Complex topics in arthroscopic subacromial space and rotator cuff surgery

Arthroscopy - Journal of Arthroscopic and Related Surgery

Volumn 18, Issue 2 SUPPL. 1, 2002, Pages 51-64

  Ryu, Richard K N ^a   Burkhart, Stephen S ^a   Parten, Peter M ^a   Gross, R Michael ^a  

^a NONE

Author keywords

[No Author keywords available]

Indexed keywords

CORTICOSTEROID;

ARTHROSCOPIC SURGERY; CLINICAL FEATURE; CLINICAL TRIAL; COMPLICATION; CONFERENCE PAPER; DIAGNOSTIC ERROR; HUMAN; PATHOGENESIS; ROTATOR CUFF RUPTURE; SHOULDER DISLOCATION; SHOULDER IMPINGEMENT SYNDROME; TREATMENT FAILURE;

ARTHROSCOPY; CONTRACTURE; HUMANS; JOINT INSTABILITY; PAIN; ROTATOR CUFF; SHOULDER IMPINGEMENT SYNDROME; SHOULDER JOINT; TREATMENT FAILURE;

EID: 0036488124     PISSN: 07498063     EISSN: None     Source Type: Journal    
DOI: 10.1053/jars.2002.31798     Document Type: Article

References (56)

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11. th annual meeting San Diego Shoulder Arthroscopy, Arthroplasty and Fractures, San Diego, CA. June 20-23, 2001.
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45. th Annual Meeting of the American Shoulder and Elbow Surgeons. San Francisco, CA. March 3, 2001.
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48. th Annual Meeting of the American Shoulder and Elbow Surgeons. San Francisco, CA. March 3, 2001.
49. th Annual Meeting of the American Shoulder and Elbow Surgeons. San Francisco, CA. March 3, 2001.
50. th Annual Meeting of the American Shoulder and Elbow Surgeons. San Francisco, CA. March 3, 2001.
51. Tibone JE, Jobe FW, Kerlan RK, et al. Shoulder impingement syndrome in athletes treated by an anterior acromioplasty. Clin Orthop 1985;198:134-140. This is one of the first papers to identify that impingement pain in an overhead athlete may be a more complex problem than in an older nonathletic individual. They report an 89 percent improvement in the symptoms of pain but only 43 percent of their patients were able to return to their preoperative athletic level. Within that group of athletes, no swimmers recovered to their pre-injury level and only 22 percent of the baseball pitchers and throwers recovered.
52. Rubenstein DL, Jobe FW, Glousman RE, et al. Anterior capsulolabral reconstruction of the shoulder in athletes. J Shoulder Elbow Surg 1992;1:229-237. Jobe et al. relate that most instability operations are more predictable in terms of restoring stability than in terms of maintaining full external rotation. This becomes pertinent with the overhead athlete. The goal of the capsular labral reconstruction is to offer a safe, predictable, reproducible surgical procedure that offers stability as well as maintains a full range of motion. His surgical procedure does not violate the subscapularis insertion and tightens the capsular structures primarily on a superior to inferior direction. The results of 76 patients at an average of 39 months postoperative were: 96 percent satisfied with procedure. 93 percent return to preoperative athletic level. The average loss of external rotation at 90 degrees of abduction was 2 degrees while the loss of abduction was I degree.
53. Barber FA, Morgan CD, Burkhart SS, et al. Labrum-biceps-cuff dysfunction in the throwing athlete. Arthroscopy 1999;15:852-857. This article focuses on the pathomechanics of internal impingement. Two differing views are featured. Chris and Frank Jobe both favor anterior laxity or increased external rotation as the primary abnormality that leads to internal impingement. Burkhart and Morgan favor a tight posterior capsule which prevents normal external rotation and shifts the fulcrum of rotation superioposterior to the insertion of the biceps tendon causing a "peel back" injury of the biceps insertion into the posterior labrum. They indicate that the instability is "pseudolaxity" and will disappear with repair of the SLAP injury. Since both authors have been successful in treating this problem, yet with differing approaches, it leaves room for the possibility that the single problem may have more than one pathomechanical pathway.
54. Neviaser RJ, Neviaser TJ. Recurrent instability of the shoulder after age 40. J Shoulder Elbow Surg 1995;4:416-418. This is a report of 12 patients with recurrent instability following their index dislocation, which occurred after the age of 40 years. Eleven of the patients with anterior instability all had a rupture of the subscapularis muscle as well as a humeral avulsion of the glenohumeral ligaments. The main message from this article is that the pathology for recurrent dislocations in this age group is frequently not the routine Bankart injury as seen with younger individuals.
55. Jensen KL, Williams GR, Rockwood CA. Current concepts review - Rotator cuff tear arthropathy. J Bone Joint Surg Am 1999;81a:1312-1324. The authors describe a condition of the shoulder in which a tear of the rotator cuff progresses in size and in location to the point where the force couples are disrupted and secondary instability ensues. The degenerative process, which results from this situation, creates basic calcium phosphate crystals, which cause an inflammatory condition that frequently results in severe bony deformity. This is a thorough overview of rotator cuff tear arthropathy and would be an excellent article for any individual interested in a deeper understanding of this disorder.
56. Burkhart SS. Arthroscopic treatment of massive rotator cuff tears. Clinical results and biomechanical rationale. Clin Orthop 1991;267:45-56. Burkhart emphasizes the importance of looking at the rotator cuff as a three-dimensional structure. He emphasizes that the length of a tear is not nearly as important as is its effect on "force couples." The loss or the maintenance of force couples on the frontal (deltoid balanced by the intact portion of the rotator cuff), and the transverse plane (the subscapularis balanced by the infraspinatus and teres minor), will allow the surgeon a better biomechanical view of the effect of a tear on the shoulder. This paper offers a logical approach to assess and plan treatment for a rotator cuff tear.