Overstuffing (sur-rembourrage).

Overstuffing is simply defined as putting too much stuff in a limited space. 

It will be experienced by some during the coming Thanksgiving Holiday when the taste and fragrance of turkey fresh out of the oven 

will cause the celebrants to put too much in the limited space of their stomach.

Overstuffing was experienced by Alice in Wonderland when she ate a cookie labeled "Eat Me": "“Curiouser and curiouser!” cried Alice (she was so much surprised, that for the moment she quite forgot how to speak good English). “Now I’m opening out like the largest telescope that ever was! Good-bye, feet!” (for when she looked down at her feet, they seemed to be almost out of sight, they were getting so far off)."

Another common example of overstuffing is the compartmental syndrome which in a 1979 New England Journal of Medicine article (Compartmental Syndromes) we indicated that: "The compartmental syndrome is a condition in which increased pressure within an anatomic space compromises the circulation and function of the contents. The two prerequisites for this syndrome are an envelope of limited compliance (such as fascia, skin, plaster cast or dressings) and a cause for the increased volume within the envelope (such as bleeding or increased net capillary filtration)."

Thirty years ago in1994 we provided the first analysis of overstuffing in shoulder arthroplasty in the book Practical Evaluation and Management of the Shoulder (freely available here) along with its effect on shoulder motion.

   

Currently, many surgeons focus on reconstructing an "anatomic" arthroplasty "recreating premorbid anatomy". However, most arthritic shoulders have had a decreased joint volume for years prior to surgery. So unless the surgeon recreates premorbid joint volume, an anatomic arthroplasty will overstuff the articulation resulting in stiffness.

For this reason, we aim to conduct a kinematic, rather than an "anatomic" arthroplasty by assuring that, with the trial components in place, the shoulder has the desired range of motion

And document the motion with a "parting shot" photograph included in the operative note to show the patient that "it will go". 

In summary, avoiding the consequences of overstuffing requires that the volume of the contents of the space are appropriate for the volume of the space. The arthroplasty surgeon has some opportunity to increase the volume of the space by soft tissue releases; the surgeon has a lot of control over the volume of what she or he puts in the space. 

All's well as long as the shoulder has a balance of mobility and stability.

There's even a song entitled "Too Much Stuff"

Stuffing in preparation for the mating season.

Sooty Grouse

Mt Rainier 

July 2024

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Here are some videos that are of shoulder interest
Shoulder arthritis - what you need to know (see this link).
How to x-ray the shoulder (see this link).
The ream and run procedure (see this link)
The total shoulder arthroplasty (see this link)
The cuff tear arthropathy arthroplasty (see this link).
The reverse total shoulder arthroplasty (see this link).
The smooth and move procedure for irreparable rotator cuff tears (see this link)
Shoulder rehabilitation exercises (see this link).