The Patient is an 18-year-old high level football player, who had his first shoulder dislocation when he was a freshman and became recurrently unstable during his junior year. At the time, he had a large fragment of bone and an arthroscopic boney Bankart repair was performed. The patient did well intially, but during his return to football broke apart the Bankart repair. He subsequently had recurrent episodes of dislocations throughout the season. The patient and his family elected patient elected to udergo left shoulder open capsulolabral repair and coracoid transfer. This is also known as Latarjet procedure. A latarjet procedure uses the bone of the coracoids to fill or augment the defect in the gleniod (socket of the shoulder). It is held in place with two lag screws
Chronic fiberous non union of old boney Bankart lesion from his first dislocation
MRI after the reinjury of boney Bankart repair with a large displaced boney lesion
Postoperative x-rays after Latarjet procedure
The patient is a 40 year old male with a large area of calcific tendonitis involving the anterior, inferior portion of his subscapularis tendon. The calcification was over 2 cm in size and would cause an audible snap as it popped across the conjoint tendon. Picture A shows the calcification and Picture B shows the calcium deposit being lanced with a spinal needle. Video clip #1 demonstrates the extraction of the calcium. Picture C and video clip #2 demonstrate the removal of all of the calcium. The patient returned to play without difficulty at 8 weeks.
Extraction of the calcium
Humeral and Glenoid Chondral Defects
These pictures demonstrate damage to the cartilage in a shoulder of a high level gymnast.
Arthroscopic Subacromial Decompression
Arthroscopic Debridement of Calcific Tendonitis
How is shoulder arthroscopy different than other surgeries?
Shoulder arthroscopy is a technique that has evolved in the United States over the last 25 years. Shoulder arthroscopy is technically demanding and is performed for treatment of labral lesions and rotator cuff tears. The patient is placed on their side and multiple portals are created to see and work within the shoulder joint and in the subacromial space. Dr Shepard trained in shoulder arthroscopy with world famous James R Andrews MD – one of the developers of the technique in the United States. Dr Andrews was the first to describe superior labral tears in high level baseball players. Dr Shepard regularly performs shoulder arthroscopy on people from high level athletes to non athletes.
Who needs shoulder arthroscopy?
There are two primary groups of people who undergo shoulder arthroscopy – young overhead athletes with labral tears from dislocations, SLAP tears, loose bodies; older people with rotator cuff tears.
The young athletes often develop SLAP lesions from repetitive overhead activities and labral tears / loose bodies from dislocations. These lesions can be treated through the arthroscope with loose body removal and labral repair. Sometimes, a capsular placation is performed to “tighten up” the capsule and ligaments of the shoulder. These injuries are most commonly seen in overhead athletes – swimmers, throwers, volleyball players, and water polo players, as well as young athletes who compete in contact sports that can often lead to dislocations – football, hockey, gymnastics, wrestling, and lacrosse.
The older person who tears his/her rotator cuff can be treated through the arthroscope as well. Most rotator cuff repairs that Dr Shepard performs are done through 3 or 4 portals (poke holes), rather than through a large, painful incision. The rotator cuff tendon can be repaired back to its anatomic location with the use of anchors (dry wall screws) and high strength sutures.
Interactive web based movies (click on the desired topic to find out more)
Click on the topics below to find out more from the Orthopaedic connection website of American Academy of Orthopaedic Surgeons.