Orthopedics: Shoulder and Elbow Surgery Matthew S Austin, Gregg R Klein, Charles L Getz
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1World Clinics Orthopedics: Shoulder and Elbow Surgery2
3World Clinics Orthopedics: Shoulder and Elbow Surgery
Editors-in-Chief Matthew S Austin MD Gregg R Klein MD Guest Editor Charles L Getz MD
September 2014 Volume 1 Number 2
4
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This issue has been published in good faith that the contents provided by contributors contained herein are original, and is intended for educational purposes only. While every effort is made to ensure the accuracy of information, the publisher and the editors specifically disclaim any damage, liability, or loss incurred, directly or indirectly, from the use or application of any of the contents of this work. If not specifically stated, all figures and tables are courtesy of the contributing authors. Where appropriate, the readers should consult with a specialist or contact the manufacturer of the drug or device.
Cover images: (Left) Postoperative view of a left shoulder. A distal tibial cortical allograft was utilized as reinforcement for a humeral stem fracture that was encountered upon implant removal in this revision case. Cerclage cables are holding fixation of the humeral fracture and allograft. Courtesy: Eric M Black, Jack E Kazanjian, Gerald R Williams Jr. (Middle) Type 2 sequela with an older patient was treated with semiconstrained arthroplasty with good results. Courtesy: Christopher Chuinard. (Right) Three-dimensional reconstruction computed tomography scan of a proximal humerus fracture aids in identifying fragment orientation and displacement. Courtesy: Corinne VanBeek, Joseph A Abboud.
WORLD CLINICS ORTHOPEDICS: Shoulder and Elbow Surgery
September 2014, Volume 1, Number 2
ISSN: 2348-702X
9789351526001
Printed in India
5Dedication
This issue of the World Clinics is dedicated to John Fenlin MD,
who first showed me how great it is to be a shoulder surgeon
I would also like to thank my many friends and colleagues
who agreed to write articles for this issue. I appreciate the time
and effort that is required to produce quality work
Finally, on a personal note, I would like to thank my wife
Samantha for putting up with me being on a computer many
nights working on this project. Without her support, all would
not have been possible
Charles L Getz6
7Contributors
Editors-in-Chief
Guest Editor
Contributing Authors
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9
10
11
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Foreword
Disorders of the shoulder and elbow have longed plagued man. There are Egyptian hieroglyphs illustrating the treatment of shoulder instability. The path to modern shoulder and elbow diagnosis and treatment passes through the writings of Hippocrates, Kocher, Perthes, and Codman to the modern giants contributing to the subspecialty. The work of these masters has laid the foundation for treating shoulder and elbow pathology.
Dr Charles Getz, from the Rothman Institute, has assembled internationally renowned contributors to bring the reader (whether a junior orthopedic resident or a seasoned attending surgeon) an outstanding compendium addressing the issues facing shoulder and elbow surgeons today. Shoulder and elbow specialists have a wide array of treatment options available to address their patient's pain and dysfunction including successful nonoperative and operative treatments. The authors address hot topics such as reverse shoulder arthroplasty and treatment of arthritis in the young patient. Advanced management techniques for reconstructing bone loss in instability surgery, rotator cuff grafting, subscapularis deficiency in shoulder arthroplasty, nonunion, and malunion of the proximal humerus are described. Trauma to the shoulder and elbow joints, infection, rehabilitation, non-arthroplasty options for elbow degenerative joint disease, and superior labrum from anterior to posterior tears are addressed by expert thought-leaders.
World Clinics in Orthopedics is a wonderful resource for those interested in a concise and well-written update on topics near and dear to the surgeon treating patients with both straight-forward and complex shoulder and elbow problems. Dr Getz has assembled a true “who's-who” of experts in their field to share their knowledge and experience with the reader. We hope you enjoy this latest issue.
Matthew S Austin md
Gregg R Klein md
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14Editorial
Charles L Getz md
Guest Editor
As a result of new technology, surgical technique, and improved understanding of pathology, the orthopedic subspecialty of shoulder and elbow surgery has evolved at an incredible pace over the past 20 years. Optimal treatments will continue to be explored, and there will be new controversies to be discussed in the future. However, this issue serves as a snapshot of where shoulder surgery is now. The authors have particular expertise in the areas on which they have written and have been asked to add their opinions where current evidence does not exist. They will examine novel techniques, changing treatment options, and difficult complications related to shoulder and elbow surgery.
The current text does not attempt to encompass the entire field of shoulder and elbow surgery, but rather, explores the topics that are considered new, challenging, and dynamic. It is my hope that by defining and clarifying the current hot topics in this field, readers will be better able to treat their patients.
Charles L Getz md
Associate Professor
Rothman Institute, Thomas Jefferson University
Philadelphia, Pennsylvania, USA
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16Acknowledgements
The editor would like to thank Joe Rusko, Marco Ulloa, and the entire Jaypee Brothers Medical Publishers (P) Ltd., New Delhi, India production team for their assistance in assembling this issue of World Clinics. I would also like to thank Dr Austin and Dr Klein for the opportunity to contribute to this series.
Charles L Getz
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18Abbreviations AC
Acromioclavicular
AP
Anteroposterior
AROM
Active ROM
ASES
American Shoulder and Elbow Score
AVN
Avascular necrosis
CA
Corocoacromial
CC
Carococlavicular
CNSS
Coagulase negative Staphylococcus species
CPM
Continuous passive motion
CRP
C-reactive protein
CT
Computed tomography
DASH
Disabilities of the Arm, Shoulder and Hand
ECM
Extracellular matrix
EMG
Electromyogram
ER
External rotation
ESR
Erythrocyte sedimentation rate
FDA
Food and Drug Association
FE
Forward elevation
HA
Hemiarthrosplasty
IGHL
Inferior glenohumeral ligament
IL
Interleukin
IR
Internal rotation
LAA
Lateral acromial angle
LTO
Lesser tuberosity osteotomy
MCP
Metacarpophalangeal
MGHL
Middle glenohumeral ligament
MRI
Magnetic resonance imaging
NCAA
National Collegiate Athletic Association
OA
Osteoarthritis
PJI
Periprosthetic joint infection
PROM
Passive range of motion
RA
Rheumatoid arthritis
ROM
Range of motion
RSA
Reverse shoulder arthroplasty
RTSA
Reverse total shoulder arthroplasty
SIS
Small intestine submucosa
SLAP
Superior labral anterior posterior
SST
Simple shoulder test
VAS
Visual analog scale
19ERRATUM
in the article by Drs. Irwin, Schwenk, and Viscusi: Perioperative Pain Management: The Secret Behind Rapid Recovery, which appeared in the March 2014 issue of World Clinics in Orthopedics was printed incorrectly. Please see the corrected table below:
Table 3   Timing of Therapy
Time period
TKA and THA
TKA only
Preoperative
  • Acetaminophen
  • Celecoxib
  • Pregabalin
Intraoperative
  • Spinal
  • CSE
  • General
Postoperative
  • Epidural
  • Acetaminophen
  • Lumbar plexus block
  • Pregabalin
  • Celecoxib
  • IV PCA
  • PO opioids
  • Adductor canal block
  • FNB
  • Intra-articular wound infusion
THA, total hip arthroplasty; TKA, total knee arthroplasty; CSE, combined spinalepidural; FNB, femoral nerve block; IV PCA, intravenous patient-controlled analgesia; POs, prescription opioids.