Editors-in-Chief Matthew S Austin MD
Gregg R Klein MD
Guest Editor Charles L Getz MD
September 2014 Volume 1 Number 2
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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
7Contributors
Editors-in-Chief
- Matthew S Austin md
- Associate Professor of Orthopedic Surgery
- Rothman Institute
- Philadelphia, Pennsylvania, USA
- Gregg R Klein md
- Vice-Chairman
- Department of Orthopedic Surgery
- Hackensack University Medical Center
- Hackensack, New Jersey, USA
Guest Editor
- Charles L Getz md
- Associate Professor
- Rothman Institute, Thomas Jefferson University
- Philadelphia, Pennsylvania, USA
Contributing Authors
- Joseph A Abboud md
- Associate Professor, Department of Orthopedics
- Rothman Institute, Thomas Jefferson University
- Philadelphia, Pennsylvania, USA
- April Armstrong md frcsc
- Professor, Department of Orthopedics
- Penn State Milton S Hershey Medical School
- Hershey, Pennsylvania, USA
- George S Athwal md frcsc
- Associate Professor
- Roth McFarlane Hand and Upper Limb Centre
- University of Western Ontario
- London, Ontario, Canada
- Luke S Austin md
- Assistant Professor, Department of Orthopedic Surgery
- Thomas Jefferson University Hospital
- Philadelphia, Pennsylvania, USA
- Olufemi R Ayeni MSc md frcsc
- Assistant Professor, Department of Orthopedic Surgery
- McMaster University
- Hamilton, Ontario, Canada
- Eric M Black md
- Fellow, Shoulder and Elbow Surgery
- Department of Orthopedic Surgery
- Rothman Institute, Thomas Jefferson University
- Philadelphia, Pennsylvania, USA
- Paul J Cagle Jr md
- Clinical Fellow, Department of Orthopedic Surgery
- Icahn School of Medicine at Mount Sinai
- New York, New York, USA
- Kevin Chan md msc
- Orthopedic Surgery Chief Resident
- Department of Orthopedic Surgery, McMaster University
- Hamilton, Ontario, Canada
- Christopher Chuinard md mph
- Shoulder and Elbow Surgeon
- Great Lakes Orthopedic Center
- Traverse City, Michigan, USA
- Derek Cuff md
- Suncoast Orthopedic Surgery and Sports Medicine
- Venice, Florida, USA
- Daniel E Davis md
- Resident, Department of Orthopedic Surgery
- Thomas Jefferson University Hospital
- Philadelphia, Pennsylvania, USA
- Salvatore J Frangiamore md ms
- Resident Physician, Department of Orthopedic Surgery
- Cleveland Clinic Foundation
- Cleveland, Ohio, USA
- Grant E Garrigues md
- Assistant Professor, Department of Orthopedic Surgery
- Duke University Medical Center
- Durham, North Carolina, USA
- Matthew J Grosso bs
- Medical Student, Department of Orthopedic Surgery
- Cleveland Clinic Foundation
- Cleveland, Ohio, USA
- Kurt J Hofmann md
- Resident, Department of Orthopedics
- Tufts Medical Center
- Boston, Massachusetts, USA
- Joseph P Iannotti phd
- Maynard Madden Professor Chair
- Orthopedic and Rheumatologic Institute, Cleveland Clinic
- Cleveland, Ohio, USA
- Jack E Kazanjian do faoao
- Clinical Assistant Professor, Department of Orthopedic Surgery
- Philadelphia College of Osteopathic Medicine
- Premier Orthopedics and Sports Medicine
- Havertown, Pennsylvania, USA
- Jay D Keener md
- Assistant Professor, Department of Orthopedic Surgery
- Washington University in St. Louis School of Medicine
- St. Louis, Missouri, USA
- Jia-Wei Kevin Ko md
- Resident Physician, Department of Orthopedics
- Oregon Health and Sciences University
- Portland, Oregon, USA
- Mark D Lazarus md
- Associate Professor, Department of Orthopedic Surgery
- The Rothman Institute, Thomas Jefferson University
- Philadelphia, Pennsylvania, USA
- Marie-Eve LeBel md mhpe frcsc
- Associate Professor, Department of Surgery
- Division of Orthopedic Surgery, Western University
- London, Ontario, Canada
- Jesse A McCarron md
- Section Chief
- Orthopedic Surgery, Veterans Affairs Medical Center
- Assistant Professor
- Department of Orthopedic Surgery and Rehabilitation
- Oregeon Health and Science University
- Portland, Oregon, USA
- Suzanne L Miller md
- Assistant Clinical Professor, Department of Orthopedics
- New England Baptist Hospital, Tufts University
- Boston, Massachusetts, USA
- Anand M Murthi md
- Attending Orthopedic Surgeon, Chief Shoulder and Elbow Service
- Department of Orthopedics and Sports Medicine
- MedStar Union Memorial Hospital
- Baltimore, Maryland, USA
- Bradford O Parsons md
- Associate Professor, Department of Orthopedic Surgery
- Icahn School of Medicine at Mount Sinai
- New York, New York, USA
- Derek Pupello mba
- Chief Executive Officer
- Foundation for Orthopedic Research and Education
- Tampa, Florida, USA
- Eric T Ricchetti md
- Staff, Department of Orthopedic Surgery
- Cleveland Clinic
- Cleveland, Ohio, USA
- Vikram M Sathyendra md
- Fellow, Department of Orthopedic Surgery
- Medstar Union Memorial Hospital
- Baltimore, Maryland, USA
- Dave R Shukla md
- Resident, Department of Orthopedic Surgery
- Icahn School of Medicine at Mount Sinai
- New York, New York, USA
- Jason A Stein md
- Orthopedic Surgeon, Department of Orthopedic Surgery
- Medstar Union Memorial Hospital
- Baltimore, Maryland, USA
- Gary F Updegrove md
- Orthopedic Surgery Resident, Department of Orthopedics
- Penn State Milton S. Hershey Medical Center
- Hershey, Pennsylvania, USA
- Corinne VanBeek md
- Attending, Department of Surgery
- Stamford Hospital
- Stamford, Connecticut, USA
- Gerald R Williams Jr md
- Professor, Chief, Division of Shoulder and Elbow Surgery
- Orthopedic Surgery, The Rothman Institute
- Thomas Jefferson University
- Philadelphia, Pennsylvania, USA
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
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
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
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: