion), the capsule the shoulder is strong, usually at about 6 to 8 expertise in hip and knee is stretched and bony damage can occur to the weeks after the injury, the patient is generally replacement, AcL Reconstruction, Humeral head (a Hill Sachs lesion) or Glenoid allowed back to full activity. If the dislocation knee and shoulder arthroscopy, (a bony bankart lesion). recurs then surgery is recommended. open shoulder surgery, trauma, In these active young patients, if there is a foot and ankle surgery, fracture large labral tear then arthroscopic surgery is management, paediatrics and recommended to repair the labrum and reduce many subspecialist procedures. the risk of recurrent dislocations. The surgery All of our practices are conveniently carries a 4 to 6 month rehabilitation period and located next to physiotherapy, x-ray the success rate is approximately 90%. and imaging facilities. Our mission is to have the facilities to offer everything our Fig 1. Arthroscopic Fig 2. Arthroscopic patients may need but also to be picture of torn Anterior picture of Hill Sachs small enough to look after the little Labrum lesion details that make all the difference to patient care. When there is a large labral tear or significant bony damage, the risk of recurrence and more Fig 5. Arthroscopic Fig 6. Diagram of labral Our WEbSiTE iS subsequent damage to the joint is very high. This risk is amplified if the patient is young, photo of labral repair repair using anchors yOur OrThOpaEdic active and plays contact sports. rESOurcE If there is significant bony damage then a A general approach to the first time dislocator If you haven’t visited our website larger and more complicated procedure is is to initially perform a thorough history and recently, please take the time to visit required to compensate for the bone loss examination. A plain x-ray will assess the bony and take a look around. It contains which involves transferring the coracoid damage. If it is possible to arrange an MRI descriptions of many common surgical process into the defect. conditions and procedures as well as with intra articular contrast, this will give a lectures, animations and videos of good view of the labrum. In summary, a dislocated shoulder is not a benign injury and can do significant structural damage lectures given by our surgeons and If the MRI reveals no bony or labral damage, to the joint. This damage can be minimised by sports physicians over recent years. commence physiotherapy immediately. There early surgery in the high risk individual. www.orthosports.com.au is no evidence in the literature to suggest that sling immobilisation is of any benefit. Once Dr Jerome Goldberg www.orthosports.com.au 1 Management of Treatment of Bunions acute ankle Sprains The term “bunion” is commonly used to describe any enlargement or deformity around the great toe. The origin of the term “bunion” is Acute ankle sprains are an extremely common injury in both sport and the general from the latin word bunio, meaning turnip. The most common cause of a community. The ‘garden variety’ ankle sprain bunion deformity is due to hallux valgus, where there is lateral deviation involves the lateral ligament complex. It of the great toe, and a medial eminence. generally occurs in a position of plantar flexion and inversion, where the foot ‘rolls AETIOLOGY to establish the diagnosis and dictate under’ the ankle. clinical assessment of the Studies have shown that painful hallux appropriate treatment. ankle is very important as it should not be valgus is a problem of the shoe wearing assumed that all ankle sprains are lateral Treatment population, occurring in up to 33% of ligament sprains. Important conditions to Non-operative management usually people as compared to 2% of the unshod exclude are: alleviates symptoms associated with persons. The fact that hallux valgus hallux valgus. Patients are encouraged 1. Syndesmosis does not occur in everyone wearing to use wide shoes with a wide toe box. sprains – This injury shoes, or does occur in the unshod Shoes can be stretched by a shoemaker is a disruption of the population suggests that there is an to relieve pressure points over the inferior tibiofibula underlying hereditary component that ligaments. It is bunion. Podiatric care, with the use of may predispose to this condition. important to bunion pads, night splints, or bunion differentiate this The first metatarso-phalangeal joint is posts, have been shown to be effective injury as it runs a subjected to a number of deforming in relieving symptoms. These products more protracted time forces. When the toe is straight, these have not been effective at preventing the course (roughly twice forces are balanced and do not cause progression of the deformity. as long as a lateral a deformity. Once hallux valgus occurs, When conservative management has ligament sprain)and the pull of tendons around the joint failed to relieve symptoms, operative External rotation test occasionally requires becomes imbalanced, allowing for further management is considered. Proper surgery. On history worsening of the deformity. Pressure correction of the deformity involves a the patient describes a dorsiflexion and on the medial eminence from shoes, external rotation mechanism, which is quite rebalancing of the forces around the and altered pressure on the great toe different to the plantar flexion inversion first metatarsophalangeal joint. I have commonly causes pain. mechanism of a lateral ligament injury. had excellent results with a procedure clinically pain is felt with forced external Painful hallux valgus occurs far more known as the ScARF osteotomy. The rotation of the foot with the ankle in a commonly in females than males. While first metatarsal is cut and the bone neutral position. deformities may first arise in the teenage shifted laterally to re-align the bony 2. Fractures – The common fractures population, patients usually seek treatment deformity. This procedure, popularised by accompanying an ankle sprain include either for this condition around the sixth decade a French surgeon, Louis Barouk, allows medial or lateral malleoli, the base of 5th of life due to worsening of the deformity, for correction of large deformities, and metatarsal or one of the midfoot bones, such difficulty with shoe wear, and pain and patients are allowed to immediately bear as the navicular. Imaging guidelines known deformity in the great toe or lessor toes. weight on the operated foot. Surgery can as the Ottawa ankle rules provide guidelines be done on both feet simultaneously. for when to x-ray an injured ankle and have DIAGNOSIS been shown to reduce radiology requirements The majority of patients report pain over for emergency departments by 30%. the medial eminence of the great toe. 3. peroneal tendon Up to half of patients will report pain subluxation – The underneath the second metatarsal head, peroneal tendons are usually due to transfer of weight bearing held in place by the to this part of the foot as the deformed peroneal retinaculum, first ray is unable to share load. which may be ruptured in an acute Pain can be present all of the time, but Before After ankle sprain. This patients usually report worsening of pain Above: the most common cause of a bunion leads to instability of with shoe wear and improvement of pain is Hallux valgus. With the scarf osteotomy these tendons. with open toed shoes or thongs. procedure, the first metatarsal is cut and the clinically this may be I prefer to order standing or weight diagnosed by asking bone shifted laterally to realign the bony deformity. the patient to actively bearing radiographs as they better Stirrup brace demonstrate the true deformity. The dorsiflex and externally KEYPOINTS rotate the foot, whilst palpating for the tendons presence or absence of arthritis and snapping from posterior to anterior over the the anatomic structure of the foot • Bunions are mainly due to hallux valgus, malleolus.
Load more

Recommended publications
  • Common Problems of the Shoulder, Examination and Omt
    COMMON PROBLEMS OF THE SHOULDER, EXAMINATION AND OMT Richard Margaitis DO Assistant Professor Family Medicine/NMM/SM Florida Hospital October 19th 2015 Objectives • At the conclusion of this lecture, the attendee should be able to: Identify basic anatomic landmarks of the shoulder Identify typical patient symptoms/complaints Differentiate various medical diagnoses of the shoulder Perform & understand the indications of specific shoulder tests Identify various diagnostic and treatment modalities Perform various OMT techniques for shoulder dysfunctions Pre-Test Question #1 1) Which nerve is most commonly injured with a gleno- humeral shoulder dislocation? a) Axillary Nerve b) Suprascapular Nerve c) Musculo-cutaneous Nerve d) Radial Nerve c) Ulnar Nerve Answer: A) Axillary Nerve Pre-Test Question #2 2) How many ligaments make up the Coraco-clavicular Ligament? a) One b) Two c) Three d) Four c) Five Answer: B) Two The Conoid and Trapezoid Ligaments Pre-Test Question #3 3) Which of the following tests is used to evaluate for Bicipital Tendonitis? a) Jobe b) Apprehension c) Hawkins’ d) Apleys e) Speeds Answer: E) Speeds Pre-Test Question #4 4) How many muscles either attach or originate on the Scapula? a) 7 b) 10 c) 15 d) 17 e) 21 Answer: D) 17 Muscles attaching to or originating on the Scapula Serratus Anterior Supraspinatus Subscapularis Trapezius Teres Major Teres Minor Triceps Brachii (long head) Biceps Brachii (short & long heads) Rhomboid Major Rhomboid Minor Coracobrachialis Omohyoid (inferior belly) Latiissimus Dorsi Deltoid Levator
    [Show full text]
  • Paper Abstracts
    PAPER ABSTRACTS Paper #1 Full-Thickness Articular Cartilage Defects of the Trochlea: Long-Term Patient Outcomes at 4-6 Years . .Jon E Browne, Kansas City, MO, USA Paper #2 •Transplantation of Cartilage-Like Tissue Made by Tissue Engineering . .Mitsuo Ochi, Izumo-shi, JAPAN Paper #3 Semitendinosus Regrowth: The Physiologic Properties of the Lizard Tail Phenomenon . .Mark David Miller, Charlottesville, USA Paper #4 Failure Properties of the Fibular Collateral and Popliteofibular Ligaments, and Popliteus Musculotendinous Complex . .Tim Bollom, Gainesville, FL, USA Paper #5 The Effect of Growth Factor therapy for Over-Stretched Anterior Cruciate Ligament Injury With Partial Mid-Substance Laceration: An Experimental Study . .Eiji Kondo, Sapporo, JAPAN Paper #6 Physiological Fracture Prophylaxis of the Distal Radius Prior to Falling . .Anton Arndt, Huddinge, SWEDEN Paper #7 Animated 3D Motion of the Normal and Injured Wrist . .Michael J Sandow, Adelaide, AUSTRALIA Paper #8 Tissue Engineering for Knee Ligament Reconstruction . .F. van Eijk, Amsterdam, NETHERLANDS Paper #9 Changes in Gene Expression of Human Articular Chondrocytes in Cell Culture . .Gabriele Striessnig, Vienna, AUSTRIA Paper #10 Existence of Slow-Cycling Cells in Meniscus: Implication on Precursor Cells . .Eisaku Fujimoto, Hiroshima, JAPAN Paper #11 The Effects of Hyaluronic Acid in the Healing of Achilles Tendon Repair . .Sinan Karaoglu, Kayseri, TURKEY Paper #12 Superior topology of the Human Talus . .Adam M Butler, Randwick, AUSTRALIA Paper #13 Diagnosis and Arthroscopic Treatment of Superior Labrum Lesion Associated With Shoulder Anterior Instability: Slap Type V. .Benno Ejnisman, São Paulo, BRAZIL Paper #14 The Reliability of MR-Arthrography in Patients With Anterior Shoulder Instability . .Pol E Huysmans, Amstelveen, NETHERLANDS Paper #15 Significance of Postoperative Arthro MRI in Predicting 5 Year Results of Arthroscopically Treated Recurrent Shoulder Dislocations .
    [Show full text]
  • Shoulder Injuries: Dislocated Shoulder and Labral Tear
    Orthopedics Shoulder Injuries: Dislocated Shoulder and Labral Tear The anatomy of the shoulder allows it to be one of the body's most mobile joints. It is not like a ball and socket but instead more like a golf ball and a golf tee. The tee portion is called the glenoid, and the ball portion is called the humeral head (top of the humerus). This allows the arm to rotate freely in many directions. Because of this mobility, however, the shoulder is easy to dislocate. A dislocated shoulder occurs when the humeral head comes partially or completely out of place. When the shoulder dislocates, the outer rim of the glenoid (called the labrum) is often injured. Damage also occurs to the ligaments and capsule that normally hold the shoulder in place. Labral tears can also occur when the shoulder slides partially out of joint. Shoulder pain in throwing athletes can also be due to a labral tear that has gradually formed over time. CAUSES AND RISK FACTORS A dislocated shoulder can occur while playing contact sports, such as football or hockey, or in sports where athletes are likely to fall – skiing, volleyball or gymnastics. A sudden, powerful blow to the shoulder causes the dislocation. Less commonly, the ligaments around the shoulder can be so loose that the shoulder can dislocate without much force at all. Once the shoulder dislocates, it is much more likely to happen again. After a second time, the risk is even greater. The younger the athlete, the more likely that dislocation will happen again.A labral tear without dislocation most commonly happens to baseball pitchers, weightlifters and golfers.
    [Show full text]
  • Dislocated Shoulder -Orthoinfo - AAOS Page 1 of 2
    Dislocated Shoulder -OrthoInfo - AAOS Page 1 of 2 Dislocated Shoulder The shoulder joint is the body's most mobile joint. It can turn in many directions. But, this advantage also makes the shoulder an easy joint to dislocate. A partial dislocation (subluxation) means the head of the upper arm bone (humerus) is partially out of the socket (glenoid). A complete dislocation means it is all the way out of the socket. Both partial and complete dislocation cause pain and unsteadiness in the shoulder. Shoulder instability Symptoms Symptoms to look for include: • Swelling • Numbness • Weakness • Bruising Sometimes dislocation may tear ligaments or tendons in the shoulder or damage nerves. The shoulder joint can dislocate forward, backward, or downward. A common type of shoulder dislocation is when the shoulder slips forward (anterior instability). This means the upper arm bone moved forward and down out of its joint. It may happen when the arm is put in a throwing position. Diagnosis The muscles may have spasms from the disruption, and this can make it hurt more. When the shoulder dislocates time and again, there is shoulder instability. The doctor will examine the shoulder and may order an X-ray. It is important that the doctor know how the dislocation happened and whether the shoulder had ever been dislocated before. Treatment http://orthoinfo.aaos.org/topic.cfm?topic=A00035 2/2/2015 Dislocated Shoulder -OrthoInfo - AAOS Page 2 of 2 The doctor will place the ball of the upper arm bone (humerus) back into the joint socket. This process is called closed reduction. Severe pain stops almost immediately once the shoulder joint is back in place.
    [Show full text]
  • Shoulder Injuries Diagnosis and Treatment
    SHOULDER INJURIES DIAGNOSIS AND TREATMENT BONE AND JOINT HEALTH JASSIN M. JOURIA Dr. Jassin M. Jouria is a practicing Emergency Medicine physician, professor of academic medicine, and medical author. He graduated from Ross University School of Medicine and has completed his clinical clerkship training in various teaching hospitals throughout New York, including King’s County Hospital Center and Brookdale Medical Center, among others. Dr. Jouria has passed all USMLE medical board exams, and has served as a test prep tutor and instructor for Kaplan. He has developed several medical courses and curricula for a variety of educational institutions. Dr. Jouria has also served on multiple levels in the academic field including faculty member and Department Chair. Dr. Jouria continues to serve as a Subject Matter Expert for several continuing education organizations covering multiple basic medical sciences. He has also developed several continuing medical education courses covering various topics in clinical medicine. Recently, Dr. Jouria has been contracted by the University of Miami/Jackson Memorial Hospital’s Department of Surgery to develop an e- module training series for trauma patient management. Dr. Jouria is currently authoring an academic textbook on Human Anatomy & Physiology. ABSTRACT Over time, the potential for injury or just general wear and tear on bones and joints can impact a person’s quality of life. Even in younger individuals, repetitive activities, such as repeatedly throwing a baseball, can cause arthritic pain and joint tears that cause pain and limit a person’s body to function as it was designed. However, many treatment options, both surgical and non-surgical, are available to provide relief and to restore normal functioning.
    [Show full text]
  • ERAS for Hip and Knee (THA and TKA) Arthroplasty – a Need to Look Beyond LOS
    ASERalert November 2016 | Volume 1, Issue 1 ERAS for Hip and Knee (THA and TKA) Arthroplasty – A Need to Look Beyond LOS OFFICIAL also in this issue PUBLICATION OF ERAS for Total Enhanced ERAS for Spine Joint Arthroplasty: Recovery for Surgery: A New Past, Present and Orthopedic Frontier ASER ALERT • VOLUME 1, ISSUE 1 • aserhq.org Future Surgery 1 ANNUAL CONGRESS OF ENHANCED RECOVERY AND 2017 PERIOPERATIVE MEDICINE APRIL 27TH-29TH, 2017 HYATT REGENCY WASHINGTON ON CAPITOL HILL 400 NEW JERSEY AVE NW, WASHINGTON, D.C. 20001 For more information please visit www.aserhq.org 2 ASER ALERT • VOLUME 1, ISSUE 1 • aserhq.org Board of Directors President’s Message Officers By Tong J (TJ) Gan, MD, MHS, FRCA, President President Tong J (TJ) Gan, MD, MHS, FRCA President-Elect Julie Thacker, MD t is my great pleasure to announce Vice-President the inaugural issue of the ASER Timothy Miller MB, ChB, FRCA Newsletter. Founded in 2014, Treasurer ASER is a multi-specialty nonprofit Roy Soto, MD Iorganization with an international Secretary membership and is dedicated to the Stefan D. Holubar MD, MS, FACS, FASCRS practice of enhanced recovery in the perioperative patient through education Directors and research. We are experiencing a period of tremendous expansion and Keith A. (Tony) Jones, MD growth, as is evidenced by the great Anthony Senagore, MD interest to implement the enhanced Maxime Cannesson, MD, PhD recovery pathway in hospitals around Terrence Loftus, MD, MBA, FACS the country. Andrew Shaw MB, FRCA, FFICM, FCCM Desiree Chappel, CRNA The ASER Mission is to advance the practice of perioperative enhanced recovery and to contribute to its pathways.
    [Show full text]
  • Sports Injuries
    Sports Injuries Lacrosse Lacrosse is America’s oldest game. It can be dated back to the Native Americans, and was used astraining for war. It is both played by boys and girls,however, some rules are drastically different between genders. Nonetheless, the combination of contact, a stick, a hard ball, and quick changes of direction, puts lacrosse players at risk for injury. Protective Equipment There is a wide range of equipment that lacrosse players wear. For girls, goggles and mouth pieces are mandatory. Lightweight gloves and headgear is optional. For boys, helmets with full face guards, shoulder pads, padded gloves, and mouth pieces are used. It is most important for this equipment to fit properly. If equipment does not fit properly it can actually cause injury. There is no helmet which has been proven through research that confused with a “dislocated shoulder,” which is when prevents concussions. the shoulder comes out of socket. Dislocated shoulders What are the most common types are not common in lacrosse. of lacrosse injuries? Concussions Contusions Concussions are quite common in lacrosse. For more information, please refer to our concussion handout. Because of the nature of the sport, bruises or contusions are very common in lacrosse. Contusions How can lacrosse injuries be prevented? are best initially treated with ice, compression, and elevation of the affected area. • Stay active year round Knee Injuries • Incorporate strength training and stretching into your normal routine Lacrosse players commonly injure their knees. Sprains of the medial and lateral collateral ligaments • Wear properly fitted equipment (MCL/LCL) occur. More serious injuries of the anterior and posterior cruciate ligaments (ACL/PCL) and to the • Hydrate adequately before, during, and menisci (cartilage of the knee) can also happen.
    [Show full text]
  • Total Joint Replacement Hip and Knee Pain Pinnacle Orthopedics Pinnacle Medical Network Total Joint Replacement
    Total Joint Replacement Hip and Knee Pain Pinnacle Orthopedics Pinnacle Medical Network Total Joint Replacement About Pinnacle Orthopedics and Pinnacle Medical Network South Louisiana’s Premier System for the Delivery of Musculoskeletal Health Care. Our talented team and professional staff offer a fully- equipped facility for the comprehensive care of your bones, joints, ligaments and muscles. Our team is dedicated to your complete care, from assessment to full recovery. Our primary goal is your safe return to work, sports, play and the activities of daily living. Allow our medical professionals to advance your orthopedic care. Total Joint Replacement “It would be embarrassing to get out of a car because everybody had to help me. Somebody would have to pull me up. I felt like this old woman.” “My life got progressively less active, less fun, and less participative.” “Just a day on my feet was exhausting and the pain became greater and greater until Advil and ibuprofen and all of those kinds of drugs couldn't numb it out. It just got worse and worse.” Total Joint Replacement Does this sound familiar? Total Joint Replacement You’re Not Alone More than 43 million people have some form of arthritis. It is estimated that the number of people affected by arthritis will increase to 60 million by 2020. Source: CDC Total Joint Replacement This information will touch upon the following topics: Understanding the Causes of Joint Pain Treatment Options What Joint Replacement Surgery Involves Realistic Expectations After Joint Replacement Total Joint Replacement Total Joint Replacement Total Joint Replacement Did you know? Nearly 21 million Americans suffer from osteoarthritis, a degenerative joint disease that is a leading cause of joint replacement surgery.
    [Show full text]
  • Thoracolumbar Spine
    THORACOLUMBAR SPINE Code No. TITTLE Running Serial No. time (Description) Minutes 29028 Percutaneous Lumbar Discectomy, Current 15:00 TL.S practice 1 Designed to teach the operative technique of percutaneous lumbar discectomy & to point out the importance of correct positioning of the instrument in order to avoid neural injury & achieve better evacuation of the posteriorly lodged fragments. 22046 Anterior Approaches to the Lumbar Spine TL.S Demonstrates the anterior lumbar spine 2 anatomy & the anterior retroperitoneal, anterior transperitoneal & anterolateral flank surgical approaches. The anterior lumbar arthrodesis is shown through cadaveric dissection, graphics & models. 22044 Anterior Retroperitioneal Approach & TL.S Fusion of the Lumbar Spine. 3 Demonstrates anterior retroperitoneal approach which provides direct access to the spine, as well as the intervening discs between the diaphragm & the sacrum. The approach is utilized for traumatic, infectious, degenerative, congenital & developmental anomalies of the lumbar spine. 21029 Anterior Spinal Canal Decompression & TL.S Interbody Fusion for Treatment of 4 Herniated Thoracic Disks 21028 Arthroscopic Microdiscectomy TL.S 5 21030 Evaluation of the Scoliosis Patient 38:00 TL.S Demonstrates the proper method of 6 evaluating the adolescent scoliosis patient, using physical examination & radiological evaluation & emphasizing the use of the spinal & neurologic evaluation. 29029 Cotrel-Dubousset Instrumentation for TL.S single thoracic idiopathic scoliosis 7 Demonstrates the classic technique of Cotrel- Dubousset instrumentation for a flexible right thoracic idiopathic scoliosis. 22045 Laminotomy/I) disketomy Surgical TL.S Technique with the patient in kneeling 8 position 22047 Microscopic Lumbar Laminectomy 38:00 TL.S With vedio camera 9 20009 The Nulceotome procedure in Automated TL.S Percutaneous Lumbar discectomy 10 Discusses the indications & contraindications for percutaneous discectomy & provides a step by step illustration of the procedure.
    [Show full text]
  • Subacromial Decompression in the Shoulder
    Subacromial Decompression Geoffrey S. Van Thiel, Matthew T. Provencher, Shane J. Nho, and Anthony A. Romeo PROCEDURE 2 22 Indications P ITFALLS ■ Impingement symptoms refractory to at least • There are numerous possible 3 months of nonoperative management causes of shoulder pain that can ■ In conjunction with arthroscopic treatment of a mimic impingement symptoms. All potential causes should be rotator cuff tear thoroughly evaluated prior to ■ Relative indication: type II or III acromion with undertaking operative treatment clinical fi ndings of impingement of isolated impingement syndrome. Examination/Imaging Subacromial Decompression PHYSICAL EXAMINATION ■ Assess the patient for Controversies • Complete shoulder examination with range of • Subacromial decompression in motion and strength the treatment of rotator cuff • Tenderness with palpation over anterolateral pathology has been continually acromion and supraspinatus debated. Prospective studies • Classic Neer sign with anterolateral shoulder have suggested that there is no difference in outcomes with and pain on forward elevation above 90° when without subacromial the greater tuberosity impacts the anterior decompression. acromion (and made worse with internal rotation) • Subacromial decompression • Positive Hawkins sign: pain with internal rotation, performed in association with a forward elevation to 90°, and adduction, which superior labrum anterior- causes impingement against the coracoacromial posterior (SLAP) repair can potentially increase ligament postoperative stiffness. ■ The impingement test is positive if the patient experiences pain relief with a subacromial injection of lidocaine. ■ Be certain to evaluate for acromioclavicular (AC) joint pathology, and keep in mind that there are several causes of shoulder pain that can mimic impingement syndrome. P ITFALLS IMAGING • Ensure that an axillary lateral ■ Standard radiographs should be ordered, view is obtained to rule out an os acromiale.
    [Show full text]
  • Shoulder Dislocation
    Shoulder Dislocation The human shoulder is an amazing machine. The unique us (ball) and the glenoid (socket) help prevent the anatomy of the shoulder enables the greatest range of joint from dislocating. The labrum, a firm tissue motion of any joint in the body. The shoulder allows over- that surrounds the glenoid, is another important head activities like screwing in a lightbulb and provides structure. When an injury happens, these liga- the strength to do a handstand or throw a 95-mile per ments and the labrum can be damaged, and a hour fastball. shoulder dislocation can result. Under normal circumstances, we rarely stop to think Causes about our shoulders. When an injury to the shoulder The normal shoulder joint can be thought of as a golf ball occurs, however, it often can be impossible to ignore. A balancing on a tee. If a large enough force in the right shoulder dislocation is one of those injuries. This article direction is applied to the arm, the ball will dislocate from covers the important aspects of shoulder dislocation: nor- the socket. This causes pain, and the shoulder will ap- mal anatomy, anatomy of a dislocation, diagnosis, treat- pear and feel abnormal. It will be difficult to move the ment, and future considerations after a dislocation. shoulder and arm. Sometimes the shoulder will go back into place on its own. When the shoulder will not go back Normal Anatomy of the Shoulder into place on its own, a reduction is required. This usually When most people think of the shoulder joint, the “ball involves a trip to the emergency room or other health and socket” comes to mind.
    [Show full text]
  • A Miniature from the 15Th Century That Narrates Shoulder Reduction
    DOI: 10.14744/ejmo.2017.46855 EJMO 2017;1(3):179-182 Letter to the Editor A Miniature From the 15th Century That Narrates Shoulder Reduction Engin Kesgin Private Antalya Medical Center, Antalya, Turkey Cite This Article: Kesgin E. A Miniature From 15th Century That Narrates Shoulder Reduction. EJMO. 2017; 1(3): 179-182 erefeddin Sabuncuoglu (1385–1470 A.D.) was a sur- gical textbook in Anatolian medicine.[2] Sgeon who lived in Amasya, which is in the northern part Sabuncuoglu was a master of Turkish, his mother lan- of middle Anatolia, in the 15th century during the period of guage. Although he knew Arabic, Greek, and Persian, he the Ottoman Empire. During his lifetime, he wrote detailed consciously wrote his book in Turkish because most phy- explanations of surgical methods and used miniatures to sicians and majority of the Anatolian public spoke Turkish demonstrate these methods. He made a significant con- at that time. The other reason was that medical books were tribution to the field of medical sciences, which included commonly written in other languages; thus, the public of the fields of obstetrics, gynecology, vascular surgery, nerve Anatolia was deprived of this knowledge in his era.[2] surgery, ophthalmology, oncology, dentistry, and plastic surgery.[1, 2] The 3rd volume of Sabuncuoglu’s manuscript’s, which deals with fractures and dislocations, includes a very de- His main book, Cerrahiyyet’ul Haniyye (Imperial Surgery), has tailed classification, definition, and treatment methods for three volumes: treatment by cauterization, surgical inter- shoulder dislocation with the inclusion of individual minia- ventions, and fractures and dislocations.
    [Show full text]