Fundamentals of the Shoulder

Contents
Part I: Shoulder Basic Science and Principles
	1: Fundamentals of the Shoulder
		1.1	 Functional Anatomy of the Shoulder Joint
		1.2	 Upper Extremity Bones (Ossa Membri Superioris)
		1.3	 Shoulder Joints
		1.4	 Muscles that Affect the Movement of the Shoulder Girdle
		1.5	 Muscles Connecting the Upper Limb to the Vertebral Column
		1.6	 The Scapular Muscles
		References
	2: Molecular Biology and Genetics in Shoulder Pathologies
		References
	3: Animal Models for Research on Shoulder Pathologies
		3.1	 Evaluation of Animal Models
		3.2	 Animal Models
			3.2.1	 Rat
			3.2.2	 Mice
			3.2.3	 Rabbit
			3.2.4	 Calf
			3.2.5	 Sheep and Goat
			3.2.6	 Dog
			3.2.7	 Primates
		3.3	 Conclusion
		References
	4: Shoulder Kinematics and Biomechanics
		4.1	 Shoulder Stability
			4.1.1	 Glenohumeral Stability
				4.1.1.1	 Static Stabilization
					Bony Static Stabilizers
					Soft Tissue Static Stabilizers
						Glenoid Labrum
						Capsuloligamentous Structures
						The Rotator Interval
				4.1.1.2	 Dynamic Stabilization
					Proprioception
					Rotator Cuff Muscles
					Long Head of the Biceps
			4.1.2	 Scapulothoracic Joint Stability
		4.2	 The Thrower’s Shoulder
		References
	5: Biomechanics of Anterior Shoulder Instability
		5.1	 Dislocation Position
		5.2	 Remplissage Procedure
			5.2.1	 Effectiveness on Off-Track Hill-Sachs Lesions
			5.2.2	 Recurrence and Return to Sports
			5.2.3	 Restriction of Range of External Rotation Motion
			5.2.4	 Contribute to Stability in the Mid-Range Position?
		5.3	 New Evaluation of the Glenoid Bone Loss
			5.3.1	 Subcritical Bone Loss
			5.3.2	 Does the Size Measurement Really Tell It All?
		References
	6: Pathomechanics in CTA and Rationale of RSA
		6.1	 Pathomechanics in Cuff Tear Arthropathy
			6.1.1	 Introduction
			6.1.2	 Historical Review
			6.1.3	 Biomechanics of the Shoulder
		6.2	 Pathogenesis of CTA
			6.2.1	 Neer Cuff Tear Arthropathy Theory
			6.2.2	 Crystal-Mediated Theory (Milwaukee Shoulder Syndrome)
			6.2.3	 Histopathological Changes in Cuff Tear Arthropathy
		6.3	 Rationale of the Reverse Shoulder Arthroplasty
			6.3.1	 History of Reverse Shoulder Arthroplasty Rationale
			6.3.2	 Biomechanics and Basics of Reverse Shoulder Arthroplasty
			6.3.3	 Controversies in Evolving Designs
				6.3.3.1	 Lateralization of the CoR
				6.3.3.2	 Inlay-Onlay Designs
				6.3.3.3	 Short-Stem or Stemless Options
				6.3.3.4	 Polyethylene Glenospheres
			6.3.4	 Solutions to Limitations
				6.3.4.1	 Instability
				6.3.4.2	 Large Dead Space
				6.3.4.3	 Decrease in External Rotation
				6.3.4.4	 Scapular Notching
				6.3.4.5	 Acromial Fractures and Displacement of the Os Acromiale
				6.3.4.6	 Glenoid Bone Erosion
			6.3.5	 Future
				6.3.5.1	 Patient-Specific Instrumentation
				6.3.5.2	 3D Planning Softwares
				6.3.5.3	 Augmented Reality
		6.4	 Conclusion
		References
	7: Rationale of Tendon-to-Bone Healing
		7.1	 Introduction
		7.2	 Tendon-to-Bone Healing
		7.3	 Biologic Augmentation of Tendon-to-Bone Healing
			7.3.1	 Biochemical Augmentation
				7.3.1.1	 Stem Cell Therapies
				7.3.1.2	 Bone Marrow-Derived Mesenchymal Stem Cells
				7.3.1.3	 Other Sources of Mesenchymal Stem Cells
				7.3.1.4	 Growth Factors
				7.3.1.5	 Platelet-Rich Plasma
				7.3.1.6	 Other Growth Factors
				7.3.1.7	 Matrix Metalloproteinase Inhibitors
			7.3.2	 Biomechanical Augmentation
				7.3.2.1	 Autografts
				7.3.2.2	 Allografts
				7.3.2.3	 Xenografts
				7.3.2.4	 Synthetic Scaffolds
		7.4	 Summary
		References
Part II: Diagnosis of Shoulder Conditions
	8: Physical Examination for Glenohumeral Joint Pathologies
		8.1	 Introduction
		8.2	 Special Tests
			8.2.1	 Anterior Instability Tests
				8.2.1.1	 Apprehension Test
				8.2.1.2	 Jobe Relocation Test
				8.2.1.3	 Anterior Drawer Test
				8.2.1.4	 Load and Shift Test
				8.2.1.5	 Hyper Extension–Internal Rotation (HERI) Test
			8.2.2	 Posterior Instability Tests
				8.2.2.1	 Posterior Drawer Test
				8.2.2.2	 Posterior Apprehension Test
				8.2.2.3	 Jerk Test
			8.2.3	 Multidirectional Instability Tests
				8.2.3.1	 Sulcus Sign
				8.2.3.2	 Hyperabduction Test
		8.3	 Intraarticular Biceps Tests (SLAP)
			8.3.1	 Active Compression (O’Brien) Test
			8.3.2	 Biceps Load Test I and II
			8.3.3	 Crank Test
			8.3.4	 Anterior Slide Test
			8.3.5	 Compression Rotation Test
		References
	9: Physical Examination for Subacromial and Acromioclavicular Pathologies
		9.1	 History
		9.2	 Physical Examination
			9.2.1	 Inspection
			9.2.2	 Palpation and ROM Assessment
			9.2.3	 Specific Tests
				9.2.3.1	 Cervical Spine Tests
				9.2.3.2	 Subacromial Impingement Tests
				9.2.3.3	 Specific Tests for Rotator Cuff
		References
	10: Radiological Assessment of the Shoulder
		10.1	 Introduction
		10.2	 Radiological Modalities and Techniques of Shoulder Imaging
			10.2.1	 Radiography
			10.2.2	 Arthrography
			10.2.3	 Ultrasonography (US)
			10.2.4	 Computed Tomography (CT)
				10.2.4.1	 CT-Arthrography
			10.2.5	 Magnetic Resonance Imaging (MRI)
				10.2.5.1	 MR-Arthrography
		10.3	 Imaging in Rotator Cuff Abnormalities
			10.3.1	 Rotator Cuff Tendonosis and Tendon Tears
			10.3.2	 Rotator Cuff Tear Arthropathy
			10.3.3	 Milwaukee Shoulder
			10.3.4	 Adhesive Capsulitis (Frozen Shoulder)
			10.3.5	 Calcific Tendinitis
		10.4	 Imaging in Shoulder Instability
			10.4.1	 Anterior Instability
			10.4.2	 Posterior Instability
		10.5	 Imaging in Some Other Shoulder Conditions
			10.5.1	 Long Head Biceps Tendon Lesions
			10.5.2	 Distal Clavicular Osteolysis
			10.5.3	 Nerve Compression or Entrapment
			10.5.4	 Enchondroma
		10.6	 Conclusion
		References
Part III: Shoulder Pathologic Conditions
	11: Shoulder Cartilage and Osteoarthritis
		11.1	 Introduction
		11.2	 Epidemiology
		11.3	 Classification Based on Etiology
		11.4	 Primary GHJ-OA
		11.5	 Secondary GHJ-OA
		11.6	 Clinical Evaluation
		11.7	 Imaging
		11.8	 Treatment
			11.8.1	 Arthroscopic Debridement
			11.8.2	 Microfracture
			11.8.3	 Osteochondral Allograft Transfer
			11.8.4	 Autologous Chondrocyte Implantation (ACI)
			11.8.5	 Osteochondral Autograft Transfer
			11.8.6	 Interposition Arthroplasty
			11.8.7	 Resurfacing Arthroplasty
			11.8.8	 Total Shoulder Arthroplasty
			11.8.9	 Reverse TSA
		11.9	 Conclusion
		References
	12: Inflammatory, Metabolic, and Neuromuscular Pathologies in Shoulder Joint
		12.1	 Polymyalgia Rheumatica
			12.1.1	 Rheumatoid Arthritis
			12.1.2	 Inflammatory Arthritis
			12.1.3	 Crystal-Associated Mono/Polyarthritis
		12.2	 Amyloidosis Associated with Immunocyte Dyscrasia (AL Amyloidosis)
			12.2.1	 Neuropathic Arthropathy
			12.2.2	 Epilepsia
			12.2.3	 Hemiplegic Shoulder
		12.3	 Conclusion
		References
	13: Nerve Entrapments Around Shoulder
		13.1	 Suprascapular Neuropathy
			13.1.1	 Anatomy
			13.1.2	 Pathophysiology
			13.1.3	 Clinics and Diagnosis
			13.1.4	 Treatment
				13.1.4.1	 Conservative Treatment
				13.1.4.2	 Surgical Treatment
		13.2	 Axillary Neuropathy and Quadrilateral Space Syndrome
			13.2.1	 Anatomy
			13.2.2	 Pathophysiology
			13.2.3	 Clinics and Diagnosis
			13.2.4	 Treatment
				13.2.4.1	 Conservative Treatment
				13.2.4.2	 Surgical Treatment
		13.3	 Long Thoracic Nerve Neuropathy and Medial Scapular Winging
			13.3.1	 Anatomy
			13.3.2	 Pathophysiology
			13.3.3	 Diagnosis
			13.3.4	 Treatment
				13.3.4.1	 Conservative Treatment
				13.3.4.2	 Surgical Treatment
		13.4	 Accessory Nerve Neuropathy and Lateral Scapular Winging
			13.4.1	 Anatomy
			13.4.2	 Pathophysiology
			13.4.3	 Diagnosis
			13.4.4	 Treatment
				13.4.4.1	 Conservative Treatment
				13.4.4.2	 Surgical Treatment
		References
	14: Fractures Around Shoulder
		14.1	 Clavicle Fractures
			14.1.1	 Classification
			14.1.2	 Clinical Anatomy
			14.1.3	 Midshaft Fractures
				14.1.3.1	 Diagnostic Approach
				14.1.3.2	 Treatment Approach
					Conservative Treatment
					Surgical Treatment
			14.1.4	 Distal Clavicular Fractures
				14.1.4.1	 Diagnostic Approach
				14.1.4.2	 Treatment Approach
					Conservative Treatment
					Surgical Treatment
			14.1.5	 Medial Clavicular Fractures
				14.1.5.1	 Diagnostic Approach
				14.1.5.2	 Treatment Approach
					Conservative Treatment
					Surgical Treatment
		14.2	 Proximal Humerus Fractures
			14.2.1	 Clinical Anatomy
			14.2.2	 Classification
			14.2.3	 Diagnostic Approach
			14.2.4	 Treatment Approach
				14.2.4.1	 Conservative Treatment
				14.2.4.2	 Surgical Treatment
		14.3	 Scapular Fractures
			14.3.1	 Clinical Anatomy
			14.3.2	 Classification
			14.3.3	 Diagnostic Approach
			14.3.4	 Treatment Approach
				14.3.4.1	 Conservative Treatment
				14.3.4.2	 Surgical Treatment
		References
Part IV: Shoulder Surgery and Complications
	15: Positioning, Anesthesia, and Analgesia in Shoulder Surgery
		15.1	 Patient Positioning
		15.2	 Beach-Chair Position (BC)
		15.3	 Lateral Decubitus Position
		15.4	 Comparison of Beach-Chair and Lateral Decubitus Positions
		15.5	 Anesthesia
		15.6	 Shoulder Block (Fig. 15.7)
		15.7	 Interscalene Plexus Block (Fig. 15.8)
		15.8	 Postoperative Analgesia
		15.9	 Discussion of the Anesthesia
			15.9.1	 Controlled Hypotension
			15.9.2	 Which Block Technique
		15.10	 Summary
		References
	16: Surgical Exposures
		16.1	 Introduction
		16.2	 Deltopectoral (Anterior) Approach
			16.2.1	 Indications
			16.2.2	 Incision and Dissection
			16.2.3	 Variations
		16.3	 Deltoid-Splitting Approach
			16.3.1	 Indications
			16.3.2	 Incision and Dissection
			16.3.3	 Variations
				16.3.3.1	 Literature Review on Deltopectoral vs. Deltoid-Splitting Approaches
		16.4	 Posterior Approach
			16.4.1	 Indications
			16.4.2	 Incision and Dissection
			16.4.3	 Variations
		References
	17: Basic Arthroscopy Portals of Shoulder
		17.1	 Glenohumeral Arthroscopy Portals
			17.1.1	 Posterior Portal
			17.1.2	 Anterior Portal
			17.1.3	 Antero-Inferior Portal (5 o’clock Portal)
			17.1.4	 Antero-superior Portal
			17.1.5	 Anterosuperolateral Portal
			17.1.6	 Portal of Wilmington
			17.1.7	 Posterior-Inferior Portal (7 o’clock Portal)
			17.1.8	 Axillary Pouch Portal
		17.2	 Subacromial Portal
			17.2.1	 Posterior Portal
			17.2.2	 Lateral Portal
			17.2.3	 Anterior Portal
			17.2.4	 Anterolateral Portal
			17.2.5	 Posterolateral Portal
			17.2.6	 Neviaser Portal
			17.2.7	 Subclavian Portal
		References
	18: Thromboembolism and Bleeding Control in Shoulder Surgery
		18.1	 Prevention of Bleeding in Shoulder Surgery
		18.2	 Preventing Excessive Bleeding During Anatomic/Reverse Shoulder Arthroplasty
		18.3	 Preventing Bleeding During Shoulder Arthroscopy
		18.4	 Thromboembolic Events After Shoulder Surgery
		18.5	 General Risk Factors for Thromboembolic Events (TEE) After Shoulder Surgery
		18.6	 Thromboembolic Events After Shoulder Arthroplasty
		18.7	 Thromboembolic Events After Shoulder Arthroscopy
		18.8	 Thromboembolic Events After Treatment of Proximal Humerus Fractures
		18.9	 Prophylaxis
		18.10	 Summary
		References
	19: Periprosthetic Infection in Shoulder Surgery
		19.1	 Introduction
		19.2	 Pathogens
		19.3	 Precautions
		19.4	 Diagnosis
		19.5	 Treatment
			19.5.1	 Debridement
			19.5.2	 Cement Spacer
			19.5.3	 One-Stage Revision Arthroplasty
			19.5.4	 Two-Stage Revision Arthroplasty
			19.5.5	 Resection Arthroplasty
		19.6	 Conclusion
		References
Part V: (Bio)technological Applications in Shoulder Treatment
	20: Anchors
		20.1	 History
		20.2	 Anchor Design
		20.3	 Anchor Materials
			20.3.1	 Arthrex®
		20.4	 Suture Materials
		20.5	 Anchor Placement
		20.6	 Summary
		References
	21: Tissue Engineering and Graft Options
		21.1	 Introduction
		21.2	 Extracellular Matrix and Scaffolds
		21.3	 Host Response and Scaffold Remodeling
		21.4	 Mechanical Features
		21.5	 Clinical Applications of Tissue Engineering in Rotator Cuff Surgery
			21.5.1	 Extracellular Matrix- Derived Scaffolds
				21.5.1.1	 Xenografts
					Porcine Intestine Submucosa Derived Scaffolds
					Porcine Dermis-Derived Scaffolds
					Bovine Pericardium Derived Scaffolds
					Bovine Dermis-Derived Scaffolds
					Equine Pericardium Derived Scaffolds
				21.5.1.2	 Allografts
					Human Dermis-Derived Scaffolds
			21.5.2	 Synthetic Scaffolds
			21.5.3	 New Generation Scaffolds
		21.6	 Clinical Applications of Tissue Engineering in Different Shoulder Issues
			21.6.1	 Superior Capsular Reconstruction
			21.6.2	 Glenoid Resurfacing
			21.6.3	 Capsular Reconstruction for Shoulder Instability
		21.7	 Summary
		References
	22: 3D Printing in Shoulder Surgery
		22.1	 Introduction
			22.1.1	 Stereolithography (SLA)
			22.1.2	 Selective Laser Sintering (SLS)
			22.1.3	 Extrusion-Based Techniques (Fused-Deposition Modeling—FDM)
			22.1.4	 Droplet-Based Techniques
		22.2	 3D Printing for Shoulder Arthroplasty
		22.3	 3D Printing for Surgical Planning of the Shoulder
		22.4	 3D Printed Anatomical and Surgical Models, Training Material, Pre- and Post-Surgical Models
			22.4.1	 3D Printed Anatomical Models
			22.4.2	 3D Printed Surgical Models
		22.5	 Bioprinting of Tissues
		22.6	 Conclusion
		References
	23: The Digitized Shoulder: From Preoperative Planning to Patient-Specific Guides
		23.1	 Introduction
		23.2	 3D Visualization and Preoperative Planning
		23.3	 New Concepts in Shoulder Arthroplasty
		23.4	 3D Printing
		23.5	 Conclusion
		References