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Disorders of the Shoulder
Diagnosis & Management
SECOND EDITION
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VOLUME 1
Disorders of the Shoulder
Diagnosis & Management
SECOND EDITION
EDITORS
JOSEPH P. IANNOTTI, MD, PHD
Maynard Madden Professor and Chairman
Department of Orthopaedic Surgery
Cleveland Clinic Lerner College of Medicine
Case Western Reserve University
The Cleveland Clinic Foundation
Cleveland, Ohio
GERALD R. WILLIAMS, JR., MD
Professor of Orthopaedic Surgery
University of Pennsylvania
Chief, Orthopaedic Surgery
Penn Presbyterian Medical Center
Philadelphia, Pennsylvania
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Disorders of the shoulder : diagnosis and management / editors, Joseph P. Iannotti,
Gerald R. Williams Jr. — 2 nd ed.
p. ; cm.
Includes bibliographical references and index.
ISBN 0 -7 8 1 7 -5 6 7 8 -2 ( alk. paper)
1 . Shoulder— Surgery. 2 . Shoulder— Diseases. I. Iannotti, Joseph P. II. Williams,
Gerald R., 1 9 5 8 -
[DNLM: 1 . Shoulder— surgery. 2 . Joint Diseases— diagnosis. 3 . Joint Diseases—
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To my son, Matthew, and my father, Frank, for their never-ending support. To my col-
league and best friend, Jerry Williams.
—Joseph P. Iannotti
To all of my teachers, especially Charles A. Rockwood, Jr., M.D., for their wisdom and
patience. To my friend and trusted colleague, Joseph Iannotti M.D., Ph.D., without
whom my professional journey would be incomplete. To my family, especially my wife,
Robin, and my children, Mark and Alexis, for the love and support we share with each
other.
—Gerald R. Williams, Jr.
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Contents
Contributors ix 11 Diagnosis of Glenohumeral Instability 339
Preface xiii Jerry S. Sher, Jonathan C. Levy, Joseph P. Iannotti,
and Gerald R. Williams, Jr.
VOLUME 1 12 Anterior and Anteroinferior Instability: Open
and Arthroscopic Management 369
Anthony Miniaci, David E. Haynes,
PART I: ROTATOR CUFF DISEASE AND
Gerald R. Williams, Jr., and Joseph P. Iannotti
TENDON RUPTURES 1
13 Posterior Instability: Open and Arthroscopic
1 Anatomy, Biomechanics, and Pathophysiology
Management 401
of Rotator Cuff Disease 3
Matthew L. Ramsey and Jeffrey S. Abrams
David L. Glaser, Jerry S. Sher, Eric T. Ricchetti,
Gerald R. Williams, Jr., and Louis J. Soslowsky 14 Multidirectional Instability: Open and
Arthroscopic Management 433
2 Diagnosis, Patient Selection, and Clinical
John J. Brems and Felix H. Savoie, III
Decision Making 39
Allen Deutsch, Matthew L. Ramsey, and Joseph P. Iannotti 15 Chronic Dislocations 461
Sean M. Griggs, G. Brian Holloway,
3 Management of Rotator Cuff Disease: Intact and
Gerald R. Williams, Jr., and Joseph P. Iannotti
Repairable Cuff 53
Joseph P. Iannotti, Michael J. Codsi, Laurent Lafosse, 16 Complications of Instability Surgery 487
and Evan L. Flatow Mark D. Lazarus and Michael Walsh
4 Management of Irreparable Rotator Cuff Tears:
The Role of Tendon Transfer 101
John G. Costouros, Christian Gerber, and Jon J.P. Warner PART III: FROZEN SHOULDER 5 3 9
5 Complications of Rotator Cuff Surgery 147 17 Diagnosis and Management of the Stiff
Brian D. Cameron, Gerald R. Williams, Jr., and Shoulder 541
Joseph P. Iannotti Frances Cuomo and G. Brian Holloway
6 Calcifying Tendinitis 185
Shawn P. Hennigan and Anthony A. Romeo
PART IV: GLENOHUMERAL
7 Disorders of the Biceps Tendon 217
JOINT ARTHRITIS AND RELATED
Ken Yamaguchi, Jay Keener, and Leesa M. Galatz
DISORDERS 5 6 1
8 Traumatic Muscle Ruptures 261
18 Pathophysiology, Classification, and
Donald F. D’Alessandro, Patrick M. Connor,
Pathoanatomy of Glenohumeral Arthritis
and Marshall A. Kuremsky
and Related Disorders 563
David N. Collins
PART II: GLENOHUMERAL 19 Biomechanics of the Glenohumeral Joint:
INSTABILITY 2 7 9 Influence on Shoulder Arthroplasty 633
Gerald R. Williams, Jr., and Joseph P. Iannotti
9 Anatomy, Biomechanics, and Pathophysiology of
Glenohumeral Instability 281 20 Alternatives to Replacement Arthroplasty for
Brian J. Cole, Clifford G. Rios, Augustus D. Mazzocca, Glenohumeral Arthritis 655
and Jon J.P. Warner Sumant G. Krishnan, David C. Harkins, and
Wayne Z. Burkhead, Jr.
10 Biomechanics and Pathologic Lesions in the
Overhead Athlete 313 21 Glenohumeral Arthrodesis 675
Patrick J. McMahon, Thay Q. Lee, and James E. Tibone Robin R. Richards
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v iii Contents
VOLUME 2 PART VII: NEUROMUSCULAR AND
SCAPULOTHORACIC DISORDERS 10 5 5
22 Unconstrained Prosthetic Arthroplasty for 34 The Scapulothoracic Articulation:
Glenohumeral Arthritis with an Intact or Anatomy, Biomechanics, Pathophysiology,
Repairable Rotator Cuff: Indications, Techniques, and Management 1057
and Results 697 John E. Kuhn
Gerald R. Williams, Jr. and Joseph P. Iannotti
35 Injuries of the Brachial Plexus 1087
23 Cuff Deficiency Arthropathy: Unconstrained and
Scott H. Kozin
Constrained Shoulder Arthroplasty 727
Ori Safran, Ludwig Seebauer, and Joseph P. Iannotti 36 Suprascapular and Axillary Nerve
Injuries 1135
24 Complications of Shoulder Arthroplasty 753
Young W. Kwon and Stephen A. Hunt
John W. Sperling and Robert H. Cofield
25 Techniques for Revision Arthroplasty: Management
of Bone and Soft Tissue Loss 773 PART VIII: NEOPLASIA AND
Michael J. Codsi and Joseph P. Iannotti INFECTION 115 5
37 Tumors of the Shoulder Girdle 1157
PART V: FRACTURES 7 9 1 Martin M. Malawer, James C. Wittig, and
Kristen KellarGraney
26 Fractures of the Scapula: Diagnosis and
Treatment 793 38 Sepsis of the Shoulder Girdle 1201
Thomas P. Goss and Brett D. Owens Wudbhav N. Sankar and John L. Esterhai, Jr.
27 Fractures of the Proximal Humerus: Classification,
Diagnosis, and Nonoperative Management 841
Joseph D. Zuckerman and Deenesh T. Sahajpal PART IX : REHABILITATION AND
OUTCOME MEASURES 12 3 3
28 Minimally Invasive Techniques for Proximal
Humeral Fractures 873 39 General Techniques of Shoulder
Leesa M. Galatz and Hyun Min Kim Rehabilitation 1235
Martin J. Kelley, Brian G. Leggin, and
29 Hemiarthroplasty for Proximal Humerus
Kenneth J. Rogers
Fractures 889
Michael A. Wirth, Zachary R. Leitze, and 40 Disease-Specific Methods of
Charles A. Rockwood, Jr. Rehabilitation 1265
Brian G. Leggin and Martin J. Kelley
30 Malunions, Nonunions, and Other Complications
of Proximal Humerus Fractures 907 41 Measurement of Shoulder Outcomes 1295
Todd F. Ritzman and Joseph P. Iannotti Brian G. Leggin, Joseph P. Iannotti, and
Gerald R. Williams, Jr.
31 Fractures of the Clavicle 943
Jonas Andermahr, David C. Ring, and Jesse B. Jupiter
PART X : PAIN MANAGEMENT 13 17
PART VI: ACROMIOCLAVICULAR AND
42 Medical Management of Chronic Shoulder
STERNOCLAVICULAR JOINTS 9 7 7
Pain 1319
32 Disorders of the Acromioclavicular Joint: Samer N. Narouze and Nagy A. Mekhail
Pathophysiology, Diagnosis, and Management 979
43 Anesthesia for Shoulder Surgery 1347
Gordon W. Nuber and Laurent Lafosse
Michael P. Smith, Robert Helfand, and
33 Disorders of the Sternoclavicular Joint: Pathophysi- John E. Tetzlaff
ology, Diagnosis, and Management 1007
Edwin E. Spencer, Jr., Michael A. Wirth, and
Charles A. Rockwood, Jr. Index I–1
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Contributors
JEFFREY S. ABRAMS, MD Department of Orthopaedic Surgery Carolina Medical Center
Attending Orthopaedic Surgeon Mayo Clinic Charlotte, North Carolina
Department of Surgery Rochester, Minnesota
University Medical Center at Princeton ALLEN DEUTSCH, MD
BRIAN J. COLE, MD, MBA
Associate Medical Director Clinical Assistant Professor
Associate Professor
Princeton Orthopaedic & Rehabilitative Department of Orthopaedic Surgery
Department of Orthopedics; Anatomy
Associates Baylor College of Medicine
and Cell Biology
Princeton, New Jersey Department of Orthopaedic Surgery
Rush University Medical Center
Kelsey-Seybold Clinic
JONAS ANDERMAHR, MD Chicago, Illinois St. Luke’s Episcopal Hospital
Associate Professor Houston, Texas
DAVID N. COLLINS, MD
Clinic for Trauma, Orthopedic,
University of Arkansas for Medical
Hand and Reconstructive Surgery JOHN L. ESTERHAI, JR., MD
Sciences
University of Cologne Professor of Orthopaedic Surgery
Arkansas Specialty Orthopaedics
Consultant University of Pennsylvania School of
Little Rock, Arkansas
Clinic of University of Cologne Medicine
Cologne, Germany PATRICK M. CONNOR, MD Professor of Orthopaedic Surgery
The Shoulder and Elbow Center Department of Orthopaedic Surgery
JOHN J. BREMS, MD The Sports Medicine Center Hospital of the University of
Director, Shoulder Fellowship Ortho Carolina Pennsylvania
Orthopaedic Surgery Clinical Faculty Philadelphia, Pennsylvania
Cleveland Clinic Foundation
Department of Orthopaedic Surgery
Cleveland, Ohio Carolina Medical Center EVAN L. FLATOW, MD
Charlotte, North Carolina Lasker Professor and Interim Chair
WAYNE Z. BURKHEAD, JR., MD
Department of Orthopaedic Surgery
Clinical Professor JOHN G. COSTOUROS, MD Chief of Shoulder Surgery
Department of Orthopaedics Clinical Instructor Mount Sinai Medical Center
UT Southwestern Medical School Department of Orthopaedic Surgery New York, New York
Physician Harvard Medical School
Department of Orthopaedics Clinical Instructor
LEESA M. GALATZ, MD
The Carrell Clinic Harvard Shoulder Service Assistant Professor
Dallas, Texas Massachusetts General Hospital Orthopaedic Surgery
Boston, Massachusetts Washington University School
BRIAN D. CAMERON, MD
of Medicine
Orthopedic Surgeon FRANCES CUOMO, MD
St. Louis, Missouri
Proliance Surgeons Assistant Professor
Edmonds Orthopedic Center Department of Orthopaedic Surgery
CHRISTIAN GERBER, MD, FRCSED
Edmonds, Washington Albert Einstein School of Medicine
Professor and Chairman
Bronx, New York
MICHAEL J. CODSI, MD Chief, Shoulder Service Department of Orthopaedics
Staff Physician Department of Orthopaedic Surgery University of Zürich
Orthopaedic Surgery Beth Isreal Medical Center Zürich, Switzerland
Cleveland Clinic Foundation New York, New York
Cleveland, Ohio DAVID L. GLASER, MD
DONALD F. D’ALESSANDRO, MD Department of Orthopaedic Surgery
ROBERT H. COFIELD, MD Associate University of Pennsylvania School of
Professor Shoulder and Elbow Center Medicine
Department of Orthopaedics Ortho Carolina Penn Orthopaedic Institute
Mayo Clinic College of Medicine Chief Penn-Presbyterian Medical Center
Consultant Sports Medicine and Shoulder Service Philadelphia, Pennsylvania
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x Contributors
THOMAS P. GOSS, MD JOSEPH P. IANNOTTI, MD, PHD JOHN E. KUHN, MD, MS
Professor of Orthopedic Surgery Maynard Madden Professor and Chief of Shoulder Surgery
University of Massachusetts Medical Chairman Associate Professor
School Department of Orthopaedic Surgery Department of Orthopaedics and
Attending Orthopedic Surgeon Cleveland Clinic Lerner College of Rehabilitation
Department of Orthopedic Surgery Medicine Vanderbilt University
University of Massachusetts Memorial Case Western Reserve University Nashville, Tennessee
Health Care The Cleveland Clinic Foundation
Worcester, Massachusetts Cleveland, Ohio MARSHALL A. KUREMSKY, MD
Resident
KRISTEN KELLAR GRANEY, MS JESSE B. JUPITER, MD Department of Orthopaedic Surgery
Interdisciplinary Tumor Biology Department of Orthopaedic Surgery Carolinas Medical Center
Program Harvard Medical School Charlotte, North Carolina
Georgetown University Director, Hand & Upper Limb Service
Clinical Researcher Massachusetts General Hospital YOUNG W. KWON, MD, PHD
Department of Orthopedic Oncology Boston, Massachusetts Assistant Professor
Washington Hospital Center Department of Orthopaedic Surgery
Washington, District of Columbia MARTIN J. KELLY, PT, DPT New York University School
Musculoskeletal Team Leader of Medicine
SEAN M. GRIGGS, MD Occupational Therapy/Physical Attending Surgeon
Hand Surgery Associates Therapy Department of Orthopaedic Surgery
Denver, Colorado Penn-Presbyterian Medical Center, New York University Hospital for Joint
University of Pennsylvania Diseases
DAVID C. HARKINS, DO Philadelphia, Pennsylvania New York, New York
Providence Orthopedics and Sports
JAY D. KEENER, MD
Medicine LAURENT LAFOSSE, MD
Assistant Professor
Monroe, Georgia Department of Orthopaedic Surgery
Department of Orthopaedic Surgery
Clinique Generale
University of North Carolina
Annecy, France
DAVID E. HAYNES, MD
Chapel Hill, North Carolina
Orthopaedic Surgeon
MARK D. LAZARUS, MD
Southwest Sports Medicine and
HYUN-MIN KIM, MD
Associate Professor
Orthopaedics
Postdoctoral Research Associate
Department of Orthopaedic Surgery
Orthopaedic Surgeon
Department of Orthopaedic
Thomas Jefferson University
Department of Orthopaedic Surgery
Surgery
Shoulder and Elbow Service
Providence Health Center
Washington University
The Rothman Institute at Jefferson
Waco, Texas
Research Fellow Department of
Philadelphia, Pennsylvania
Orthopaedic Surgery
ROBERT HELFAND, MD Barnes-Jewish Hospital THAY Q. LEE, PHD
Chief St. Louis, Missouri Professor and Vice Chairman for
Orthopaedic Anesthesia Section
Research
Department of Anesthesia SCOTT H. KOZIN, MD
Orthopaedic Surgery and Biomedical
Cleveland Clinic Foundation Associate Professor
Engineering
Cleveland, Ohio Department of Orthopaedic Surgery
University of California, Irvine
Temple University
Orange, California
SHAWN P. HENNIGAN, MD Director
Research Career Scientist
Attending Surgeon Upper Extremity Center of
Orthopaedic Biomechanics Laboratory
Bay Care Clinic Orthopaedic Surgery Excellence
VA Long Beach Healthcare System
Aurora Bay Care Medical Center Shrines Hospital for Children
Long Beach, California
Green Bay, Wisconsin Philadelphia, Pennsylvania
BRIAN G. LEGGIN, PT, MS, OSC
G. BRIAN HOLLOWAY, MD SUMANT G. KRISHNAN, MD Clinical Specialist
Shoulder and Elbow Center Clinical Assistant Professor Penn Therapy and Fitness
Knoxville Orthopaedic Clinic Department of Orthopaedic Surgery Penn Presbyterian Medical Center
Knoxville, Tennessee University of Texas Southwestern Philadelphia, Pennsylvania
Medical Center
STEPHEN A. HUNT, MD Attending Orthopaedic Surgeon ZACHARY R. LEITZE, MD
Clinical Fellow Shoulder and Elbow Service Department of Orthopaedics
Steadman-Hawkins Clinic The Carrell Clinic Dixie Regional Medical Center
Vail, Colorado Dallas, Texas St. George, Utah
