shoulder

Background

 total shoulder arthroplast allPoly Glenoid

 

Indications

 

RA 

OA 

AVN 

 

Contra-indications

 

Infection

Charcot

Paralysis of deltoid

Torn rotator cuff

Insufficient glenoid bone stock

 

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

 

Synovial Chondromatosis

DefinitionSynovial Chondromatosis Knee MRI

 

Chondroid Metaplasia of synovium affecting large joints

 

Nodules of hyaline cartilage

- formed in the subsynovial layer of joint capsules

 

Epidemiology

 

Rare lesion

Most common in 20's and 30's

Sex: M > F (2:1)

Monoarticular

 

Site

 

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