After patients have had surgery, we prefer to instruct them in a home rehabilitation program without the aid of a physical therapist. This assures us that the exercises are appropriate and the patient is less likely to be confused by more than one source of information. Despite this, the internet often interferes with this plan. It is important to be realistic about goals and explain that…

Ultrasound (US) is an excellent imaging modality to diagnose rotator cuff and biceps disorders, but it is by no means the perfect imaging modality for the shoulder. However, there are several other shoulder imaging modalities, such as magnetic resonance imaging (MRI), computed tomography (CT), and radiography. However, US affords several advantages over other modalities, such as MRI. First, it is cheaper to perform than an MRI…

Arthroscopic techniques are rarely used in the treatment of shoulder fractures. However, arthroscopy may be beneficial in some cases of greater tuberosity fracture, coracoid fracture, fracture of the glenoid rim, and displaced intra-articular humeral head malunion. These procedures can be technically demanding and are best used to address small fractures ( Fig. 17.1 ). Open full size image FIGURE 17.1 Anterior glenoid rim fracture. Literature Review…

One of the most painful acute conditions affecting the shoulder is calcific tendinitis. Patients experience a sudden, atraumatic onset of severe pain that is present at rest and increases with any shoulder movement. The pain is often severe enough to cause the individual to present at a local emergency room or to demand immediate evaluation in the orthopedist's office. Patients often appear to be in distress…

Acromioclavicular (AC) joint pathology can be divided into conditions that cause pain or conditions of instability that may cause pain or compromise function. AC joint pain can be secondary to a specific injury, from repetitive minor trauma, or as part of the aging process. The most common etiologies of pain are posttraumatic arthritis, persistent pain from a low-grade AC separation, primary osteoarthritis, rheumatoid arthritis, septic arthritis,…

The biggest problem with the arthroscopic treatment of massive rotator cuff tears is the possibility of misdiagnosis. Often, a massive tear is retracted and appears irreparable, but after soft tissue release, the defect is partially or completely reparable. On the other hand, often the surgeon feels that a repair is possible preoperatively based on imaging, but realizes at the time of surgery that it is not…

It is not clear that there is a specific definition for a massive rotator cuff tear, but it can be loosely defined as one that involves two complete tendon tears or one that is as greater than 5 cm in length from anterior to posterior. It is difficult for surgeons to determine whether a massive, retracted rotator cuff tear is reparable. This is true for both arthroscopic…

An arthroscopic rotator cuff repair consists of the following elements: glenohumeral joint inspection, subacromial space inspection, partial bursectomy, assessment of rotator cuff tendon reparability, identification of tear geometry, coracoacromial ligament (CA) management, acromioplasty, greater tuberosity repair site preparation, anchor placement, suture placement, and knot tying. Each of the individual elements can be accomplished arthroscopically; however, performing them in a single operation requires strict adherence to a…

Partial-thickness rotator cuff tears constitute an interesting and difficult group of shoulder lesions. In large part, the difficulty stems from terminology: we use the phrase partial-thickness rotator cuff tear to describe the anatomic end result of several different pathophysiologic pathways. If we consider rotator cuff disease to be an intrinsic tendinopathy and part of the natural aging process, partial-thickness rotator cuff tears represent a transition from…