'Shoulders Made Simple'
The following information is intended for General Practitioners. It includes a link to download my 'Shoulders Made Simple' powerpoint presentation. This does not include the videos - they are presented separately on this page below the link.
The powerpoint presentation is a large file and does take some time to download. If you have problems opening it, try waiting a short time and trying again. If you still can't open it, please contact me and I can send you a DVD with the presentation.
Open Rotator Cuff Repair
The video below shows an open rotator cuff repair. This is a small tear but was quite retracted and did require significant releases to enable it to be repaired without tension.This is a short video - you can watch the longer version with commentary designed for patients by going to the "Shoulder Problems" section of my website.
The following video shows a sub-acromial decompression. This is a right shoulder with the view from the back. The antero-lateral corner is shown in the middle of the screen and it is there that the decompression starts. You will see the anterior portion of the acromion removed first. The shaver is then used to remove the required amount of bone, working from front to back. This is a short video - you can watch the longer version with commentary designed for patients by going to the "Shoulder Problems" section of my website.
Excision of Calcium from Rotator Cuff.
The video below shows excision of calcium from the rotator cuff. This is a very large deposit. Half way through the video you can see large pieces of calcium being removed. The last section shows the final result. Extreme care is taken to remove only the loose calcium deposits and to ensure no defect in the rotator cuff occurs. A probe is used to make sure no full thickness hole has been left. This is a short video - you can watch the longer version with commentary designed for patients by going to the 'Shoulder Problems' section of my website.
Arthroscopic Excision of the Distal Clavicle
This video of the right shoulder shows an arthroscopic excision of the distal clavicle (excision of the acromio-clavicular joint). You will see the distal end of the clavicle on the top left and the acromion on the top right. A burr is used to remove the end of the clavicle which effectively excises the acromio-clavicular joint. A 1cm gap is created.
This video shows the technique of sub-acromial bursa injections. The technique is discussed in detail and then two videos of the injection are shown. The video shows the right shoulder and I have marked the bony outline of the acromion.
It is important to start by palpating the postero-lateral corner of the acromion. The needle should be directed upwards and should initially be felt to hit the bone of the acromion. It is then redirected underneath the acromion and advanced as deeply as possible before commencing the injection. It is vital that the injection should only occur when minimal resistance is felt. A 21 gauge needle should be used and at least 10mls of local anaesthetic and one ampoule of steroid is needed. You will note multiple passes of the needle. This is necessary to ensure the anaesthetic and steroid is spread adequately throughout the bursa. So long as the needle is not removed from the skin, very little patient discomfort occurs.
This video shows an apprehension test. It is an extremely important test to demonstrate anterior instability in the shoulder commonly seen in patients with recurrent dislocation.The patient lies prone on the table and the arm is brought into abduction. It is then externally rotated. The patient will complain of a feeling of instability ('it's about to pop out of joint!') when rotation reaches an uncomfortable position. A downward pressure is then applied to the upper arm and the patient will notice the feeling disappear. This represents a positive 'relocation test'. I also like to then release the pressure. The feeling of instability will then return. (I call this the 'release test'). I find it very useful to support the patients arm on my leg while doing this test - as illustrated in the video.
Exmaination of the Rotator Cuff
The video below demonstrates examination of the rotator cuff. It details impingement testing which is useful in diagnosing subacromial bursitis. It also demonstrates strength testing of each of the rotator cuff muscles. Strength testing is useful in diagnosing rotator cuff tears- weakness is seen with significant cuff tears.