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Rotator Cuff Contusion

Nonoperative Treatment, Including Injections, Rehabilitation, and Indications for Surgery James J. Kinderknecht, MD Abstract Sports-related injuries to the rotator cuff are fairly common, especially partial tears, which are most often traumatic injuries but can also be due to “overuse” of the glenohumeral joint. Treatment of rotator cuff tears is variable and depends upon the degree of the tear, but it is standard for non-surgical management to be…

Overview

Introduction ▪ Rotator cuff tears are common in throwers and contact athletes. ▪ A thorough knowledge of shoulder anatomy is essential to translating patient history, physical examination, and imaging findings into a treatment plan. ▪ In the athletic population, the mechanism of injury and host factors are often quite different from the typical degenerative tears seen in older patients. ▪ Many rotator cuff tear classification systems…

Shoulder Instability Rehabilitation and Return to Sport

Postoperative Rehabilitation: Anterior Stabilization Terrance A. Sgroi, PT, DPT, SCS, MTC Abstract The shoulder is an inherently unstable ball and socket joint that places that places high demands on the glenohumeral joint, so the rehabilitation process following an arthroscopic anterior shoulder stabilization surgery must be detailed and individualized. The rehabilitation process is divided into 5 phases, with each phase becoming more aggressive in exercise protocol and therapy…

Multidirectional Shoulder Instability

Epidemiology, Mechanism of Injury, History, Imaging, and Physical Examination Tracey Didinger, MD Joseph D. Cooper, MD Seth C. Gamradt, MD Abstract It is critical to diagnose multidirectional instability (MDI) because standard surgical procedures used to treat traumatic anterior shoulder instability are oftentimes inadequate to address MDI. This diagnosis can be made challenging due to the similarity between laxity and instability. The most common cause of MDI is congenital redundancy…

Posterior Shoulder Instability

Epidemiology, Mechanism of Injury, History, Physical Examination, and Imaging Joseph A. Gil, MD Brett D. Owens, MD Abstract When treating posterior instability knowledge of risk factors that predispose a patient to develop this condition, possible mechanisms of injury, and how to diagnose it via physical examination and imaging are key. Cases presenting on the different places on the subluxation to dislocation spectrum, caused by either repetitive microtrauma, acute…

Anterior Shoulder Instability

Epidemiology, Mechanism of Injury, History, Physical Examination, and Imaging for Anterior Instability LCDR James R. Bailey, MD Barrett A. Little, MD Kevin M. Dale, MD Dean C. Taylor, MD Abstract Anterior shoulder instability can be a difficult injury for both athletes to sustain and surgeons to treat. This chapter describes the epidemiology, mechanism of injury, history, physical examination, and imaging of this diagnosis. Keywords: anterior shoulder instability; epidemiology; history; imaging;…

Surgical Procedures for the Control of Chronic Pain

The results of conventional surgical therapy (e.g., deafferentation) for chronic benign pain syndromes are poor. The results of so-called neuromodulation therapy, neurostimulation, and infusion techniques are continually improving, however, particularly in benign pain syndrome, which has typically been the most challenging to treat. Surgical experience with central deafferentation (e.g., cordotomy) suggested that patients with neoplastic pain achieved satisfactory pain relief more frequently than those with benign…

Functional Restoration in Chronic Spinal Pain

Functional Restoration Principles Functional restoration is an intensive and goal-oriented form of interdisciplinary chronic pain management. It was originally developed at the Productive Rehabilitation Institute of Dallas for Ergonomics (PRIDE) to treat individuals with chronic spinal pain (CSP) who are disabled from performing important activities of daily living (ADLs), including work duties. It is now applicable to many forms of chronic pain in addition to CSP,…

Physical Therapy: Art and Science of Practice

Introduction Most spine specialists recognize that early mobilization (activation) of patients with neck or back pain is not harmful and is, in fact, necessary. Activity early in an acute course of neck/back pain shows 50% improvement of pain symptoms in greater than 90% of patients. For this reason, physical therapy is the first-line treatment and remains the backbone of spine care. Most patients suffering an acute…

Pharmacologic Strategies in Back Pain and Radiculopathy

Back pain is a major health problem in the United States. About 70% to 85% of the population experiences back pain at some point in their lives, with the annual prevalence ranging from 15% to 45%. Usually, the clinical course is benign, with 95% recovering within a few weeks to months of onset. It is most common in middle-aged adults, with equal distribution in men and…

Psychological Strategies for Chronic Pain

Pain is not what occurs at the periphery; it is what the brain perceives, and it is indisputably modifiable by emotions and beliefs. Actual damage is neither necessary nor sufficient for the perception of pain. Anger, depression, anxiety, fear, and other psychological variables can all increase the perception of both acute and chronic pain, as can believing it to be an indicator of a destructive process.…

Chronic Pain: Basic Science

Pain sensation is an important physiologic means by which an organism is informed about the immediate external environment and internal bodily function. The pain “experience” is the integration of a number of neurologic functions. In response to a brief painful stimulus, a rapid unconscious reflex and subsequent purposeful movement steer the organism away from the source of pain. The painful experience may be paired with a…

Arachnoiditis and Epidural Fibrosis

Spinal arachnoiditis is a nonspecific inflammatory process of the arachnoid layer of the spinal cord or cauda equina. Arachnoiditis was first described by Victor Horsley in 1909. Since Horsley, numerous authors have described it with a variety of terms, including chronic spinal arachnoiditis, adhesive spinal arachnoiditis, meningitis serosa circumscripta spinalis, chronic spinal meningitis, spinal meningitides with radiculomyelopathy, lumbar adhesive arachnoiditis, spinal arachnoiditis, spinal fibrosis, and lumbosacral…

Postoperative Deformity of the Cervical Spine

Introduction The evaluation and management of cervical spine deformity remains one of the most challenging issues within spinal surgery. Although multiple etiologies exist, iatrogenic malalignment represents a significant portion of cases. This chapter focuses on the evaluation of patients with postoperative cervical deformity, reviews preventive measures, and details our surgical approach. A series of case examples demonstrates our current techniques while emphasizing surgical principles. The importance…

Failed Total Disc Arthroplasty

Background There have been multiple high-quality studies evaluating the safety and efficacy of both cervical and lumbar disc arthroplasty; the results of these studies have been favorable enough that surgeons are performing disc arthroplasty surgery with increased frequency. The aim of this chapter is not to delve into the vast amount of literature that addresses the safety, efficacy, and cost-effectiveness of arthroplasty versus fusion. Rather, the…

Revision Spine Surgery

“A goal without a plan is just a wish” – Antoine de Saint-Exupéry The number of elective spinal surgeries performed yearly continues to increase at an accelerating pace. Although advances in diagnostics, implant design, and biologic adjuncts have made these operations more predictable in outcome, a significant number of patients report persistent or recurrent symptoms. These patients represent a major challenge to spine care providers. In…

Failed Back Surgery Syndrome: Historical Perspective

The Edwin Smith Papyrus (17th century bce ) described 48 cases of fractures, tumors, injuries, and wounds that occurred during the time period in which it was written. The document also laid out a fairly complex method of examining and diagnosing the patients who were reported in the document. If that were not enough, the scrolls went on to further separate the injured patients who presented…

Adjacent-Segment Disease

Adjacent-segment pathology (ASP) is a common complication of spinal surgery. This chapter focuses on the causes, common clinical scenarios, and treatment options to avoid or treat ASP. Surgery changes the anatomy, physiology, kinematics, and biomechanics of the operated and contiguous elements of the spine. Nowhere are the influences of these factors more important than at the segments immediately above or below a surgical fusion. Short-term gratification…

Pseudarthrosis

Introduction Spinal fusions are one of the most common spine surgeries performed today. The number of spinal fusion surgeries performed has significantly increased over the past 2 decades. From 1998 to 2008, the rates of spinal fusion surgery have increased by 137%. Although there have been significant improvements in spine surgery over the years, complications still exist. One prevalent complication is pseudarthrosis, which is the failure…

Postoperative Spinal Infections

Introduction Postoperative spinal wound infections are relatively frequent problems that treating spine surgeons must know how to diagnose and address. Although strategies to reduce the occurrence of infection after spine surgery have seen some success, infection rates of up to 20% continue to be reported in the literature. These infections result in significant acute and chronic morbidity to the patient and cause significant financial drain to…