Shoulder/Humerus- BAUK or BULK

In general orthopaedic practice, you get lots of shoulder problems, esp. working
in Industrial Areas, where workers have to do a lot of pulling/ pushing repetitive
work (esp. those over 45). In Australia, people are staying fit longer and pushing
their bodies harder and harder into their 60s, 70s and 80s.

Case 1: BULK= murder (don’t BAULK) for surgeon? how to arthroscope

120kg with painful shoulders.

A lot of our patients are working out in the gym meaning
We end up having to work out in the OR, trying to operate on them,
Dealing with the technical problems caused by their shear muscle size/BULK.
Huge shoulder girdle muscle mass means that the arthroscope has two point
fixation (one at the capsule, the second at the centre of mass of the muscle) as
Opposed to usual one (capsule and skin so close together as to be considered as
one).

Case 2: Rush pin= great technique

Fracture of humeral shaft, 68F, put in two or more Rush pins using MIS
incisions (here one over lateral epicondyle and the other over greater
tuberosity).It is easy to complicated this Fx. Hanging casts and moulded
(Sarmiento) braces Are uncomfortable and patients hate them, an incision over
the fracture might damage the radial nerve and locking nails turn it into a big;
procedure. Rush pins are simple and easy but alas the technique has nearly been
forgotten.
(Leslie V)Rush wrote a wonderful book (Fracture Problems) showing how to use
this technique for just about every Fx. It does work as I worked with a
consultant who did just that.

Fx mid shaft humerus. 52 yo,F. Hx of breast Ca in remission. Rush pins placed.

Histology shoed NOT a metastasis.
(almost)Healed at 4 mths. But definitely at 5 mths.Still radial n palsy. MRI
organized. ? Explore. NCS confirmed dense palsy. Tinels + at 7 cm distal to
elbow.

Case 3: OA shoulder, 60yo M, fit. ? replace

Case 4: Calcium in rotator cuff, what TO DO?

Large deposit on Ca in rotator cuff, painful,

It is like tooth-paste to get out, hard, leaving large defect in cuff. So? Leave

Case 5:

Non-union clavicle. MVA. Painful. 38 yo, M.

Bone grafted incl. OP1. United at 2 mths.
Non-union clavicle. NON painful. No change at 6 mths.
Leave. 41 yo, M.

Case 6:

OA glenoid. No trauma. 41 yo,M. Confirmed on CT.

Case 7:

Fx surg neck humerus from MBA, closed reduction, excellent position,

10 years later in a 38 yo,F.

Case 8
Hypertrophic AC jnt. Painful. 55 yo,M.

Case 9:

Fx mid-shaft humerus in a 40 yo, sailor. Fixed 2 Rush pins.

Case 10:

Fx mid shaft humerus. 50 yo,M, fall at party.

Two pins via great. Tub. Easy. 1 cm incision.

Case 11:
Labral detachment, debrided, at shoulder arth. 47yo,M.

Case 12.

Pain AC jnt, 60 yo,M. Exuberant OA.

Excision of AC jnt. Large ganglion over lying jnt. Excised.