BOOK
Shoulder Instability: A Comprehensive Approach E-Book
Matthew T Provencher | Anthony A Romeo
(2011)
Additional Information
Book Details
Abstract
Shoulder Instability, by Drs. Mark Provencher and Anthony Romeo, is the first comprehensive resource that helps you apply emerging research to effectively manage this condition using today’s best surgical and non-surgical approaches. Detailed illustrations and surgical and rehabilitation videos clearly demonstrate key techniques like bone loss treatment, non-operative rehabilitation methods, multidirectional instability, and more. You’ll also have access to the full contents online at www.expertconsult.com.
- Watch surgical and rehabilitation videos online and access the fully searchable text at www.expertconsult.com.
- Stay current on hot topics including instability with bone loss treatment, non-operative rehabilitation methods, multidirectional instability, and more.
- Gain a clear visual understanding of the treatment of shoulder instability from more than 850 images and illustrations.
- Find information quickly and easily with a consistent format that features pearls and pitfalls, bulleted key points, and color-coded side tabs.
- Explore shoulder instability further with annotated suggested readings that include level of evidence.
State-of-the-art, comprehensive resource for the surgical and non-surgical treatment of shoulder instability
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front cover | Cover | ||
| Shoulder instability | i | ||
| Copyright | iv | ||
| Dedication | v | ||
| Contributors | vii | ||
| Foreword | xiii | ||
| Preface | xv | ||
| Acknowledgments | xvii | ||
| Video contents | xxi | ||
| Anterior instability | xxi | ||
| Posterior instability | xxi | ||
| Extensive labral tears | xxii | ||
| 1 Anatomy and principles of treatment | 1 | ||
| Clinical anatomy and biomechanics of the glenohumeral joint (including stabilizers) | 3 | ||
| Key points | 3 | ||
| Introduction | 4 | ||
| Anatomy and biomechanics | 4 | ||
| Passive bony stabilizers | 4 | ||
| Proximal humerus | 5 | ||
| Glenoid | 7 | ||
| Passive soft tissue stabilizers | 8 | ||
| Inferior glenohumeral ligament complex (ighlc) | 8 | ||
| Superior labrum | 11 | ||
| Rotator interval | 12 | ||
| Active stabilizers | 13 | ||
| Rotator cuff | 13 | ||
| Long head of the biceps tendon | 15 | ||
| Humerothoracic muscles | 16 | ||
| Coracoacromial arch anatomy | 16 | ||
| Coracoacromial ligament | 16 | ||
| Acromioclavicular joint | 16 | ||
| Coracoid process | 16 | ||
| Summary | 17 | ||
| References | 17 | ||
| Examination and classification of instability | 20 | ||
| Key points | 20 | ||
| Introduction | 20 | ||
| Definitions | 20 | ||
| Classification historical background | 21 | ||
| Algorithmic approach | 21 | ||
| Physical exam | 21 | ||
| Inspection | 22 | ||
| Palpation | 22 | ||
| Range of motion | 23 | ||
| Muscular strength testing | 23 | ||
| Neurovascular exam | 24 | ||
| Anterior instability | 25 | ||
| Posterior instability | 27 | ||
| Inferior and multidirectional instability | 28 | ||
| Biceps and slap | 28 | ||
| Diagnostic injections | 29 | ||
| Examination under anesthesia | 30 | ||
| Summary | 31 | ||
| References | 32 | ||
| Suggested readings | 32 | ||
| Beach chair and lateral decubitus setuppros and cons | 33 | ||
| Key points | 33 | ||
| Introduction | 33 | ||
| Lateral decubitus | 33 | ||
| Description of setup (figs. 3-1 to 3-12) | 33 | ||
| Complications | 36 | ||
| Beach chair | 36 | ||
| Description of setup (figs. 3-13 to 3-20) | 37 | ||
| Complications | 41 | ||
| Summary | 41 | ||
| References | 42 | ||
| Suggested readings | 42 | ||
| Open and arthroscopic instrumentation for instability repair | 43 | ||
| Key points | 43 | ||
| Introduction | 43 | ||
| Anesthesia | 43 | ||
| Examination under anesthesia | 44 | ||
| Arthroscopic shoulder stabilization | 45 | ||
| Patient positioning | 45 | ||
| Arthroscopy equipment setup | 45 | ||
| Skin marking and portal placement | 45 | ||
| Open shoulder stabilization | 47 | ||
| Patient positioning | 48 | ||
| Surgical approaches | 48 | ||
| Tools and implants for open and arthroscopic stabilization procedures | 48 | ||
| Suture anchors | 49 | ||
| Suture passing instruments | 49 | ||
| Conclusion | 51 | ||
| References | 51 | ||
| Suggested readings | 51 | ||
| Sutures and glenoid anchors for instability | 53 | ||
| Key points | 53 | ||
| Introduction | 53 | ||
| Suture material | 54 | ||
| Suture performance and knots | 55 | ||
| Suture anchors | 58 | ||
| Suture anchor materials | 60 | ||
| Glenoid anchor techniques | 61 | ||
| Conclusions | 62 | ||
| References | 62 | ||
| Suggested readings | 63 | ||
| 2 Anterior instability | 65 | ||
| Findings and pathology associated with anterior shoulder instability | 67 | ||
| Key points | 67 | ||
| Introduction | 67 | ||
| Anatomy and biomechanics | 67 | ||
| Anatomic variants | 69 | ||
| Lesions of the glenoid labrum and ligamentous attachments | 70 | ||
| Bankart lesion | 70 | ||
| Anterior labroligamentous periosteal sleeve avulsion (alpsa) | 70 | ||
| Glenolabral articular disruption (glad) | 70 | ||
| Bony bankart | 70 | ||
| Humeral avulsion of glenohumeral ligament (hagl) | 72 | ||
| Superior labral anterior and posterior tears | 74 | ||
| Capsular lesions | 75 | ||
| Capsular injury | 75 | ||
| Thermal capsular damage | 75 | ||
| Humeral lesions | 76 | ||
| Hill-sachs defect | 76 | ||
| Physical examination (see chapter videos) | 76 | ||
| Imaging evaluation | 76 | ||
| Conclusions | 77 | ||
| References | 77 | ||
| Clinical history and physical examination | 79 | ||
| Key points | 79 | ||
| Introduction | 79 | ||
| History | 79 | ||
| The basic examination | 80 | ||
| Types of shoulder instability | 80 | ||
| Anterior shoulder instability | 80 | ||
| Posterior shoulder instability | 83 | ||
| Inferior shoulder instability | 84 | ||
| Multidirectional instability | 86 | ||
| References | 86 | ||
| Suggested readings | 87 | ||
| Radiographic studies and findings | 88 | ||
| Key points | 88 | ||
| Introduction | 88 | ||
| Imaging evaluation | 88 | ||
| Plain x-rays | 88 | ||
| Standard anteroposterior view | 88 | ||
| True anteroposterior (grashey) view | 88 | ||
| Stryker notch view (fig. 8-4) | 88 | ||
| Axillary view (fig. 8-5) | 89 | ||
| Transcapular (y) view | 89 | ||
| Dynamic x-ray examination | 89 | ||
| Considerations | 89 | ||
| Arthrography | 90 | ||
| Computed tomography scan | 90 | ||
| Magnetic resonance imaging and magnetic resonance arthrography | 91 | ||
| Normal capsule and ligament anatomy and pitfalls in MRI interpretation | 91 | ||
| Bankart lesion | 97 | ||
| Perthes lesion | 97 | ||
| Anterior labral periosteal sleeve avulsion (alpsa) lesion | 98 | ||
| Humeral avulsion of the glenohumeral ligaments (hagl) lesion | 98 | ||
| Glenoid labral articular disruption (glad) lesion | 98 | ||
| Kim’s lesion | 99 | ||
| Conclusion | 99 | ||
| References | 99 | ||
| Suggested readings | 100 | ||
| Nonoperative treatment of anterior shoulder instability | 101 | ||
| Key points | 101 | ||
| Introduction | 101 | ||
| Anatomy and biomechanics | 101 | ||
| Physical examination | 101 | ||
| Imaging evaluation | 102 | ||
| Accessory plain film views | 102 | ||
| Treatment | 103 | ||
| On-the-field management of acute anterior dislocation | 103 | ||
| Rehabilitation guidelines | 105 | ||
| Phase i: reduction of inflammation | 105 | ||
| Phase ii: range of motion and muscle activation | 105 | ||
| Phase iii: strengthening and proprioception | 105 | ||
| Phase IV: return to sport | 106 | ||
| References | 107 | ||
| Suggested readings | 107 | ||
| Nonoperative rehabilitation for traumatic and atraumatic glenohumeral instability | 108 | ||
| Key points | 108 | ||
| Introduction | 108 | ||
| Rehabilitation factors | 108 | ||
| Onset of pathology | 108 | ||
| Degree of instability | 109 | ||
| Frequency | 109 | ||
| Direction of instability | 109 | ||
| Premorbid status of tissue | 110 | ||
| Neuromuscular control | 110 | ||
| Arm dominance | 110 | ||
| Patient age | 111 | ||
| Patient goals | 111 | ||
| Rehabilitation guidelines | 111 | ||
| Traumatic shoulder instability | 111 | ||
| Phase ii—intermediate phase | 114 | ||
| Phase iii—advanced strengthening phase | 114 | ||
| Phase IV—return to activity phase | 119 | ||
| Rehabilitation for atraumatic shoulder instability | 120 | ||
| Atraumatic instability protocol | 122 | ||
| Conclusion | 124 | ||
| References | 124 | ||
| Suggested readings | 125 | ||
| Arthroscopic treatment of anterior instabilitysurgical technique | 126 | ||
| Key points | 126 | ||
| Introduction | 126 | ||
| Indications/contraindications | 126 | ||
| Indications for arthroscopic management | 126 | ||
| Contraindications for arthroscopic management | 127 | ||
| Controversial indications | 128 | ||
| Preoperative history, examination, and imaging | 128 | ||
| History | 128 | ||
| Examination findings | 129 | ||
| Radiographic findings | 130 | ||
| Description of technique(s) | 132 | ||
| Adjunctive techniques | 139 | ||
| Postoperative regimen | 141 | ||
| Postoperative complications | 141 | ||
| Prognosis and outcomes | 142 | ||
| Results of arthroscopic bankart repair and capsulorrhaphy | 142 | ||
| References | 145 | ||
| Suggested readings | 146 | ||
| Open treatment of anterior instabilitysurgical technique | 147 | ||
| Key points | 147 | ||
| Introduction | 147 | ||
| Contact athletes | 148 | ||
| Bony defects of humeral head/glenoid | 148 | ||
| Pathoanatomy of anterior instability | 148 | ||
| Preoperative considerations | 149 | ||
| History | 149 | ||
| Physical examination | 149 | ||
| Imaging | 149 | ||
| Indications and contraindications | 149 | ||
| Surgical technique | 150 | ||
| Anesthesia and positioning | 150 | ||
| Examination under anesthesia/arthroscopic evaluation | 150 | ||
| Technical details | 150 | ||
| Postoperative considerations | 152 | ||
| Standardized postoperative rehabilitation protocol | 152 | ||
| Weeks 4 to 8 | 152 | ||
| Weeks 8 to 12 | 153 | ||
| Weeks 12 to 16 | 154 | ||
| >week 16 | 155 | ||
| Special situations | 155 | ||
| Complications | 155 | ||
| Results | 156 | ||
| References | 158 | ||
| Suggested readings | 158 | ||
| Biomechanics of glenohumeral bone loss and treatment mechanics | 160 | ||
| Key points | 160 | ||
| Introduction | 160 | ||
| Shoulder stability and the glenoid and humeral osseous defects | 160 | ||
| Glenoid osseous defect | 160 | ||
| Which size of the glenoid osseous defect should be treated? | 160 | ||
| Previous studies | 160 | ||
| The glenoid osseous defect is located anteriorly rather than anteroinferiorly | 161 | ||
| Which size of the glenoid osseous defect should be treated? | 162 | ||
| Recent studies | 162 | ||
| How to express the glenoid defect size | 163 | ||
| Biomechanics of the bone grafting procedure for a large glenoid osseous defect | 163 | ||
| Hill-sachs lesion | 164 | ||
| Location and size of hill-sachs lesions | 165 | ||
| Critical size of a hill-sachs lesion and contact between the glenoid and the humeral head | 165 | ||
| Glenoid track in cadaveric shoulders | 165 | ||
| Clinical application of the “glenoid track” | 165 | ||
| “Glenoid track” in live patients | 165 | ||
| Biomechanics of the treatment for a large hill-sachs lesion | 166 | ||
| References | 169 | ||
| Suggested readings | 169 | ||
| Radiographic and arthroscopic evaluation of glenoid and humeral head bone loss | 170 | ||
| Key points | 170 | ||
| Introduction | 170 | ||
| Plain radiographic evaluation | 171 | ||
| Glenoid bone loss | 172 | ||
| Humeral head bone loss | 173 | ||
| Radiographic measurement | 174 | ||
| Glenoid bone loss | 174 | ||
| Humeral head bone loss | 178 | ||
| Arthroscopic evaluation and measurement | 181 | ||
| Glenoid bone loss | 182 | ||
| Humeral head bone loss | 183 | ||
| Conclusion | 184 | ||
| References | 184 | ||
| Suggested readings | 184 | ||
| Arthroscopic treatment of glenoid bone losssurgical technique | 186 | ||
| Key points | 186 | ||
| Introduction | 186 | ||
| Indications/contraindications | 186 | ||
| Preoperative history, examination, and radiographic findings | 186 | ||
| Preoperative history | 186 | ||
| Examination findings | 186 | ||
| Radiographic findings | 187 | ||
| Description of techniques | 187 | ||
| Arthroscopic bony bankart repair | 187 | ||
| Procedure (see video 15-1) | 188 | ||
| Variations/unusual situations | 191 | ||
| Arthroscopic iliac bone block procedure with capsulolabral reconstruction | 191 | ||
| Procedure (see video 15-2) | 191 | ||
| Postoperative care | 194 | ||
| Postoperative complications | 194 | ||
| Prognosis and outcomes | 194 | ||
| References | 195 | ||
| Suggested readings | 196 | ||
| Open bony augmentation of glenoid bone lossthe latarjet and variantssurgical technique | 197 | ||
| Key points | 197 | ||
| Introduction | 197 | ||
| Indications/contraindications | 197 | ||
| Preoperative history, examination, and radiographic findings | 198 | ||
| Preoperative history | 198 | ||
| Examination findings | 198 | ||
| Radiographic findings | 199 | ||
| Description of techniques | 199 | ||
| Surgical anatomy | 199 | ||
| Patient positioning | 199 | ||
| Surgical exposure | 199 | ||
| Procedure | 200 | ||
| Step 1—coracoid osteotomy and preparation | 200 | ||
| Step 2—glenoid exposure | 201 | ||
| Step 3—glenoid preparation and coracoid fixation | 202 | ||
| Intraoperative complications | 204 | ||
| Variations/unusual situations | 204 | ||
| Postoperative care | 205 | ||
| Postoperative complications | 206 | ||
| Prognosis and outcomes | 207 | ||
| References | 207 | ||
| Suggested readings | 207 | ||
| The latarjet proceduretechnique and fixation constructs | 209 | ||
| Key points | 209 | ||
| Introduction | 209 | ||
| Coracoid graft osteolysis concept and proposal of classification system | 209 | ||
| Mini-plate (wedge profile plate) | 212 | ||
| Mini-plate surgical technique | 212 | ||
| Anesthesia and surgical position | 212 | ||
| Surgical exposure technique | 212 | ||
| Mini-plate technique | 213 | ||
| Conclusion | 214 | ||
| References | 215 | ||
| Suggested readings | 215 | ||
| Technique of arthroscopic bristow-latarjet-bankart procedure: the 2b3 procedure | 216 | ||
| Key points | 216 | ||
| Introduction | 216 | ||
| Indications/contraindications | 217 | ||
| Description of technique | 217 | ||
| Patient positioning | 217 | ||
| Portals | 217 | ||
| Procedure | 217 | ||
| Step one: glenoid preparation and drilling | 217 | ||
| Step two: coracoid harvesting | 218 | ||
| Step three: coracoid transfer | 221 | ||
| Step four: coracoid fixation | 221 | ||
| Step five: capsulolabral (i.e., bankart) repair | 223 | ||
| Postoperative care | 223 | ||
| Prognosis and outcomes | 224 | ||
| References | 224 | ||
| Suggested readings | 225 | ||
| Open bony augmentation of glenoid bone lossiliac crest and allograftsurgical technique | 226 | ||
| Key points | 226 | ||
| Introduction | 226 | ||
| Indications/contraindications for iliac crest autograft | 226 | ||
| Preoperative history, examination, and radiographic findings | 227 | ||
| Preoperative history | 227 | ||
| Examination findings | 227 | ||
| Radiographic findings | 227 | ||
| Description of technique for iliac crest autograft | 227 | ||
| Procedure | 229 | ||
| Intraoperative complications | 230 | ||
| Variations/unusual situations | 231 | ||
| Postoperative care | 231 | ||
| Postoperative complications | 231 | ||
| Prognosis and outcomes | 232 | ||
| References | 232 | ||
| Suggested readings | 233 | ||
| Humeral head defectsbiomechanics, measurements, and treatments | 234 | ||
| Key points | 234 | ||
| Introduction | 234 | ||
| Biomechanics | 234 | ||
| Indications/contraindications | 236 | ||
| Indications | 237 | ||
| Contraindications | 237 | ||
| Preoperative history, examination, and radiographic findings | 237 | ||
| Preoperative history | 237 | ||
| Examination findings | 238 | ||
| Radiographic findings | 238 | ||
| Description of technique(s) | 238 | ||
| Osteoarticular allograft reconstruction of humeral head defects through deltopectoral approach | 240 | ||
| Preoperative planning | 240 | ||
| Examination under anesthesia | 240 | ||
| Patient positioning | 241 | ||
| Surgical approach | 241 | ||
| Procedure | 242 | ||
| Glenoid reconstruction | 242 | ||
| Closure | 243 | ||
| Variations/unusual situations | 243 | ||
| Patient positioning | 243 | ||
| Surgical approach | 243 | ||
| Procedure | 244 | ||
| Postoperative care | 244 | ||
| Deltopectoral approach reconstruction of the glenoid and humeral head defects—postoperative protocol | 244 | ||
| Posterolateral approach reconstruction of the humeral head—postoperative protocol | 245 | ||
| Postoperative complications | 245 | ||
| Prognosis and outcomes | 245 | ||
| References | 246 | ||
| Suggested readings | 247 | ||
| Recent advances in the diagnosis and treatment of glenohumeral bone loss | 248 | ||
| Key points | 248 | ||
| Introduction | 248 | ||
| Section i: measuring glenoid bone loss | 248 | ||
| Section ii—bipolar glenoid and humeral bone defects | 251 | ||
| Introduction | 251 | ||
| Epidemiology | 251 | ||
| Pathophysiology | 251 | ||
| Patient evaluation | 251 | ||
| Pathoanatomy | 252 | ||
| Management | 253 | ||
| Summary | 253 | ||
| Section iii—alpsa tears and bone loss | 253 | ||
| Preoperative history, examination, and radiographic findings | 253 | ||
| Preoperative history | 253 | ||
| Examination findings | 253 | ||
| Radiographic findings | 254 | ||
| Description of technique(s) | 254 | ||
| Section IV: latarjet orientation | 254 | ||
| Section v: distal tibia allograft for glenoid bone loss | 255 | ||
| Indications/contraindications | 255 | ||
| Preoperative history, examination, and radiographic findings | 255 | ||
| Preoperative history | 255 | ||
| Examination findings | 256 | ||
| Radiographic findings | 256 | ||
| Description of technique(s) | 256 | ||
| Postoperative care | 257 | ||
| Postoperative complications | 257 | ||
| Prognosis and outcomes | 257 | ||
| References | 258 | ||
| Rehabilitation: return-to-play and in-season guidelines | 259 | ||
| Key points | 259 | ||
| Introduction | 259 | ||
| Relevant anatomy and biomechanics | 259 | ||
| A dynamic rehabilitation program for optimal return to play | 260 | ||
| The initial visit | 260 | ||
| The early postoperative phase: scapulohumeral rhythm restoration, recruitment, and dynamic stabilization | 260 | ||
| The early postoperative phase: motion principles | 262 | ||
| The early postoperative phase: strength principles | 265 | ||
| Conclusions | 267 | ||
| References | 267 | ||
| Suggested readings | 267 | ||
| 3 Posterior Instability | 269 | ||
| Pathology and biomechanics of posterior instability | 271 | ||
| Key points | 271 | ||
| Introduction | 271 | ||
| Anatomy and biomechanics | 271 | ||
| Key structures | 271 | ||
| Biomechanical function | 273 | ||
| Physical examination | 276 | ||
| Imaging evaluation | 276 | ||
| Treatment options | 278 | ||
| References | 279 | ||
| Suggested readings | 280 | ||
| Posterior instability: clinical history, examination, and surgical decision making | 281 | ||
| Key points | 281 | ||
| Introduction | 281 | ||
| Anatomy and biomechanics | 281 | ||
| Capsular laxity versus rim-loading mechanism as a pain generator | 286 | ||
| Physical examination | 286 | ||
| Instability tests | 286 | ||
| Imaging evaluation | 288 | ||
| Treatment options | 288 | ||
| Triple instability portal | 290 | ||
| Surgical technique | 290 | ||
| Decision making of the additional capsular plication and rotator interval closure | 291 | ||
| Aftercare | 291 | ||
| References | 292 | ||
| Suggested readings | 292 | ||
| Imaging findings in posterior instability | 294 | ||
| Key points | 294 | ||
| Introduction | 294 | ||
| Imaging modalities | 294 | ||
| Capsule | 295 | ||
| Glenoid version | 295 | ||
| Glenoid hypoplasia | 295 | ||
| Posterior dislocation | 296 | ||
| Polpsa lesion | 297 | ||
| Kim lesion | 297 | ||
| Glad lesion | 301 | ||
| Bennett lesion | 302 | ||
| Humeral avulsion of the posterior band of the inferior glenohumeral ligament | 302 | ||
| References | 304 | ||
| Suggested readings | 304 | ||
| Arthroscopic treatment of posterior instabilitysurgical technique | 305 | ||
| Key points | 305 | ||
| Introduction | 305 | ||
| History and physical examination | 306 | ||
| Imaging | 310 | ||
| Nonoperative treatment | 311 | ||
| Surgical treatment | 312 | ||
| Arthroscopic posterior shoulder stabilization: surgical technique | 312 | ||
| Setup and examination under anesthesia | 312 | ||
| Portal creation and diagnostic arthroscopy | 313 | ||
| Labral preparation | 313 | ||
| Labral repair | 315 | ||
| Labral repair with capsular plication | 317 | ||
| Isolated capsular plication | 317 | ||
| Labral repair with posterior capsular release | 318 | ||
| Rotator interval closure | 318 | ||
| Postoperative rehabilitation | 318 | ||
| Prognosis and outcomes | 319 | ||
| References | 320 | ||
| Suggested readings | 321 | ||
| Open surgical solutions for posterior instability of the shoulder | 324 | ||
| Key points | 324 | ||
| Introduction | 324 | ||
| Indications/contraindications | 324 | ||
| Surgical indications for open posterior instability procedures | 324 | ||
| Contraindications to open posterior shoulder instability procedures | 325 | ||
| Preoperative history, examination, and radiographic findings | 325 | ||
| Examination findings | 326 | ||
| Radiographic findings | 327 | ||
| Description of technique(s) | 327 | ||
| Examination under anesthesia | 327 | ||
| Positioning | 327 | ||
| Surgical approaches | 328 | ||
| Open posterior instability surgeries | 328 | ||
| General equipment: | 328 | ||
| Posterior capsulorrhaphy | 329 | ||
| Posterior bone block procedure | 337 | ||
| Anterior shift augmentation | 337 | ||
| Posterior inferior glenohumeral ligament (pighl) reconstruction | 337 | ||
| Posterior capsulotendinous tensioning procedure (infraspinatus tenodesis) | 339 | ||
| Postoperative care | 340 | ||
| Postoperative complications | 340 | ||
| Prognosis and outcomes | 340 | ||
| References | 341 | ||
| Suggested readings | 342 | ||
| Rehabilitation after posterior instability repairopen vs. arthroscopic | 343 | ||
| Key points | 343 | ||
| Introduction | 343 | ||
| Operative treatment | 343 | ||
| Rehabilitation guidelines | 344 | ||
| Management of pain and inflammation | 344 | ||
| 4 Multidirectional instability | 355 | ||
| Pathology and findings in patients with multidirectional instability | 357 | ||
| Key points | 357 | ||
| Introduction | 357 | ||
| Pathology | 357 | ||
| Physical examination | 358 | ||
| Findings | 359 | ||
| Rotator interval | 359 | ||
| Intraoperative findings | 360 | ||
| Neuromuscular pathology | 360 | ||
| Glenoid morphology: | 360 | ||
| Conclusions | 361 | ||
| References | 362 | ||
| Suggested readings | 362 | ||
| Clinical history, examination, arthroscopic findings, and treatment of multidirectional instability | 363 | ||
| Key points | 363 | ||
| Introduction | 363 | ||
| Clinical history | 363 | ||
| Physical examination | 364 | ||
| Tests for laxity | 364 | ||
| Tests for instability | 365 | ||
| Imaging means | 365 | ||
| Pathoanatomic arthroscopic findings | 365 | ||
| Specific arthroscopic treatment | 366 | ||
| References | 367 | ||
| Suggested readings | 368 | ||
| Nonoperative management and scapular dyskinesis | 369 | ||
| Key points | 369 | ||
| Introduction | 369 | ||
| Anatomy and biomechanics | 369 | ||
| Alterations of the scapula associated with glenohumeral instability | 370 | ||
| Physical examination | 370 | ||
| Scapular evaluation in glenohumeral instability | 370 | ||
| Nonoperative treatment options | 371 | ||
| Rehabilitation of the scapula in glenohumeral instability | 371 | ||
| Rehabilitation guidelines | 371 | ||
| Specific scapular rehabilitation exercises | 371 | ||
| References | 377 | ||
| Suggested readings | 377 | ||
| Arthroscopic treatment of multidirectional instabilitysurgical technique | 379 | ||
| Key points | 379 | ||
| Introduction | 379 | ||
| Indications | 380 | ||
| Contraindications | 380 | ||
| Preoperative history, examination, and radiographic findings | 380 | ||
| Examination findings | 380 | ||
| Radiographic findings | 381 | ||
| Description of management techniques | 381 | ||
| Nonoperative technique | 381 | ||
| Operative, arthroscopic techniques | 382 | ||
| Anatomy/pathoanatomy | 382 | ||
| Steps in the surgical process | 382 | ||
| Step 1: exposure/setup | 382 | ||
| Step 2: specific instruments/equipment/implants | 382 | ||
| Step 3: anesthesia | 383 | ||
| Step 4: diagnostic arthroscopy | 383 | ||
| Step 5: capsular preparation | 383 | ||
| Step 6: capsular repair | 383 | ||
| Step 7 | 384 | ||
| Step 8 | 384 | ||
| Step 9 | 385 | ||
| Avoiding pitfalls and complications | 386 | ||
| Variations/unusual situations | 388 | ||
| Postoperative care | 388 | ||
| Postoperative regimen | 388 | ||
| Prognosis and outcomes | 389 | ||
| References | 389 | ||
| Suggested readings | 389 | ||
| Open treatment of multidirectional instabilitysurgical technique | 390 | ||
| Key points | 390 | ||
| Introduction | 390 | ||
| Definition | 390 | ||
| Pathology | 390 | ||
| Indications | 392 | ||
| Contraindications | 392 | ||
| Preoperative history, examination, and radiographic findings | 392 | ||
| Preoperative history | 392 | ||
| Examination findings | 392 | ||
| Radiographic findings | 393 | ||
| Description of technique | 393 | ||
| Postoperative care | 399 | ||
| Postoperative rehabilitation | 400 | ||
| Prognosis and outcome | 400 | ||
| References | 400 | ||
| Suggested readings | 401 | ||
| 5 Revision instability and special topics | 403 | ||
| Instability treatment failurecommon reasons and prevention | 405 | ||
| Key points | 405 | ||
| Introduction | 405 | ||
| Determination of risk factors associated with instability recurrence following arthroscopic bankart repair | 406 | ||
| Preoperative history | 406 | ||
| Patient age | 406 | ||
| Sporting activity | 406 | ||
| Hyperlaxity/capsular deficiency | 406 | ||
| Previous shoulder stabilization surgery | 406 | ||
| Examination findings | 406 | ||
| Signs of shoulder hyperlaxity | 406 | ||
| Radiographic findings | 407 | ||
| Glenoid bone loss | 407 | ||
| Humeral bone loss | 408 | ||
| Hagl lesion | 408 | ||
| How to select a patient for arthroscopic bankart repair: the instability severity index score (isis) | 408 | ||
| Arthroscopic bankart repair and alternative techniques to minimize failure | 410 | ||
| Arthroscopic bankart repair—tips and tricks | 410 | ||
| Trillat procedure | 410 | ||
| Hill-sachs remplissage | 410 | ||
| Bristow-latarjet procedure | 412 | ||
| The nice “à la carte” surgical management of recurrent anterior shoulder instability (fig. 34-16) | 412 | ||
| Isis score ≤3 points | 412 | ||
| Patients with isis score >3 points | 413 | ||
| Conclusion | 413 | ||
| References | 415 | ||
| Suggested readings | 415 | ||
| Rotator intervalconsiderations and techniques for instability | 417 | ||
| Key points | 417 | ||
| Introduction | 417 | ||
| Indications | 417 | ||
| Preoperative history, examination, and radiographic findings | 418 | ||
| History | 418 | ||
| Physical examination | 418 | ||
| Radiographic findings | 419 | ||
| Description of technique | 420 | ||
| Relevant anatomy | 420 | ||
| Biomechanical considerations for open versus arthroscopic ri closure | 420 | ||
| Open ri closure—biomechanics | 420 | ||
| Arthroscopic ri closure—biomechanics | 420 | ||
| Patient positioning and surgical exposure: | 421 | ||
| Procedure—preferred technique | 421 | ||
| Variations of technique | 422 | ||
| Postoperative care | 423 | ||
| Postoperative complications | 423 | ||
| Prognosis and outcomes | 424 | ||
| References | 424 | ||
| Suggested readings | 425 | ||
| Extensive labral tearspathology and surgical treatment | 426 | ||
| Key points | 426 | ||
| Introduction | 426 | ||
| Indications/contraindications | 426 | ||
| Preoperative history | 427 | ||
| Examination findings | 427 | ||
| Radiographic findings | 428 | ||
| Description of technique | 428 | ||
| Variations/unusual situations | 432 | ||
| Postoperative care | 432 | ||
| Postoperative complications | 432 | ||
| Prognosis and outcomes | 432 | ||
| References | 433 | ||
| Suggested readings | 433 | ||
| Nerve injuries with instability proceduresprevention and management | 435 | ||
| Key points | 435 | ||
| Introduction | 435 | ||
| Incidence | 435 | ||
| Commonly injured nerves | 435 | ||
| Mechanism of injury | 436 | ||
| Prevention of nerve injury | 436 | ||
| Management of nerve injuries | 437 | ||
| Surgical treatment of nerve injuries | 437 | ||
| Illustrative cases | 437 | ||
| Case 1 | 437 | ||
| Case 2 | 438 | ||
| References | 440 | ||
| Suggested readings | 441 | ||
| Subscapularis deficiency after shoulder instability proceduresprevention and management | 442 | ||
| Key points | 442 | ||
| Introduction | 442 | ||
| Indications | 442 | ||
| Preoperative history, examination, and radiographic findings | 442 | ||
| History | 442 | ||
| Physical examination | 443 | ||
| Radiographic findings | 443 | ||
| Description of techniques | 444 | ||
| Surgical anatomy | 444 | ||
| Patient positioning | 445 | ||
| Surgical exposure | 445 | ||
| Procedure | 445 | ||
| Variations/unusual situations | 446 | ||
| Postoperative care | 447 | ||
| Postoperative complications | 447 | ||
| Prognosis and outcomes | 448 | ||
| References | 449 | ||
| Suggested readings | 449 | ||
| Recurrent instability due to capsular deficiency | 450 | ||
| Key points | 450 | ||
| Introduction | 450 | ||
| Anatomy | 452 | ||
| Preoperative evaluation | 452 | ||
| Indications | 453 | ||
| Surgical technique | 453 | ||
| Surgical approach | 453 | ||
| Labral reconstruction | 453 | ||
| Capsular reconstruction | 453 | ||
| Postoperative care and rehabilitation | 454 | ||
| Results | 455 | ||
| References | 455 | ||
| Suggested readings | 456 | ||
| Glenohumeral stiffness and arthritis after instability surgerycauses and treatment | 457 | ||
| Key points | 457 | ||
| Introduction | 457 | ||
| Clinical history, physical examination, and radiographic evaluation | 457 | ||
| Clinical history | 457 | ||
| Differential-directed approach | 457 | ||
| Physical examination | 457 | ||
| Radiographic findings | 458 | ||
| Stiffness without glenohumeral arthritis | 459 | ||
| Overtightening | 459 | ||
| Inappropriate diagnosis | 459 | ||
| Infection | 459 | ||
| Chondrolysis | 459 | ||
| Stiffness with glenohumeral arthritis | 459 | ||
| Arthritis after instability episodes | 459 | ||
| Arthritis after instability surgery | 460 | ||
| Nonoperative management | 460 | ||
| Discussion with the patient | 460 | ||
| Anti-inflammatory medicine | 460 | ||
| Corticosteroids | 460 | ||
| Viscosupplementation | 460 | ||
| Physical therapy | 460 | ||
| Operative management | 461 | ||
| Joint-preserving treatment | 461 | ||
| Arthroscopic debridement and capsular releases | 461 | ||
| Indications | 461 | ||
| Description of technique | 461 | ||
| Postoperative care | 461 | ||
| Joint replacing treatment | 462 | ||
| Partial joint replacement: surface replacement | 462 | ||
| Humeral hemiarthroplasty | 462 | ||
| Humeral hemiarthroplasty with glenoid reaming: “ream and run” | 462 | ||
| Humeral hemiarthroplasty with biologic glenoid resurfacing | 462 | ||
| Total shoulder arthroplasty with polyethylene glenoid replacement | 463 | ||
| Description of technique | 463 | ||
| Patient positioning | 463 | ||
| Surgical exposure | 463 | ||
| Postoperative care | 465 | ||
| Summary | 465 | ||
| References | 465 | ||
| Suggested readings | 465 | ||
| Recognition and management of combined instability and rotator cuff tears | 466 | ||
| Key points | 466 | ||
| Introduction | 466 | ||
| Pathomechanism | 466 | ||
| Anterior mechanism | 467 | ||
| Posterior mechanism | 467 | ||
| Redislocation risk | 467 | ||
| Axillary nerve injury: terrible triad | 468 | ||
| Suprascapular nerve injury | 469 | ||
| Therapy | 469 | ||
| Treatment of nerve injuries | 469 | ||
| Nonoperative treatment | 469 | ||
| Surgical treatment | 469 | ||
| First-time dislocation | 469 | ||
| Chronic instability | 470 | ||
| Own therapeutic approach | 470 | ||
| References | 473 | ||
| Suggested readings | 474 | ||
| The patient with hyperlaxity and shoulder instabilityehlers-danlos and other disorders | 475 | ||
| Key points | 475 | ||
| Introduction | 475 | ||
| Indications/contraindications | 476 | ||
| Preoperative history, examination, and radiographic findings | 477 | ||
| Preoperative history | 477 | ||
| Examination findings | 478 | ||
| Radiographic findings | 480 | ||
| Description of technique | 480 | ||
| Variations/unusual situations | 484 | ||
| Caveats | 484 | ||
| Postoperative care | 485 | ||
| Return to sport guidelines | 485 | ||
| Postoperative complications | 485 | ||
| Prognosis and outcomes | 485 | ||
| References | 485 | ||
| Suggested readings | 485 | ||
| Management of chronic shoulder dislocations | 487 | ||
| Key points | 487 | ||
| Introduction | 487 | ||
| Chronic posterior dislocation | 488 | ||
| Indications/contraindications | 488 | ||
| Preoperative history, examination, and radiographic findings | 489 | ||
| Preoperative history | 489 | ||
| Examination findings | 489 | ||
| Radiographic findings | 489 | ||
| Description of technique(s) | 491 | ||
| Conservative management | 491 | ||
| Closed reduction | 491 | ||
| Open reduction | 492 | ||
| Disimpaction and bone grafting | 492 | ||
| Technique (fig. 43-9) | 492 | ||
| Disimpaction | 493 | ||
| Transfer of the subscapularis tendon | 493 | ||
| Deltopectoral approach | 493 | ||
| Lesser tuberosity transfer | 494 | ||
| Index | 505 | ||
| A | 505 | ||
| B | 508 | ||
| C | 510 | ||
| D | 513 | ||
| E | 513 | ||
| F | 514 | ||
| G | 514 | ||
| H | 516 | ||
| I | 518 | ||
| J | 519 | ||
| K | 519 | ||
| L | 519 | ||
| M | 520 | ||
| N | 522 | ||
| O | 522 | ||
| P | 522 | ||
| Q | 525 | ||
| R | 525 | ||
| S | 527 | ||
| T | 530 | ||
| U | 531 | ||
| V | 531 | ||
| W | 531 | ||
| Y | 531 |