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First-time anterior shoulder dislocation: Decision-making and surgical techniques

OVERVIEW Chapter synopsis Introduction: The glenohumeral joint has the largest range of motion of any joint, leaving it susceptible to instability. Pathophysiology: Instability can lead to a wide variety of injuries to the shoulder, with labral tears being the most common. Work-up: Specific physical exam maneuvers and imaging tests can help diagnose instability and discern concomitant injury patterns. Special attention must be paid to quantifying bone…

Management of the throwing shoulder

OVERVIEW Chapter synopsis The disabled throwing shoulder remains a unique surgical challenge. Few other shoulder conditions so blur the line between pathology and adaptive change. Our understanding of the underlying pathology continues to evolve, with the theories of internal impingement and glenohumeral internal rotation deficit (GIRD) guiding treatment approaches. The cornerstone of nonoperative management remains posterior capsular stretching and dynamic strengthening, which are often effective. Surgical…

Suture anchor fixation for anterior shoulder instability

OVERVIEW Chapter synopsis This chapter describes the use of knotted and knotless suture anchors for arthroscopic labral repair to address anterior instability. The techniques for anterior stabilization, including anchor insertion, are described in detail. The use of suture anchors has become the standard for soft tissue repairs, and this chapter discusses the advantages of both knotted and knotless repair techniques. Important points Suture anchors and their…

Open and arthroscopic distal clavicle excision technique

OVERVIEW Chapter synopsis This chapter aims to outline the anatomy, pathology, and clinical evaluation of acromioclavicular (AC) joint pain. We describe the surgical management of AC joint pathology via three different techniques: arthroscopic indirect, direct, and open surgical excision of the distal clavicle. The clinical outcomes as they pertain to the different techniques are reported along with possible postoperative complications. Important points Indications (with or without…

Arthroscopic subacromial decompression

OVERVIEW Chapter synopsis Despite limited indications, arthroscopic subacromial decompression is one of the most commonly performed procedures about the shoulder. A thorough history and physical examination are essential to confirm a diagnosis of shoulder impingement to maximize patient outcomes. Arthroscopic acromioplasty alone or in the setting of rotator cuff repair can be performed efficiently using multiple methods, including the lateral decompression or posterior cutting block techniques.…

Knot-tying and suture-passing techniques

OVERVIEW Chapter synopsis This chapter reviews basic principles and techniques of arthroscopic suture passage and knot tying. The authors also review basics types of instrumentation and different types of arthroscopic knots. Important points A firm understanding of available technology including different anchor types and available instrumentation is essential for a smooth arthroscopic case. Confidence with multiple suture-passing devices gives the surgeon the ability to adapt to…

Rehabilitation of the athlete’s shoulder

OVERVIEW Chapter synopsis 4–5 lines which summarize contents of the chapter in the format of a journal article abstract. The throwing motion is accomplished through utilization of the kinetic chain. Rehabilitation of shoulder injuries should involve evaluation for and restoration of all kinetic chain deficits that may hinder kinetic chain function so that the comprehensive diagnosis can be established to guide content and timing of treatment…

Patient positioning, portal placement, normal arthroscopic anatomy, and diagnostic arthroscopy

OVERVIEW Chapter synopsis Diagnostic arthroscopy provides the surgeon with an important tool to evaluate the shoulder joint and subacromial space. Potential benefits are numerous and complications infrequent. Important points Beach chair and lateral decubitus positioning both have advantages and disadvantages; the practitioner should be familiar with both. Proper portal placement is critical. Understanding of normal anatomy allows recognition of pathology. Pearls Separate portal sites allow superior…

Interventions for Redressing Disparities Related to Social Determinants of Health in Surgery

Background The United States (US) Department of Health and Human Services defines social determinants of health (SDOH) as “the conditions in environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.” SDOH include housing, transportation, education, literacy, employment, environment, discrimination, and violence domains within which individuals' demographic characteristics (e.g., race, country…

Social Determinants of Health: Study Designs and Outcomes

Introduction The social determinants of health (SDH) play a critical role in shaping how people access and interact with the healthcare system, subsequently impacting their health outcomes. A growing body of research demonstrates how SDH significantly shapes health outcomes and health disparities. This research is the result of thorough and thoughtful research designs and protocols, which aim to answer high-quality questions and whose results aim to…

Framing Theoretically Informed Social Determinants of Health Research Questions

Background Advances in medicine have revolutionized patient care over the past decades, with improved patient outcomes and life expectancy. This is particularly true for surgery where the advent of minimally invasive and robotic techniques along with enhanced recovery pathways has led to significant reductions in surgery-related morbidity and mortality across the spectrum of surgical conditions. , The primary focus of these advancements has been on optimizing…

Psychological Stress and the Surgical Stressor

Introduction Perioperative and postoperative morbidity and mortality are seen as correlates of the preoperative condition of the patient, the quality of surgical care provided, and the extent of surgical stress. The latter are of clear importance. Considered here are pre- and postoperative stress responses—psychological, behavioral, biologic—and patients' view of illness, hospitalization, and surgery as stressors. We begin with defining stress and the similarity of physiologic models…

Health Literacy

The value of using narratives in health has been thoroughly demonstrated; therefore, I begin this chapter with a short story about a patient who taught me the importance of health literacy and the need for clear and effective patient–provider communication. A 65-year-old female experienced multiple transient ischemic attacks during a 1-week period. A carotid ultrasound examination showed significant bilateral internal carotid artery disease. A surgeon met…

Insurance as a Social Determinant of Health in Surgery

Social Determinants of Health and Insurance Status Social determinants of health (SDOH) are conditions in the environment where people are born, live, learn, work, play, worship, and age, that can affect their health, functioning, and quality-of-life outcomes and risks. According to the Office of Disease Prevention and Health Promotion from the US Department of Health and Human Services (DHHS), SDOH can be grouped into five domains:…

Community Engagement as a Social Determinant of Health in Surgery

Identification of Social Determinants of Health Access to healthcare varies across countries, communities, and individuals, oftentimes influenced by health policies as well as social and economic conditions. The interplay of differing factors, such as insurance coverage, low income, transportation costs, geographical barriers, and sociocultural expectations, must be taken into consideration when analyzing healthcare access. Limitations in access to healthcare not only lead to negative ramifications in…

Race, Ancestry, and Social Determinants of Health in Surgery

Overview Health inequities related to racial/ethnic identity are associated with a substantial economic burden in the United States. A recent analysis of data from the Medical Expenditure Panel Survey, the Behavioral Risk Factor Surveillance System, the National Vital Statistics System, and the American Community Survey estimated these costs at $421–451 billion. Most of this economic burden was attributable to the poorer health of the Black population,…

Addressing the Social Determinants of Health to Enhance Clinical Trial Participation

Introduction Notwithstanding the evident advances in cancer screening, detection of disease, and treatment options, health disparities in cancer care and treatment remain the leading cause of life-years lost in the United States. This trend continues to plague minority populations at an inequitable rate compared with their counterparts. Overcoming these iniquities will not be easy but can be obtained by approaching clinical trials through a lens committed…

Neighborhood as a Social Determinant of Health in Surgery

Introduction Social determinants of health (SDOH) defined broadly are the nonclinical factors that impact a person's health. According to the World Health Organization, SDOH consist of the conditions in which people are born, grow, learn, work, and age. Alongside schools and workplaces, neighborhoods represent one of the major contexts in which people lead a considerable portion of their lives. Place and location can determine the quality…