Background: Lower-extremity arthroplasty constitutes the largest burden on health-care spending of any Medicare diagnosis group. Demand for upper extremity also continues to rise. It is necessary better understand costs as health care shifts toward a bundled-payment accounting approach. We aimed (1) identify whether variation exists in total cost different types joint arthroplasty, and, if so, (2) determine which parameters drive this variation. Methods: The episode inpatient 22,215...

The coracoacromial ligament (CAL) was first described as a pain generator by Dr Charles Neer in the early 1970s. Since that time, considerable controversy regarding CAL management during acromioplasty has persisted. This review aims to better understand role of shoulder physiology and pathology. Sixty-six articles from 1958 2016 were identified using an electronic search PubMed, Cochrane Library, AccessMedicine, MD Consult for case series well cohort prospective studies. authors used...

Muscle tendon transfers (MTTs) are effective surgical procedures for reducing pain and improving active shoulder range of motion patient-reported outcomes a wide pathologies, including serratus anterior trapezius muscle palsy, irreparable subscapularis tears, posterosuperior rotator cuff posterior tears in the setting reverse arthroplasty, symptomatic complete deltoid deficiency.The principles MTT include ensuring that transferred is expendable, unit has similar excursion, line pull...

Recurrent anterior shoulder instability after coracoid process transfers may be caused by trauma, sports injury, or technical failure of the index procedure. Surgical techniques vary with regard to graft orientation and positioning number screws utilized for fixation.To identify surgical patient-related factors associated failure, defined as need revision surgery. We hypothesized that failures will occur more commonly single-screw fixation malposition.Case series; Level evidence,...

Abstract: Shoulder pain and instability are common complaints in primary care orthopaedic sports medicine clinics. Diagnoses treatment can prove to be a challenge for practitioners, especially if the underlying normal pathologic anatomy is not well understood. The glenohumeral joint multiaxial synovial ball socket that permits wide range of motion at cost inherent stability. To provide support joint, osseous capsuloligamentous static stabilizers function concert with dynamic muscular...

Preoperative axillary nerve palsy is a contraindication to reverse total shoulder arthroplasty (rTSA) due the theoretical risk of higher dislocation rates and poor functional outcomes. Treatment fracture-dislocations proximal humerus with rTSA particularly challenging, as these injuries commonly present concomitant neurologic soft tissue injury. The aim current study was determine efficacy for this fracture pattern in geriatric patients presenting occult or profound injury.A retrospective...

Posterior shoulder instability is becoming increasingly recognized in young active patient populations. Diagnosing posterior can be challenging because patients commonly present with a complaint of pain without history dislocation or subluxation event. Additionally, labral tear not always clearly visualized on advanced imaging studies. As such, physical examination critical to the diagnosis. We report simple maneuver for diagnosis symptomatic instability. The thumb test attempts replicate...

Background Heterotopic ossification (HO) develops after nearly 2/3 of traumatic blast amputations in the contemporary battlefield. This phenomenon has potentially devastating consequences for servicemen and women its pathophysiology warrants further investigation using a previously developed animal model. Questions/purposes We asked, what is (1) severity (quantity) (2) type (location) HO bone formation hindlimb amputation with two distinct media. hypothesized that more “war-relevant” medium...

The Neer classification is among the most widely used systems to describe proximal humerus fractures (PHF) despite poor interobserver agreement. purpose of this study was verify whether or not blinded shoulder surgeons and trainees agree with authors articles published in highest impact-factor orthopedic journals.All regarding PHF between 2017 2019 top 10 journals as rated by impact factor were searched. Articles included if at least 1 figures. Figures extracted without legend, X-rays ±...

Contemporary arthroscopic double-row suture anchor rotator cuff repairs have superior biomechanics compared with prior iterations. Numerous techniques been described, but consensus regarding value has yet to be established. We describe an effective and easily reproducible technique: the "Montgolfier double-row" repair technique. This knotless construct evenly distributed, load-sharing, radially oriented limb configuration much like envelope cables of a Montgolfier hot-air balloon, its...

Biceps tenotomy is a common procedure performed in arthroscopic shoulder surgery. Numerous studies have demonstrated the effectiveness of both biceps and tenodesis to relieve pain restore function for diagnoses bicipital tenosynovitis, SLAP tears, rotator interval pulley lesions, failed repairs. It also frequently as concomitant with cuff repair. We report technique improve efficiency bicep using squeeze maneuver. This simple method manually squeezing muscle belly while performing tenotomy....

Case: A 69-year-old woman with chronic upper extremity lymphedema secondary to bilateral mastectomy and axillary lymph node dissection for breast cancer 10 years before presented the clinic a massive rotator cuff tear. Her shoulder pain dysfunction persisted despite nonoperative treatment. She underwent left arthroscopic repair (RCR) biceps tenotomy. Arm, forearm, wrist circumference measurements were obtained, preoperatively, immediately postoperatively, 1-week 2-weeks postoperatively. No...

History and Physical Examination A 46-year-old man with no significant medical or family history was referred to our tertiary spine surgery clinic for evaluation. He had been having low back pain right lower extremity originating in his posterior thigh radiating foot since lifting some heavy equipment approximately 1 year before presentation us. originally sought treatment a chiropractor, which did not alleviate symptoms. then presented primary care physician, who ordered physical therapy,...

Arthroscopic shoulder surgery can be performed for retrieval of bullets and retained metallic fragments in the glenohumeral subacromial spaces. Previous case reports series have demonstrated effectiveness an arthroscopic approach over open procedure, as it is less invasive, allows improved inspection documentation joint surfaces periarticular structures, potentially leads to a faster recovery. An extracting foreign bodies from both quadrilateral space posterior extra-articular by first...