Sunday, June 30, 2013

This site's content: shoulder pain, arthritis, rotator cuff and more - free

The up-to-date online shoulder book: a critical analysis of what's new and what's true. Enjoy browsing!

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


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
       The normal shoulder
       Range of motion
       Functional range of motion
       Agenda for research
       Physical therapists
       Outcome measures
            The Simple Shoulder Test
                 The SST
                 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 #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
       Mental health
       Atrial fibrillation
       Atrial fibrillation 2
       Obesity 1
       Obesity 2
       Obesity 3
       Obesity 4
       Obesity 5
       Obesity 6
       Age 1
       Age 2
       Opiod use 1
       Opiod use 2
       Sleep apnea
       Workers' compensation
       Catastrophic thinking
       Compliance and worker's compensation
       General health status
       Psychological distress
       Preoperative pain 1
       Preoperative pain 2
       Preoperative health
       Emotional health

VII. The Problem
          X-rays 1
          X-rays 2
          Position of humeral head center
          Standardized x-ray views
         Use and abuse
         Ceci n'est pas une pomme

            Is the shoulder stiff?
            The stiff shoulder
            The secret of stretching
            The swimmer's stretch 1
            The swimmer's stretch 2
            Effect of posterior capsular tightness
            Frozen shoulder
            Frozen shoulder and diabetes
            The value of exercise

            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 1
             ?Impingement 2
             Inflammatory markers
             Motion and pain in patients with cuff tears
             Association with supra scapular neuropathy
                 Imaging of the rotator cuff
                 AP x-ray
                 Acromial anatomy
                 Acromion and cuff tears 1
                 Acromion and cuff tears 2
                     The central tendon of the supraspinatus
                     Tear size and fatty infiltration
                 Ultrasound and fatty degeneration
           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
                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
          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
            The Sunshine Act/Industry Payments to Doctors
            Sunshine rule
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
                 Management of cuff tears
                 Guidelines for treatment
                 Can the tear be repaired?
                 Nonoperative management 1
                 Nonoperative management 2
                 Nonoperative management 3
                 Nonoperative management
                 Getting better without surgery
                 Growth hormone
                 Anabolic steroids
                 Platelet rich plasma
                          Effect on healing
                          Evidence 1
                          Evidence 2
                          Lack of evidence
                 Smooth and move - a rancher's results
                 The smooth and move vs. repair
                 The smooth and move
                 In older individuals
                 Treatment of partial thickness tears
                 Curettage for partial thickness tears

                 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 and cuff repair
                 Platelet-leukocyte membrane
                 Platelet fibrin matrix
                 Platelet rich plasma
                 The importance of suture number
                 Cuff function after repair - rat model
                 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

                 Position of immobilization
                 Position of immobilization #2
                 Early vs delayed motion

                 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 1
                 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 mass
                 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

                     When does it happen?
                     Improvement in spite of failure of the repair
                     Failure with continuity 1
                     Failure with continuity 2

                     Failure with continuity 3
                     Suture anchor problems

            Types of Arthritis
            Nonoperative management
               Exercises 1
               Exercises 2
               The stiff shoulder
               The secret of stretching
               The swimmer's stretch
               Stretching and the electric toothbrush
               Forward lean
               The secret of stretching
               The swimmer's stretch 1
               The swimmer's stretch 2
               How to stretch and how not to stretch
               Stiff shoulder and diabetes
               The value of exercise

               Drugs for arthritis
               Glucosamine and chondroitin
               Non-steroidal medication 1
               Non-steroidal medication 2

            Arthroscopic debridement

                    Injections for arthritis
                    Hyaluronate 1
                    Hyaluronate 2
                    Hyaluronate 3
                    Platelet rich plasma
                       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
                 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

                     The secret of stretching
                     Exercises 1
                     Exercises 2
                     Exercises 3
                     The stiff shoulder
                     The secret of stretching
                     The swimmer's stretch 1
                     The swimmer's stretch 2
                     Stretching and the electric toothbrush
                     Forward lean
                     Maintaining range of motion
                     Range of motion exercises
                     How to stretch and how not to stretch
                     The value of exercise
                     Rehabilitation: the traction three
                     Rehabilitation: early strengthening
                     Rehabilitation tips
                     Careful of rotator cuff
                          Protection 1
                          Protection 2
                          Protection 3
                          Surgical management 1
                          Surgical management 2
                          Lesser tuberosity osteotomy
                          Lesser tuberosity osteotomy
                          Tuberosity osteotomy vs tenotomy 1
                          Tuberosity osteotomy vs tenotomy 2
                          Tuberosity osteotomy vs tenotomy 3
                          Function after transosseous repair

                 Hemiarthroplasty 1
                 Hemiarthroplasty 2
                 For avascular necrosis
                 For post-traumatic arthritis
                 For dysplasia
            Ream and run
                 Overview of the ream and run
                 Not the same as a hemiarthroplasty
                 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 B2 glenoid - back to active duty
                 For B2 glenoid - five year followup
                 For B2 glenoid function at 9 months
                 For B2 glenoid - commit 100% to rehabiliation
                 For post traumatic arthritis
                 In women
                 Essential points about the ream and run
                 Manipulation and open release for stiffness
                    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 - 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
                    In comparison to stemmed humeral component
                    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
                          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

                      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
                      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

                           Technique for documenting position after surgery
                      Keeled component
                            Survivorship in young adults
                            Ten year outcomes for keeled components
                      Metal back
                            Cementless metal back
                            Failure rate

                          Prognostic factors
                          Comparison to hemiarthroplasty
                          Improvement in function
                          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
                          Unsatisfactory arthroplasty
                          Complications and survivorship
                          Complication rate
                          Predicting complications
                          Thromboembolic prophylaxis
                          Thromboembolic prophylaxis and conflict of interest
                          Thromboembolism - systematic review
                          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
                         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
                             Glenoid component failure
                             Glenoid loosening
                             Glenoid failure
                             Patterns of glenoid component loosening
                             Glenoid lucent lines and 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
                          Our current protocol for revision
                          Revision 1
                          Revision 2
                          Revision rates
                          Considerations regarding revision
                          Approach to revision
                          Revision surgery 1
                          Revision surgery 2
                          Rate of revision
                          For stiffness 1
                          For stiffness 2
                          For glenoid failure 1
                          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 instability
                          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
                          Revisions in NY state
                          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

                            Advantages of lateral offset
                             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
                            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
                  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
                      Improvement in function
                      Change in quality of life
                      Pain and function
                      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
                      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

                 Revision of reverse

         Resection arthroplasty

         Complications of arthroplasty
                 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

                 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
          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
          Pain medication
          Shared decision making
          C difficile
    Causation and statistics


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