Physical Address

304 North Cardinal St.
Dorchester Center, MA 02124

Transitioning From Open to Arthroscopic Rotator Cuff Repair: Pearls for Success

Introduction The goal of any rotator cuff repair technique is to relieve pain, improve strength, increase range of motion, and restore function. An arthroscopic rotator cuff repair can be demanding and requires a sound understanding of biomechanics and tear patterns as well as attention to details. Yet, the credibility of the arthroscopic technique for rotator cuff repair has advanced so dramatically over the past two decades…

Open and Mini-Open Rotator Cuff Repair: State of the Art

Introduction The goals of rotator cuff repair surgery are to relieve pain; decrease the likelihood of rotator cuff tear extension; and restore strength, motion, and function of the shoulder. The most predictable result is that of pain relief, whereas restoration of strength and motion is less predictable. Throughout the years, surgical techniques have evolved from all-open approaches with detachment of the anterior deltoid to all-arthroscopic techniques.…

Surgical Management of Impingement Syndrome and AC Joint Arthrosis

Introduction Shoulder pain is a common presenting complaint in patients of varying ages and activity levels. Cross-sectional studies have quantified the prevalence of shoulder pain in different countries as ranging from 4.7% to 46.7% in the general population. Although Neer clearly outlined the stages of impingement, interpreting epidemiologic trends of impingement syndrome can be challenging because the term is generically applied to a variety of shoulder…

Patient Positioning and Anesthesia for Rotator Cuff Surgery

Introduction Shoulder arthroscopy can be performed with the patient in either the lateral decubitus position (LDP) or the beach chair position (BCP). There are advantages and disadvantages of both positions with respect to the ease, efficiency, and economics of setup; conversion to an open approach; orientation and visualization; the best type of anesthesia; and the complications and risks. Regardless of the position used, improper setup can…

Anchors and Fixation Devices for Cuff Tears: What Is the State of the Art?

Introduction Arthroscopic repair of the rotator cuff could not have advanced as rapidly as it has without improvements in the implants that allow fixation of the damaged tendon to bone. Suture anchors and high-strength sutures are essential to this technique. The suture and suture anchor’s function is to secure the tendon to the appropriate site without excessive tension or loosening until physiologic healing can occur. Conceptually,…

When to Fix a Cuff Tear: Surgical Indications

Introduction A rotator cuff tear (RCT) is a commonly encountered diagnosis that, when symptomatic, can be treated operatively or nonoperatively. Often, it can be an incidental finding on imaging that necessitates no specific management. However, patients are often symptomatic and will require some form of treatment. The majority of patients with an atraumatic RCT will have improved pain and functional scores with a nonoperative treatment regimen.…

Nonoperative Care of Rotator Cuff Disorders: Physical Therapy, Modalities, and Injectables

Introduction Rotator cuff lesions are among the most common causes of shoulder pain and upper quarter disability seen in orthopedics and physical therapy. Surprisingly, a lack of data exists on the natural history of patients with rotator cuff disease, but in general the frequency of rotator cuff tears increases with age, and full-thickness tears are uncommon in patients younger than 40. Once thought to be predominately…

Impingement Syndrome: Diagnosis and Management

Introduction Shoulder impingement syndromes are caused by external or internal impingement. External impingement includes subacromial and subcoracoid impingement, and is caused by the abnormalities of the anterolateral acromion and coracoacromial arch, leading to disorders of the outlet structures. Internal impingement is caused by pinching of the posterosuperior labrum on the glenoid rim and the undersurface of the rotator cuff with the arm in abduction and external…

Imaging for Rotator Cuff Pathology

Radiographs Plain radiographs offer an indirect evaluation of the rotator cuff and soft tissue of the shoulder joint, and this imaging modality is an important tool in the diagnosis of shoulder pathology. There are multiple imaging findings that can provide indirect information on the status of the rotator cuff and shoulder joint. This is a good first-line evaluation for shoulder pathology. Indications It is our preference…

Rotator Cuff History and Physical Exam

Introduction Rotator cuff tears and rotator cuff pathology are exceedingly common causes of shoulder pain, with many studies citing them as the leading causes of shoulder pain. Successful treatment of rotator cuff disorders hinges on making an accurate diagnosis. Clinicians need to be aware of patient factors that predispose to rotator cuff disease, including a history of trauma, advanced age, diabetes, hyperlipidemia, obesity, and a positive…

What Happens With Cuff Tears?: Natural History and Epidemiology

Introduction Rotator cuff disease is prevalent in the aging population and is the most common cause of shoulder disability. Considerable controversy exists in the orthopedic community regarding the optimal management of rotator cuff pathology. By studying the natural history, we can better understand risk factors for tear enlargement and the progression of irreversible muscle changes with time. This allows the refinement of surgical indications and provides…

Biomechanics and Clinical Functionof the Rotator Cuff

Introduction The shoulder is a complex anatomic structure due to its multiple passive and active structures working together for stability and joint motion. The shoulder’s ability for multiple degrees of motion is based on the interaction of multiple structures that react to mechanical stimuli and adjust accordingly. The rotator cuff, a group of muscles surrounding the glenohumeral joint, not only acts as a dynamic stabilizer further…

Arthroscopic Anatomy of the Shoulder and Cuff

Introduction Recent advances in arthroscopic techniques, instrumentation, and implants have revolutionized the management of rotator cuff pathology. For nearly all rotator cuff tear types, arthroscopic repair has been repeatedly demonstrated to be safe and effective when compared with equivalent open surgical procedures. Among many other advantages, arthroscopy allows for outstanding visualization of the rotator cuff tissue and surrounding intraarticular structures. An appreciation of the arthroscopic anatomy…

Clinical Anatomy of the Rotator Cuff

Introduction Traditional comprehension of anatomy cannot keep up with technologic progress in medicine, especially advances in shoulder surgery. The rapid pace of technologic change in arthroscopic procedures and practices and advances in imaging methods require a better comprehension of detailed arthroscopic structures that cannot be observed by human visual means. Due to the current high numbers of arthroscopic surgeries, it is critical that this covers both…

Spine Issues in Skeletally Immature Athletes

There are many challenges facing the sports physician in the care of the spine in pediatric athletes. They may be asked to evaluate a child or adolescent with a known condition and assess whether he or she can safely participate in athletic activities. Second, when an acute traumatic event has occurred, sports physicians may be asked to evaluate and provide initial management for the injured athlete.…

Head Injuries in Skeletally Immature Athletes

The incidence of sports- and recreation-related traumatic brain injuries (TBIs) has continued to increase during the past decade. The two most common athletic activities associated with emergency department treatment for TBI are bicycling and football. Risk for TBI is inherent to participation in sports and recreation activities, and compared with adults, children and adolescents have an increased risk for TBIs, with increased severity and prolonged recovery.…

Foot and Ankle Injuries in the Adolescent Athlete

Most of the injuries that occur in the ankle and foot of the pediatric athlete are not unique to athletic participation but occur normally during childhood. However, some injuries occur with greater frequency in the athlete. The conditions covered in this chapter occur in childhood and may present in the athlete, raising the question of whether the athlete should be allowed to participate in sports activities.…

Knee Injuries in Skeletally Immature Athletes

Anterior Cruciate Ligament Injuries Injuries to the anterior cruciate ligament (ACL) in skeletally immature athletes were traditionally thought to be rare. Historically, the incidence of ACL rupture in this population was reported as 1% to 3.4%. Avulsion of the tibial spine was reported to be more common than ACL rupture. However, as awareness of these injuries has increased, and with improvements in diagnostic modalities, especially MRI,…

Pediatric and Adolescent Hip Injuries

Almost a decade ago it was estimated that over 30 million children participated in organized sports programs, with a third of them suffering an injury yearly that required evaluation by a nurse or physician. There are physical and physiologic differences between the adolescent and adult athlete that may cause the younger athlete to be more vulnerable to injury. Children may not have as much coordination and…

Wrist and Hand Injuries in the Adolescent Athlete

The incidence of hand injuries increases 20-fold after age 10, with sports being the most common mechanism of injury. High impact sports such as football tend to produce injuries from single traumatic events, whereas repetitive overuse injuries are more common in sports such as gymnastics, golf, and tennis. We have focused on conditions and treatment considerations unique to the adolescent population. One of the most challenging…