HPI - 2 years post-traumatic proximal humeral malunion.
He cannot live with it anymore because of pain.
What is the best surgical option for this patient?
HPI - Acute injury in motorcycle accident 5 days ago
What additional Xrays would you get in this case?
HPI - 50M, RHD.
Known history of rotator cuff tear about 2 years ago.
History of 3 prior right shoulder surgeries (? RCR).
History of successful RCR on opposite (left) shoulder >1.5 years ago.
+ painful ADLS, + night pain, + pain with overhead activities.
Difficulty raising his right arm in forward flexion and abduction. Significant weakness.
How would you manage this patient?
HPI - A 21-y/o RHD male c/o recurrent left shoulder instability. He reports ~20 instability events (all self-reduced) prior to arthroscopic Prior Bankart repair + remplissage. Now 9 months s/p stabilization, he reports recurrent instability that began ~5 months post-op. Now reports instability while sleeping. He has taken a medical leave from college due to symptoms.
He plays golf, soccer, and basketball.
How would you treat this patient?
HPI - 58M, s/p motorcycle accident 5 weeks ago.
Isolated LEFT shoulder injury.
Has pain and limited function of left shoulder.
Was seen in ER were he was told x-rays where normal, and now follows up after PMD ordered MRI of shoulder.
Shoulder was normal prior to accident.
What x-ray view would have aided in the initial treatment of this patient?
HPI - Patient presented with history of pain and pain on the lateral side of both elbows 2 years ago and was missed diagnosed as lateral epicondylitis and was treated with local injection of cortisone.
What is the most likely diagnosis?
HPI - 33 yr old with traumatic initial dislocation about a year ago. Passed out and shoulder hit a dresser. Was reduced in ER. Since then has been managed non op by other surgeons. Has had about 7 dislocations since almost all of them have to be reduced under sedation bc of engaging hill sachs. Presents to me after seeing two other orthopods.
After reviewing images it seems there is a large engaging hill sachs. The anterior glenoid rim is without large bony bankart. MRI does show labral tearing.
I believe this needs surgical fixation. My question is how to address the engaging hill sachs. Will remplissage be enough or should I be thinking about allograft / bony procedure?
Thank you in advance for the input and advice.
How would you address the instability?
HPI - Traumatic event causing dislocation right shoulder dislocation. The patient has no prior history of dislocation.
Following closed reduction (see postop P1 images below), how would you treat this injury?
HPI - Patient was involved in a car accident 1 year ago with severe head injury, coma for 1 month, neglected humeral head fracture for 10 months, underwent open rotator cuff repair 2 months ago.
How would you treat the patient at this time (P1 images above)?
HPI - MBA 6 years ago
Patient isn't the best historian and, as his injury was sustained in another state, we have not been able to access his imaging or notes
Right proximal humerus ?fracture ?fracture-dislocation, treated non-operatively
Associated with brachial plexus injury of uncertain extent (patient describes complete paralysis of right upper extremity)
Plexus treated expectantly with recovery over 12-18 months
States reasonable shoulder function after plexus recovery for 1-2 years, but lasts 4 years has developed increasingly severe right shoulder pain with associated stiffness
Previously a fisherman, unable to work due to pain for 6 months
States had been placed on waiting list for "rotator cuff repair" in the other state 3 years ago, but never called for surgery
Having moved states, now presents to us "only" wanting more movement and less pain
What would be your preferred treatment option for this patient bearing in mind his age?
HPI - Patient fell and sustained a dislocation of the shoulder 3 weeks ago.
Shoulder reduced on its own.
Non-contact, recreational athlete.
HPI - 51 year old LHD male presents one day following an acute injury to his right elbow (non-dominant) when lifting a heavy object. He felt a pop near his elbow and had immediate pain and swelling. On physical exam, he has decreased ROM and significant ecchymosis around the elbow. Radiographs are negative for fracture or dislocation.
How would you treat the distal biceps avulsion in this patient?
HPI - Patient was operated in Feb 2014 for supraspinatus tear right shoulder arthoscopically.Sympotms improved after surgery .At about 3 weeks post op patient developed sudden pain following physiotherapy which subsided after rest for few days.Three months after surgery patient developed severe sudden pain in right shoulder which progressively increased and was also present on rest.
Patient had no fever .
ESR was 50 and crp was negative ,counts were normal
Repeat MRI ON 26 JUNE 14 showed tear of supraspinatus infraspinatus and subscapularis along with signal changes at greater tuberosity.
After course of iv antibiotics symptoms subsided and pain releif was about 70%. After shifting to oral antibiotics pain also increased after about one week .At present pain is about 50%better and movements have slightly improved .
Serial xrays show increasing erosion around greater tuberosity
What is the diagnosis of this post operative complication
HPI - 37 year old Male s/p shoulder dislocation and closed reduction.
How would you classify this bony bankart?
HPI - 38 y/o male smoker, thin build with permanent Rt femoral nerve neurotmesis deep in pelvis s/p GSW >12 months ago with early pelvic infection and Rt acetabular fx now healed and no infection for > 6 months off abx. Patient motivated to achieve more strength and mobility despite achieving independent gait with minimal pain. Knee extension only from IT band and tensor fascia. Functional and stable yet weak gait with intact hamstrings and gastrocnemius. Unable to perform leg raise in supine or sitting position. Neurosurgeon does not plan femoral nerve grafting.
What is your treatment recommendation for this previously active recreational athlete, community leader and businessman?
HPI - 26 yr old Male with hx of traumatic dislocation in high school. Had open Bankart repair 10 yrs ago. Did well until this year had snowboarding injury and dislocated. Rehabbed for a few months but dislocated again while playing softball.
Continued to with rehab but does have recurrent instability.
MRI and CT show large anterior inferior bony Bankart fragment.
Question is revision Bankart repair (open vs arthroscopic) or think about bony procedure such as LaterJet?
HPI - Patient presented 3 months after injury with a painful and stiff knee joint. The patient was initially treated with immobilization after suffering from tibial spine avulsion. At three months the cast was removed and patient was put in physiotherapy. Now 6 months after injury patient has full range of motion, no instability, however he continues to have mild pain at night after increased activity.
What should be the treatment for this injury at this time?
HPI - Patient presented with anterior dislocation right shoulder joint
Closed reduction done same day .post reduction Xray satisfactory
Serial Xray show inferior sublaxation increasing
MRI shoulder done at 3 weeks shows posterior sublaxation and rotator cuff tear
What would be your next step in treatment for this patient?
HPI - 43 yr old male with shoulder pain. Hx of cuff repair 4 years ago.
HPI - Right-hand dominant 38 year old male.
Past Surgical History: Right open bony-Bankart repair ~ 20 years ago. 2 screws in-situ.
Complaining of recurrent instability x 15 years.
Daily pain and crepitus with ROM.
Equally bothered by pain vs instability.
How would you manage this 38 year old patient?
HPI - 69 male complicated r shoulder hx.
Initial proximal humerus fx. Had ORIF. Did ok but developed impingement. Eventually had removal of hardware and rotator cuff repair.
Then had p acnes infection. Was treated with IV abx protocol and shoulder wash out twice.
Now presents to me with shoulder pain.
MRI shows large cysts in humeral head.
Aspiration showed continued p acnes infection.
I elected to perform two staged reverse tsa.
Placed abx spacer. Pain has improved significantly.
Infection labs have always been normal.
Now do I:
Plan for placement of reverse while obtaining frozen, but will p acnes show up?
Place reverse along with calcium sulfate abx beads?
How to determine if p acnes infection has been irradicated?
HPI - 32 yr old male with hx of "shoulder dislocation" when in high school during football. Not aware if posterior or anterior. Was scheduled to have surgery back then but choose not to. Did well for many years but recently started to develop locking and catching and occational shoulder pains, otherwise very functional.
Options for this patient?
HPI - 45 yr old female with hx of shoulder pain had mini open cuff repair (anterior subscap / supra as per op note) 7 months ago by another surgeon.
What are her current options?
HPI - 65 yo M alcoholic complains of multiple shoulder dislocations. Most recent dislocation occurred 2 months ago and he has been unable to use the arm for the past 2 months.
Treatment for this chronic posterior shoulder dislocation?
HPI - Several year history of shoulder pain. Progressive worsening of pain, weakness and crepitus.
What procedure would you recommend to alleviate this patient's shoulder pain and dysfunction?