The Resident's Guide to Shoulder and Elbow Surgery

364 Pages·2022·20.814 MB·English

by  Caroline M. Chebli, Anand M. Murthi

The Resident's
Guide to Shoulder
and Elbow Surgery
Caroline M. Chebli
Anand M. Murthi
Editors
123
The Resident’s Guide to Shoulder
and Elbow Surgery
Caroline M. Chebli • Anand M. Murthi
Editors
The Resident’s Guide
to Shoulder and Elbow
Surgery
Editors
Caroline M. Chebli Anand M. Murthi
James A. Haley Medical Center MedStar Union Memorial Hospital
Tampa, FL, USA Baltimore, MD, USA
ISBN 978-3-031-12254-5 ISBN 978-3-031-12255-2 (eBook)
https://doi.org/10.1007/978-3-031-12255-2
© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature
Switzerland AG 2022
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To our ACESS (Association of Clinical
Elbow and Shoulder Surgeons) family who
are the authors of this guidebook. They don’t
understand the concept of an actual deadline
unless there is a party and then they are
always on time!! But we love them anyway
and thank them for their time and
commitment to education.
Preface
The field of Shoulder and Elbow Surgery has grown tremendously in the recent
past. When we were applying for fellowship, there were only a few positions avail-
able. Today, it is a highly competitive Accreditation Council for Graduate Medical
Education and/or American Shoulder and Elbow Surgeons approved fellowship
within the match. This popularity is partly due to the incredible advances that have
been made over the last 20 or so years. New technology and innovation have allowed
us to improve our diagnostics and patient care. To that end, it is difficult to decipher
the best practices within this rapidly growing field. As physicians who are actively
involved in the education of medical students, residents, and fellows, we sought to
create a reference guide for best practices. We gathered some of the most prolific
thinkers in the field and paired them with residents and fellows to create this book.
Many of the authors are fellowship directors, residency directors, chairman, team
physicians, and national and international educators. The book is meant to be a
quick guide for medical students, residents, and fellows. It is organized in outline
form for easy reference. As anyone who has ever been in the “hot-seat” during
rounds or in the operating room, you will recognize the value in having a quick
reference to the most asked questions. References are included to validate the infor-
mation and for a more in-depth review of the topic. We hope this guide will aid in
medical education and illuminate each topic so that the salient information is read-
ily accessible.
Tampa, FL, USA Caroline M. Chebli
Baltimore, MD, USA Anand M. Murthi
vii
Contents
1 Glenohumeral Osteoarthritis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Blake C. Meza, Joshua I. Mathew, and Lawrence V. Gulotta
2 Rotator Cuff Tear Arthropathy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Kevin J. Cronin, Christopher D. Joyce, and Joseph A. Abboud
3 Inflammatory Arthritis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Ian D. Engler and Andrew Jawa
4 Rotator Cuff Tear . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Noah Quinlan and Robert Z. Tashjian
5 Anterior Shoulder Instability. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
Caroline Vonck and Seth Gamradt
6 Posterior Instability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
Ryan Bicknell
7 Multidirectional Instability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
Akshar H. Patel, Felix H. Savoie III, and Michael J. O’Brien
8 SLAP Tears and Biceps Tendinopathy . . . . . . . . . . . . . . . . . . . . . . . . . . 107
Matthew J. Deasey and Stephen F. Brockmeier
9 Adhesive Capsulitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
Marc S. Kowalsky
10 Impingement and Acromioclavicular Arthritis . . . . . . . . . . . . . . . . . . . 133
Lauren Zurek and Bradford Parsons
11 Proximal Humerus Fractures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141
Jack E. Kazanjian
12 Clavicle Fractures (Medial, Midshaft, Lateral) . . . . . . . . . . . . . . . . . . . 157
Andrew Boltuch and Jonathan Levy
13 Acromioclavicular Joint Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167
Trenton Sprenkle and Steven Klepps
ix
x Contents
14 Sternoclavicular Joint Dislocation and Instability . . . . . . . . . . . . . . . . . 181
Eitan M. Kohan and Charles L. Getz
15 Scapula Fractures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191
Joseph T. Labrum IV and Ian R. Byram
16 Distal Biceps Rupture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205
Paul Sethi, Thomas Evely, and Jade Cohen
17 Triceps Rupture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 219
Jay Keener
18 Medial and Lateral Epicondylitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 235
Jesse McCarron and John Kafrouni
19 Elbow Dislocation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 249
Gary F. Updegrove and April D. Armstrong
20 Lateral Ulnar Collateral Ligament Injury . . . . . . . . . . . . . . . . . . . . . . . 257
Nicholas J. Sacksteder and Edward R. Hobgood
21 Medial Collateral Ligament Tears . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 265
Meaghan A. Tranovich and Brian R. Wolf
22 Arthritis of the Elbow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 279
Emilie Cheung and Stephanie Tieu Kha
23 Distal Humerus Fractures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 295
Spencer Albertson and Christopher Chuinard
24 Monteggia Fractures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 307
Carl M. Cirino and Brad O. Parsons
25 Radial Head Fractures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 317
Brenton P. Hill and Derek J. Cuff
26 Terrible Triad of the Elbow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 323
Roman Ashmyan and Cyrus Lashgari
27 Pediatric Supracondylar Humerus Fracture . . . . . . . . . . . . . . . . . . . . . 337
Kyle G. Achors and Gregory S. Bauer
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 363
Glenohumeral Osteoarthritis 1
Blake C. Meza , Joshua I. Mathew ,
and Lawrence V. Gulotta
Introduction
Primary glenohumeral osteoarthritis is a chronic degenerative disorder of the articu-
lar cartilage of the shoulder, defined by damage to the articular cartilage as a result
of chronic stresses, overuse, repetitive microtrauma, and structural anomalies in
joint and cartilage composition.
Epidemiology
• Occurs in a bimodal distribution.
– Men in their 50s
– Men and women in their 70s and 80s
• Recent estimates suggest that nearly one-third of the global population over age
60 suffer from glenohumeral osteoarthritis [1].
• The rate of radiographic evidence of glenohumeral arthritis is even higher, but
the presence of arthritic changes on X-ray does not necessarily correlate with
symptomatic disease.
• Like other diseases of the elderly, the global disease burden of glenohumeral
osteoarthritis, as well as the future potential need for surgical intervention, will
continue to increase as the population ages [2].
• Risk factors:
– Several factors are associated with an increased risk of developing glenohu-
meral osteoarthritis, including age, sex, obesity, genetics, previous injuries,
and certain occupations or sports [3, 4].
B. C. Meza · J. I. Mathew · L. V. Gulotta (*)
Shoulder and Elbow Division, Sports Medicine Institute, Hospital for Special Surgery,
New York, NY, USA
e-mail: [email protected]
© The Author(s), under exclusive license to Springer Nature Switzerland AG 2022 1
C. M. Chebli, A. M. Murthi (eds.), The Resident’s Guide to Shoulder and Elbow
Surgery, https://doi.org/10.1007/978-3-031-12255-2_1
2 B. C. Meza et al.
– BMI greater than 24 has been associated with an increased risk of glenohu-
meral arthritis, whereas BMI greater than 30 has been associated with
increased odds of requiring shoulder arthroplasty.
– Caucasian patients of Northern European descent are believed to be at
increased risk for degenerative arthritis of the shoulder [5].
1. History
• Patients with glenohumeral osteoarthritis will typically report having shoul-
der pain with activity but not at rest, shoulder stiffness, crepitus, or “catching”
with shoulder motion.
• Obtain a thorough history from the patient in order to differentiate other pos-
sible etiologies of their shoulder pain.
(a) Description of Pain
• Onset, location, descriptive characteristics
– How long has the patient had pain? Is it progressively getting worse?
– Where is the pain located?
– Is it sharp? Is it more like an aching cramp? Does it radiate down the
arm or into the neck?
• Alleviating or aggravating factors
– Osteoarthritic pain occurs with side-to-side movement of the shoulder
– Have they found holding the arm in certain positions or performing
specific activities is more difficult?
– What have they taken for the pain? Has it helped their pain?
• Severity
– As the disease progresses, patients will commonly have difficulty with
sleeping on the arthritic shoulder and other activities of daily living.
– Does the pain interfere with work, getting dressed, or sleeping?
– Is their dominant or nondominant arm affected?
• Other symptoms
– Is their shoulder stiff? Do they feel like their shoulder “gets caught”?
– Are any other joints affected?
– Are they having any systemic symptoms, like fevers, chills, etc.?
(b) Other Etiologies to Consider
• Differential diagnosis for shoulder pain: rotator cuff injury, adhesive cap-
sulitis, fracture, other types of arthritis (posttraumatic arthritis, inflamma-
tory arthropathy, and rotator cuff arthropathy)
– Any history of recent or remote trauma to the shoulder?
– Is there a personal or family history of autoimmune disorders (i.e.,
rheumatoid arthritis) or endocrinopathies (i.e., diabetes,
hypothyroidism)?
• Prior treatments
– Physical therapy, corticosteroid injections, and over-the-counter anti-
inflammatories may all play a role in the nonoperative management.
– Has the patient tried any of these? If so, did they experience any
improvement in symptoms? For how long?