Shoulder Arthroscopy: Principles and Practice

Contents
1: Anatomy of the Shoulder
	1.1	 Glenohumeral Joint
		1.1.1	 Capsuloligamentous Structures
		1.1.2	 Glenoid
		1.1.3	 Glenoid Labrum
		1.1.4	 Humeral Head
	1.2	 Acromioclavicular Joint
	1.3	 Extraarticular/Subacromial Space
		1.3.1	 Acromion and Spine of the Scapula
		1.3.2	 Coracoacromial Ligament
		1.3.3	 Coracoid
		1.3.4	 Coracohumeral Ligament
		1.3.5	 Synovial Bursae
	1.4	 Muscles
		1.4.1	 Deltoid
		1.4.2	 Rotator Cuff
			1.4.2.1	 Supraspinatus
			1.4.2.2	 Infraspinatus
			1.4.2.3	 Teres Minor
			1.4.2.4	 Subscapularis
			1.4.2.5	 Rotator Cuff Innervation and Vascular Supply
		1.4.3	 Long Head of the Biceps
		1.4.4	 Latissimus Dorsi
	1.5	 Neurovascular Structures
		1.5.1	 Axillary Nerve
		1.5.2	 Suprascapular Nerve
		1.5.3	 Musculocutaneous Nerve
		1.5.4	 Anterior Humeral Circumflex Artery
		1.5.5	 Posterior Humeral Circumflex Artery
	References
2: Biomechanics of the Shoulder
	2.1	 Kinematics of the Shoulder Complex
	2.2	 Kinesiology of the Shoulder Complex
	2.3	 Scapula
	2.4	 Glenohumeral Joint
		2.4.1	 Glenoid Labrum
		2.4.2	 Capsule and Ligaments
		2.4.3	 Dynamic Stabilizers of the Glenohumeral Joint
	2.5	 Acromioclavicular Joint
	2.6	 Sternoclavicular Joint
		2.6.1	 Sternoclavicular and Acromioclavicular Motion
	2.7	 Summary
	References
3: Biology of Injury and Repair of Soft Tissues of the Shoulder
	3.1	 Introduction
	3.2	 Biology of the Intact Rotator Cuff
		3.2.1	 Four Zones of the Intact Tendon-Bone Interface
		3.2.2	 Fetal Development of the Native Tendon and the Tendon-Bone Junction
	3.3	 Biology of Rotator Cuff Degeneration in Adults
		3.3.1	 Extrinsic Causes for Rotator Cuff Degeneration
		3.3.2	 Intrinsic Causes for Rotator Cuff Degeneration
	3.4	 Biology of the Rotator Cuff Tear
	3.5	 Biology of Rotator Cuff Healing
		3.5.1	 Influence of Cells on Healing
		3.5.2	 Influence of Growth Factors on Healing
			3.5.2.1	 Transforming Growth Factor-Beta
			3.5.2.2	 Fibroblast Growth Factor
			3.5.2.3	 Bone Morphogenetic Protein
			3.5.2.4	 Matrix Metalloproteinases and Tissue Inhibitor Metalloproteinases
		3.5.3	 Influence of the Extracellular Matrix on Healing
		3.5.4	 Influence of Load and Mobilization on Healing
		3.5.5	 Influence of Muscle Changes on Rotator Cuff Healing
			3.5.5.1	 Retraction
			3.5.5.2	 Fatty Infiltration
			3.5.5.3	 Atrophy
		3.5.6	 Exogenous Factors That Affect Rotator Cuff Healing
			3.5.6.1	 Nonsteroidal Anti-inflammatory Drugs
			3.5.6.2	 MMP Inhibition with Doxycycline
			3.5.6.3	 Diabetes
			3.5.6.4	 Steroids
			3.5.6.5	 Nicotine
	3.6	 Long Head of the Biceps Tendon
	3.7	 Glenoid Labrum
	3.8	 Summary
	References
4: Principles of Shoulder Arthroscopy Rehabilitation
	4.1	 Introduction
	4.2	 Rehabilitation Following Rotator Cuff Repair
		4.2.1	 Stages of Rehabilitation
			4.2.1.1	 Early Phase (0–6 Weeks)
			4.2.1.2	 Recovery Phase (6–12 Weeks)
			4.2.1.3	 Functional Phase (12 Weeks Onwards)
	4.3	 Rehabilitation Following Shoulder Stabilization
		4.3.1	 Bone Loss
		4.3.2	 Stages of Rehabilitation
		4.3.3	 Rehabilitation in Arthroscopic Bankart Repair
			4.3.3.1	 Early Phase (1–6 Weeks)
			4.3.3.2	 Intermediate Phase (6–12 Weeks)
			4.3.3.3	 Functional Phase (12–16 Weeks)
		4.3.4	 Rehabilitation in Coracoid Transfer (Latarjet Procedure)
			4.3.4.1	 Phase 1 (Weeks 0–3)
			4.3.4.2	 Phase 2 (Weeks 3–9)
			4.3.4.3	 Phase 3 (Weeks 9–12)
			4.3.4.4	 Phase 4 (Week 12 Onwards)
	4.4	 Summary
	References
5: Instrumentation in Shoulder Arthroscopy
	5.1	 Introduction
	5.2	 Arthroscopy Tower
	5.3	 The Arthroscope
	5.4	 Fluid Management
		5.4.1	 Arthroscopic Irrigation Systems
			5.4.1.1	 Gravity-Based Irrigation
			5.4.1.2	 Automatic Pumps
	5.5	 Accessory Hand Instruments
		5.5.1	 Sterile Skin-Marking Pens
		5.5.2	 Spinal Needles
		5.5.3	 Cannulas
		5.5.4	 Dilators
		5.5.5	 Switching Sticks and Wissinger Rods
		5.5.6	 Probes
		5.5.7	 Chisel Dissectors
		5.5.8	 Rasps
	5.6	 Cutting Instruments
		5.6.1	 Basket Forceps and Scissors
		5.6.2	 Suture Cutters
	5.7	 Grasping Tools
		5.7.1	 Suture Retrievers
		5.7.2	 Graspers
	5.8	 Suture Passers
		5.8.1	 Direct Suture Passers
		5.8.2	 Indirect Suture Passers
	5.9	 Knot Pushers
	5.10	 Power Instruments
		5.10.1	 Blades Designed for Cutting Soft Tissues
		5.10.2	 Blades Designed for Bone Resectioning
	5.11	 Radiofrequency Equipment
	References
6: Operating Room Setup and Patient Positioning
	6.1	 Introduction
	6.2	 Shoulder Arthroscopy in the Beach Chair Position
		6.2.1	 Operating Room Setup
		6.2.2	 Patient Positioning
		6.2.3	 Sterile Preparation and Draping
	6.3	 Shoulder Arthroscopy in the Lateral Decubitus Position
		6.3.1	 Operating Room Setup
		6.3.2	 Patient Positioning
		6.3.3	 Sterile Preparation and Draping
	References
7: Anesthesia in Shoulder Arthroscopy
	7.1	 Introduction
	7.2	 Shoulder Innervation
	7.3	 Ultrasound-Guided Brachial Plexus Block
	7.4	 Interscalene Brachial Plexus Block
		7.4.1	 Possible Complications and Adverse Effect of Interscalene Brachial Plexus Block
	7.5	 Superior Trunk Block
	7.6	 Bleeding and Clear Surgical Field
	7.7	 Postoperative Pain Control
	References
8: Portal Placement and Related Anatomy
	8.1	 Introduction
	8.2	 Anatomic Landmarks and Relevant Neurovascular Structures
	8.3	 Glenohumeral Joint Portals
		8.3.1	 Posterior Portal (P)
		8.3.2	 Posteroinferior Portal (PI)
		8.3.3	 Anteroinferior Portal (AI)
		8.3.4	 Five O’clock Portal
		8.3.5	 Anterosuperior Portal (AS)
		8.3.6	 Portal of Wilmington
		8.3.7	 Portals for Specific Procedures: Arthroscopic Posterior Bone Block
	8.4	 Subacromial Space Portals
		8.4.1	 Posterior Portal
		8.4.2	 Lateral Portal
		8.4.3	 Posterolateral Portal
		8.4.4	 Anterolateral Portal
		8.4.5	 Superolateral Portal
		8.4.6	 Neviaser Portal (N)
		8.4.7	 Suprascapular Nerve (SSN) Portal
	8.5	 Peri-coracoid Area Portals
		8.5.1	 Arthroscopic Latarjet, Anterior Bone Block, and Infraclavicular Brachial Plexus Release
		8.5.2	 Arthroscopic Acromioclavicular Joint Repair and Reconstruction
	8.6	 Subdeltoid Space Portals for Specific Procedures
		8.6.1	 Arthroscopic Suprapectoral Long Head Biceps Tenodesis
		8.6.2	 Arthroscopic Humeral Plates and Nail Removal
	8.7	 Summary
	References
9: Diagnostic Shoulder Arthroscopy
	9.1	 Introduction
	9.2	 Operating Room and Patient Positioning
	9.3	 Arthroscopic Instruments
	9.4	 General Principles and Portals
	9.5	 Glenohumeral Diagnostic Arthroscopy
		9.5.1	 Superior Region
		9.5.2	 Anterior Region
		9.5.3	 Inferior Region
		9.5.4	 Posterior Region
	9.6	 Bursal Diagnostic Arthroscopy
	9.7	 Summary
	References
10: Anchors and Sutures
	10.1	 Material Properties
		10.1.1	 Anchors
			10.1.1.1	 PEEK Anchors
			10.1.1.2	 Biodegradable Anchors
			10.1.1.3	 Biocomposites
			10.1.1.4	 All-Suture Anchors
		10.1.2	 Sutures
			10.1.2.1	 Suture Abrasion
			10.1.2.2	 Suture Slipping
	10.2	 Knot Types and Uses
		10.2.1	 Sliding Knots
			10.2.1.1	 Duncan Knot
			10.2.1.2	 SMC Knot
			10.2.1.3	 Tennessee Slider
			10.2.1.4	 San Diego Knot
			10.2.1.5	 The Weston Knot
		10.2.2	 Non-sliding Knots
			10.2.2.1	 Revo or SCOI Knot
	10.3	 Anchor Design
		10.3.1	 Arthrex
			10.3.1.1	 Corkscrew Family (Medial Row Anchor)
			10.3.1.2	 SwiveLock (Lateral Row Anchor)
			10.3.1.3	 FiberTak
			10.3.1.4	 SutureTak (Glenoid Anchor)
		10.3.2	 Zimmer Biomet Sports Medicine
			10.3.2.1	 JuggerKnot (Glenoid Anchor)
		10.3.3	 DePuy Mitek
			10.3.3.1	 Healix Advance Anchor (Medial Row Anchor)
			10.3.3.2	 Gryphon BR (Glenoid Anchor)
		10.3.4	 Smith & Nephew
			10.3.4.1	 TwinFix Ultra (Medial Row Anchor)
			10.3.4.2	 Footprint Anchor (Lateral Row Anchor)
			10.3.4.3	 Q-Fix (All-Suture Anchor)
			10.3.4.4	 Raptor Anchor (Glenoid Anchor)
		10.3.5	 CONMED
			10.3.5.1	 Super Revo FT (Medial Row Anchor)
			10.3.5.2	 CrossFT (Medial Row Anchor)
			10.3.5.3	 Y-Knot (Glenoid and Cuff Versions)
	10.4	 Anchor Placement
	10.5	 Failure Mechanisms
		10.5.1	 Anchor Pull Out
		10.5.2	 Anchor Breakage
		10.5.3	 Anchor Eyelet Failure
		10.5.4	 Suture Breakage
		10.5.5	 Suture-Tendon Cut Out
	10.6	 Repair Types: Single Row Versus Double Row
	10.7	 Summary
	References
11: Arthroscopic Suture Management
	11.1	 Introduction
	11.2	 Arthroscopic Rotator Cuff Repair
		11.2.1	 One Anchor Preloaded with Two Sutures
		11.2.2	 Two Anchors Preloaded with Two Sutures Each
		11.2.3	 Side-to-Side Repair
	11.3	 Arthroscopic Bankart Repair
	11.4	 Summary
	References
12: Arthroscopic Knot Tying
	12.1	 Introduction
	12.2	 Arthroscopic Instruments for Knot Tying
		12.2.1	 Cannulas
		12.2.2	 Suture Retrievers
		12.2.3	 Knot Pusher
	12.3	 Arthroscopic Knots
		12.3.1	 Half Hitches
			12.3.1.1	 Underhand Half-Hitch Technique
			12.3.1.2	 Overhand Half Hitch Technique
			12.3.1.3	 Tying and Advancing an Arthroscopic Half Hitch
		12.3.2	 Non-sliding Arthroscopic Knots
		12.3.3	 Sliding Arthroscopic Knots
		12.3.4	 Tips and Tricks
			12.3.4.1	 Carry the Sutures to Same Cannula and Check Orientation of the Limbs by Knot Pusher
			12.3.4.2	 Sliding Half Hitches on a Post Limb
			12.3.4.3	 Post Switching without Rethreading the Knot Pusher and Past Pointing
	12.4	 Literature Review
	12.5	 Summary
	References
13: Complications in Shoulder Arthroscopy
	13.1	 Introduction
	13.2	 Anesthesiologic Complications
	13.3	 Infection
	13.4	 Neurologic Complications
		13.4.1	 Axillary Nerve Injury
		13.4.2	 Suprascapular Nerve Injury
	13.5	 Stiffness
		13.5.1	 Shoulder Stiffness After Arthroscopic Rotator Cuff Surgery
		13.5.2	 Shoulder Stiffness After Arthroscopic Glenohumeral Instability Repair
		13.5.3	 Treatment
	13.6	 Acromioplasty-Related Complications
		13.6.1	 Acromial Stress Fracture
		13.6.2	 Anterosuperior Instability
	13.7	 Heterotopic Ossification
	13.8	 Hardware Complications
	13.9	 Summary
	References
14: Shoulder Instability: Diagnosis and Classification
	14.1	 Introduction
	14.2	 Clinical Diagnosis
		14.2.1	 History
		14.2.2	 Clinical Examination
			14.2.2.1	 General Evaluation
			14.2.2.2	 Specific Evaluation
	14.3	 Imaging
	14.4	 Classification
	14.5	 Summary
	References
15: Acute Traumatic Anterior Shoulder Instability
	15.1	 Epidemiology
	15.2	 Pathophysiology
		15.2.1	 Bankart Lesion
		15.2.2	 ALPSA Lesion
		15.2.3	 HAGL Lesion
		15.2.4	 Capsular Lesion
		15.2.5	 SLAP Lesion
		15.2.6	 Osseous Injuries
		15.2.7	 Tendon Injuries
	15.3	 Clinical Diagnosis
		15.3.1	 History
		15.3.2	 Clinical Examination
			15.3.2.1	 In-Game Event
			15.3.2.2	 Outpatient Clinic
			15.3.2.3	 Apprehension Test
			15.3.2.4	 Relocation Test
			15.3.2.5	 Surprise/Release Test
	15.4	 Imaging
		15.4.1	 Plain Radiographs
		15.4.2	 Computed Tomography
		15.4.3	 Magnetic Resonance Imaging
	15.5	 Treatment
		15.5.1	 Decision-Making Algorithm
			15.5.1.1	 Age and Gender
			15.5.1.2	 Time to Surgery
			15.5.1.3	 Activity Level
		15.5.2	 Clinical Case/Example
	15.6	 Surgical Technique
		15.6.1	 Patient Positioning
		15.6.2	 Portals
		15.6.3	 Diagnostic Arthroscopy
		15.6.4	 Step-by-Step Procedure (Box 15.1)
			15.6.4.1	 Glenoid Preparation
			15.6.4.2	 Anchor Placement and Capsulolabral Plication
			15.6.4.3	 Knot Tying
	15.7	 Postoperative Care
	15.8	 Literature Review
	15.9	 Summary
	References
16: Recurrent Anterior Shoulder Instability
	16.1	 Epidemiology
	16.2	 Pathophysiology
		16.2.1	 Lesions of the Glenoid Labrum and Ligamentous Attachments
			16.2.1.1	 Bankart Lesion
			16.2.1.2	 Anterior Labroligamentous Periosteal Sleeve Avulsion (ALPSA)
			16.2.1.3	 Glenolabral Articular Disruption (GLAD)
			16.2.1.4	 Bony Bankart Lesion
			16.2.1.5	 Humeral Avulsion of Glenohumeral Ligament (HAGL)
			16.2.1.6	 Superior Labral Anterior and Posterior (SLAP) Tears
		16.2.2	 Bony Humeral Lesions
			16.2.2.1	 Hill-Sachs Lesion
	16.3	 Clinical Diagnosis
		16.3.1	 History
		16.3.2	 Clinical Examination
	16.4	 Imaging
	16.5	 Treatment
		16.5.1	 Decision-Making Algorithm
	16.6	 Surgical Technique
		16.6.1	 Patient Positioning
		16.6.2	 Portals
		16.6.3	 Diagnostic Arthroscopy
		16.6.4	 Step-by-Step Procedure (Figs. 16.10 and 16.11) (Box 16.1)
	16.7	 Postoperative Care
	16.8	 Literature Review
	16.9	 Summary
	References
17: Posterior Shoulder Instability
	17.1	 Introduction
	17.2	 The ABC Classification
	17.3	 Epidemiology
		17.3.1	 First-Time Acute PSI
		17.3.2	 Dynamic PSI
		17.3.3	 Static PSI
	17.4	 Pathophysiology
		17.4.1	 First-Time Acute PSI
		17.4.2	 Dynamic PSI
		17.4.3	 Static PSI
	17.5	 Clinical Diagnosis
		17.5.1	 History
			17.5.1.1	 First-Time Acute PSI
			17.5.1.2	 Dynamic PSI
			17.5.1.3	 Static PSI
		17.5.2	 Clinical Examination
	17.6	 Imaging
	17.7	 Treatment
		17.7.1	 First-Time Acute PSI
		17.7.2	 Dynamic PSI
		17.7.3	 Static PSI
		17.7.4	 Decision-Making Algorithm
	17.8	 Surgical Technique
		17.8.1	 Arthroscopic Reduction and Defect Disimpaction of an Acute Reverse Hill-Sachs Defect in a Patient with Acute Posterior Dislocation (A2)
			17.8.1.1	 Setup and Patient Positioning
			17.8.1.2	 Step-by-Step Procedure
			17.8.1.3	 Postoperative Care
		17.8.2	 Arthroscopic Capsulolabral Repair in a Patient with Structural Dynamic PSI (B2) with Posterior Labral Tear
			17.8.2.1	 Patient Positioning
			17.8.2.2	 Portals and Diagnostic Arthroscopy
			17.8.2.3	 Step-by-Step Procedure
			17.8.2.4	 Tips and Tricks
			17.8.2.5	 Postoperative Care
		17.8.3	 Arthroscopic Coverage of a Reverse Hill-Sachs Defect with Modified Arthroscopic McLaughlin Type Procedure
			17.8.3.1	 Patient Positioning
			17.8.3.2	 Portals and Diagnostic Arthroscopy
			17.8.3.3	 Step-by-Step Procedure
			17.8.3.4	 Postoperative Care
	References
18: Multidirectional Instability of the Shoulder
	18.1	 Epidemiology
	18.2	 Pathophysiology
	18.3	 Clinical Diagnosis
		18.3.1	 History
		18.3.2	 Clinical Examination
	18.4	 Imaging
	18.5	 Treatment
		18.5.1	 Decision-Making Algorithm
		18.5.2	 Clinical Case/Example
	18.6	 Surgical Technique
		18.6.1	 Exam Under Anesthesia
		18.6.2	 Patient Positioning
		18.6.3	 Portals
		18.6.4	 Diagnostic Arthroscopy
		18.6.5	 Step-by-Step Procedure (Box 18.1)
	18.7	 Postoperative Care
	18.8	 Literature Review
	18.9	 Summary
	References
19: SLAP Lesions
	19.1	 Introduction
	19.2	 Epidemiology
	19.3	 Pathophysiology
	19.4	 Clinical Diagnosis
		19.4.1	 History
		19.4.2	 Clinical Examination
			19.4.2.1	 O’Brien Test (Active Compression Test)
			19.4.2.2	 Speed Test
			19.4.2.3	 Kibler Test (Anterior Slide Test)
			19.4.2.4	 Crank Test
			19.4.2.5	 Kim Test (Biceps Load Test)
			19.4.2.6	 O’Driscoll Test (Dynamic Labral Shear Test)
			19.4.2.7	 Labral Tension Test
	19.5	 Imaging
	19.6	 Treatment
		19.6.1	 Decision-Making Algorithm
		19.6.2	 Clinical Case/Example
	19.7	 Surgical Technique
		19.7.1	 Patient Positioning
		19.7.2	 Portals
		19.7.3	 Diagnostic Arthroscopy
		19.7.4	 Step-by-Step Procedure (Box 19.1)
	19.8	 Postoperative Care
	19.9	 Literature Review
	19.10	 Summary
	References
20: Arthroscopic Treatment of HAGL and Reverse HAGL Lesions
	20.1	 Introduction
	20.2	 Epidemiology
	20.3	 Pathophysiology
	20.4	 Clinical Diagnosis
		20.4.1	 History
		20.4.2	 Clinical Examination
	20.5	 Imaging
	20.6	 Treatment
		20.6.1	 Decision-Making Algorithm
		20.6.2	 Clinical Case/Example
	20.7	 Surgical Technique
		20.7.1	 Patient Positioning
		20.7.2	 Diagnostic Arthroscopy
		20.7.3	 Step-by-Step Procedure: HAGL Repair (Box 20.1)
		20.7.4	 Posterior HAGL Repair
	20.8	 Postoperative Care
	20.9	 Literature Review
	20.10	 Summary
	References
21: Arthroscopic Treatment of Bony Bankart Lesions
	21.1	 Epidemiology
	21.2	 Pathophysiology
	21.3	 Clinical Diagnosis
		21.3.1	 History
		21.3.2	 Clinical Examination
	21.4	 Imaging
	21.5	 Treatment
		21.5.1	 Clinical Case/Example
	21.6	 Surgical Technique
		21.6.1	 Patient Positioning
		21.6.2	 Portals
		21.6.3	 Step-by-Step Procedure (Box 21.1)
			21.6.3.1	 Mobilization of the Labroligamentous Complex
			21.6.3.2	 Repair of Inferior Labrum Adjacent to the Osseous Fragment
			21.6.3.3	 Osseous Fragment and Superior Labrum Repair
			21.6.3.4	 Management of the Associated Pathology
			21.6.3.5	 Repair Augmentation
	21.7	 Postoperative Care
	21.8	 Summary
	References
22: Arthroscopic Treatment of Hill-Sachs Lesions
	22.1	 Epidemiology
	22.2	 Pathophysiology
	22.3	 Imaging
	22.4	 Treatment
		22.4.1	 Decision-Making Algorithm
	22.5	 Surgical Technique
		22.5.1	 Patient Positioning
		22.5.2	 Portals
		22.5.3	 Step-by-Step Procedure
	22.6	 Postoperative Care
	22.7	 Literature Review
	22.8	 Summary
	References
23: Arthroscopic Treatment of Glenoid Bone Loss: Bone Block Grafting
	23.1	 Introduction
	23.2	 Clinical Diagnosis
		23.2.1	 History
		23.2.2	 Clinical Examination
	23.3	 Imaging
	23.4	 Treatment
		23.4.1	 Decision-Making Algorithm
	23.5	 Surgical Technique
		23.5.1	 Bone Graft Harvesting (if Iliac Crest Autograft Is Preferred)
		23.5.2	 Patient Positioning
		23.5.3	 Portals
		23.5.4	 Step-by-Step Procedure
	23.6	 Postoperative Care
	23.7	 Summary
	References
24: Arthroscopic Treatment of Glenoid Bone Loss: Distal Clavicle Grafting
	24.1	 Epidemiology
	24.2	 Pathophysiology
	24.3	 Clinical Diagnosis
	24.4	 Imaging
	24.5	 Glenoid Bone Reconstruction Procedures
		24.5.1	 Coracoid Bone Autograft
		24.5.2	 Iliac Crest Bone Autograft (ICBG)
		24.5.3	 Distal Tibia Allograft (DTA)
		24.5.4	 Distal Clavicle Osteochondral Autograft (DCA)
	24.6	 Indications and Contraindications
	24.7	 Decision-Making Algorithm
	24.8	 Surgical Technique
		24.8.1	 Patient Positioning
		24.8.2	 Portals
		24.8.3	 Diagnostic Arthroscopy
		24.8.4	 Step-by-Step Procedure
			24.8.4.1	 Graft Harvesting
			24.8.4.2	 Graft Preparation
			24.8.4.3	 Author’s Preferred Method: Suture Button Fixation
				Graft Preparation
				Graft Delivery and Fixation
				Labral Restoration
			24.8.4.4	 Tips and Tricks
	24.9	 Postoperative Care
	24.10	 Literature Review
	24.11	 Summary
	References
25: Arthroscopic Latarjet Procedure
	25.1	 Introduction
	25.2	 Indications and Contraindications
	25.3	 Surgical Technique
		25.3.1	 Patient Positioning
		25.3.2	 Portals
		25.3.3	 Diagnostic Arthroscopy
		25.3.4	 Step-by-Step Procedure
		25.3.5	 Tips and Tricks
	25.4	 Postoperative Care
	25.5	 Literature Review
	25.6	 Summary
	References
26: Advanced Soft Tissue Procedures for Glenohumeral Instability: The BLS Technique
	26.1	 Introduction
	26.2	 Surgical Rationale
	26.3	 Indications and Contraindications
	26.4	 Surgical Technique
	26.5	 Postoperative Care
	26.6	 Literature Review
	26.7	 Summary
	References
27: Advanced Soft Tissue Procedures for Glenohumeral Instability: The ASA Technique
	27.1	 Introduction
	27.2	 Surgical Rationale
	27.3	 Indications and Contraindications
	27.4	 Surgical Technique
	27.5	 Postoperative Care
	27.6	 Literature Review
	27.7	 Summary
	References
28: Advanced Soft Tissue Procedures for Glenohumeral Instability: Labral Augmentation
	28.1	 Introduction
	28.2	 Surgical Rationale
	28.3	 Indications and Contraindications
	28.4	 Surgical Technique
		28.4.1	 Patient Positioning
		28.4.2	 Portals
		28.4.3	 Diagnostic Arthroscopy
		28.4.4	 Step-by-Step Procedure
			28.4.4.1	 Graft Preparation
			28.4.4.2	 Graft Passage and Fixation
		28.4.5	 Tip & Tricks
	28.5	 Postoperative Care
	28.6	 Literature Review
	References
29: Failed Glenohumeral Instability Surgery
	29.1	 Introduction
	29.2	 Pathophysiology
		29.2.1	 Recurrent Trauma
		29.2.2	 Specific Patient Circumstances
		29.2.3	 Bony Defects
		29.2.4	 Capsular Defects
		29.2.5	 Technical Errors
	29.3	 Clinical Diagnosis
		29.3.1	 History
		29.3.2	 Clinical Examination
	29.4	 Imaging
	29.5	 Treatment
		29.5.1	 Conservative Treatment
		29.5.2	 Management of Associated Lesions
		29.5.3	 Revision Surgery
			29.5.3.1	 Failed Arthroscopic Bankart Repair
			29.5.3.2	 Failed Latarjet/Bone Block
	29.6	 Summary
	References
30: Neuropathies and Nerve Entrapments Around the Scapula and the Shoulder
	30.1	 Introduction
	30.2	 Suprascapular Nerve Entrapment
		30.2.1	 Anatomy
		30.2.2	 Etiology and Pathomechanics
		30.2.3	 Clinical Diagnosis
		30.2.4	 Instrumental Diagnosis
		30.2.5	 Differential Diagnosis
		30.2.6	 Treatment
	30.3	 Spinal Accessory Nerve Entrapment
		30.3.1	 Anatomy
		30.3.2	 Etiology and Pathomechanics
		30.3.3	 Clinical Diagnosis
		30.3.4	 Instrumental Diagnosis
		30.3.5	 Differential Diagnosis
		30.3.6	 Treatment
	30.4	 Long Thoracic Nerve Entrapment
		30.4.1	 Anatomy
		30.4.2	 Etiology and Pathomechanics
		30.4.3	 Clinical Diagnosis
		30.4.4	 Instrumental Diagnosis
		30.4.5	 Treatment
	30.5	 Axillary Nerve Entrapment
		30.5.1	 Anatomy
		30.5.2	 Etiology and Pathomechanics
		30.5.3	 Clinical Diagnosis
		30.5.4	 Instrumental Diagnosis
		30.5.5	 Differential Diagnosis
		30.5.6	 Treatment
	30.6	 Dorsal Scapular Nerve Entrapment
		30.6.1	 Anatomy
		30.6.2	 Etiology and Pathomechanics
		30.6.3	 Clinical Diagnosis
		30.6.4	 Instrumental Diagnosis
		30.6.5	 Differential Diagnosis
		30.6.6	 Treatment
	References
31: The Overhead Athlete
	31.1	 Introduction
	31.2	 Anatomic Factors in DTS
		31.2.1	 Labral Injuries
		31.2.2	 Biceps Injuries
		31.2.3	 Rotator Cuff Injuries
	31.3	 Physiological Factors in DTS
		31.3.1	 Muscle Strength Imbalance
		31.3.2	 Muscle Inflexibility
		31.3.3	 Alterations in GH Internal Rotation (GIR), External Rotation (GER), and Total Range of Motion (TROM)
	31.4	 Biomechanical Factors in DTS
		31.4.1	 Kinetic Chain Deficits
		31.4.2	 Scapular Dyskinesis
		31.4.3	 Altered Mechanics of the Throwing or Serving Motion
	31.5	 Clinical Diagnosis
	31.6	 Imaging
	31.7	 Treatment
		31.7.1	 The Concept of Adaptive Pathology
		31.7.2	 Nonoperative Treatment
		31.7.3	 Surgical Treatment for the DTS Patient
	31.8	 Surgical Technique
		31.8.1	 Labral Lesions
		31.8.2	 Rotator Cuff Tears
		31.8.3	 Biceps Injuries
		31.8.4	 The “Failed” Surgery in DTS Patients
	31.9	 Postoperative Care
		31.9.1	 Acute Phase
		31.9.2	 Recovery Phase
		31.9.3	 Functional Phase
		31.9.4	 Return to Play
	31.10	 Summary
	References
32: Scapulothoracic Arthroscopy
	32.1	 Introduction
	32.2	 Epidemiology
	32.3	 Anatomy
	32.4	 Pathophysiology
	32.5	 Clinical Diagnosis
		32.5.1	 History
		32.5.2	 Clinical Examination
	32.6	 Imaging
	32.7	 Treatment
		32.7.1	 Clinical Case/Example
	32.8	 Surgical Technique
		32.8.1	 Patient Positioning
		32.8.2	 Portals
		32.8.3	 Step-By-Step Procedure
	32.9	 Postoperative Care
	32.10	 Literature Review
	32.11	 Summary
	References
33: Rotator Cuff Tears: Diagnosis and Classification
	33.1	 Introduction
	33.2	 Clinical Diagnosis
	33.3	 Imaging
	33.4	 Classification of Rotator Cuff Tears
		33.4.1	 Pattern
		33.4.2	 Extension
		33.4.3	 Atrophy and Fatty Infiltration
		33.4.4	 Retraction
		33.4.5	 Location
	33.5	 Summary
	References
34: Impingement Syndromes
	34.1	 Introduction
	34.2	 Pathophysiology
		34.2.1	 Subacromial Impingement
		34.2.2	 Posterosuperior Impingement
		34.2.3	 Anterior Impingement
			34.2.3.1	 Subcoracoid Impingement
			34.2.3.2	 Anterosuperior Impingement
			34.2.3.3	 Chondral Print
			34.2.3.4	 FUSSI Lesion
	34.3	 Clinical Diagnosis
	34.4	 Imaging
		34.4.1	 Radiography
		34.4.2	 Magnetic Resonance Imaging
		34.4.3	 Ultrasonography
	34.5	 Treatment
		34.5.1	 Decision-Making Algorithm
		34.5.2	 Clinical Case/Example
	34.6	 Surgical Technique
		34.6.1	 Patient Positioning
		34.6.2	 Portals
		34.6.3	 Diagnostic Arthroscopy (Video 34.1)
		34.6.4	 Step-by-Step Procedure
		34.6.5	 Tips & Tricks
	34.7	 Postoperative Care
	34.8	 Literature Review
	34.9	 Summary
	References
35: Partial-Thickness Rotator Cuff Tears
	35.1	 Introduction
	35.2	 Epidemiology
	35.3	 Pathophysiology
	35.4	 Clinical Diagnosis
		35.4.1	 History
		35.4.2	 Clinical Examination
	35.5	 Imaging
	35.6	 Treatment
		35.6.1	 Decision-Making Algorithm
		35.6.2	 Clinical Case/Example
	35.7	 Surgical Technique
		35.7.1	 Patient Positioning and Setup
		35.7.2	 Portals
		35.7.3	 Diagnostic Arthroscopy
		35.7.4	 Step-by-Step Procedure (Box 35.1)
			35.7.4.1	 Transtendinous Repair
			35.7.4.2	 Completion of the Tear
	35.8	 Postoperative Care
	35.9	 Literature Review
	35.10	 Summary
	References
36: Full-Thickness Rotator Cuff Tears
	36.1	 Epidemiology
	36.2	 Relevant Anatomy, Pathoanatomy, and the Importance of Footprint Restoration
	36.3	 Clinical Diagnosis
		36.3.1	 History
		36.3.2	 Clinical Examination
	36.4	 Imaging
	36.5	 Treatment
		36.5.1	 Decision-Making Algorithm
		36.5.2	 Clinical Case/Example
	36.6	 Surgical Technique
		36.6.1	 Authors’ Preference for Linked, Double-Row Repair Constructs
			36.6.1.1	 Patient Positioning
			36.6.1.2	 Portals
			36.6.1.3	 Step-by-Step Procedure (Box 36.1)
			36.6.1.4	 Diagnostic Arthroscopy
			36.6.1.5	 Subacromial Bursectomy/Decompression
			36.6.1.6	 Tear Pattern Recognition and Tissue Quality/Mobility Assessment
			36.6.1.7	 Advanced Mobilization Techniques (If Required)
			36.6.1.8	 Greater Tuberosity Bone Bed Preparation
			36.6.1.9	 Medial-Row Anchor Insertion
			36.6.1.10	 Suture Passage
			36.6.1.11	 Lateral-Row Fixation
	36.7	 Post-Operative Care
	36.8	 Literature Review
	36.9	 Summary
	References
37: Large to Massive Rotator Cuff Tears
	37.1	 Introduction
	37.2	 Epidemiology
	37.3	 Pathophysiology
		37.3.1	 Tear Classification
	37.4	 Clinical Diagnosis
		37.4.1	 History
		37.4.2	 Clinical Examination
	37.5	 Imaging
	37.6	 Treatment
		37.6.1	 Decision-Making Algorithm
		37.6.2	 Clinical Case/Example
	37.7	 Surgical Technique
		37.7.1	 Patient Positioning
		37.7.2	 Portals
		37.7.3	 Step-by-Step Procedure
	37.8	 Postoperative Care
	37.9	 Recent Developments
	37.10	 Summary
	References
38: Rotator Interval and Biceps Tendon Disorders
	38.1	 Epidemiology
	38.2	 Anatomy and Pathophysiology
	38.3	 Clinical Diagnosis
		38.3.1	 History
		38.3.2	 Clinical Examination
	38.4	 Imaging
	38.5	 Treatment
		38.5.1	 Decision-Making Algorithm
		38.5.2	 Clinical Case/Example
	38.6	 Surgical Technique
	38.7	 Postoperative Care
	38.8	 Literature Review
	38.9	 Summary
	References
39: Subscapularis Tendon Tears
	39.1	 Epidemiology
	39.2	 Pathophysiology
		39.2.1	 Classification (Fig. 39.5)
			39.2.1.1	 Type IIA Relatively Young (Sometimes Acute)
			39.2.1.2	 Type IIB Typical Tear
			39.2.1.3	 Type III Acute-on-Chronic Tear or Chronic Tear
			39.2.1.4	 Type IV Chronic Tear (Sometimes Acute-on-Chronic)
	39.3	 Clinical Diagnosis
		39.3.1	 History
		39.3.2	 Clinical Examination
	39.4	 Imaging
	39.5	 Treatment
		39.5.1	 Indications
		39.5.2	 Contraindications
		39.5.3	 Clinical Case/Example
	39.6	 Surgical Technique
		39.6.1	 Patient Positioning
		39.6.2	 Portals
		39.6.3	 Diagnostic Arthroscopy
		39.6.4	 Step-by-Step Procedure
			39.6.4.1	 Less Than 1/Fourth Tear
			39.6.4.2	 1/4 ~ 1/3 Tear
			39.6.4.3	 Greater Than 1/3 Full-Thickness Tear
			39.6.4.4	 Large Tears (1/2 ~ 2/3 Tear, Type IV)
		39.6.5	 Tips and Tricks
	39.7	 Postoperative Care
	39.8	 Literature Review
	39.9	 Summary
	References
40: Augmentation in Rotator Cuff Repair: Improving Biology
	40.1	 Introduction
	40.2	 Platelet-Rich Plasma (PRP)
	40.3	 Microfracture
	40.4	 Mesenchymal Stem Cells
	40.5	 Amniotic Membrane (AM) and Umbilical Cord (UC)
	40.6	 Improving Atrophy
	40.7	 Cost-Effectiveness of Rotator Cuff Augmentation
	References
41: Augmentation in Rotator Cuff Repair: Improving Biomechanics
	41.1	 Introduction
	41.2	 The Biomechanical Advantages of Rotator Cuff Augmentation
	41.3	 Rotator Cuff Repair with Tendon Augmentation/Interposition
	41.4	 Summary
	References
42: Patch Graft Augmentation in Rotator Cuff Repair
	42.1	 Epidemiology
	42.2	 Pathophysiology
	42.3	 Clinical Diagnosis
		42.3.1	 History
		42.3.2	 Clinical Examination
	42.4	 Imaging
	42.5	 Indications and Contraindications
	42.6	 Surgical Technique
		42.6.1	 Patient Positioning
		42.6.2	 Portals
		42.6.3	 Diagnostic Arthroscopy
		42.6.4	 Step-by-Step Procedure
	42.7	 Postoperative Care
	42.8	 Literature Review
	42.9	 Summary
	References
43: Arthroscopic Suprascapular Nerve Release
	43.1	 Epidemiology
	43.2	 Pathophysiology
	43.3	 Clinical Diagnosis
		43.3.1	 History
		43.3.2	 Clinical Examination
	43.4	 Instrumental Diagnosis
	43.5	 Indications and Contraindications
		43.5.1	 Decision-Making Algorithm
	43.6	 Surgical Technique
		43.6.1	 Patient Positioning
		43.6.2	 Equipment
		43.6.3	 Portals
		43.6.4	 Diagnostic Arthroscopy
		43.6.5	 Step-by-Step Procedure (Box 43.1)
			43.6.5.1	 Decompression at the Spinoglenoid Notch
	43.7	 Postoperative Care
	43.8	 Literature Review
	43.9	 Summary
	References
44: Treatment Options for Irreparable Rotator Cuff Tears: Arthroscopic Tendon Transfers
	44.1	 Introduction
	44.2	 Epidemiology
	44.3	 Pathophysiology/Clinical Diagnosis
	44.4	 Imaging
	44.5	 Indications and Contraindications
		44.5.1	 Indications to Isolated Tendon Transfers
		44.5.2	 Contraindications to Isolated Tendon Transfers
		44.5.3	 Indications to Tendon Transfers Combined with a Reverse Shoulder Arthroplasty
		44.5.4	 Decision-Making Algorithm
			44.5.4.1	 Unidirectional Deficit
			44.5.4.2	 Bi-/Multidirectional Deficit
		44.5.5	 Clinical Case/Example (Fig. 44.3)
	44.6	 Surgical Technique
		44.6.1	 Patient Positioning
		44.6.2	 Portals
		44.6.3	 Diagnostic Arthroscopy
		44.6.4	 Step-by-Step Procedure
		44.6.5	 Tips and Tricks
	44.7	 Postoperative Care
	44.8	 Literature Review
	44.9	 Summary
	References
45: Treatment Options for Irreparable Rotator Cuff Tears: Superior Capsule Reconstruction
	45.1	 Introduction
	45.2	 Surgical Rationale
	45.3	 Indications and Contraindications
		45.3.1	 Clinical Case/Example
	45.4	 Surgical Technique
		45.4.1	 Patient Positioning
		45.4.2	 Portals
		45.4.3	 Diagnostic Arthroscopy
		45.4.4	 Step-by-Step Procedure
		45.4.5	 Tips and Tricks
			45.4.5.1	 Subscapularis Tendon Tear Repair
			45.4.5.2	 Thickness of the Graft
			45.4.5.3	 Medial-to-Lateral Length of the Graft
			45.4.5.4	 Shuttling of the Graft
			45.4.5.5	 Graft Fixation Site on the Superior Glenoid Rim
			45.4.5.6	 Configuration of Graft Fixation on the Humerus
			45.4.5.7	 Donor Site
	45.5	 Postoperative Care
	45.6	 Literature Review
	45.7	 Summary
	References
46: Treatment Options for Irreparable Rotator Cuff Tears: Biceps Autograft Augmentation
	46.1	 Introduction
	46.2	 Clinical Diagnosis
	46.3	 Imaging
	46.4	 Surgical Rationale
	46.5	 Indications and Contraindications
	46.6	 Surgical Technique
		46.6.1	 Patient Positioning
		46.6.2	 Portals
		46.6.3	 Diagnostic Arthroscopy
		46.6.4	 Step-by-Step Procedure
			46.6.4.1	 Subacromial Decompression
			46.6.4.2	 Proximal Biceps Tenodesis
			46.6.4.3	 Partial Rotator Cuff Repair
		46.6.5	 Tips and Tricks
	46.7	 Postoperative Care
	46.8	 Literature Review
	46.9	 Summary
	References
47: Treatment Options for Irreparable Rotator Cuff Tears: Subacromial Spacer
	47.1	 Introduction
	47.2	 Surgical Rationale
	47.3	 Indications and Contraindications
		47.3.1	 Clinical Case/Example
	47.4	 Surgical Technique
		47.4.1	 Implant Characteristics
		47.4.2	 Step-by-Step Procedure
	47.5	 Literature Review
	47.6	 Summary
	References
48: Treatment Options for Irreparable Rotator Cuff Tears: Reverse Total Shoulder Arthroplasty
	48.1	 Introduction
	48.2	 Pathophysiology
	48.3	 Clinical Diagnosis
	48.4	 Imaging
	48.5	 Indications
	48.6	 Surgical Technique
		48.6.1	 Surgical Approach
		48.6.2	 Implant Choice
			48.6.2.1	 Implant-Related Complications
				Inferior Notching
				Stress Fractures
				Polyethylene Wear
			48.6.2.2	 Implant Lateralization
			48.6.2.3	 Onlay/Inlay Design
			48.6.2.4	 Convertibility
			48.6.2.5	 Stemless Implants
	48.7	 Postoperative Care
	48.8	 Literature Review
	48.9	 Summary
	References
49: Failed Rotator Cuff Surgery
	49.1	 Introduction
	49.2	 Epidemiology
	49.3	 Pathophysiology
	49.4	 Clinical Diagnosis
		49.4.1	 History
		49.4.2	 Clinical Examination
	49.5	 Imaging
	49.6	 Treatment
	49.7	 Surgical Technique
		49.7.1	 Patient Positioning
		49.7.2	 Portals
		49.7.3	 Diagnostic Arthroscopy
		49.7.4	 Step-by-Step Procedure
			49.7.4.1	 Soft Tissue Mobilization
			49.7.4.2	 Bone Preparation
			49.7.4.3	 Tissue Repair
			49.7.4.4	 Augmentation
	49.8	 Postoperative Care
	49.9	 Summary
	References
50: Acromioclavicular Joint Instability: Diagnosis and Classification
	50.1	 Epidemiology
	50.2	 Pathophysiology
	50.3	 Clinical Diagnosis
	50.4	 Imaging and Classification
	50.5	 Summary
	References
51: Treatment of Acute Acromioclavicular Joint Dislocations
	51.1	 Indications and Contraindications
	51.2	 Decision-Making Algorithm
	51.3	 Surgical Technique
		51.3.1	 Patient Positioning
		51.3.2	 Portals
		51.3.3	 Diagnostic Arthroscopy
		51.3.4	 Step-by-Step Procedure (Box 51.1)
			51.3.4.1	 Coracoid Exposure
			51.3.4.2	 Superior Approach to the Distal Clavicle
			51.3.4.3	 Tunnel Placement
			51.3.4.4	 Button Placement
			51.3.4.5	 Arthroscopic AC Cerclage
	51.4	 Postoperative Care
	51.5	 Literature Review
	51.6	 Summary
	References
52: Treatment of Chronic Acromioclavicular Joint Dislocation
	52.1	 Epidemiology
	52.2	 Clinical diagnosis
	52.3	 Imaging
		52.3.1	 Conventional Radiology
		52.3.2	 Magnetic Resonance Imaging and Computed Tomography
	52.4	 Treatment
		52.4.1	 Indications
		52.4.2	 Contraindications
		52.4.3	 Surgery-Related Risks
		52.4.4	 Decision-Making Algorithm
		52.4.5	 Clinical Case/Example
	52.5	 Surgical Technique
		52.5.1	 Patient Positioning
		52.5.2	 Diagnostic Arthroscopy
		52.5.3	 Step-by-Step Procedure
		52.5.4	 Tips and Tricks
	52.6	 Postoperative Care
	52.7	 Literature Review
	52.8	 Summary
	References
53: Acromioclavicular Joint Osteoarthritis
	53.1	 Epidemiology
	53.2	 Pathophysiology
	53.3	 Clinical Diagnosis
		53.3.1	 History
		53.3.2	 Clinical Examination
	53.4	 Imaging
	53.5	 Treatment
		53.5.1	 Decision-Making Algorithm
		53.5.2	 Clinical Case/Example
	53.6	 Surgical Technique
		53.6.1	 Portals
		53.6.2	 Step-by-Step Procedure
	53.7	 Postoperative Care
	53.8	 Literature Review
	53.9	 Summary
	References
54: Osteolysis of the Distal End of the Clavicle
	54.1	 Introduction
	54.2	 Epidemiology
	54.3	 Pathophysiology
	54.4	 Clinical Diagnosis
		54.4.1	 History
		54.4.2	 Differential Diagnosis
		54.4.3	 Clinical Examination
	54.5	 Imaging
		54.5.1	 Conventional Radiology
		54.5.2	 Bone Scan
		54.5.3	 Ultrasound
		54.5.4	 Computed Tomography
		54.5.5	 Magnetic Resonance Imaging
	54.6	 Treatment
		54.6.1	 Nonoperative Treatment
		54.6.2	 Operative Treatment
		54.6.3	 Decision-Making Algorithm
		54.6.4	 Clinical Case/Example
	54.7	 Surgical Technique
		54.7.1	 Patient Positioning
		54.7.2	 Portals
		54.7.3	 Step-by-Step Procedure
		54.7.4	 Tips & Tricks
	54.8	 Postoperative Care
	54.9	 Literature Review
	54.10	 Summary
	References
55: Calcific Tendonitis
	55.1	 Introduction
	55.2	 Epidemiology
	55.3	 Pathophysiology
	55.4	 Clinical Diagnosis
		55.4.1	 History
		55.4.2	 Clinical Examination
	55.5	 Imaging
	55.6	 Treatment
		55.6.1	 Decision-Making Algorithm
		55.6.2	 Clinical Case/Example
	55.7	 Surgical Technique
	55.8	 Postoperative Care
	55.9	 Literature Review
	55.10	 Summary
	References
56: Adhesive Capsulitis
	56.1	 Epidemiology
	56.2	 Pathophysiology
		56.2.1	 Comorbidities
		56.2.2	 Natural History
			56.2.2.1	 Pre-Adhesive Stage
			56.2.2.2	 Acute Adhesive or “Freezing” Stage
			56.2.2.3	 Fibrotic or “Frozen” Stage
			56.2.2.4	 “Thawing” Phase
	56.3	 Clinical Diagnosis
		56.3.1	 History
		56.3.2	 Clinical Examination
	56.4	 Imaging
	56.5	 Treatment
		56.5.1	 Nonoperative Treatment
			56.5.1.1	 Oral Medications
			56.5.1.2	 Intra-Articular Injections
			56.5.1.3	 Physical Therapy
		56.5.2	 Invasive Procedures and Operative Treatment
			56.5.2.1	 Suprascapular Nerve Block
			56.5.2.2	 Manipulation under Anesthesia
			56.5.2.3	 Arthroscopic Release
			56.5.2.4	 Open Release
		56.5.3	 Decision-Making Algorithm
		56.5.4	 Clinical Case/Example
	56.6	 Surgical Technique
		56.6.1	 Patient Positioning
		56.6.2	 Diagnostic Arthroscopy
		56.6.3	 Step-by-Step Procedure
		56.6.4	 Tips & Tricks
	56.7	 Postoperative Care
	56.8	 Literature Review
	56.9	 Summary
	References
57: Early Glenohumeral Osteoarthritis
	57.1	 Epidemiology
	57.2	 Diagnosis
	57.3	 Arthroscopic Treatment
		57.3.1	 Diagnostic Arthroscopy
		57.3.2	 Debridement with Capsular Release and Osteophytectomy
		57.3.3	 Microfracture
		57.3.4	 Biologic Resurfacing
		57.3.5	 Biologic Total Shoulder Resurfacing
		57.3.6	 Partial Resurfacing of the Humeral Head
	57.4	 Summary
	References
58: Arthroscopic Management of Glenohumeral Arthritis
	58.1	 Epidemiology
	58.2	 Pathophysiology
	58.3	 Clinical Diagnosis
		58.3.1	 History
		58.3.2	 Clinical Examination
	58.4	 Imaging
	58.5	 Treatment
	58.6	 Surgical Technique
		58.6.1	 Patient Positioning and Examination under Anesthesia
		58.6.2	 Diagnostic Arthroscopy
		58.6.3	 Step-by-Step Procedure
	58.7	 Postoperative Care
	58.8	 Literature Review
	58.9	 Summary
	References
59: Arthroscopic Management of Tuberosity Fractures
	59.1	 Introduction
	59.2	 Imaging
	59.3	 Classification
	59.4	 Treatment
	59.5	 Surgical Technique
		59.5.1	 Set-up and Equipment
		59.5.2	 Step-by-Step Procedure
		59.5.3	 Complications & Pitfalls
	59.6	 Literature Review
	59.7	 Summary
	References
60: Arthroscopic Management of Glenoid Fractures
	60.1	 Introduction
	60.2	 Pathophysiology
	60.3	 Classification
	60.4	 Diagnosis
	60.5	 Surgical Technique
	60.6	 Postoperative Care
	60.7	 Summary
	References
61: Outcome Measurement Tools for Functional Assessment of the Shoulder
	61.1	 Introduction
	61.2	 Categories of Shoulder Outcome Measures
	61.3	 Measurement Properties of Outcome Measures
	61.4	 Computerized Adaptive Testing
	61.5	 General Health Outcome Measurement Tools
		61.5.1	 Medical Outcomes Study 36-Item Short Form (SF-36)
		61.5.2	 Patient-Reported Outcomes Measurement Information System (PROMIS)
	61.6	 Limb-Specific Outcome Measurement Tools
		61.6.1	 Disabilities of the Arm, Shoulder, and Hand (DASH) Score
	61.7	 Joint-Specific Outcome Measurement Tools
		61.7.1	 UCLA Shoulder Score
		61.7.2	 Constant Score
		61.7.3	 American Shoulder and Elbow Surgeons (ASES) Outcome Score
		61.7.4	 Shoulder Pain and Disability Index (SPADI)
		61.7.5	 Simple Shoulder Test (SST)
		61.7.6	 Single Assessment Numeric Evaluation (SANE)
		61.7.7	 Shoulder Activity Level
	61.8	 Condition-Specific Outcome Measurement Tools
		61.8.1	 Western Ontario Shoulder Outcome Instruments
		61.8.2	 Rotator Cuff Quality-of-Life (RCQOL)
	61.9	 Summary
	References
62: Patient Education and Patient Expectation in Shoulder Surgery
	62.1	 Introduction
	62.2	 Measures
	62.3	 Survey of Expectations and Concerns
	62.4	 Patient Education
		62.4.1	 Doctor and Patient Dialog
		62.4.2	 Posters and Models
		62.4.3	 Information Letter
		62.4.4	 App
		62.4.5	 Web Based
		62.4.6	 Standardized Information or Need-Based
		62.4.7	 Decision Aids
	62.5	 Patient Expectations
		62.5.1	 Subacromial Pain Syndrome
		62.5.2	 Rotator Cuff Repair
	62.6	 Factors Influencing Patient Satisfaction
	62.7	 Summary
	References
63: Animal Models in Shoulder Research
	63.1	 Introduction
	63.2	 Rat Model
		63.2.1	 Mechanobiology
		63.2.2	 Biological Studies
		63.2.3	 Scaffolds
		63.2.4	 Chronic Model
		63.2.5	 Adhesive Capsulitis
	63.3	 Mouse Model
	63.4	 Large Animal Models
		63.4.1	 Canine Model
		63.4.2	 Sheep Model
		63.4.3	 Rabbit Model
		63.4.4	 Primate Model
	63.5	 Summary
	References