OKOJ, Volume 8, No. 8

Current Management of Skeletal Metastasis

Skeletal metastasis is a frequent cause of significant pain and functional morbidity for cancer patients. Whether a lesion is the first sign of systemic disease or occurs in a patient with advanced disease, the orthopaedic surgeon may perform a critical role in providing diagnostic assistance, pain relief, skeletal stabilization, and preservation of functional capacity. Knowledge of the evaluation of metastasis of unknown origin, biopsy techniques, surgical and nonsurgical management of painful lesions, and stabilization of impending and actual pathologic fractures is essential to the orthopaedic surgeon. Principles of evaluation, diagnosis, and surgical and nonsurgical interventions are discussed, including key points regarding specific anatomic considerations.

    • Keywords:
    • skeletal metastases

    • bone metastases

    • metastatic bone cancer

    • percutaneous acetabuloplasty

    • Subspecialty:
    • Musculoskeletal Oncology

Arthroscopic Transosseous Equivalent Double-Row Rotator Cuff Repair

Dr. Murthi performs an arthroscopic double-row rotator cuff repair on a 40-year-old, right-hand-dominant, male firefighter who traumatically injured his rotator cuff after a fall on the job. The patient has symptomatic complaints of pain and weakness with overhead activity. On examination, he has full passive range of motion, with no evidence of any adhesions, capsulitis, or neurovascular complications. Diagnostic arthroscopy reveals tears of the supraspinatus and infraspinatus tendons, mild arthrosis within the glenohumeral joint, and some degeneration of the superior glenoid labrum. In a demonstration of his surgical approach, Dr. Murthi shows how to mark the shoulder for portal placement, perform a release of the supraspinatus tendon to improve its excursion, débride the subacromial space, prepare the greater tuberosity for suture anchor placement, and complete a tension-free repair of the rotator cuff with double-row fixation. Postoperative therapy includes passive and active-assisted range-of-motion exercise as tolerated within the first week, isometric deltoid exercise at 3 weeks, active range-of-motion exercise with terminal stretching at 6 weeks, and shoulder strengthening at 10 weeks.

    • Keywords:
    • rotator cuff tear

    • rotator cuff injury

    • rotator cuff repair

    • arthroscopic double-row fixation of the supraspinatus tendon

    • interscalene block

    • Subspecialty:
    • Shoulder and Elbow

Diagnosis and Management of Internal Shoulder Impingement

Internal impingement of the shoulder refers to mechanical abutment of the supraspinatus and infraspinatus muscles against the posterosuperior glenoid rim when the arm is abducted and externally rotated. A variety of pathologic findings associated with internal shoulder impingement make diagnosis challenging. These include tears of the posterosuperior labrum and articular side of the rotator cuff, osteochondral damage of the humeral head and glenoid, cyst formation within the greater tuberosity, and stretching of the anteroinferior capsulolabral complex. More recently glenohumeral internal rotation deficit (GIRD) has been described as the essential condition leading to increased external rotation and resultant internal impingement of the shoulder. The mainstay of treatment is a focused, comprehensive rehabilitation program; surgery is occasionally indicated.

    • Keywords:
    • internal shoulder impingement

    • rotator cuff tear

    • partial-thickness rotator cuff tear

    • SLAP tear

    • posterior labral tear

    • posterior labrum tear

    • glenoid labrum tear

    • overhead throwing

    • glenohumeral internal rotation deficit

    • GIRD

    • Subspecialty:
    • Shoulder and Elbow

Complications of Spine Surgery: Esophageal Injury and Voice Complications

Esophageal injuries, dysphagia, and dysphonia may arise as a result of direct trauma to nerves and tissues during anterior cervical spine surgery, indirectly during endoscopy or endotracheal tube placement, or postoperatively as a result of chronic irritation or erosion of tissues due to sharp or prominent instrumentation. Esophageal perforations are rare complications, but are potentially fatal. Once diagnosed, treatment involves wound débridement, immediate repair or reconstruction, and broad-spectrum antibiotic therapy to prevent life-threatening sequelae such as mediastinitis. Some degree of dysphagia and dysphonia is typical after anterior cervical spine surgery, but patients with symptoms that persist or are more significant after 6 weeks should undergo an otololaryngology consultation. Careful surgical technique and adherence to certain safety principles during endoscopic procedures and intubation can help minimize these complications.

    • Keywords:
    • esophageal perforation

    • esophageal rupture

    • esophageal tear

    • esophagus tear

    • esophageal dysfunction

    • FEES

    • fiberoptic endoscopic evaluation of swallowing

    • VFSS

    • videofluoroscopic swallowing study

    • anterior cervical diskectomy and fusion

    • anterior cervical spine surgery

    • dysphagia

    • dysphonia

    • Subspecialty:
    • Spine

The Shoulder and Beyond: The Kinetic Chain and the Scapula in Shoulder Function and Dysfunction

To understand shoulder injury, one must have an adequate knowledge of normal shoulder function and the dysfunction resulting from injury. The goal of evaluation, treatment, and rehabilitation of the shoulder is the restoration of function. When evaluating the shoulder and shoulder function, the forces and loads that are measured are the result of the interactive moments. These interactive moments, in turn, result in distal muscle activations and sequential joint motions up through the shoulder. This provides proximal stability for distal mobility, which allows maximum shoulder and arm function. Integrated scapulohumeral rhythm is key to functional glenohumeral stability. The kinetic chain is the best framework for understanding this dynamic shoulder function.

    • Keywords:
    • overhead throwing

    • glenohumeral internal rotation deficit

    • kinetic chain

    • kinetic chain alteration

    • kinetic chain breakage

    • kinetic chain model

    • long axis rotation

    • scapular dyskinesis

    • scapulohumeral rhythm

    • Subspecialty:
    • Sports Medicine