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Surgery of the Shoulder
Published in Timothy W R Briggs, Jonathan Miles, William Aston, Heledd Havard, Daud TS Chou, Operative Orthopaedics, 2020
Nick Aresti, Omar Haddo, Mark Falworth
Since the publication of the first edition of this book, arthroscopic shoulder surgery has seen a significant expansion and consequentially open procedures have become increasingly less common. Thankfully, the principles behind the various procedures have stayed the same. Similarly, several large and well-published randomised controlled trials have questioned the efficacy of commonly used procedures and the practice of many surgeons is changing as a result.
Pearls and pitfalls in stabilizing surgery
Published in Andreas B. Imhoff, Jonathan B. Ticker, Augustus D. Mazzocca, Andreas Voss, Atlas of Advanced Shoulder Arthroscopy, 2017
S. Tal Hendrix, John M. Tokish
Determining the surgical approach for patients with instability remains among the most controversial topics in shoulder surgery. The arthroscopic Bankart is attractive because it is fast, relatively simple, and is minimally invasive. Many authors, however, have noted that there are certain risk factors that predispose the arthroscopic Bankart to a high degree of failure.1,16,17 In such cases, an open approach may be preferred, and has been shown to be superior to arthroscopic techniques in high level studies.18
The Pericardium (PC)
Published in Narda G. Robinson, Interactive Medical Acupuncture Anatomy, 2016
Communication between the median and musculocutaneous nerves is fairly common but unpredictable. These connections occur proximal or distal to the coracobrachialis muscle or sometimes within the structure.4 Unpredictable neuroanatomy elevates the risk of nerve injury during shoulder surgery or other plastic and reconstructive repair procedures. Entrapment syndromes can arise as a result of scarring and contracture,5 as has been reported following biceps tenodesis.6
MRI evaluation of shoulder pathologies in wheelchair users with spinal cord injury and the relation to shoulder pain
Published in The Journal of Spinal Cord Medicine, 2022
Ursina Arnet, Wiebe H. de Vries, Inge Eriks-Hoogland, Christian Wisianowsky, Lucas H. V. van der Woude, DirkJan H. E. J. Veeger, Markus Berger
Shoulder pain is a common complaint of persons with spinal cord injury (SCI).1,2 Especially in persons with SCI this is relevant since they rely on their upper extremities for mobility, such as wheelchair propulsions and transfers. Persons with SCI and shoulder pain also report higher incidence of work drop-out and a poorer quality of life.3 In clinical practice, diagnosis of the cause of shoulder pain is not easy. Cornerstones of diagnosis are patient history and clinical exams. Clinical tests showed to have only moderate diagnostic value for identifying rotator cuff tears (RotCT) or other shoulder pathologies.4,5 Often additional magnetic resonance imaging (MRI) of the shoulder is performed to confirm pathology and plan interventions, such as physiotherapy, exercise programs, oral anti-inflammatory drugs, infiltration of the joint (i.e. intra-articular corticosteroid injection), surgical therapy or a combination of those.6–8 These interventions might be based on the findings of the MRI since it is generally assumed that shoulder pathology demonstrated by MRI findings is causing shoulder pain. Interventions, especially surgery, are not without risks and post-operative rehabilitation includes a period of 6–12 weeks of immobilization and inpatient rehabilitation. The outcome of shoulder surgery is diverging, some studies however reported a decrease of pain after surgical intervention.7,9–11
Post-surgery rehabilitation following rotator cuff repair. A survey of current (2020) Italian clinical practice
Published in Disability and Rehabilitation, 2022
Fabrizio Brindisino, Andrea De Santis, Giacomo Rossettini, Leonardo Pellicciari, Marco Filipponi, Giuseppe Rollo, Jo Gibson
Shoulder surgery has evolved over the years, moving from open procedures to the current minimal access and arthroscopic techniques [13]. Arthroscopic surgery has become the gold standard, largely as a result of its efficacy in relation to postoperative pain, skin incisions, and minimal invasiveness; it also ensures a potentially better recovery process (e.g., smaller incisions, less soft-tissue dissection, no need for deltoid detachment, less postoperative pain, and potential accelerated recovery) if compared to open surgical procedures [13]. Several studies have investigated which suturing techniques are most efficacious (e.g., simple row versus double row) [13], both in terms of clinical outcomes, such as pain, function, and residual disability (e.g., using American Shoulder and Elbow Surgeon [ASES] scores and University of California, Los Angeles [UCLA] scores) [14], and impact on recurrence rates. However, there continues to be a lack of consensus as to which arthroscopic technique is associated with optimal outcomes.
Diabetes is an independent risk factor for infection after non-arthroplasty shoulder surgery: a national database study
Published in The Physician and Sportsmedicine, 2021
Alexander Bitzer, Jacob D. Mikula, Keith T. Aziz, Matthew J. Best, Suresh K. Nayar, Uma Srikumaran
A total of 99,970 patients were identified as having undergone one of the included shoulder surgery procedures from 2011 to 2018 (Table 1). Of these patients, 13,857 (13.9%) were diabetic. Within the diabetic cohort, 4,394 (31.7%) were insulin-dependent diabetic patients. Diabetic patients tended to be older (59.7 vs. 51.0 average years, P < 0.01), have a higher body mass index (BMI) (33.6 vs. 29.5, P < 0.01), and were more likely to be female (42.7% vs. 37.6%). Both diabetic and non-diabetic cohorts were comprised predominantly of white individuals; however, the non-diabetic patient population had a significantly higher proportion of white patients (73.3% vs 72.3%, P = 0.01), while the diabetic patient population had a higher proportion of black patients (11.0% vs. 7.6%, P < 0.01) compared to the non-diabetic group. Patients within the diabetic cohort were more likely to have a statistically significant higher rate of concurrent medical comorbidities compared to the non-diabetic patient cohort (P < 0.01) (Table 1).