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Glenoid component

Historically, the glenoid component has been the “weak link” of shoulder replacement. In addition to being the most difficult part of the surgical procedure, the glenoid component is the most likely site of component failure, which has led many surgeons to avoid glenoid resurfacing in nearly all cases. Fortunately, glenoid component materials and designs have improved greatly, as have techniques for implantation of glenoid components. Problems…

Glenoid exposure

Whenever we have questioned surgeons who routinely perform hemiarthroplasty instead of total shoulder arthroplasty for conditions such as primary osteoarthritis about why they chose not to resurface the glenoid, by far the most common response is that they encounter problems with glenoid exposure. When questioned further, it is evident that most of these surgeons simply lack the information necessary to correctly and reliably provide visualization of…

Preoperative planning and imaging

Although the majority of cases of unconstrained shoulder arthroplasty are routine, certain patients have unique characteristics that merit special consideration. Preoperative planning identifies patients who may require deviation from routine unconstrained shoulder arthroplasty. Preoperative planning should be done well in advance of the surgical procedure and not be an afterthought the morning of surgery. The surgeon should review the patient's clinical history and physical examination, radiographs,…

Indications and contraindications

Indications for unconstrained shoulder arthroplasty can be divided into arthroplasty performed for acute fracture and arthroplasty performed for chronic shoulder disease. This chapter focuses on indications for unconstrained shoulder arthroplasty in patients with chronic shoulder disease. Indications for unconstrained shoulder arthroplasty in patients with an acute fracture are covered in Chapter 26 . Multiple chronic indications for unconstrained shoulder arthroplasty include, but are not limited to,…

Anesthesia, patient positioning, and patient preparation

This chapter reviews the anesthesia used for shoulder replacement surgery. Additionally, proper patient positioning and surgical preparation and draping are described. Anesthesia Provided that no contraindication exists, all of our shoulder arthroplasty patients undergo a preoperative interscalene block administered in the preoperative holding area by an anesthesiologist. The interscalene block serves two purposes. First, use of the block minimizes the amount of general anesthetic needed during…

Operating room setup

This chapter outlines the organization of the operating room used for shoulder arthroplasty. Organization of the arthroplasty surgical suite focuses on the correct position of equipment, staff, and lights. In addition, all necessary surgical instrumentation must be available. Operating Room Layout A large operating room is preferable when shoulder arthroplasty is being performed. Larger operating rooms allow a complete set of implants to be stored in…

Becoming a shoulder arthroplasty surgeon

Shoulder arthroplasty is much less frequently performed than hip and knee arthroplasty; it accounts for only 7.5% of inpatient joint replacements in the United States, largely because hip and knee arthrosis is much more common than glenohumeral arthrosis. Additionally, patients with glenohumeral arthrosis tolerate the symptoms better than those with hip and knee arthrosis because they do not rely on their shoulders for locomotion. Consequently a…

Evolution of shoulder arthroplasty

First Shoulder Arthroplasty Although Jules Emile Péan is credited with performing the first shoulder arthroplasty, it was probably Themistocles Gluck who first recognized prosthetic replacement as a potential treatment option in the shoulder. Gluck, a Romanian who studied in Germany in the second half of the 19th century, pioneered joint replacement for the treatment of tuberculosis infection. Gluck reported on his design of an ivory shoulder…

Olecranon Stress Fractures

Introduction ▪ Olecranon stress fractures are relatively rare injuries that have been described in overhead or throwing athletes, such as baseball and softball players, weight lifters, gymnasts, and divers ( ), ▪ The condition was documented originally in a javelin thrower in 1946 ( ) and later in overhead throwing athletes in multiple case series ( ) and then in a 2014 case series of 200…

Osteochondritis Dissecans of the Capitellum

Osteochondritis dissecans (OCD) of the capitellum is a condition of the lateral elbow that often affects skeletally immature athletes, especially those who repeatedly subject the radiocapitellar joint to compressive forces. Ultimately, repetitive stress of this nature leads to disruption of a localized portion of the subchondral bone and, if allowed to progress, the overlying articular cartilage. The etiology of this disorder is multifactorial and often cannot…

Triceps Tendon Injury

Introduction ▪ Distal triceps tendon injuries are very rare. ▪ These injuries have a 2:1 male:female ratio and are most commonly seen in individuals 30 to 50 years of age. ▪ These injuries occur after an eccentric loading of the triceps tendon. ▪ Tears involving less than 50% of the tendon may be treated conservatively. ▪ Complete tears require operative fixation. ▪ Several techniques exist for…

Distal Biceps Tendon Injury

Epidemiology, Etiology, Anatomy, History, Examination, and Imaging Samuel A. Taylor, MD Frank A. Cordasco, MD, MS Abstract Distal biceps ruptures are most common among middle-aged men and occur most commonly in the dominant arm and is associated with the following risk factors: smoking, history of anabolic steroid use, chronic renal disease, elevated body mass index, and history of contralateral rupture. Mechanism of injury may be related to a…

Lateral: Extensor Carpi Radialis Brevis Tendon Injury

Introduction ▪ Lateral epicondylitis is the most common overuse disorder affecting the lateral side of the elbow. ▪ This syndrome typically presents with intense pain about the extensor origin (lateral aspect) of the elbow. The pathogenesis of this disease originates from the extensor carpi radialis brevis (ECRB) tendon, but other closely associated structures can cause similar pain. ▪ Lateral epicondylitis historically was associated with the sport…

Medial: Flexor-Pronator Tendon Injury

Introduction ▪ The flexor-pronator muscle mass at the medial side of the elbow provides dynamic stability against valgus forces. Flexor-pronator tendon degeneration occurs with repetitive forced wrist extension and forearm supination during activities involving wrist flexion and forearm pronation. ▪ Athletes may be particularly symptomatic during the late cocking or early acceleration phases of the throwing motion. ▪ Nonsurgical management is the mainstay of treatment, and…

Lateral: Posterolateral Rotary Instability

Introduction ▪ This chapter reviews posterolateral rotary instability of the elbow. ▪ Elbow instability may significantly limit a patient’s function and ability to perform sports and activities of daily living. ▪ Posterolateral rotary instability has become more frequently and accurately recognized because of improved understanding of elbow anatomy, biomechanics, diagnostic physical exam techniques, and treatment options. ▪ Imaging modalities are serving a more important role in…