1. New Technique in Shoulder Surgery for Sports Injury Dennis Crawford MD, PhD Assistant Professor Surgical Director, Sports Medicine Program Department of Orthopedics & Rehabilitation Oregon Health Sciences University Center for Health & Healing Portland Oregon

2. Shoulder Surgery: State of the Art ‘07 All Arthroscopic All Arthroscopic –Stabilization for dislocation –Stabilization for instability –Rotator cuff repairs –SLAP repairs –Biceps tendon repair –Capsular release Internal Rotation contracture Internal Rotation contracture Frozen Shoulder Frozen Shoulder Open Open –Clavicle fixation Improved outcomes Improved outcomes

3. Definitions Instability Instability –Failure of the dynamic and static mechanisms of joint biomechanics to maintain a functional position of two articulating surfaces Subluxation Subluxation –Partial, transient loss of articulating congruency Dislocation Dislocation –Complete loss of articulating congruency

4. Shoulder Dislocations First time dislocators First time dislocators –< 20 yrs > 75% redislocation rate > 75% redislocation rate –20-30 yrs 30-50% redislocation rate 30-50% redislocation rate Arthroscopic repair Arthroscopic repair –Out-patient –Reduce re-dislocation rate <2-5% <2-5% –Return to Sports 3-6 months 3-6 months

5. Type of Instability> Surgical Timing Traumatic Injury Traumatic Injury –Most commonly anterior dislocation anterior dislocation –Anatomic Injury “Bankart” Lesion “Bankart” Lesion –Labral Tear Acquired laxity Acquired laxity –Swimmers/Gymnasts multidirection multidirection Subtle capsular injuries Subtle capsular injuries –Globally “stretched”

6. Fundamental Shoulder Arthroscopy

7. Arthroscopic Exam of Shoulder

8. Arthroscopic Exam: SLAP ? & Biceps

9. Arthroscopic Exam: Bankart lesion

10. Arthroscopic Bankart Repair: 1

11. Arthroscopic Bankart Repair: 2

12. Arthroscopic Bankart Repair: 3

13. Arthroscopic Bankart Repair: 4

14. Return to Sports after Scope Bankart Sling for 4-6 weeks Sling for 4-6 weeks –Immediate Rhomboid strengthening Rhomboid strengthening Core & conditioning Core & conditioning Weeks 4-10 Weeks 4-10 –Restore normal ROM Weeks 8-16 Weeks 8-16 –Restore Rotator Cuff strength –Restore Scapulo-thoracic kinetics Weeks 12-20 Weeks 12-20 –Return to sports –Throwing/overhead athletes Graded increase in stress Graded increase in stress –Throwing programs 6 months 6 months –Unrestricted activity Assuming full strength and ROM Assuming full strength and ROM

15. Thank you Dennis C. Crawford, MD. PhD Assistant Professor Director, Sports & Arthroscopic Surgery Department of Orthopedics Oregon Health & Science University