Curbside Consultation of the Shoulder 49 Clinical Questions

by Nicholson, Gregory; Provencher, Matthew

• ISBN13: 9781556428272
• ISBN10: 1556428278
• Edition: 1st
• Format: Paperback
• Copyright: 2008-07-15
• Publisher: Slack Incorporated

Summary

Are you looking for concise, practical answers to those questions that are often left unanswered by traditional shoulder references? Are you seeking brief, evidence-based advice for complicated cases or controversial decisions?Curbside Consultation of the Shoulder: 49 Clinical Questionsprovides quick answers to the thorny questions most commonly posed during a "curbside consultation" between orthopedic surgical colleagues. Drs. Gregory P. Nicholson and Matthew T. Provencher have designed this unique reference which offers expert advice, preferences, and opinions on tough clinical questions commonly associated with the shoulder. The unique Q&A format provides quick access to current information related to the shoulder with the simplicity of a conversation between two colleagues. Numerous images, diagrams, and references are included to enhance the text and to illustrate the management of shoulders. Curbside Consultation of the Shoulder: 49 Clinical Questionsprovides information basic enough for residents while also incorporating expert advice that even high-volume clinicians will appreciate. Practicing orthopedic surgeons, orthopedic residents, and medical students will benefit from the user-friendly and casual format and the expert advice contained within. Some of the questions that are answered: How do you manage first time shoulder dislocations in a high level athlete? How do you diagnose and manage SLAP lesion, both in athletes and in laborers, and the impact of age on outcomes? What are the indications for long head of biceps tenotomy versus tenodesis in RC repair surgery? After an arthroscopic instability repair for recurrent anterior instability, when is the patient allowed to return to contact sports? What are the indications of ORIF of an acute fracture of the mid-shaft clavicle? What are the indications of ORIF and indications for hemiarthroplasty in the treatment of a proximal humerus fracture? When is arthroscopic closure of the rotator interval indicated in the setting of shoulder instability-anterior, posterior, multidirectional?

Author Biography

Gregory P. Nicholson, MD is an Associate Professor of Orthopaedic Surgery at Rush University Medical Center in Chicago, Illinois. He is an author of numerous articles, papers, and chapters on conditions and injuries on the shoulder and elbow. He is a team physician for the Chicago White Sox baseball team. He is a member of the American Shoulder and Elbow Surgeons and American Orthopaedic Society for Sports Medicine. Matthew T. Provencher, MD, LCDR, MC, USNR was born in New Hampshire, and completed his undergraduate education at the United States Naval Academy. There, he graduated with Distinction, was inducted into Phi Kappa Phi (National Honor Society), Tau Beta Pi (National Engineering Honor Soecity), Sigma Pi Sigma (National Physics Honor Society), and was named the Secretary of the Navy Distinguished Graduate. He was also a 4-year varsity oarsman and All-American at Navy. He completed his medical education at Dartmouth Medical School where he graduated with Honors and was elected to the Alpha Omega Alpha Honor Society. Matt completed his orthopaedic residency at the Naval Medical Center San Diego and his orthopaedic sports fellowship at Rush University under the direction of Bernard R. Bach, Jr, MD. Matt has been awarded the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS) Science Award, the ISAKOS Richard Caspari Award (runner-up), the American Orthopaedic Society for Sports Medicine (AOSSM) Aircast Research Award, and was also both an AOSSM (Asia-Pacific) and an AOA John Fahey North American Traveling Fellow. Matt is currently the Assistant Director of Shoulder, Knee and Sports Surgery at the Naval Medical Center San Diego, a full-time academic practice. He is an active member of Arthroscopy Association of North America (AANA), AOSSM, ISAKOS, International Cartilage Repair Society (ICRS), and Society of Military Orthopaedic Surgeons (SOMOS).

Table of Contents

Dedication

Acknowledgments

About the Editors

Contributing Authors

Preface

Physical Examination Questions

What Are the Physical Examination Findings That Lead You to a Diagnosis of Glenohumeral Internal Rotation Deficit in the Throwing Athlete and What Nonoperative Treatment Options Have Led to Improvement of the Condition?

What Physical Examination Tests or Findings and Radiographs Do You Use to Diagnose Subacromial Impingement, and When Do You Utilize Subacromial Injections?

What Are the Physical Examination Findings (Signs and Symptoms, Pertinent Positives and Negatives) That Direct You Toward a Diagnosis of Superior Labrum Anterior to Posterior Lesion?

Imaging Questions

A 19-Year-Old Male Has Suffered Four Recurrent Dislocations During Sporting Activity

He Has Been Able to Self-Reduce the Last Two Episodes

What Is the Advanced Imaging Study of Choice?

What Are the Radiographic Views Necessary to Evaluate Osteoarthritis of the Shoulder?

Are These Adequate Prior to Total Shoulder Arthroplasty, or Is an Advanced Imaging Study (Computed Tomography Scan, Magnetic Resonance Imaging) Indicated?

What Is the Imaging Modality To Best Diagnose a Superior Labrum Anterior to Posterior Tear and What Does It Look Like?

Sports Questions

How Do You Manage the Long Head of Biceps Tendon in a 28-Year-Old Weekend Athlete With a Type IV Superior Labrum Anterior to Posterior Lesion That Involves Tearing Into the Biceps and Affects at Least 25% of the Tendon Thickness?

A Volleyball Hitter Has Weakness of External Rotation and Visible Atrophy of the Infraspinatus

What Are the Potential Causes, What Are the Indications for Suprascapular Nerve Decompression, and What Is the Operative Approach?

After a "Stinger" During a Football Game, There Is Weakness of the Deltoid, Rotator Cuff, and Biceps and Triceps

Why Did This Happen and When Would You Allow Him to Return to Play Again?

When Is the Patient Allowed to Return to Contact Sports After an Arthroscopic Instability Repair for Recurrent Anterior Instability?

What Is the Treatment for a Patient

Who Presents With a "Squeaking" Shoulder 4 Months After an Arthroscopic Labral Repair Performed With a Bioabsorbable Tack?

Pediatric Questions

A 14-Year-Old Pitcher Presents With Shoulder and Arm Pain

It Is Midseason

There Is No Instability, and the Pain Is Primarily Over the Lateral Deltoid

Radiographs Reveal Widening of the Lateral Aspect of the Proximal Humeral Physis

What Is the Diagnosis and Treatment Strategy?

How Do You Treat a 14-Year-Old Female

Who Can Voluntarily Sublux the Shoulder Posteriorly and Anteriorly, and Has a Sulcus Sign?

Trauma Questions

A 16-Year-Old Hockey Player Has a Collision With His Arm Forcibly Extended

A Magnetic Resonance Imaging Scan Reveals a Lesser Tuberosity Fracture With 2 to 3 mm of Elevation and 2 mm of Medial Displacement

Is This Due to the Apophysis of the Lesser Tuberosity?

And How Do You Diagnose and Manage Traumatic Fractures of the Lesser Tuberosity of the Humerus?

What Are the Indications for Open Reduction And Internal Fixation of an Isolated Greater Tuberosity Fracture, and What Approach and Operative Technique Is Appropriate?

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