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Case_Manager_Talk - Shoulder Surgery Why Doesnt It Work...

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Shoulder Surgery - Why Shoulder Surgery - Why Doesn’t It Work? Doesn’t It Work? Mark D. Lazarus, M.D. Associate Professor Department of Orthopaedic Surgery The Rothman Institute Thomas Jefferson University Philadelphia, Pennsylvania
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Duh, genius!!! It’s WORK COMP !
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Acromioplasty Acromioplasty
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Acromioplasty and WC Acromioplasty and WC 0 10 20 30 40 50 60 70 80 90 100 Shoulder Score No WC WC
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Percent RTW Percent RTW 0 10 20 30 40 50 60 70 80 90 100 RTW No WC WC
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Time to RTW Time to RTW 0 5 10 15 20 25 Weeks No WC WC
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Work Comp Work Comp Countless studies demonstrate: Worse functional results Longer time to RTW Lower rate of RTW
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Causes of Failure Causes of Failure Incorrect diagnosis Poor biology Incorrect treatment Poor technique Inappropriate rehabilitation
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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
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Impingement Syndrome Adhesive Capsulitis Internal Impingement Occult Instability Microtraumatic Instability Rotator Cuff Tear Frozen Shoulder Rotator Cuff Tendonitis
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Impingement Syndrome Impingement Syndrome External pressure from acromial hooks or spurs causes rotator cuff pain and tearing
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Neer (1972) Neer (1972) Coined the term “impingement syndrome” Recommended anterior acromioplasty as a treatment for partial, complete, and irreparable tears
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Neer (1972) Neer (1972) “A characteristic ridge of proliferative spurs…on the undersurface of the anterior process…apparently CAUSED BY repeated impingement of the rotator cuff and humeral head, with traction on the coracoacromial ligament…”
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Neer (1982) Neer (1982) “Impingement Lesions” Defined the stages of impingement 95% of rotator cuff tears secondary to subacromial impingement
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Bigliani and Morrison (1986) Bigliani and Morrison (1986) Differentiated acromial types: Type 1 => flat Type 2 => curved
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