Fundamentals of the Shoulder

Contents
Part I: Shoulder Basic Science and Principles
1: Fundamentals of the Shoulder
1.1 Functional Anatomy of the Shoulder Joint
1.2 Upper Extremity Bones (Ossa Membri Superioris)
1.3 Shoulder Joints
1.4 Muscles that Affect the Movement of the Shoulder Girdle
1.5 Muscles Connecting the Upper Limb to the Vertebral Column
1.6 The Scapular Muscles
References
2: Molecular Biology and Genetics in Shoulder Pathologies
References
3: Animal Models for Research on Shoulder Pathologies
3.1 Evaluation of Animal Models
3.2 Animal Models
3.2.1 Rat
3.2.2 Mice
3.2.3 Rabbit
3.2.4 Calf
3.2.5 Sheep and Goat
3.2.6 Dog
3.2.7 Primates
3.3 Conclusion
References
4: Shoulder Kinematics and Biomechanics
4.1 Shoulder Stability
4.1.1 Glenohumeral Stability
4.1.1.1 Static Stabilization
Bony Static Stabilizers
Soft Tissue Static Stabilizers
Glenoid Labrum
Capsuloligamentous Structures
The Rotator Interval
4.1.1.2 Dynamic Stabilization
Proprioception
Rotator Cuff Muscles
Long Head of the Biceps
4.1.2 Scapulothoracic Joint Stability
4.2 The Thrower’s Shoulder
References
5: Biomechanics of Anterior Shoulder Instability
5.1 Dislocation Position
5.2 Remplissage Procedure
5.2.1 Effectiveness on Off-Track Hill-Sachs Lesions
5.2.2 Recurrence and Return to Sports
5.2.3 Restriction of Range of External Rotation Motion
5.2.4 Contribute to Stability in the Mid-Range Position?
5.3 New Evaluation of the Glenoid Bone Loss
5.3.1 Subcritical Bone Loss
5.3.2 Does the Size Measurement Really Tell It All?
References
6: Pathomechanics in CTA and Rationale of RSA
6.1 Pathomechanics in Cuff Tear Arthropathy
6.1.1 Introduction
6.1.2 Historical Review
6.1.3 Biomechanics of the Shoulder
6.2 Pathogenesis of CTA
6.2.1 Neer Cuff Tear Arthropathy Theory
6.2.2 Crystal-Mediated Theory (Milwaukee Shoulder Syndrome)
6.2.3 Histopathological Changes in Cuff Tear Arthropathy
6.3 Rationale of the Reverse Shoulder Arthroplasty
6.3.1 History of Reverse Shoulder Arthroplasty Rationale
6.3.2 Biomechanics and Basics of Reverse Shoulder Arthroplasty
6.3.3 Controversies in Evolving Designs
6.3.3.1 Lateralization of the CoR
6.3.3.2 Inlay-Onlay Designs
6.3.3.3 Short-Stem or Stemless Options
6.3.3.4 Polyethylene Glenospheres
6.3.4 Solutions to Limitations
6.3.4.1 Instability
6.3.4.2 Large Dead Space
6.3.4.3 Decrease in External Rotation
6.3.4.4 Scapular Notching
6.3.4.5 Acromial Fractures and Displacement of the Os Acromiale
6.3.4.6 Glenoid Bone Erosion
6.3.5 Future
6.3.5.1 Patient-Specific Instrumentation
6.3.5.2 3D Planning Softwares
6.3.5.3 Augmented Reality
6.4 Conclusion
References
7: Rationale of Tendon-to-Bone Healing
7.1 Introduction
7.2 Tendon-to-Bone Healing
7.3 Biologic Augmentation of Tendon-to-Bone Healing
7.3.1 Biochemical Augmentation
7.3.1.1 Stem Cell Therapies
7.3.1.2 Bone Marrow-Derived Mesenchymal Stem Cells
7.3.1.3 Other Sources of Mesenchymal Stem Cells
7.3.1.4 Growth Factors
7.3.1.5 Platelet-Rich Plasma
7.3.1.6 Other Growth Factors
7.3.1.7 Matrix Metalloproteinase Inhibitors
7.3.2 Biomechanical Augmentation
7.3.2.1 Autografts
7.3.2.2 Allografts
7.3.2.3 Xenografts
7.3.2.4 Synthetic Scaffolds
7.4 Summary
References
Part II: Diagnosis of Shoulder Conditions
8: Physical Examination for Glenohumeral Joint Pathologies
8.1 Introduction
8.2 Special Tests
8.2.1 Anterior Instability Tests
8.2.1.1 Apprehension Test
8.2.1.2 Jobe Relocation Test
8.2.1.3 Anterior Drawer Test
8.2.1.4 Load and Shift Test
8.2.1.5 Hyper Extension–Internal Rotation (HERI) Test
8.2.2 Posterior Instability Tests
8.2.2.1 Posterior Drawer Test
8.2.2.2 Posterior Apprehension Test
8.2.2.3 Jerk Test
8.2.3 Multidirectional Instability Tests
8.2.3.1 Sulcus Sign
8.2.3.2 Hyperabduction Test
8.3 Intraarticular Biceps Tests (SLAP)
8.3.1 Active Compression (O’Brien) Test
8.3.2 Biceps Load Test I and II
8.3.3 Crank Test
8.3.4 Anterior Slide Test
8.3.5 Compression Rotation Test
References
9: Physical Examination for Subacromial and Acromioclavicular Pathologies
9.1 History
9.2 Physical Examination
9.2.1 Inspection
9.2.2 Palpation and ROM Assessment
9.2.3 Specific Tests
9.2.3.1 Cervical Spine Tests
9.2.3.2 Subacromial Impingement Tests
9.2.3.3 Specific Tests for Rotator Cuff
References
10: Radiological Assessment of the Shoulder
10.1 Introduction
10.2 Radiological Modalities and Techniques of Shoulder Imaging
10.2.1 Radiography
10.2.2 Arthrography
10.2.3 Ultrasonography (US)
10.2.4 Computed Tomography (CT)
10.2.4.1 CT-Arthrography
10.2.5 Magnetic Resonance Imaging (MRI)
10.2.5.1 MR-Arthrography
10.3 Imaging in Rotator Cuff Abnormalities
10.3.1 Rotator Cuff Tendonosis and Tendon Tears
10.3.2 Rotator Cuff Tear Arthropathy
10.3.3 Milwaukee Shoulder
10.3.4 Adhesive Capsulitis (Frozen Shoulder)
10.3.5 Calcific Tendinitis
10.4 Imaging in Shoulder Instability
10.4.1 Anterior Instability
10.4.2 Posterior Instability
10.5 Imaging in Some Other Shoulder Conditions
10.5.1 Long Head Biceps Tendon Lesions
10.5.2 Distal Clavicular Osteolysis
10.5.3 Nerve Compression or Entrapment
10.5.4 Enchondroma
10.6 Conclusion
References
Part III: Shoulder Pathologic Conditions
11: Shoulder Cartilage and Osteoarthritis
11.1 Introduction
11.2 Epidemiology
11.3 Classification Based on Etiology
11.4 Primary GHJ-OA
11.5 Secondary GHJ-OA
11.6 Clinical Evaluation
11.7 Imaging
11.8 Treatment
11.8.1 Arthroscopic Debridement
11.8.2 Microfracture
11.8.3 Osteochondral Allograft Transfer
11.8.4 Autologous Chondrocyte Implantation (ACI)
11.8.5 Osteochondral Autograft Transfer
11.8.6 Interposition Arthroplasty
11.8.7 Resurfacing Arthroplasty
11.8.8 Total Shoulder Arthroplasty
11.8.9 Reverse TSA
11.9 Conclusion
References
12: Inflammatory, Metabolic, and Neuromuscular Pathologies in Shoulder Joint
12.1 Polymyalgia Rheumatica
12.1.1 Rheumatoid Arthritis
12.1.2 Inflammatory Arthritis
12.1.3 Crystal-Associated Mono/Polyarthritis
12.2 Amyloidosis Associated with Immunocyte Dyscrasia (AL Amyloidosis)
12.2.1 Neuropathic Arthropathy
12.2.2 Epilepsia
12.2.3 Hemiplegic Shoulder
12.3 Conclusion
References
13: Nerve Entrapments Around Shoulder
13.1 Suprascapular Neuropathy
13.1.1 Anatomy
13.1.2 Pathophysiology
13.1.3 Clinics and Diagnosis
13.1.4 Treatment
13.1.4.1 Conservative Treatment
13.1.4.2 Surgical Treatment
13.2 Axillary Neuropathy and Quadrilateral Space Syndrome
13.2.1 Anatomy
13.2.2 Pathophysiology
13.2.3 Clinics and Diagnosis
13.2.4 Treatment
13.2.4.1 Conservative Treatment
13.2.4.2 Surgical Treatment
13.3 Long Thoracic Nerve Neuropathy and Medial Scapular Winging
13.3.1 Anatomy
13.3.2 Pathophysiology
13.3.3 Diagnosis
13.3.4 Treatment
13.3.4.1 Conservative Treatment
13.3.4.2 Surgical Treatment
13.4 Accessory Nerve Neuropathy and Lateral Scapular Winging
13.4.1 Anatomy
13.4.2 Pathophysiology
13.4.3 Diagnosis
13.4.4 Treatment
13.4.4.1 Conservative Treatment
13.4.4.2 Surgical Treatment
References
14: Fractures Around Shoulder
14.1 Clavicle Fractures
14.1.1 Classification
14.1.2 Clinical Anatomy
14.1.3 Midshaft Fractures
14.1.3.1 Diagnostic Approach
14.1.3.2 Treatment Approach
Conservative Treatment
Surgical Treatment
14.1.4 Distal Clavicular Fractures
14.1.4.1 Diagnostic Approach
14.1.4.2 Treatment Approach
Conservative Treatment
Surgical Treatment
14.1.5 Medial Clavicular Fractures
14.1.5.1 Diagnostic Approach
14.1.5.2 Treatment Approach
Conservative Treatment
Surgical Treatment
14.2 Proximal Humerus Fractures
14.2.1 Clinical Anatomy
14.2.2 Classification
14.2.3 Diagnostic Approach
14.2.4 Treatment Approach
14.2.4.1 Conservative Treatment
14.2.4.2 Surgical Treatment
14.3 Scapular Fractures
14.3.1 Clinical Anatomy
14.3.2 Classification
14.3.3 Diagnostic Approach
14.3.4 Treatment Approach
14.3.4.1 Conservative Treatment
14.3.4.2 Surgical Treatment
References
Part IV: Shoulder Surgery and Complications
15: Positioning, Anesthesia, and Analgesia in Shoulder Surgery
15.1 Patient Positioning
15.2 Beach-Chair Position (BC)
15.3 Lateral Decubitus Position
15.4 Comparison of Beach-Chair and Lateral Decubitus Positions
15.5 Anesthesia
15.6 Shoulder Block (Fig. 15.7)
15.7 Interscalene Plexus Block (Fig. 15.8)
15.8 Postoperative Analgesia
15.9 Discussion of the Anesthesia
15.9.1 Controlled Hypotension
15.9.2 Which Block Technique
15.10 Summary
References
16: Surgical Exposures
16.1 Introduction
16.2 Deltopectoral (Anterior) Approach
16.2.1 Indications
16.2.2 Incision and Dissection
16.2.3 Variations
16.3 Deltoid-Splitting Approach
16.3.1 Indications
16.3.2 Incision and Dissection
16.3.3 Variations
16.3.3.1 Literature Review on Deltopectoral vs. Deltoid-Splitting Approaches
16.4 Posterior Approach
16.4.1 Indications
16.4.2 Incision and Dissection
16.4.3 Variations
References
17: Basic Arthroscopy Portals of Shoulder
17.1 Glenohumeral Arthroscopy Portals
17.1.1 Posterior Portal
17.1.2 Anterior Portal
17.1.3 Antero-Inferior Portal (5 o’clock Portal)
17.1.4 Antero-superior Portal
17.1.5 Anterosuperolateral Portal
17.1.6 Portal of Wilmington
17.1.7 Posterior-Inferior Portal (7 o’clock Portal)
17.1.8 Axillary Pouch Portal
17.2 Subacromial Portal
17.2.1 Posterior Portal
17.2.2 Lateral Portal
17.2.3 Anterior Portal
17.2.4 Anterolateral Portal
17.2.5 Posterolateral Portal
17.2.6 Neviaser Portal
17.2.7 Subclavian Portal
References
18: Thromboembolism and Bleeding Control in Shoulder Surgery
18.1 Prevention of Bleeding in Shoulder Surgery
18.2 Preventing Excessive Bleeding During Anatomic/Reverse Shoulder Arthroplasty
18.3 Preventing Bleeding During Shoulder Arthroscopy
18.4 Thromboembolic Events After Shoulder Surgery
18.5 General Risk Factors for Thromboembolic Events (TEE) After Shoulder Surgery
18.6 Thromboembolic Events After Shoulder Arthroplasty
18.7 Thromboembolic Events After Shoulder Arthroscopy
18.8 Thromboembolic Events After Treatment of Proximal Humerus Fractures
18.9 Prophylaxis
18.10 Summary
References
19: Periprosthetic Infection in Shoulder Surgery
19.1 Introduction
19.2 Pathogens
19.3 Precautions
19.4 Diagnosis
19.5 Treatment
19.5.1 Debridement
19.5.2 Cement Spacer
19.5.3 One-Stage Revision Arthroplasty
19.5.4 Two-Stage Revision Arthroplasty
19.5.5 Resection Arthroplasty
19.6 Conclusion
References
Part V: (Bio)technological Applications in Shoulder Treatment
20: Anchors
20.1 History
20.2 Anchor Design
20.3 Anchor Materials
20.3.1 Arthrex®
20.4 Suture Materials
20.5 Anchor Placement
20.6 Summary
References
21: Tissue Engineering and Graft Options
21.1 Introduction
21.2 Extracellular Matrix and Scaffolds
21.3 Host Response and Scaffold Remodeling
21.4 Mechanical Features
21.5 Clinical Applications of Tissue Engineering in Rotator Cuff Surgery
21.5.1 Extracellular Matrix- Derived Scaffolds
21.5.1.1 Xenografts
Porcine Intestine Submucosa Derived Scaffolds
Porcine Dermis-Derived Scaffolds
Bovine Pericardium Derived Scaffolds
Bovine Dermis-Derived Scaffolds
Equine Pericardium Derived Scaffolds
21.5.1.2 Allografts
Human Dermis-Derived Scaffolds
21.5.2 Synthetic Scaffolds
21.5.3 New Generation Scaffolds
21.6 Clinical Applications of Tissue Engineering in Different Shoulder Issues
21.6.1 Superior Capsular Reconstruction
21.6.2 Glenoid Resurfacing
21.6.3 Capsular Reconstruction for Shoulder Instability
21.7 Summary
References
22: 3D Printing in Shoulder Surgery
22.1 Introduction
22.1.1 Stereolithography (SLA)
22.1.2 Selective Laser Sintering (SLS)
22.1.3 Extrusion-Based Techniques (Fused-Deposition Modeling—FDM)
22.1.4 Droplet-Based Techniques
22.2 3D Printing for Shoulder Arthroplasty
22.3 3D Printing for Surgical Planning of the Shoulder
22.4 3D Printed Anatomical and Surgical Models, Training Material, Pre- and Post-Surgical Models
22.4.1 3D Printed Anatomical Models
22.4.2 3D Printed Surgical Models
22.5 Bioprinting of Tissues
22.6 Conclusion
References
23: The Digitized Shoulder: From Preoperative Planning to Patient-Specific Guides
23.1 Introduction
23.2 3D Visualization and Preoperative Planning
23.3 New Concepts in Shoulder Arthroplasty
23.4 3D Printing
23.5 Conclusion
References