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Arthroscopic management of lateral epicondylitis

OVERVIEW Chapter synopsis Lateral epicondylitis, also known as “tennis elbow,” is a chronic overuse injury and a common source of elbow pain. Patients who fail conservative treatment may be considered for arthroscopic debridement of the extensor carpi radialis brevis (ECRB) origin. Arthroscopic treatment is minimally invasive, clinically effective, allows for assessment of concomitant intra-articular pathology, and is well-tolerated by patients. This chapter details the preoperative considerations,…

Elbow synovitis, loose bodies, and posteromedial impingement

Overview Chapter synopsis Overhead-throwing athletes place a tremendous amount of force on their elbows during activity. Over time, this may lead to inflammatory conditions, posteromedial impingement, osteophytes, and loose bodies. Elbow arthroscopy has become the treatment of choice for these conditions when nonoperative treatment has failed. A thorough history and physical examination are necessary to guide the surgeon to the proper diagnosis and subsequent use of…

Arthroscopic management of elbow stiffness and arthritis

OVERVIEW Chapter synopsis Stiffness and contracture of the elbow are common after elbow injury, surgical interventions, and with arthritic conditions. Initial treatments are typically nonoperative and include static bracing and structured rehabilitation. For patients who experience suboptimal motion that severely limits their activities of daily living, surgical intervention is typically indicated. Arthroscopic techniques are a viable alternative to traditional open contracture release. Important points Arthroscopic contracture…

Arthroscopy of the thrower’s elbow

OVERVIEW Chapter synopsis Valgus extension overload can cause posteromedial pain in the thrower’s elbow as osteophytes form on the posteromedial aspect of the olecranon and impinge on the olecranon fossa. Repetitive microtrauma results in the attenuation and instability of the medial ulnar collateral ligament (MUCL), and increased forces on the radiocapitellar joint causes chondromalacia and possible osteochondritis dissecans (OCD). Arthroscopic spur resection and removal of loose…

Arthroscopic and open management of osteochondritis dissecans of the elbow

Overview Chapter synopsis Osteochondritis dissecans is a multifactorial focal insult to the articular surface resulting in separation of the articular cartilage and subchondral bone. In the elbow, the most common location for osteochondritis dissecans is the capitellum and generally it occurs in younger (12–14 years old) athletes with a history of overuse. Most often patients present with pain and inability to participate in sports and radiographs…

Patient positioning and portal placement

OVERVIEW Chapter synopsis A thorough understanding of the indications for elbow arthroscopy and the anatomic structures about the elbow allows safe and effective arthroscopic treatment of a number of elbow disorders. Appropriate patient positioning and correct portal placement are essential. Important points Thorough physical and imaging examinations are necessary for accurate diagnosis. A complete patient history is essential for identifying differential diagnoses. The most common contraindications…

General principles of elbow surgery

OVERVIEW Chapter synopsis Surgical management of athletic injuries of the elbow necessitates a detailed understanding of the intricate anatomy and the complex range of functions of the elbow. This chapter provides a detailed, technical anatomic overview. Following surgical intervention, return to function of the elbow is dependent on successful rehabilitation; an understanding of these principles is requisite of surgeons. Important points The flexion crease of the…

Nonarthroplasty options for glenohumeral arthritis and chondrolysis

OVERVIEW Chapter synopsis Glenohumeral arthritis in the young and active population remains a challenge. Chondrolysis is defined as a diffuse, rapid cartilage destruction with narrowing or loss of joint space. A detailed patient history, examination, and advanced imaging modalities are key to identify the etiology and to develop an individualized treatment strategy. Nonoperative treatment, including patient education, pharmacotherapy, physical therapy, and intra-articular injections should be considered…

Arthroscopic pectoralis minor tenotomy

OVERVIEW Chapter synopsis Pectoralis minor syndrome results from pathologic tightness or hyperactivity of the pectoralis minor that can produce periscapular and neurogenic symptoms. Non-responders to physical therapy can be treated successfully with arthroscopic pectoralis minor tenotomy Important points A history of overhead sports or prior surgical intervention A constellation of anterior shoulder pain, nonspecific neurological symptoms, and tenderness along the pectoralis minor insertion Positive response to…

Management of pectoralis major muscle injuries

OVERVIEW Chapter synopsis The incidence of pectoralis major muscle tears continues to increase. Understanding the mechanism of injury and a thorough physical examination are essential for the proper diagnosis of such injury. For active, high-demand individuals, surgical repair is recommended to return to pre-injury levels. Important points History and physical examination are often sufficient to make the diagnosis of a pectoralis major muscle injury. While technically…

Anatomic acromioclavicular joint reconstruction

OVERVIEW Chapter synopsis Acromioclavicular joint injuries are among the most common shoulder injuries. Classification and indication for surgical or nonsurgical treatment are based on clinical and radiologic findings. Recent surgical techniques allow for anatomic reconstruction of the unstable joint. Important points Classification is based on both clinical and radiologic examination findings. High-grade injuries—typically types IV, V, and VI, with greater than 100% displacement in either a…

Biceps tenodesis: Open techniques

OVERVIEW Chapter synopsis Biceps tenodesis is an effective treatment for pathologies of the long head of the biceps tendon. This chapter presents a technique for a mini-open subpectoral biceps tenodesis using a technique with an all-suture anchor preloaded with needles. This technique allows efficient and proper tendon fixation while minimizing potential complications. Important points Be sure that concomitant problems such as rotator cuff pathology are diagnosed…

Biceps tenodesis: Arthroscopic techniques

OVERVIEW Chapter synopsis Biceps tenodesis is an effective treatment for pathology of the long head of the biceps tendon. Recent evidence has seen an increase in the number of biceps tenodeses performed. This chapter discusses arthroscopic methods for performing tenodesis, explaining the procedures in a stepwise manner. Common pitfalls and clinical pearls are also discussed. Important points Be sure that concomitant problems such as rotator cuff…

Scapulothoracic fusion

OVERVIEW Chapter synopsis Scapulothoracic fusion is a complex procedure that is used in salvage situations. Indication for this procedure include facioscapulohumeral dystrophy or conditions that lead to periscapular muscle or nerve injury that cause significant winging. Pain and loss of motion are often the driving symptoms for scapulothoracic fusion. Results can be good when the procedure is used in the right patient population. Important points Scapulothoracic…

Arthroscopic and open management of scapulothoracic disorders in athletes

OVERVIEW Chapter synopsis Scapulothoracic bursitis, crepitus, dyskinesis, and winging are related conditions of the shoulder that are frequently seen together in different combinations. Crepitus, or snapping scapula, may be asymptomatic or may be seen with bursitis. Nonoperative treatment is often effective and includes corticosteroid injections in the scapulothoracic bursae and physical therapy. Surgery to resect inflamed bursae and/or bony prominences may be performed arthroscopically or via…

Arthroscopic capsular release for the treatment of stiff shoulder pathology

OVERVIEW Chapter synopsis The arthroscopic management of stiff shoulder pathology is detailed. The diagnosis, imaging, indications for operative treatment, and specific technique of arthroscopic capsular release, along with aftercare, are detailed. Important points Patients that have not responded to appropriate conservative treatment and have had symptoms for over 4 months are candidates for arthroscopic capsular release. An existing shoulder arthroplasty implant may be more effectively treated…

Arthroscopic management of glenohumeral osteoarthritis

OVERVIEW Chapter synopsis Osteoarthritis resulting in pain and functional limitations is a significant and growing problem with an aging population. Many treatment options exist, ranging from conservative treatment and physical therapy to total shoulder arthroplasty. Although arthroplasty procedures are effective in reducing pain and improving function, the longevity of total shoulder implants makes this a less desirable option in younger and more active individuals. As a…

Arthroscopic and open decompression of the suprascapular nerve

OVERVIEW Chapter synopsis Suprascapular nerve compression at the suprascapular notch and spinoglenoid notch can cause a significant shoulder pathology. This can be surgically managed with arthroscopy, open release of the transverse suprascapular ligament (TSL), or excision of a pathology in the spinoglenoid notch. Important points Superior and posterolateral shoulder pain is common. Space-occupying lesions or dynamic conditions can cause suprascapular neuropathy. It is important to rule…

Arthroscopic repair of superior labral anterior-posterior lesions

OVERVIEW Chapter synopsis Superior labrum, anterior-to-posterior, lesions, a.k.a. “SLAP” lesions, continue to present problems both in terms of making an accurate diagnosis of a symptomatic SLAP lesion and in terms of decision-making as to the ideal treatment. This chapter discusses preoperative considerations, surgical technique, and results. In addition it provides a list of references that a shoulder surgeon can use to optimize patient outcomes and minimize…

Biologics in rotator cuff repair

OVERVIEW Chapter synopsis High failure rates after rotator cuff repair have encouraged the search for biologics that may stimulate improved healing. This chapter will consider a number of different biologic approaches to augmenting rotator cuff repairs. Key cytokines and growth factors that play important roles are identified as potential targets for biologic therapies. The efficacy and limitations of a number of commercially available biologic treatments are…