Case_Manager_Talk - Shoulder Surgery - Why Shoulder Surgery...

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Unformatted text preview: Shoulder Surgery - Why Shoulder Surgery - Why Doesnt It Work? Doesnt It Work? Mark D. Lazarus, M.D. Associate Professor Department of Orthopaedic Surgery The Rothman Institute Thomas Jefferson University Philadelphia, Pennsylvania Duh, genius!!! Its WORK COMP ! Acromioplasty Acromioplasty Acromioplasty and WC Acromioplasty and WC 10 20 30 40 50 60 70 80 90 100 Shoulder Score No WC WC Percent RTW Percent RTW 10 20 30 40 50 60 70 80 90 100 RTW No WC WC Time to RTW Time to RTW 5 10 15 20 25 Weeks No WC WC Work Comp Work Comp Countless studies demonstrate: Worse functional results Longer time to RTW Lower rate of RTW Causes of Failure Causes of Failure Incorrect diagnosis Poor biology Incorrect treatment Poor technique Inappropriate rehabilitation Incorrect Diagnosis Incorrect Diagnosis No gold standard diagnostic test for many diagnoses Many problems are pain diagnoses Syndromes Multiple studies have demonstrated that incorrect diagnosis is the most frequent cause of surgical failure in the shoulder I m p i n g e m e n t S y n d r o m e A d h e s i v e C a p s u l i t i s I n t e r n a l I m p i n g e m e n t O c c u l t I n s t a b i l i t y M i c r o t r a u m a t i c I n s t a b i l i t y R o t a t o r C u f f T e a r F r o z e n S h o u l d e r R o t a t o r C u f f T e n d o n i t i s Impingement Syndrome Impingement Syndrome External pressure from acromial hooks or spurs causes rotator cuff pain and tearing Neer (1972) Neer (1972) Coined the term impingement syndrome Recommended anterior acromioplasty as a treatment for partial, complete, and irreparable tears Neer (1972) Neer (1972) A characteristic ridge of proliferative spurson the undersurface of the anterior processapparently CAUSED BY repeated impingement of the rotator cuff and humeral head, with traction on the coracoacromial ligament Neer (1982) Neer (1982) Impingement Lesions Defined the stages of impingement 95% of rotator cuff tears secondary to subacromial impingement Bigliani and Morrison (1986)...
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This note was uploaded on 10/16/2011 for the course BUSINESS 421 taught by Professor ?? during the Spring '10 term at Thomas Edison State.

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Case_Manager_Talk - Shoulder Surgery - Why Shoulder Surgery...

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