Shoulder InjuriesSurgical Consideration

Shoulder InjuriesSurgical Consideration

John F. Meyers, M.D.John F. Meyers, M.D.

FracturesFractures

Clavicle FracturesClavicle Fractures

• Surgical Indications Rare

• Tenting or Breaking Skin

• Marked Comminution

• Surgical Indications Rare

• Tenting or Breaking Skin

• Marked Comminution

ScapularScapular

Closed TreatmentClosed Treatment

GlenoidGlenoid

Restore StabilityRestore Stability

Acromioclavicular Seperations

Acromioclavicular Seperations

• Grade 1

• Grade 2

• Grade 3

• Grade 4

• Grade 1

• Grade 2

• Grade 3

• Grade 4

Epiphyseal Fracture of Clavicle

Epiphyseal Fracture of Clavicle

Shoulder Impingement Syndrome

Shoulder Impingement Syndrome

Definition – NeerDefinition – Neer

A Spectrum of Diseases the result from an impingement of the Rotator Cuff, the

overlying Subacromial Bursa, and occasionally the Tendon of the Biceps

against the anterior edge of the Acromion and it’s associated

Coracoacromial Arch

A Spectrum of Diseases the result from an impingement of the Rotator Cuff, the

overlying Subacromial Bursa, and occasionally the Tendon of the Biceps

against the anterior edge of the Acromion and it’s associated

Coracoacromial Arch

Impingement PositionsImpingement Positions

• Functional position is forward flexion not Abduction (Neer)

• Forward Flexion with Internal Rotation -> Greater Tuberosity rotates under Coracoacromial Arch

• Repetitive Adduction -> Coracoid Process Impingement

• Functional position is forward flexion not Abduction (Neer)

• Forward Flexion with Internal Rotation -> Greater Tuberosity rotates under Coracoacromial Arch

• Repetitive Adduction -> Coracoid Process Impingement

Classic Impingement LesionNeer

JBJS – 1972

Classic Impingement LesionNeer

JBJS – 1972

• Stage 1– Less than age 25– Edema & Hemorrhage

• Stage 2– Age 25 – 40– Fibrosis & Tendinitis

• Stage 3– Greater Than Age 40– Bone Spurs & Tendon Rupture

• Stage 1– Less than age 25– Edema & Hemorrhage

• Stage 2– Age 25 – 40– Fibrosis & Tendinitis

• Stage 3– Greater Than Age 40– Bone Spurs & Tendon Rupture

Acromial MorphologyBigliani, et al – 1983

Acromial MorphologyBigliani, et al – 1983

• Type 1 (Flat) – 0% Cuff Tears

• Type 2 (Curved) – 20% Cuff Tears

• Type 3 (Hooked) – 80% Cuff Tears

• Type 1 (Flat) – 0% Cuff Tears

• Type 2 (Curved) – 20% Cuff Tears

• Type 3 (Hooked) – 80% Cuff Tears

Classification of Rotator Cuff Pathology

Classification of Rotator Cuff Pathology

• Compressive Failure• Tensile Failure• Acute Traumatic Tears• Calcific Tendinitis

• Compressive Failure• Tensile Failure• Acute Traumatic Tears• Calcific Tendinitis

Acute Traumatic TearsMechanisms of Injury

Acute Traumatic TearsMechanisms of Injury

• Active Abduction Against Resistance

• Forced Adduction

• Acute Traumatic Dislocation

• Active Abduction Against Resistance

• Forced Adduction

• Acute Traumatic Dislocation

* May have predisposing impingement or tensile rotator cuff disease

Tensile FailureTensile Failure

• Failure during eccentric contracture

• Undersurface Tear (inside -> Outside)

• Common in throwing athletes

• Often no Subacromial Impingement at Surgery

• Failure during eccentric contracture

• Undersurface Tear (inside -> Outside)

• Common in throwing athletes

• Often no Subacromial Impingement at Surgery

Surgical TreatmentSurgical Treatment

• Arthroscopic Debridement Alone

• Arthroscopic Debridement & Acromioplasty

• Arthroscopic Acromioplasty & Mini-Open Repair

• Classic Open Repair

• Arthroscopic Debridement Alone

• Arthroscopic Debridement & Acromioplasty

• Arthroscopic Acromioplasty & Mini-Open Repair

• Classic Open Repair

Arthroscopic DebridementArthroscopic Debridement

• Incomplete Tears Without Impingement

• Calcific Rotator Cuff Tendinitis Without Impingement

• Incomplete Tears Without Impingement

• Calcific Rotator Cuff Tendinitis Without Impingement

Arthroscopic Debridement & Acromioplasty

Arthroscopic Debridement & Acromioplasty

• Incomplete Rotator Cuff Tear & Impingement

• Complete Rotator Cuff Tears & Impingement

(Primary Goal is Pain Relief)

• Incomplete Rotator Cuff Tear & Impingement

• Complete Rotator Cuff Tears & Impingement

(Primary Goal is Pain Relief)

Arthroscopic Acromioplasty & Mini-Open Repair

Arthroscopic Acromioplasty & Mini-Open Repair

Small, Complete, Easily Repairable Lesion

Physically Activew Patient with Symptomatic Weakness

Small, Complete, Easily Repairable Lesion

Physically Activew Patient with Symptomatic Weakness

Classic Open RepairClassic Open Repair

Acute Traumatic Tears

Failed Arthroscopic Debridement

Acute Traumatic Tears

Failed Arthroscopic Debridement