Ever wondered how to explain the rotator cuff as a secondary stabilizer in the GH joint to either your athlete or their family? Dr. Simonich has the perfect analogy.
He tells his patients that it is like if I were to take a big exercise ball in my right arm and pull it into my chest. My chest would be the socket, the exercise ball my humeral head, my arm would be the rotator cuff and my hand the tendons of the cuff. That demonstration can help show how difficult it is for the rotator cuff to stabilize the joint.
What are the two types of shoulder dislocations, where do you see them and how should we treat them?
TUBS (Traumatic Unilateral Bankart Surgical) and AMBRI (atraumatic multidirectional bilateral rehab rarely inferior capsular shift) are the two types of dislocations.
You will see TUBS is most often in contact or collision sports like football or rugby. AMBRI is seen often in swimmers especially at the end of a long season.
Post a TUBS dislocation and relocation Dr. Simonich likes to use the apprehension test as an indicator of further treatment. He also uses athlete age (young athletes have a high rate of recurrence) individual goals, sport played and level of participation as indicators for surgery. Surgery reduces the high rate of recurrence in young athletes.
What are the types of AC joint separation and how do you treat them?
AC joint separations are relatively easy to see and cause biplanar instability. There are 5 types with Type I and II requiring conservative treatment, Type III going either way but trending non-operatively and Type IV V VI requiring reconstruction with a joint tie-down.
Clavicle fracture treatments have changed throughout the years due to research. What does the current research say?
Prior to 06’-07’ most clavicle fractures were treated non operatively. Research was introduced in two studies in those years that saw a better union rate with fixation in the clavicle post-fracture and surgeons began to surgically treat and fixate.
In 2017 a new study showed that while the rate of union is still higher in clavicle fractures with fixation, fixation doesn’t improve shoulder function nor does it decrease limitations in the shoulder. Dr. Simonich will put a plate to fixate the clavicle on an athlete with shortening, displacement, or comminution because they get faster healing rates, are more predictable and can get them back to their sports.
Watch the Athletic Shoulder 2019 presentation on Facebook
There is very little research to support its efficacy
It actually slows the healing down by creating congestion at the damage site. Similar to a lane closure on a freeway due to an accident. when the cars back up the Emergency crew can not get there quickly and the 30-minute commute now takes 90 minutes.
There is no Google or Waze app for the human body. It really tries to repair rather than destroy itself. Let it run its course.
We confuse swelling and inflammation
Swelling can occur when a part of the body becomes inflamed. However, it is caused by the accumulation of fluid in tissues throughout the body, or in a specific region of the body
Inflammation is classified as a protective response from the immune system to injury, infection, or irritation.
Discussion on the SMB not in the book…
Practical application of the principal
How to talk to your coaches about it
How to talk with your athletes about it
How to discuss changing your physician's protocol
Slight exception to the rules:
If you have a dislocation and need to transport, ice will reduce swelling which will allow for a better relocation.
If you are using it once as an emotional trigger to help calm down the athlete
What About MarcPro
Using my code (TheSMB) helps to ensure your best discount as well as support the SMB
A medical-grade device that can run for hours to relieve the congestion of waste in and around the damaged tissue.
Try out the loaner program and see if it is worth your while – Email Gary@MarcPro.com and mention the Sports Medicine Broadcast and the Loaner Program