, Author at Neurology Advisor

Managing the Failed Rotator Cuff Repair

The Problem Rotator cuff repair results in predictable pain relief and a variable return of function in the majority of patients. However, it may take up to a year to achieve maximum improvement in shoulder strength and function. In certain cases patients may continue to experience pain and weakness in the shoulder following rotator cuff…

Evaluation and Management of Fractures of the Capitellum

The Problem Fractures of the capitellum represent a distinct subset of coronal plane partial articular injuries of the distal humerus, and account for less than 1% of all elbow fractures. These are coronal shear fractures that may involve the capitellum in isolation, extend medially to involve the trochlea, or occur with complex osseous or ligamentous…

Evaluation and Management of Scapular Winging due to long thoracic nerve palsy

The Problem Scapular winging is a rare condition that results in abnormal scapular motion, causing pain and decreased functionality of the upper extremity. The diagnosis can be missed, leading to unnecessary surgery, although a thorough physical examination and proper diagnostic studies can lead to the correct diagnosis as well as elucidating the underlying etiology. Causes…

My Approach to Superior Labral Pathology

The Problem Injury to the superior glenoid labrum and biceps anchor is an important cause of shoulder pain in overhead athletes and active individuals. Accurate diagnosis is often challenging, and management of these injuries remains controversial. “Superior labrum anterior-posterior” – or SLAP – tears represent a variety of injuries originally classified into four types (Figure…

Glenohumeral Degenerative Disease: Osteoarthritis

The Problem Degenerative osteoarthritis (OA) of the glenohumeral joint may be a primary, idiopathic process. However, it can also be secondary to a number of inciting factors including post-traumatic, previous capsulorrhaphy, chondrolysis from intra-articular pain pumps, hardware complication, persistent instability, and developmental problems that accelerate the degenerative process. Although both OA and inflammatory arthropathies such…

Chronic Glenohumeral Dislocation: Anterior and Posterior

The Problem Chronic glenohumeral dislocations represent a therapeutic challenge for the orthopaedic surgeon. Patients with a chronic glenohumeral dislocation often present with a complex combination of pathologic findings, all of which impact the treatment strategy and ultimate prognosis. These include injuries to the humeral head articular surface, the glenoid, the rotator cuff, and the capsulolabral…

Management of Recurrent Anterior Shoulder Instability

The Problem Recurrent shoulder instability is a difficult problem arising from a destabilizing injury to the static and dynamic anterior restraints of the glenohumeral joint. The most common lesion found in anterior instability is an avulsion of the anteroinferior capsulolabral structures from the glenoid rim (Bankart lesion). Recurrent shoulder dislocation events may also result in…

Fractures of the Olecranon and Proximal Ulna

The Problem Fractures of the olecranon are classically the result of fall on the elbow with eccentric triceps contraction. These range from small extra-articular fragments to intra-articular comminuted fractures that may be associated with elbow dislocations. Fractures of the proximal ulna are higher energy injuries and are associated with injuries to the proximal radio-ulnar joint;…

Sarcoidosis

What every physician needs to know: Sarcoidosis is a rare (incidence of 10-40/100,000) multi-organ, granulomatous disease of unknown etiology. While the lungs and hilar and mediastinal lymph nodes are usually involved, any organ system may be effected. The disease manifestations depend upon the duration of disease, site and extent of organ involvement and the activity…

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