Recently, the reimbursement or payment model in healthcare has begun to shift from a fee-for-service to a value-based system. While some physicians are concerned about this shift, I think it is a welcome change that will ultimately improve patient care. Surgeon volume is one area that received much attention as a means of improving value and thus patient care.
Historically, shoulder dislocations were treated non-operatively in nearly all cases. It was felt that surgery was “the last resort.” However, we now understand the each dislocation has negative consequences that may lower the ultimate outcome. The most challenging cases of shoulder instability are patients who have multiple dislocations.
Atrophy is an important consideration in rotator cuff tears. Atrophy is when a muscle shrinks in size well accepted that greater atrophy leads to a poorer chance of healing following rotator cuff repair. In general, the greater the atrophy, the lower the chance of obtaining healing.
Shoulder dislocation can be a devastating event for athletes and active individuals. When these injuries occur during sports the first question for the athlete is often “When can I return?” The management of shoulder dislocations has evolved over the years. In past years, multiple dislocations were tolerated.
For many years open treatment was considered the procedure of choice for surgical stabilization of a patient with shoulder dislocation. With this approach, an incision is made in the front of the shoulder and then the labrum and capsule are repaired to the bone. The downside of this approach is that it is quite invasive (which raises the risk of infection) and it is difficult to address other pathology in the shoulder.
Superior capsule reconstruction (SCR) is a procedure that is used in the treatment of irreparable rotator cuff tears. The procedure was first described in 2013 by Dr. Teruhisa Mihata from Japan. Patch grafting has a long history of being used to "bridge gaps" in irreparable rotator cuff tears. Mihata’s innovation was attaching the graft to the glenoid or socket site of the joint as opposed to sewing the graft into soft tissue.
The most common fracture or broken bone in the shoulder is the proximal humerus, which is the upper arm bone or ball of the shoulder. The majority of proximal humerus fractures can be treated without an operation. However, in cases of substantial separation or displacement, surgical treatment may be beneficial.
Shoulder arthritis may not only be painful, but may more debilitating than you realize. If you are a golfer, you may have noticed how arthritis pain has affected your golf game. Shoulder replacement can alleviate the pain, but can it actually improve your game?
Like any surgery, post-operative pain control is a component of total shoulder arthroplasty (TSA). This has become increasingly important in with the move toward outpatient TSA.
With changes in health care physicians are increasingly being scrutinized for the care they administer including rotator cuff repair. More and more we are required to ask ourselves whether a procedure or medicine is cost-effective, that is does it produce a result medically and does it come at a reasonable cost.