New Technique in Shoulder New Technique in Shoulder Surgery for Sports InjurySurgery for Sports Injury

Dennis Crawford MD, PhDDennis Crawford MD, PhD

Assistant ProfessorAssistant Professor

Surgical Director, Sports Medicine ProgramSurgical Director, Sports Medicine Program

Department of Orthopedics & RehabilitationDepartment of Orthopedics & Rehabilitation

Oregon Health Sciences UniversityOregon Health Sciences University

Center for Health & Healing Center for Health & Healing

Portland OregonPortland Oregon

Shoulder Surgery: State of the Shoulder Surgery: State of the Art ‘07Art ‘07• All ArthroscopicAll Arthroscopic

– Stabilization for Stabilization for dislocationdislocation

– Stabilization for Stabilization for instabilityinstability

– Rotator cuff repairsRotator cuff repairs– SLAP repairsSLAP repairs– Biceps tendon repairBiceps tendon repair– Capsular releaseCapsular release

• Internal Rotation Internal Rotation contracturecontracture

• Frozen ShoulderFrozen Shoulder

• OpenOpen– Clavicle fixationClavicle fixation

• Improved outcomesImproved outcomes

DefinitionsDefinitions• InstabilityInstability

– Failure of the dynamic Failure of the dynamic and static mechanisms and static mechanisms of joint biomechanics to of joint biomechanics to maintain a functional maintain a functional position of two position of two articulating surfacesarticulating surfaces

• SubluxationSubluxation– Partial, transient loss of Partial, transient loss of

articulating congruencyarticulating congruency

• DislocationDislocation– Complete loss of Complete loss of

articulating congruencyarticulating congruency

Shoulder DislocationsShoulder Dislocations

• First time dislocatorsFirst time dislocators– < 20 yrs < 20 yrs

• > 75% redislocation rate> 75% redislocation rate

– 20-30 yrs20-30 yrs• 30-50% redislocation rate30-50% redislocation rate

• Arthroscopic repairArthroscopic repair– Out-patientOut-patient– Reduce re-dislocation rate Reduce re-dislocation rate

• <2-5%<2-5%

– Return to SportsReturn to Sports• 3-6 months3-6 months

Type of Instability> Surgical Type of Instability> Surgical TimingTiming• Traumatic InjuryTraumatic Injury

– Most commonly Most commonly • anterior dislocationanterior dislocation

– Anatomic InjuryAnatomic Injury• ““Bankart” LesionBankart” Lesion

– Labral TearLabral Tear

• Acquired laxity Acquired laxity – Swimmers/GymnastsSwimmers/Gymnasts

• multidirectionmultidirection

• Subtle capsular injuriesSubtle capsular injuries– Globally “stretched”Globally “stretched”

Fundamental Shoulder ArthroscopyFundamental Shoulder Arthroscopy

Arthroscopic Exam of ShoulderArthroscopic Exam of Shoulder

Arthroscopic Exam: SLAP ? & BicepsArthroscopic Exam: SLAP ? & Biceps

Arthroscopic Exam: Bankart lesionArthroscopic Exam: Bankart lesion

Arthroscopic Bankart Repair: 1Arthroscopic Bankart Repair: 1

Arthroscopic Bankart Repair: 2Arthroscopic Bankart Repair: 2

Arthroscopic Bankart Repair: 3Arthroscopic Bankart Repair: 3

Arthroscopic Bankart Repair: 4Arthroscopic Bankart Repair: 4

Return to Sports after Scope BankartReturn to Sports after Scope Bankart • Sling for 4-6 weeksSling for 4-6 weeks

– ImmediateImmediate• Rhomboid strengtheningRhomboid strengthening• Core & conditioningCore & conditioning

• Weeks 4-10Weeks 4-10– Restore normal ROMRestore normal ROM

• Weeks 8-16Weeks 8-16– Restore Rotator Cuff strengthRestore Rotator Cuff strength– Restore Scapulo-thoracic kineticsRestore Scapulo-thoracic kinetics

• Weeks 12-20Weeks 12-20– Return to sportsReturn to sports– Throwing/overhead athletesThrowing/overhead athletes

• Graded increase in stressGraded increase in stress– Throwing programsThrowing programs

• 6 months 6 months – Unrestricted activity Unrestricted activity

• Assuming full strength and ROMAssuming full strength and ROM

Thank youThank you

Dennis C. Crawford, MD. PhDDennis C. Crawford, MD. PhDAssistant ProfessorAssistant Professor

Director, Sports & Arthroscopic SurgeryDirector, Sports & Arthroscopic Surgery

Department of Orthopedics Department of Orthopedics

Oregon Health & Science UniversityOregon Health & Science University