Rotator cuff tendon lesions of the subacromial space include tendinosis (impingement syndrome), partial-thickness tears, and full-thickness tears. Full-thickness tears come in all patterns and sizes and can be further classified as being fully reparable, partially reparable, or irreparable, depending on several factors that will be reviewed in later chapters. Impingement syndrome refers to extrinsic compression of the rotator cuff tissue by the acromion or coracoid resulting…

Glenohumeral joint sepsis is an unusual indication for shoulder arthroscopy. Arthroscopy has greatly facilitated the management of this difficult condition. Treatment goals include acquiring fluid cultures and tissue biopsies to identify the infecting organism or organisms and determining the extent of tissue involvement, followed by joint irrigation and débridement in a manner that minimizes morbidity and allows early functional recovery. Serial needle aspirations cannot remove all…

With the increased use of magnetic resonance imaging (MRI), we now diagnose more patients with periarticular shoulder cysts who are referred for care. It is unknown whether this represents a true increase in the incidence of cysts or merely reflects the sensitivity of MRI ( Figs. 8.1–8.3 ). Open full size image FIGURE 8.1 Coronal magnetic resonance imaging of paralabral cyst. Open full size image FIGURE…

Articular cartilage pathology in the shoulder can present in many scenarios. The most common is some degree of osteoarthrosis or chondromalacia. The less common scenarios are avascular necrosis, rheumatoid arthritis, chondrolysis, and osteochondromatosis. The current arthroscopic treatment of these conditions is limited with little scientific evidence to guide orthopedic surgeons, but with increased knowledge and technology, this will inevitably change. The lesions that surgeons encounter in…

There are three basic conditions that produce shoulder stiffness and are amenable to arthroscopic treatment: idiopathic adhesive capsulitis, posttraumatic stiffness, and postoperative stiffness. The treatment of the stiff, osteoarthritic shoulder is discussed in Chapter 7 . Idiopathic adhesive capsulitis is widely believed to be a painful but self-limited condition that resolves between 6 months and 2 years. Recent reports suggest that although most patients improve, many…

The long head of the biceps tendon has both intra-articular and extra-articular segments. Biceps lesions can occur at the supraglenoid attachment, intra-articularly (lateral to the supraglenoid attachment), or extra-articularly. Regardless of the specific site of pathology, the long head of the biceps tendon is a common source of pain in the shoulder. Debridement, “superior labrum anterior-to-posterior” (SLAP) repair, biceps tenodesis, or biceps tenotomy are options for…

Orthopedic surgeons have a fundamental desire to find a simple solution to glenohumeral instability, leading to various operative approaches. Despite the fact that Bankart and Perthes had independently described anterior labral pathology in the 1900s, surgeons in the mid-1900s observed that abduction and external rotation resulted in glenohumeral joint dislocation. Consequently, several operations were popularized to eliminate dislocation by limiting the offending motion—external rotation. These procedures…

Only with an understanding of normal glenohumeral joint and subacromial space anatomy can the surgeon appreciate which structures are damaged. Diagnostic Glenohumeral Arthroscopy Portal placement is critical, so it is important to take sufficient time to mark the portal sites precisely. Draw the bone outlines of the acromion, the distal clavicle, and the coracoid with a surgical skin marker. Be careful not to draw the most…

This chapter covers the general organization of the operating room, anesthesia, patient positioning, as well as equipment and instruments. Clinical Data It is helpful to have a copy of the patient's record in the operating room. This allows the surgeon to compare the examination under anesthesia with the examination documented in the office. For patients with glenohumeral instability, the surgeon can compare the patient's report of…

In the initial edition of this text, we approached teaching shoulder arthroscopy from the vantage point that a minority of the current surgeons in practice had trained in shoulder arthroscopy. We therefore titled the first chapter “Making the Transition.” However, at present, most young orthopedic surgeons have already learned the basic skills of shoulder arthroscopy during their residency or fellowship. Despite this shift, it is still…