Thursday, January 15, 2009

Surprise, Surprise

"The Effect of Coracoacromial Ligament Excision and
Acromioplasty on Superior and Anterosuperior Glenohumeral
Stability"- Journal of Arthroscopic Surgery, Jan. 09.
Sometimes having good health insurance is a dangerous thing. I've had orthopedists talk parents into bilateral versions of this on high school age athletes. Remove the coroacromial ligs like tonsils. It's intended to cure impingement syndromes. However, if these researchers are correct, the surgery actually increases anterosuperior translation of the humerus an average of 2.5mm!
Be patient with impingement syndromes. Conservative therapy works just fine, especially when you can get to it as fast as an ATC can. Activity modification, myofascial realease, joint mobes & plenty of modalities works.

7 comments:

wrw7772000 said...

Joe-

Don't believe this is the same article - discusses coracoacromial resection - here is the abstract of study done on 9 cadavers - all conditions tested did reveal some level of ant/sup humeral head translation. http://www.ncbi.nlm.nih.gov/pubmed/18971056?dopt=AbstractPlus

There is not much space to begin with and if that space is compromised even by .5 mm, that is a significant change to the structure and function of the shoulder.

Bill

Juan Ruiz-Tagle said...

Joe...
Do you believe that ultrasound, electric stimulation, and the other machines like it really work? or are they just fancy placebos?

Joe Przytula said...

Good critical thinking once again Juan. A great topic for a post.

Brian said...

Parameter, parameters, and parameters....The question with the past research investigating modalities use in subacromial impingement(I think there's a JAT review article on this!?) or any other pathology is maybe we haven't researched what are the various parameters that TENS, US, etc can be set to and what exactly is the physiological response....

JH said...

I'm gonna ask a silly question...Why does the surgery allow 2.5 cm anterosuperior translation?

ABPrints said...

Good question Juan, I belive those modalities do work. In the right contexts. We collectively overused them. As hands on therapy has become more relevant, we have tossed those therapies out. I don't use them as much as I did 5 years ago though.

wrw7772000 said...

ABPrints - I agree - as your hands on skills get better with practice - modalities are used less but I think with more purpose in mind. When I was younger, I did US and EMS probably w/o a lot of critical thought. Now being more experienced, I use them with a specific purpose in mind.
Some of those purposes are physiological sometimes psychological and physiological both.

That all being said - this type of surgery on a young athlete - does it set them up for increased problems when they are older - maybe they are going into construction or manufacturing which requires a lot of overhead movement - 2.5 mm ant/sup translation to that individual is going to be significant.

Good stuff.

Bill