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Complex Shoulder Disorders: Evaluation and Treatment

Dr. Tonino is Associate Professor and Chief of Sports Medicine, Loyola University Medical Center, Maywood, IL. Dr. Gerber is Professor and Chairman, Department of Orthopedics, University of Zurich, Balgrist, Switzerland. Dr. Itoi is Professor and Chair, Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan. Dr. Porcellini is Chief of Unit of Shoulder and Elbow Surgery, Cattolica, Italy. Dr. Sonnabend is Professor of Orthopaedics and Traumatic Surgery, University of Sydney, New South Wales, Australia. Dr. Walch is Director, Centre Orthopédique Santy, Lyon, France.

Reprint requests: Dr. Tonino, Department of Sports Medicine, Loyola University Medical Center, 2160 South First Avenue, Maywood, IL 60153.

Dr. Tonino or a member of his immediate family has stock or stock options held in Regeneration Technologies. Dr. Gerber or a member of his immediate family serves as a board member, owner, officer, or committee member of the Swiss Society of Orthopaedic Surgery; is affiliated with the publication Shoulder and Elbow Surgery; has received royalties from Zimmer; serves as a paid consultant to Storz; and has received research or institutional support from Zimmer Medacta. Dr. Sonnabend or a member of his immediate family serves as a paid consultant to DePuy; and has received research or institutional support from DePuy and Zimmer. Dr. Itoi or a member of his immediate family is affiliated with the publication American Journal of Sports Medicine; has received royalties from Alcare; is a member of a speakers’ bureau or has made paid presentations on behalf of Alcare, DePuy, Eli Lilly, Johnson & Johnson, Merck, Mitek, Novartis, Pfizer, Smith & Nephew, and Wyeth; and has received research or institutional support from Alcare and Smith & Nephew. Dr. Walch or a member of his immediate family serves as a board member, owner, officer, or committee member of the Société Française de Chirurgie Orthopédique, the European Society of Shoulder and Elbow Surgery, and the Société Française d’Arthroscopie, and is an ASES corresponding member; is affiliated with the publication Journal of Shoulder and Elbow Surgery; and has received royalties from and has received nonincome support (such as equipment or services), commercially derived honoraria, or other non-research–related funding (such as paid travel) from Tornier. Neither Dr. Porcellini nor a member of his immediate family has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article.

Evaluation of patients with shoulder disorders often presents challenges. Among the most troublesome are revision surgery in patients with massive rotator cuff tear, atraumatic shoulder instability, revision arthroscopic stabilization surgery, adhesive capsulitis, and bicipital and subscapularis injuries. Determining functional status is critical before considering surgical options in the patient with massive rotator cuff tear. When nonsurgical treatment of atraumatic shoulder stability is not effective, inferior capsular shift is the treatment of choice. Arthroscopic revision of failed arthroscopic shoulder stabilization procedures may be undertaken when bone and tissue quality are good. Arthroscopic release is indicated when idiopathic adhesive capsulitis does not respond to nonsurgical treatment; however, results of both nonsurgical and surgical treatment of posttraumatic and postoperative adhesive capsulitis are often disappointing. Patients not motivated to perform the necessary postoperative therapy following subscapularis repair are best treated with arthroscopic débridement and biceps tenotomy.