shoulder

Osteoarthritis

EpidemiologyShoulder OA

 

Usually 50-60 years old

 

Aetiology

 

1° uncommon

 

2° most common

- AVN

- trauma

- cuff arthropathy (Neer)

- instability

 

Pathology

 

Cuff & biceps intact as rule

- rare to have OA and rotator cuff pathology

 

Shoulder

Approaches

 

Anterior

Anterolateral

Posterior

 

Anterior Approach / Deltopectoral

 

Indications

- shoulder stabilization

- arthroplasty

- fracture fixation

 

Approach

 

Position

- beach chair

- upper body elevated 30- 40o / reduces venous pressure and bleeding

Throwing Athlete

Throwing

 

Wind-up

- cocking

- ER up to 180o in pitcher

 

Acceleration

- large scapular muscles 

- acceleration - 7000o/sec

- rotatory acceleration similar to car tyre at 130 kph

 

Control and deceleration

- fragile cuff & glenohumeral ligament complex 

 

Anatomy

 

Revision Stabilisation

Causes for failure

 

1.  Patient factors

 

A.  Recurrent Trauma

- contact athletes higher risk

 

B.  MDI / Ligamentous Laxity / Voluntary dislocaters

 

C.  Poor rehabilitation

- poor motivation

- too rapid

- patients rarely get stiff, better to go very slow

 

2.  Surgeon Factors

 

A.  Unrecognised bony defect

HAGL

DefinitionHAGL Arthroscopy

 

Humeral Avulsion of Glenohumeral Ligament

 

Incidence

 

Bokor et al JBJS Br 1999

- 514 cases surgical treatment traumatic instability

- incidence 7.5%

- 25% associated SSC tear

- likelihood of HAGL if no Bankart or MDI 27%