Tuesday, October 11, 2011

The smooth and move surgery for stiff shoulders with subacromial ahesions

Shoulders may become stiff because of adhesions in the humeroscapular motion interface (subacromial adhesions). 

These adhesions may arise from chronic bursitis, after injury or after rotator cuff surgery.

If stretching exercises are not successful in resolving the patient's symptoms, a 'smooth and move' procedure may be considered. The goal of this procedure is to re-establish the smoothness of the humeroscapular motion interface by completely releasing any adhesions from the axillary nerve in front to the axillary nerve in the back: the 'nerve-to-nerve' release.

Sometimes there is scarring of the coracohumeral ligament (the horizontal white band in the figure below), which may also need to be released.

If the greater tuberosity is prominent, it may also require smoothing so that it is congruent with the remainder of the proximal humerus.

If there is roughness on the undersurface of the acromion, it can be smoothed without destroying the integrity of the coracoacromial arch.

The goal is to establish a smooth, stabilizing articulation between the proximal humeral convexity below and an intact coracoacromial arch above.

At the conclusion of the procedure, with the muscles completely relaxed, a gentle manipulation of the shoulder can be used to assure that the range of motion is completely regained.

Immediately following this procedure, a full motion stretching program is directed at maintaining the range of motion achieved at surgery.


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