Continuing Education Column Shoulder Operation Sang -Hoon Lhee, MD Duk-Hwan Kho, MD Jin-Young Park, MD Department of Orthopaedic Surgery/Shoulder, Elbow and Sports Service, Konkuk University College of Medicine E - mail : drpark@chol.com J Korean Med Assoc 2009; 52(8): 795-804 Abstract Although shoulder pain is a very common problem and compromised shoulder movement due to pain, stiffness, or weakness can cause substantial disability, many patients fail to recognize a need for a proper treatment. The diagnosis and treatment of the shoulder should be specified for each of the disease entity. Most of shoulder pain can be managed non-operatively with a well-organized rehabilitation program. However, the surgery should always remain as an option in case of failure of conservative managements, which can be seen from a definite indication of a patient s condition. The article presents four representative disease entities other than shoulder trauma occurring in old age which doctors see most often at outpatient s clinics. Impingement syndrome, rotator cuff tear, calcifying tendonitis, and arthritis are described in this article, introducing each diseases and surgical indications and descriptions, and their results. Keywords: Shoulder; Rotator cuff; Calcifying tendinitis; Impingement syndrome; Glenohumeral arthritis 795
Lhee SH Kho DH Park JY Figure 1. Type : Flat Acromion, Type : Curved Acromion, Type : Hooked Acromion Figure 2. Acromioplasty-Cutting anterior subacromial spur and flattening undersurface of the acromion. Also Coracoacromial Ligament is released. 796
Shoulder Operation Figure 3. Fraying of the undersurface of the acromion. Figure 5. Flattened subacromial undersurface after arthroscopic acromioplasty. Figure 4. Subacromial spur seen from arthroscopic camera. 797
Lhee SH Kho DH Park JY Figure 6. Rotator cuff tear identified during minimal open rotator cuff repair. Figure 8. Rotator cuff repair is done. Figure 7. Rotator cuff is sutured and ready to pull laterally. 798
Shoulder Operation Figure 9. Rotator cuff tear seen from arthroscopic camera. Figure 11. Simple X-ray showing calcific tendonitis. Figure 10. Rotator cuff repair done through arthroscopic technique. Figure 12. Ultrasound shoing calcific tendonitis. 799
Lhee SH Kho DH Park JY Figure 13. Calcific deposit found on bursal side of supraspinatus tendon through arthroscopic examination. Figure 15. Repair of the supraspinatus tendon after removal of the calcific deposit. Figure 14. Calcific deposit being removed. 800
Shoulder Operation Figure 16. Simple X-ray of shoulder osteoarthritis. Figure 17. Post-operative simple X-ray after total shoulder arthroplasty. 801
Lhee SH Kho DH Park JY Figure 18. Simple X-ray sho-wing cuff tear arthropathy. Figure 19. Simple X-ray showing reverse shoulder arthroplasty. 802
Shoulder Operation 11. Cummins CA, Sasso LM, Nicholson D. Impingement syndrome: temporal outcomes of nonoperative treatment. J Shoulder Elbow Surg 2009; 18: 172-177. 12. Neer CS, 2nd. Anterior acromioplasty for the chronic impingement syndrome in the shoulder: a preliminary report. J Bone Joint Surg Am 1972; 54: 41-50. 13. Chin PY, Sperling JW, Cofield RH, Stuart MJ, Crownhart BS. Anterior acromioplasty for the shoulder impingement syndrome: long-term outcome. J Shoulder Elbow Surg 2007; 16: 697-700. 14. Odenbring S, Wagner P, Atroshi I. Long-term outcomes of arthroscopic acromioplasty for chronic shoulder impingement syndrome: a prospective cohort study with a minimum of 12 years follow-up. Arthroscopy 2008; 24: 1092-1098. 15. Stephens SR, Warren RF, Payne LZ, Wickiewicz TL, Altchek DW. Arthroscopic acromioplasty: a 6 -to 10-year follow-up. Arthroscopy 1998; 14: 382-388. 16. Bartolozzi A, Andreychik D, Ahmad S. Determinants of outcome in the treatment of rotator cuff disease. Clin Orthop Relat Res 1994 Nov (308): 90-97. 17. Ellman H, Hanker G, Bayer M. Repair of the rotator cuff. Endresult study of factors influencing reconstruction. J Bone Joint Surg Am 1986; 68: 1136-1144. 18. Frost P, Andersen JH, Lundorf E. Is supraspinatus pathology as defined by magnetic resonance imaging associated with clinical sign of shoulder impingement? J Shoulder Elbow Surg 1999; 8: 565-568. 19. Milgrom C, Schaffler M, Gilbert S, van Holsbeeck M. Rotatorcuff changes in asymptomatic adults. The effect of age, hand dominance and gender. J Bone Joint Surg Br 1995; 77: 296-298. 10. Sher JS, Uribe JW, Posada A, Murphy BJ, Zlatkin MB. Abnormal findings on magnetic resonance images of asymptomatic shoulders. J Bone Joint Surg Am 1995; 77: 10-15. 11. Gerber C, Meyer DC, Schneeberger AG, Hoppeler H, von Rechenberg B. Effect of tendon release and delayed repair on the structure of the muscles of the rotator cuff: an experimental study in sheep. J Bone Joint Surg Am 2004; 86-A: 1973-1982. 12. Morse K, Davis AD, Afra R, Kaye EK, Schepsis A, Voloshin I. Arthroscopic versus mini-open rotator cuff repair: a comprehensive review and meta-analysis Am J Sports Med 2008; 36: 1824-1828. 13. Millar NL, Wu X, Tantau R, Silverstone E, Murrell GA. Open versus two forms of arthroscopic rotator cuff repair. Clin Orthop Relat Res 2009; 467: 966-978. 14. Youm T, Murray DH, Kubiak EN, Rokito AS, Zuckerman JD. Arthroscopic versus mini-open rotator cuff repair: a comparison of clinical outcomes and patient satisfaction. J Shoulder Elbow Surg 2005; 14: 455-459. 15. Park JY, Chung KT, Yoo MJ. A serial comparison of arthroscopic repairs for partial- and full-thickness rotator cuff tears. Arthroscopy 2004; 20: 705-711. 16. Park JY, Lhee SH, Choi JH, Park HK, Yu JW, Seo JB. Comparison of the clinical outcomes of single - and doublerow repairs in rotator cuff tears. Am J Sports Med 2008; 36: 1310-1316. 17. Ark JW, Flock TJ, Flatow EL, Bigliani LU. Arthroscopic treatment of calcific tendinitis of the shoulder. Arthroscopy 1992; 8: 183-188. 18. Jerosch J, Strauss JM, Schmiel S. Arthroscopic treatment of calcific tendinitis of the shoulder. J Shoulder Elbow Surg 1998; 7: 30-37. 19. Re LP, Jr., Karzel RP. Management of rotator cuff calcifications. Orthop Clin North Am 1993; 24: 125-132. 803
Lhee SH Kho DH Park JY 20. Seil R, Litzenburger H, Kohn D, Rupp S. Arthroscopic treatment of chronically painful calcifying tendinitis of the supraspinatus tendon. Arthroscopy 2006; 22: 521-527. 21. Cuomo F, Checroun A. Avoiding pitfalls and complications in total shoulder arthroplasty. Orthop Clin North Am 1998; 29: 507-518. 22. van de Sande MA, Brand R, Rozing PM. Indications, complications, and results of shoulder arthroplasty. Scand J Rheumatol 2006; 35: 426-434. 23. Wirth MA, Rockwood CA, Jr. Complications of total shoulderreplacement arthroplasty. J Bone Joint Surg Am 1996; 78: 603-616. Peer Reviewers Commentary 804