Much of our content has been organized as a Rotator Cuff Book and a Shoulder Arthritis Book
This blog
One stop procedure for ream and run
Consultation
Our stadium
I. The Shoulder Fellowship at the University of Washington
More about the fellowship
II. Practical Evaluation and Management of the Shoulder
III. How the shoulder works
IV. Fly fishing
V. The Shoulder
Anatomy
Vascular
The normal shoulder
Range of motion
Functional range of motion
Agenda for research
Physical therapists
Outcome measures
The Simple Shoulder Test
The SST
Validation
In shoulder arthritis
For tracking recovery
VI. The Patient - factors that affect outcome
The importance of the patient in the result
Patient health and surgical risk
Charlson Comorbidity Index
Ten modifiable factors that can improve health and outcome
Alcohol Consumption and Complications
Effect of insurance and ethnicity
Effect of income
Osteoporosis
Osteoporosis #2
Diabetes 1
Diabetes 2 - glycemic control
Smoking - effect on healing
Smoking - relation to pain 1
Smoking - relation to pain 2
Smoking - effect on cuff tear size
Depression
Mental health
Atrial fibrillation
Atrial fibrillation 2
Obesity 1
Obesity 2
Obesity 3
Obesity 4
Obesity 5
Obesity 6
Age 1
Age 2
Asprin
Opiod use 1
Opiod use 2
Hypertension
Sleeplessness
Sleep apnea
Workers' compensation
Catastrophic thinking
Compliance and worker's compensation
General health status
Psychological distress
Preoperative pain 1
Preoperative pain 2
Preoperative health
Exercise
Emotional health
VII. The Problem
X-rays
X-rays 1
X-rays 2
Position of humeral head center
Standardized x-ray views
MRI
Use and abuse
Ceci n'est pas une pomme
Stiffness
Is the shoulder stiff?
The stiff shoulder
The secret of stretching
The swimmer's stretch 1
The swimmer's stretch 2
Stretching
Exercises
Effect of posterior capsular tightness
Frozen shoulder
Frozen shoulder and diabetes
The value of exercise
Instability
Stabilizing effect of negative joint pressure
Bankart repair 1
Bankart repair 2
Fracture dislocation
Dislocation in the older patient
Arthroscopic repair: > 13% recurrence rate
Rotator cuff
Overview of the rotator cuff
The rotator cuff
Tendon healing and remodeling
The anterior cable
Rotator cuff disorders
Evaluating for a cuff tear
Clinical considerations relating to shoulder strength
What is a rotator cuff tear 1
What is a rotator cuff tear 2
How does the cuff fail?
How does the cuff heal?
Patterns of cuff failure
Clinical examination for a cuff tear
Is it cuff tear or cuff wear?
Types of cuff failure
Is there a critical stage?
Relation of fatty infiltration to tendon retraction
Cartilage degeneration in massive cuff tear
Stiffness and cuff tears
Smoking - effect on cuff tear size
Symptomatic and asymptomatic tears
Asymptomatic tear natural history
Impingement
?Impingement 1
?Impingement 2
Inflammatory markers
Motion and pain in patients with cuff tears
Association with supra scapular neuropathy
Imaging
Imaging of the rotator cuff
AP x-ray
Acromial anatomy
Acromion and cuff tears 1
Acromion and cuff tears 2
MRI
The central tendon of the supraspinatus
Tear size and fatty infiltration
Ultrasound and fatty degeneration
Arthritis
What is arthritis?
Types of arthritis
Types of arthritis 2
The arthritic shoulder
Why do arthritic shoulders get stiff?
Comparing the normal and the arthritic shoulder
Shoulder arthritis 1
Shoulder arthritis 2
Classification of glenohumeral arthritis
Glenoid pathoanatomy
The axillary view
The Bad Arthritic Triad
X-rays of osteoarthritis
X-rays of post traumatic arthritis
X-rays of chondrolysis
X-ray of capsulorrhaphy arthropathy
X-rays of rheumatoid arthritis
X-rays of avascular necrosis
X-rays of dysplasia
X-rays of rotator cuff tear arthropathy
X-rays of rotator cuff tear arthropathy 2
Importance of good x-rays
X-rays for arthritis 1
X-rays for arthritis 2
Arthritic glenoid anatomy
Is a CT scan necessary1?
Is a CT scan necessary 2?
Measuring glenoid pathoanatomy
Postoperative glenohumeral anatomy
Glenoid type
Walch classification
Is there a type B1 glenoid?
Glenoid morphology and posterior subluxation
Glenoid dysplasia 1
Glenoid dysplasia 2
Glenoid dysplasia 3
Glenoid dysplasia 4
Glenoid retroversion
Glenoid version
The glenoid plane
MRI and axillary views for assessing version
Osteoarthritis
Glenoid retroversion
Propionibacterium and arthritis
x-ray appearance
Chondrolysis from the infusion of local anesthetics via a pain pump
Caused by pain pump infusion of local anesthetics
Chondrolysis and pain pumps 1
Chondrolysis and pain pumps 2
Chondrolysis and pain pumps 3
Chondrolysis and pain pumps 4
Toxicity of local anesthetics
Risk factors for chondrolysis
x-rays in chondrolysis
x-rays in chondrolysis 2
Case 1
Case 2
Case 3
More cases
Still more cases
In other joints
Post arthroscopic glenohumeral chondrolysis ?review
Chondrolysis - ?review
Cuff tear arthropathy
Capsulorrhaphy arthropathy
Dysplasia
Posttraumatic arthritis
Posttraumatic arthritis 2
Bleeding arthropathy
Avascular necrosis
From steroids
From steroids for leukemia
x-ray appearance
Rheumatoid arthritis
Living with arthritis
VIII. The Physician/Surgeon
The importance of the surgeon
Effect of surgeon volume on the result
Effect of surgeon volume on cost and outcome
Effect of surgeon volume on cost
Effect of surgeon experience on outcome
Effect of surgeon experience on complications
Effect of surgeon experience on result 1
Effect of surgeon experience on result 2
Effect of surgeon volume on revision rate
Effect of provider volume
Effect of surgeon volume on shoulder arthroplasty result
Effect of hospital volume
Conflict of Interest
Disclosing conflict of interest
Conflict of interest and liability
Demographics of disclosure at the AAOS
Effect of company support
Thromboembolic prophylaxis and conflict of interest
Conflict of interest and MRIs
Conflicts of interest
Conflict of interest and liability
Demographics of disclosure at the AAOS
Effect of company support
Thromboembolic prophylaxis and conflict of interest
Conflict of interest and MRIs
Conflicts of interest
IX. The Procedure
When is the time for surgery? Questions to ask the Surgeon
When is it time for a shoulder replacement?
Effect of age
Nerve block anesthesia
Brachial plexus block anesthesia 1
Brachial plexus block anesthesia 2
Brachial plexus block vs general anesthesia
Nerve block anesthesia
Rotator cuff
Nonoperative management 1
Nonoperative management 2
Nonoperative management 3
Nonoperative management
Getting better without surgery
Injection
Growth hormone
Anabolic steroids
Platelet rich plasma
Nonoperative management 2
Nonoperative management 3
Nonoperative management
Getting better without surgery
Injection
Growth hormone
Anabolic steroids
Platelet rich plasma
Repair
Rotator cuff repair
Surgical approach for rotator cuff surgery
Repair of full thickness tear
Rising incidence of repair
Trends in cuff repair
When to repair
When to repair 2
Appropriate use criteria
Challenge of reattachment to bone
Intraoperative determinants of repairability
Protecting the axillary nerve
Effect of immobilization
Position of immobilization
Single row vs double row
Suture bridge
Suture tension overload - suture load not evenly distributed
Effect of surgeon experience on outcome
Augmentation with a patch 1
Augmentation with a patch 2
Effect of technique on contact area
Acromioplasty?
Acromioplasty and cuff repair
Platelet-leukocyte membrane
Platelet fibrin matrix
Platelet rich plasma
The importance of suture number
Cuff function after repair - rat model
Sharapova
Biceps tenodesis and cuff repair
Latissimus dorsi transfer
Latissimus transfer
Lat transfer
Tendon transfers for irreparable tears
Tendon transfers for irreparable tears 2
Deltoid flap
Rehabilitation
Immobilization?
Outcome
Outcome of repair - Harryman
Age and integrity
Results of mini open repair
Compliance and worker's compensation
Outcome of mini-open
Followup ultrasound
Does cuff integrity matter 1?
Does cuff integrity matter 2?
Does cuff integrity matter 3?
Outcome of single tendon tears in older patients
Does repair prevent atrophy?
Recovery of function
Acromial index and outcome
Single vs double row 1
Single vs double row 2
Single row vs suture bridge
Arthroscopic repair of small and partial tears
Integrity versus clinical result of repair of small tears
Maria Sharapova
Effect of obesity
Surgical approach for rotator cuff surgery
Repair of full thickness tear
Rising incidence of repair
Trends in cuff repair
When to repair
When to repair 2
Appropriate use criteria
Challenge of reattachment to bone
Intraoperative determinants of repairability
Protecting the axillary nerve
Effect of immobilization
Position of immobilization
Single row vs double row
Suture bridge
Suture tension overload - suture load not evenly distributed
Effect of surgeon experience on outcome
Augmentation with a patch 1
Augmentation with a patch 2
Effect of technique on contact area
Acromioplasty?
Acromioplasty and cuff repair
Platelet-leukocyte membrane
Platelet fibrin matrix
Platelet rich plasma
The importance of suture number
Cuff function after repair - rat model
Sharapova
Biceps tenodesis and cuff repair
Latissimus dorsi transfer
Latissimus transfer
Lat transfer
Tendon transfers for irreparable tears
Tendon transfers for irreparable tears 2
Deltoid flap
Rehabilitation
Immobilization?
Outcome
Outcome of repair - Harryman
Age and integrity
Results of mini open repair
Compliance and worker's compensation
Outcome of mini-open
Followup ultrasound
Does cuff integrity matter 1?
Does cuff integrity matter 2?
Does cuff integrity matter 3?
Integrity and functional outcome 2
Integrity and functional outcome 3
Integrity and functional outcome 4
Integrity and functional outcome 5
Integrity and functional outcome 6
Change in muscle massIntegrity and functional outcome 3
Integrity and functional outcome 4
Integrity and functional outcome 5
Integrity and functional outcome 6
Outcome of single tendon tears in older patients
Does repair prevent atrophy?
Recovery of function
Acromial index and outcome
Single vs double row 1
Single vs double row 2
Single row vs suture bridge
Arthroscopic repair of small and partial tears
Integrity versus clinical result of repair of small tears
Maria Sharapova
Effect of obesity
Failure
When does it happen?
Improvement in spite of failure of the repair
Failure with continuity 1
Failure with continuity 3
Complications
Suture anchor problems
Arthritis
Definition
Types of Arthritis
Diagnosis
Nonoperative management
Exercises
Exercises 1
Exercises 2
The stiff shoulder
The swimmer's stretch
Stretching and the electric toothbrush
Forward lean
Strengthening
The secret of stretching
Medication
Drugs for arthritis
Glucosamine and chondroitin
Non-steroidal medication 1
Non-steroidal medication 2
Arthroscopic debridement
Arthroscopy
Stretching and the electric toothbrush
Forward lean
Strengthening
The secret of stretching
Medication
Drugs for arthritis
Glucosamine and chondroitin
Non-steroidal medication 1
Non-steroidal medication 2
Arthroscopic debridement
Arthroscopy
Injection
Steroids
Preservatives - cytotoxic effects
Arthroplasty - general
General comments about arthroplasty
Surgical options
The glenoid socket - the key to shoulder arthroplasty
The glenoid - the key to shoulder arthroplasty
How is the roundness of the humeral head restored?
When is it the right time for shoulder joint replacement?
What about the medications the patient is taking before joint replacement?
What about antibiotics after joint replacement?
Increasing rate of shoulder arthroplasty
Patient expectations
Cost and value
Glenoid retroversion
Arthroplasty - general
General comments about arthroplasty
Surgical options
The glenoid socket - the key to shoulder arthroplasty
The glenoid - the key to shoulder arthroplasty
How is the roundness of the humeral head restored?
When is it the right time for shoulder joint replacement?
What about the medications the patient is taking before joint replacement?
What about antibiotics after joint replacement?
Increasing rate of shoulder arthroplasty
Patient expectations
Cost and value
Glenoid retroversion
Selecting the type of arthroplasty
Overview of surgical treatment of arthritis
Fixation of the humerus with impaction grafting
Swelling of arm after arthroplasty
Increasing implant fixation
3-D templating
Measuring outcome
From suture anchors
Rate of use of anatomic vs reverse
Rehabilitation
The secret of stretching
Exercises
Rehabilitation: early strengthening
Rehabilitation tips
Overview of surgical treatment of arthritis
Fixation of the humerus with impaction grafting
Swelling of arm after arthroplasty
Increasing implant fixation
3-D templating
Measuring outcome
From suture anchors
Rate of use of anatomic vs reverse
Rehabilitation
The secret of stretching
Exercises
Rehabilitation tips
Subscapularis
Hemiarthroplasty
Hemiarthroplasty 1
Hemiarthroplasty 2
For avascular necrosis
For post-traumatic arthritis
For dysplasia
Overview of the ream and run
Not the same as a hemiarthroplasty
Genesis
The ream and run
Ream and run essentials
Technique 1
Technique 2
Technique 3
How is reaming done?
For a B2 glenoid 1
For a B2 glenoid 2
For a B2 glenoid 3
For a B2 glenoid 4
For a B2 glenoid 5
For a B2 glenoid 6
For a B2 glenoid 7
For a B2 glenoid 8
For post traumatic arthritis
In women
Essential points about the ream and run
Manipulation and open release for stiffness
Outcome
Tracking recovery with the SST
Activities after surgery
Video of activities after ream and run
Shaping the socket
Healing of the reamed bone
Initial clinical results
In patients under 55 years
Throwing batting practice five years later
Hockey 3 months after a ream and run
Function at 2 years
Big fish 1
Big fish 2
Tough mudder
Joint surface regeneration
Glenoid remodeling
Review of outcomes
Karate 8th degree black belt
Creative rehabilitation after the ream and run
Ultimate rehab
Patient reported outcomes
Comments from patients
Factors affecting outcome
First day after surgery
Result at 2 months after surgery
Result at 14 weeks after surgery
Result at 5 months after surgery 1
Result at 5 months after surgery 2
Result at 6 months after surgery
Swimming at 7 months
Result at one year after surgery
2.5 year followup
Durability at three years
2 - 4 year results
Martial arts at 2.5 years after ream and run
Joint surface regeneration at 4 years after ream and run
Eight year perspective
Ream and run diary
Comparison to total shoulder
Is wear an issue?
Improvement in glenohumeral pathoanatomy
Resurfacing
Resurfacing - cadaver study
Resurfacing - cadaver study
Does it recreate normal anatomy?
Resurfacing humeral anatomy
Four year outcomes 1
Four year outcomes 2
For cuff tear arthropathy
Arthrosurface
In comparison to stemmed humeral component
Interposition
Foreign body reaction to dermal matrix
Meniscus allograft 1
Meniscus allograft 2
Biological resurfacing 1
Biological resurfacing 2
Biological resurfacing 3
Failure of interposition
Cuff tear arthropathy prosthesis
The cuff tear arthropathy arthroplasty
CTA prosthesis
CTA prosthesis vs. reverse total shoulder 1
CTA prosthesis vs. reverse total shoulder 2
CTA prosthesis vs. reverse total shoulder 3
Functional result
Total shoulder replacement
The total shoulder
When do we use it?
Key steps in total shoulder arthroplasty
Total shoulder vs. hemiarthroplasty
Patient-specific instruments
3-D templating
Activities recommended after
Technique
Design
Effect of design 1
Effect of design 2
Effect of conformity
Inset glenoid
Less conforming glenoid components
Custom glenoid components
Effect of glenohumeral mismatch
The step glenoid
Humeral component
Eccentric and offset heads
Humeral head selection
Attempt to restore normal anatomy
Stemless
Glenoid
Glenoid preparation
Glenoid component 1
Glenoid component 2
Glenoid component 3
Minimizing the risk of loosening
Reaming hazards
Pegged vs keeled?
"Magic peg" glenoid
Glenoid component fixation
Positioning
Glenoid version and stability
Evaluating and managing glenoid bone loss
Effect of glenoid deformity on glenoid component positioning
Bone graft for glenoid erosion
Vacuum assisted fixation
Wedge-shaped glenoid component
Pegged
Uncemented
Technique for documenting position after surgery
Keeled component
Survivorship
Survivorship in young adults
Ten year outcomes for keeled components
Metal back
Outcome
Cementless metal back
Failure
Results
Ingrowth
Failure rate
Outcome
Prognostic factors
Comparison to hemiarthroplasty
Improvement in function
Results
Radiographic survival
Radiographic position
Radiolucent lines
Perforation of glenoid bone
Ten year outcomes 1
Ten year outcomes 2
Erosion-does total shoulder correct it?
Comparison to hemiarthroplasty and reverse
Total shoulder in B2 glenoids
In revision of painful hemiarthroplasty 1
In revision of painful hemiarthroplasty 2
How to think about revision rates
From the Australian Orthopaedic Association the effect of design
Relation to surgeon volume
Cost and outcome
Effect of glenoid position
Complications
Unsatisfactory arthroplasty
Stiffness
Complications and survivorship
Complication rate
Predicting complications
Thromboembolic prophylaxis
Thromboembolism
Thromboembolic prophylaxis and conflict of interest
Thromboembolism - systematic review
Instability
Fracture - periprosthetic of the humerus
Periprosthetic fracture 1
Periprosthetic fracture 2
Nerve injury
Nerve injury 2
Unsatisfactory results
For failed hemiarthroplasty for fracture
Risk for infection
Infection
Glenoid component failure
Patterns of glenoid component loosening
x-ray evidence of loosening
Radiographic failure
Radiographic loosening
Heat damage from curing cement
Rocking horse loosening
Review of glenoid failure
Glenoid component wear
Glenoid component loosening
Osteolysis with components radiated in air
Associated with retroversion
Revision for failed glenoid
Rocking horse loosening
Early migration of the component
Associated with delayed cuff dysfunction 1
Associated with delayed cuff dysfunction 2
Failure of metal backed glenoids
Revision
Reimplantation
Considerations regarding revision
Approach to revision
Revision surgery 1
Revision surgery 2
For glenoid failure 2
For glenoid failure 3
For glenoid failure 4
For glenoid failure 5
Humeral component revision
For humeral fracture
For subscapularis deficiency
For infection
Revision for superior instabilityFor glenoid failure 3
For glenoid failure 4
For glenoid failure 5
Humeral component revision
For humeral fracture
For subscapularis deficiency
For infection
Managing glenoid failure without reimplantation
Glenoid reimplantation
Use of allografts for glenoid bone deficiency
Of a well fixed humeral component
Use of long stem humeral components
Resection
Revisions in NY state
Readmission
Propionibacterium
Positive cultures at the time of revision
Failed resurfacing
Positive cultures in revision arthroplasty
Cyanoacrylate as a sealant
Reverse Total Shoulder
The reverse total shoulder 1
The reverse total shoulder 2
CTA prosthesis vs. reverse total shoulder
Scapular motion
Wear simulation
Know the system you are using
Mechanics 1
Mechanics 2
For rheumatoid arthritis
For failed anatomic arthroplasty
For failed anatomic
For failed hemiarthroplasty
For type B2 glenoid
Impaction grafting hybrid fixation of humeral component
In younger patients
In younger patients
Glenosphere
Design
Advantages of lateral offset
Placement
Effect of position on range of motion
Effect of position on rotation
Effect of position on impingement
Effect of position and head size on notching
In setting of superior glenoid wear
Accuracy of positioning
Fixation
Glenosphere fixation 1
Glenosphere fixation 2
Glenosphere fixation 3
Glenosphere fixation 4
Glenosphere fixation: preserve bone
Glenosphere fixation and scapular notching
Baseplate screw dangers
Baseplate screw dangers #2
Initial glenoid fixation
Effect of baseplate geometry
Stemless reverse
Uncemented
Stability
With Latissimus Transfer
Is allograft necessary for managing proximal humeral bone loss?
Conversion from anatomic arthroplasty using modular system
Use in revision of failed arthroplasty 1
Use in revision of failed arthroplasty 2
Use in revision of failed arthroplasty 3
Use in revision of failed arthroplasty 4
Use in revision of failed arthroplasty 5
Use in revision of failed arthroplasty 6
In failed arthroplasty
Use for massive glenoid defects
For cuff tear arthropathy - influence of design
CT navigation
Use for irreparable cuff tears
Outcome
Improvement in function
Change in quality of life
Functionality
Pain and function
Obesity
Strength
Effect of surgeon experience on result
Patient activities after reverse
Shoulder motion after reverse
From the Australian Orthopaedic Association the effect of design
Complications of reverse
Complications 1
Complications 2
Complications 3
Complications 4
Complications and BMI
Scapular fractures
Scapular fractures 2
Complications relate to indications for surgery
Complications relate to diagnosis
Effect of surgeon experience on complications
Dissociation
Scapular notching 1
Scapular notching 2
Scapular notching 3
Cost effectiveness
Component failure
Acromial fracture - fatigue
Acromial base fracture
Acromial fracture
Scapular spine fracture
Spine fracture
Polyethylene wear
Dislocations
Revision of reverse
Resection arthroplasty
Complications of arthroplasty
Infection
The bugs within us
Bacteria in us and on us
Positive cultures in revision arthroplasty
Unexpected positive cultures
Do antibiotics in cement help?
?Guidelines for diagnosis
Prognostic factors for positive cultures at revision arthroplasty
Periprosthetic infections after total shoulder
Periprosthetic infections after hemiarthroplasty
Vancomycin elution from cement
Limited utility of intraoperative frozen sections
After hemiarthroplasty
Reinfection after revision for shoulders with positive cultures
Resection vs spacer for infection
Case of infection 1
Case of infection 2
"Classical" criteria for infection
Arthroscopic biopsy for evaluation
Propionibacterium
Delayed appearance after shoulder arthroplasty 1
Delayed appearance after shoulder arthroplasty 2
Complication of ream and run
Infection beyond the skin
X. Health Care Issues
Value
Measuring improvement: MCID vs Percent of possible improvement (PPI)
Value in shoulder surgery
New Technology, Is it worth it?
Value of postoperative x-rays
Costs of implants
More on implant costs
Variability in implant costs
Health care costs, payers and complications
Utility of shoulder arthroplasty
Measuring disability
Measuring disability and outcome
Computer navigation
Immediate post operative radiographs
How to think about revision rates
Implant survivorship
Cost effectiveness of shoulder arthroplasty
Value of shoulder arthroplasty
Penalties for readmission
Does cuff repair save society $?
Medicaid and access to shoulder care
Cost utility of reverse
Patient safety
Malpractice
Pain medication
Shared decision making
C difficile
Complications
Causation and statistics
Measuring disability and outcome
Computer navigation
Immediate post operative radiographs
How to think about revision rates
Implant survivorship
Cost effectiveness of shoulder arthroplasty
Value of shoulder arthroplasty
Penalties for readmission
Does cuff repair save society $?
Medicaid and access to shoulder care
Cost utility of reverse
Patient safety
Malpractice
Pain medication
Shared decision making
C difficile
Complications
Causation and statistics
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Consultation for those who live a distance away from Seattle.
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You may be interested in some of our most visited web pages including:shoulder arthritis, total shoulder, ream and run, reverse total shoulder, CTA arthroplasty, and rotator cuff surgery as well as the 'ream and run essentials'
You may be interested in some of our most visited web pages including:shoulder arthritis, total shoulder, ream and run, reverse total shoulder, CTA arthroplasty, and rotator cuff surgery as well as the 'ream and run essentials'
