Gartsman's Shoulder Arthroscopy E-Book

Hussein Elkousy, T. Bradley Edwards

• Publisher: Elsevier
• Year: 2018
• eBook ISBN: 9780323529594
• Edition: 3
• Topic: Medicine
• Subtopic: Orthopedics

Covering the entire spectrum of operative shoulder arthroscopy, including both routine and complex shoulder procedures, Gartsman's Shoulder Arthroscopy, 3rd Edition, provides a straightforward, "classroom" approach that walks you through each step of these challenging surgeries. Two master surgeons in the field, Drs. Hussein Elkousy and T. Bradley Edwards, present clear explanations of the standard approach to each procedure, plus variations and complications that frequently arise. Focused, concise coverage includes review of anatomy, indications and contraindications, non-operative options, pre-operative assessment and imaging, and more.- Provides a uniform, consistent approach to all aspects of shoulder arthroscopy, including "pearls" from the expert author team of Hussein Elkousy and T. Bradley Edwards.- Includes new and revised content on bicep lesions and acromioclavicular joint pathology, arthroscopic diagnostic and management tools, rehabilitation and new non-metallic implants and knotless techniques.- Contains more videos, techniques and images on how to address rotator cuff and labral pathology.- Features superb intraoperative photographs and line drawings, as well as accompanying videos for dynamic clarification – all updated to offer the latest visual guidance in the field.- Expert Consult™ eBook version included with purchase. This enhanced eBook experience allows you to search all of the text, figures, and references from the book on a variety of devices.

Section Three

Subacromial Space Surgery

Outline

• Chapter 10 Impingement Syndrome
• Chapter 11 Partial-Thickness Rotator Cuff Tears
• Chapter 12 Full-Thickness Rotator Cuff Tears
• Chapter 13 Massive Rotator Cuff Tears
• Chapter 14 Irreparable Rotator Cuff Tears
• Chapter 15 Acromioclavicular Joint Pathology
• Chapter 16 Calcific Tendinitis
• Chapter 17 Fractures
• Chapter 18 Diagnostic Ultrasonography
• Chapter 19 Rehabilitation

Chapter 10

Impingement Syndrome

Rotator cuff tendon lesions of the subacromial space include tendinosis (impingement syndrome), partial-thickness tears, and full-thickness tears. Full-thickness tears come in all patterns and sizes and can be further classified as being fully reparable, partially reparable, or irreparable, depending on several factors that will be reviewed in later chapters. Impingement syndrome refers to extrinsic compression of the rotator cuff tissue by the acromion or coracoid resulting in pain with or without damage to the rotator cuff. The impingement is due to contact of these structures with the underlying rotator cuff (static). Internal impingement is associated with glenohumeral pathology or dyskinesis of the rotator cuff and scapular stabilizers, and is not addressed in this chapter.

Diagnosis

Because impingement involves the rotator cuff, it presents similar to rotator cuff tears. The patient complains of subdeltoid pain with radiation down the lateral arm to the area of the deltoid insertion or down the front of the arm into the biceps muscle. Pain occurs as the arm passes through the arc of 70 to 100 degrees of abduction. Typical activities that are bothersome include reaching overhead (e.g., for items on a high shelf), behind the back (e.g., to fasten a brassiere or belt), or to the side (e.g., to insert an ATM card, use a seatbelt, or access an alarm clock). Patients with severe symptoms may complain of pain that interferes with sleep. The role of trauma is variable; some patients present with symptoms after major injury, but in many others, the pain occurs after repetitive activities without trauma or antecedent injury.

Physical examination normally demonstrates full passive range of motion. Small limitations in elevation and behind-the-back internal rotation are due to the patient's pain rather than true passive glenohumeral joint contracture. Active abduction and behind-the-back internal rotation are painful. The patient often reports pain while actively lowering the arm after the examiner raises it passively. The primary (Neer) and secondary (Hawkins) impingement signs are positive, and pain is relieved with a subacromial lidocaine injection (impingement test). The patient may have pain with palpation over the supraspinatus insertion.

Three special physical exam tests consistent with impingement have been described and are recorded as positive when subacromial pain is produced. The primary (Neer) sign occurs when the examiner places the shoulder in maximal elevation. To demonstrate the secondary (Hawkins) sign, the shoulder is elevated 80 degrees and then maximally internally rotated. The tertiary sign (painful arc) consists of subacromial pain with the shoulder in 90 degrees of abduction. The location of the pain should be carefully noted. A patient with soft tissue pain from rhomboid-trapezius spasm may have increased pain during each of these maneuvers, but the pain is not localized to the subacromial region.

After the physical examination, the surgeon may perform an impingement test. This test consists of injecting local anesthetic into the subacromial space and then attempting to elicit the impingement signs again. If the pain is eliminated or substantially reduced, the test is recorded as positive. The physician must be aware that a positive test result only confirms that the structures producing pain lie within the subacromial space; it is not, by itself, diagnostic of impingement syndrome. Our preferred technique for subacromial injection is posterior, but other surgeons are equally successful with lateral or anterior approaches. We use ultrasound guidance to confirm the location of the injection.

The diagnosis of impingement syndrome is clinical, and arthroscopy does not routinely play ...

Table of contents

• Cover image
• Title Page
• Table of Contents
• Copyright
• Dedication
• Preface
• Video Contents
• Section One The Basics
• Section Two Glenohumeral Joint Surgery
• Section Three Subacromial Space Surgery
• Index