Repair of athletic shoulder injuries:
Saved in:
| Format: | Book |
|---|---|
| Language: | English |
| Published: |
Philadelphia [u.a.]
Saunders
2001
|
| Series: | The orthopedic clinics of North America
32,3 |
| Subjects: | |
| Online Access: | Inhaltsverzeichnis |
| Physical Description: | XI S., S. 381 - 542 zahlr. Ill., graph. Darst. |
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| adam_text | REPAIR OF ATHLETIC SHOULDER INJURIES
CONTENTS
Anatomy, Pathophysiology, and Biomechanics of Shoulder
Instability 381
William C. Doukas and Kevin P. Speer
Instability in the athlete presents a unique challenge to the orthopaedic
surgeon. A spectrum of both static and dynamic pathophysiology, as well as
gross and microscopic histopathology, contribute to this complex clinical
continuum. Biomechanical studies of the shoulder and ligament cutting
studies in recent years have generated a more precise understanding of the
individual contributions of the various ligaments and capsular regions to
shoulder instability. An understanding of the underlying pathology and
accurate assessment of degree and direction of the instability by clinical
examination and history are essential to developing appropriate treatment
algorithms.
Differential Diagnosis of Shoulder Injuries in Sports 393
Stephen Owens and John M. Itamura
The shoulder is very susceptible to injury in sports. Its use as a battering ram
in collision sports, frequent falls and direct blows, and the demanding
combination of power, flexibility, and repetition in overhand sports make
this joint highly vulnerable. The complex anatomy of the shoulder creates a
challenge for the clinician faced with an injury, be it chronic or acute, and
many symptons overlap. Chronic symptoms are often vague and nonspe¬
cific, highlighting the importance of a careful history and physical exami¬
nation. This article looks at various shoulder injuries that are relevant to
sports and discusses their differential diagnosis.
ORTHOPEDIC CLINICS OF NORTH AMERICA VOLUME 32* NUMBER 3 JULY 2001 vii
Traumatic Anterior Shoulder Instability 399
Anthony A. Romeo, Brian S. Cohen, and Dominic S. Carreira
Arthroscopic Bankart Repair with the Suretac Device for
Traumatic Anterior Shoulder Instability in Athletes 411
Brian J. Cole, Anthony A. Romeo, and Jon J. P. Warner
Arthroscopic treatment of anterior shoulder instability in the athlete has
evolved tremendously over the past decade. Currently, most techniques
include the use of suture and suture anchors. However, the variety of
arthroscopic instruments and techniques that are available shows the com¬
plexity of intra articular tissue fixation, which includes anchor placement,
suture passing, and knot tying. Stabilization using the Suretac device
(Acufex Microsurgical, Mansfield, MA) simplifies tissue fixation by elimi¬
nating the need for arthroscopic suture passing and intra articular knot
tying. However, a successful outcome is highly dependent on accurate
patient selection. Preoperative evaluation, examination under anesthesia,
and the pathoanatomy defined by a thorough arthroscopic examination
suggest the most effective treatment strategy. The ideal candidate for shoul¬
der stabilization using the Suretac device is an athlete with a relatively pure
traumatic anterior instability pattern with detachment pathology (e.g.,
Bankart lesion) and minimal capsular deformation.
Evaluation and Management of Shoulder Instability in the Elite
Overhead Thrower 423
David W. Altchek and William R. Hobbs
The elite throwing athlete places significant forces on the soft tissue stabi¬
lizers of the shoulder with every pitch. Anterior translation forces can be as
high as 40% of body weight and distraction forces as high as 80% body
weight during the act of throwing. Injury to the static and dynamic stabi¬
lizers can lead to significant pain and loss of function in these athletes. To
successfully treat the injured thrower, it is important to accurately diagnose
the pathologic process. This article reviews the biomechanics of throwing
and pathologic processes seen in the elite thrower. We cover the essentials
of the history and physical in this population and conclude with a discus¬
sion of the various treatment regimens.
SLAP Lesions in the Overhead Athlete 431
Stephen S. Burkhart and Craig Morgan
The authors report an 87% rate of return to preinjury levels of throwing in
54 baseball players and an 84% rate of return to preinjury performance levels
in pitches after repair of type II SLAP lesions. The etiology, biomechanics,
surgical repair, and rehabilitation are discussed in detail.
Arthroscopic Repair of Partial Thickness Rotator Cuff Tears and
SLAP Lesions in Professional Baseball Players 443
John E. Conway
Our understanding of the conditions that affect the throwing shoulder
continues to evolve. Surgical techniques also have advanced, and the
arthroscopic repair of rotator cuff tears, superior labrum anterior to poste¬
rior (SLAP) lesions, and capsular ligament attenuation is now possible.
viii CONTENTS
Anterior Superior Instability with Rotator Cuff Tearing: SLAC
Lesion 457
Felix H. Savoie, Larry D. Field, and Stephen Atchinson
Anterosuperior instability of the shoulder may occur from a variety of
pathologic lesions. We describe a specific entity, the SLAC (superior labrum,
anterior cuff) lesion that involves an association of anterior superior labral
tear with a partial supraspinatus tear. We retrospectively isolated a group of
40 patients with this lesion. The presenting complaints, physical examina¬
tion findings, surgical findings, and results were isolated. Overhead activi¬
ties were the most common etiology; load and shift instability testing and
whipple rotator cuff testing were the most common physical examination
findings. Surgical repair was successful in 37 of the 40 patients. The SLAC
lesion is a definable clinical entity with predictable history, examination,
surgical pathology, and satisfactory results from surgery.
Posterior Instability 463
John Antoniou and Douglas T. Harryman
Posterior shoulder instability is a pathology that is increasingly seen in
athletes. Excessive capsular laxity was originally proposed as the key
component. Recent cadaveric and arthroscopic work has identified the
importance of glenolabral integrity and glenoid depth in maintaining gle¬
nohumeral stability. Arthroscopic techniques to treat posterior instability are
emerging. Until recently, reports of arthroscopic reconstruction focused
entirely on capsular glenohumeral stability by altering two separate mecha¬
nisms: deepening of the glenoid concavity and reducing the capsular joint
volume. This is accomplished by shifting the capsule to buttress the glenoid
labrum. Thus increasing capsular tension increases the resultant compres
sive force vector into a deepened glenolabral concavity that, when combined
together, enhances glenohumeral stability. In clinical and laboratory set¬
tings, we have shown that posteroinferior shoulder instability is associated
with both capsular laxity and well defined pathological lesions of the
glenolabral concavity. Our results indicate that arthroscopic posterior cap
sulolabral repair and augmentation is a useful tool to restore the depth of the
glenolabral concavity and to reduce the redundant posteroinferior capsule.
This technique is effective in treating posteroinferior instability.
Treatment of the Athlete with Multidirectional Shoulder
Instability 475
William N. Levine, William D. Prickett, Marcel Prymka, and Ken
Yamaguchi
Coracoid Impingement Syndrome, Rotator Interval
Reconstruction, and Biceps Tenodesis in the Overhead Athlete 485
Melyssa M. Paulson, Neil F. Watnik, and David M. Dint s
Anterior shoulder problems are extremely common in throwing athletes.
Coracoid impingement syndrome, lesions of the long head of the biceps
tendon, and rotator interval lesions are included in the extensive differential
diagnosis which exists for anterior shoulder pain. In this article, we focus on
the anatomy, pathophysiology, clinical presentation, diagnosis, and surgical
treatment of these conditions.
CONTENTS IX
Technique for Repair of the Subscapularis Tendon 495
Robert D. Travis, Wayne Z. Burkhead, Jr., and Robert Doane
Subscapularis tendon injuries, if left undiagnosed, can result in significant
disability for individual patients. This article outlines the anatomy, tech¬
niques of diagnosis, and a method of repair that has been successful in the
senior author s hands. Early recognition and aggressive operative repair are
emphasized.
All Arthroscopic Rotator Cuff Repairs 501
Gary M. Gartsman
The arthroscopic operation for repair of full thickness rotator cuff tears is
successful and has the advantages of glenohumeral joint inspection, treat¬
ment of intra articular lesions, smaller incisions, no deltoid detachment, less
soft tissue dissection, less pain, and more rapid rehabilitation. However,
these advantages must be balanced against the technical difficulty of this
method, which limits its application to surgeons skilled in both open and
arthroscopic shoulder operations. This article contains many technical
pearls to, as much as possible, simplify and improve all arthroscopic cuff
repair.
Monopolar Radiofrequency Energy for Arthroscopic Treatment
of Shoulder Instability in the Athlete 511
Gary S. Fanton and Amir M. Khan
Monopolar radiofrequency energy is increasingly being used in the treat¬
ment of shoulder instability. Basic science studies and early clinical results
have shown that application of thermal energy can result in successful
shrinkage of the shoulder capsule. This procedure is useful in treating
certain traumatic and recurrent instability conditions of the shoulder espe¬
cially in the athlete where range of motion is preserved, recovery is faster
than with open procedures, and there is little disruption or alteration of
inherent anatomy. The procedure is technically easy to perform, and the
complication rate is low. Success, however, depends on proper patient
selection, attention to the rehabilitation program, and patient compliance.
Long term follow up will be necessary to determine if results for this
procedure will deteriorate over time, especially in patients with multidirec¬
tional instability.
Technical Note: A New Arthroscopic Sliding Knot 525
Mark H. Field, T. Bradley Edwards, and Felix H. Savoie
Sliding knots are an essential element of arthroscopic shoulder surgery. The
authors have been using a previously undescribed arthroscopic sliding knot
with good clinical success. This knot has been used in arthroscopic rotator
cuff repair, arthroscopic shoulder stabilization, and arthroscopic SLAP re¬
pair. The technique of this knot is illustrated.
Shoulder Rehabilitation Strategies, Guidelines, and Practice 527
W. Ben Kibler, John McMullen, and Tim Uhl
Shoulder rehabilitation can best be understood and implemented as the
practical application of biomechanical and muscle activation guidelines to
the repaired anatomic structures in order to allow the most complete return
to function. The shoulder works as a link in the kinetic chain of joint motions
and muscle activations to produce optimum athletic function. Functional
X CONTENTS
shoulder rehabilitation should start with the establishment of a stable base
of support and muscle facilitation in the truck and legs, and then proceeds
to the scapula as healing is achieved and proximal control is gained. The
pace of this flow of exercises is determined by achievement of the func¬
tional goals of each segment in the kinetic chain. In the early rehabilitation
stages, the incompletely healed shoulder structures are protected by exer¬
cises that are directed towards the proximal segments. As healing proceeds,
the weak scapular and shoulder muscles are facilitated in their reactivation
by the use of proximal leg and trunk muscles to re establish normal coupled
activations. Closed chain axial loading exercises form the basis for scapular
and glenohumeral functional rehabilitation, as they more closely simulate
normal scapula and shoulder positions, proprioceptive input, and muscle
activation patterns. In the late rehabilitative stages, glenohumeral control
and power production complete the return of function to the shoulder and
the kinetic chain. In this integrated approach, glenohumeral emphasis is
part of the entire program and is towards the end of rehabilitation, rather
than being the entire program and being at the beginning of the program.
Index 539
Subscription Information Inside back cover
CONTENTS Xi
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| spelling | Repair of athletic shoulder injuries Anthony A. Romeo ... guest ed. Philadelphia [u.a.] Saunders 2001 XI S., S. 381 - 542 zahlr. Ill., graph. Darst. txt rdacontent n rdamedia nc rdacarrier The orthopedic clinics of North America 32,3 Schouders gtt Sportblessures gtt Arm Injuries surgery Arthroscopy Athletic Injuries Rotator Cuff surgery Shoulder Shoulder joint Rotator cuff Shoulder joint Surgery Shoulder Surgery Shoulder Wounds and injuries Leistungssportler (DE-588)4074133-3 gnd rswk-swf Therapie (DE-588)4059798-2 gnd rswk-swf Schultergelenkverletzung (DE-588)4053565-4 gnd rswk-swf Leistungssportler (DE-588)4074133-3 s Schultergelenkverletzung (DE-588)4053565-4 s Therapie (DE-588)4059798-2 s DE-604 Romeo, Anthony A. Sonstige oth The orthopedic clinics of North America 32,3 (DE-604)BV000001089 32,3 HBZ Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=009525963&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
| spellingShingle | Repair of athletic shoulder injuries The orthopedic clinics of North America Schouders gtt Sportblessures gtt Arm Injuries surgery Arthroscopy Athletic Injuries Rotator Cuff surgery Shoulder Shoulder joint Rotator cuff Shoulder joint Surgery Shoulder Surgery Shoulder Wounds and injuries Leistungssportler (DE-588)4074133-3 gnd Therapie (DE-588)4059798-2 gnd Schultergelenkverletzung (DE-588)4053565-4 gnd |
| subject_GND | (DE-588)4074133-3 (DE-588)4059798-2 (DE-588)4053565-4 |
| title | Repair of athletic shoulder injuries |
| title_auth | Repair of athletic shoulder injuries |
| title_exact_search | Repair of athletic shoulder injuries |
| title_full | Repair of athletic shoulder injuries Anthony A. Romeo ... guest ed. |
| title_fullStr | Repair of athletic shoulder injuries Anthony A. Romeo ... guest ed. |
| title_full_unstemmed | Repair of athletic shoulder injuries Anthony A. Romeo ... guest ed. |
| title_short | Repair of athletic shoulder injuries |
| title_sort | repair of athletic shoulder injuries |
| topic | Schouders gtt Sportblessures gtt Arm Injuries surgery Arthroscopy Athletic Injuries Rotator Cuff surgery Shoulder Shoulder joint Rotator cuff Shoulder joint Surgery Shoulder Surgery Shoulder Wounds and injuries Leistungssportler (DE-588)4074133-3 gnd Therapie (DE-588)4059798-2 gnd Schultergelenkverletzung (DE-588)4053565-4 gnd |
| topic_facet | Schouders Sportblessures Arm Injuries surgery Arthroscopy Athletic Injuries Rotator Cuff surgery Shoulder Shoulder joint Rotator cuff Shoulder joint Surgery Shoulder Surgery Shoulder Wounds and injuries Leistungssportler Therapie Schultergelenkverletzung |
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