2019.04.13 春季聯合學術研討會

• Relive Video conferencingPrimary massive cuff tear after dislocation
  林坤輝（台北慈濟醫院）
  49y/o male，heavy worker，1st shoulder dislocation，massive rotator cuff tear
• Post-cuff repair with retear
  1. 徐郭堯、邱致皓、張世昇、翁浚睿、陳昭宇、詹益聖（林口長庚）
  70 歲女性數年前開過 Right open cuff repair，縫補了 supraspinatus and Subscapularis，目前 active forward elevation 80，external rotation 0 度，subscapularis 功能還維持著，MRI 顯示 irrepairable posterosuperior cuff tear with Goultallier 3 fatty infiltration，teres minor 也有一些 fatty infiltration。
  2. 洪立維 釋高上 侯勝茂（新光醫院）
  65 y/o soccer goalkeeper. Right shoulder rotator cuff massive tear status post rotors or cuff repair.
  Weakness and instability noted with nocturnal pain. MRI showed massive rotator cuff re-tear.
• Post-cuff repair with suboptimal results
  1. 徐郭堯、邱致皓、張世昇、翁浚睿、陳昭宇、詹益聖（林口長庚）
  70 歲男性，兩個月前跌倒，主訴疼痛，active forward elevation 125，external rotation lag，passive forward elevation 140，external rotation 60 度，belly press test 4/5，horn blower sign negative，MRI顯示 posterosuperior cuff tear with Goultallier 2 fatty infiltration。第一次手術做了 balanced repair，術後病患 active forward elevation 到達 120 度，較不疼痛，active external roation 10 度，沒有 lag，但力量進步有限。
  2. 李建和（北醫）
  A 78 years old man with massive rotator cuff tear with pseudoparalysis left for 6 months, status post
  cuff repair with persistent pseudoparalysis for 2 months, what’s next step?
• Post-muscle transfer with poor results
  徐郭堯、邱致皓、張世昇、翁浚睿、陳昭宇、詹益聖（林口長庚）
  57 歲男性，之前做過 LD transfer，目前 active forward elevation 60 度，horn blower positive，Xray顯示 Hamada type 4 massive rotator cuff tear arthritis，MRI 顯示 subscapularis,supraspinatus，infraspinatus and teres minor 都 fatty infiltration
• Failed SLAP repair (視時間討論)
  徐郭堯、邱致皓、張世昇、翁浚睿、陳昭宇、詹益聖（林口長庚）
  44 y/o male, fell in 2017-12 with Left shoulder post-traumatic pain and difficult elevation, had Left SLAP repair with 1 metal anchor. Still felt painful and difficult elevation after 1st operation. Had revision SLAP in 2018-06. 3rd time arthroscopy because he still had no improvement. Tried prolotherapy with glucose as well. Arthro MRI revealed healed labrum. EMG and NCV was done to rule out axillary nerve injury. How to interpret the result of NCV result? What now?

Relive Video conferencing

• Dr. George Athwal
• Dr. Alexandre Lädermann
• Dr. Bassem T. Elhassan

• Shoulder dislocation (acute and chronic)－Part I、Moderator：林冠宇
  1. 曾渥然、王子康（新竹台大醫院）
  67 years old woman, a right hand dominant person, presented in our ED with first time left shoulder dislocation. Closed reduction was done in the OR. Post-op x-rays showed engaged Hill-Sachs and bony Bankart lesion. What are your treatment plans?
  2. 林冠宇（高雄榮總）
  82 y/o male, right shoulder chronic anteriorly dislocated with glenoid bone defect for 6 months
  3. 林冠宇（高雄榮總）
  63 y/o male, right shoulder chronic posterior locked dislocation for 4 months
• Deltoid insufficiency－Part II、Moderator：蔣恩榮
  1. 馬筱笠（台北榮總）
  A 64y/o female with Deltoid detachment consequent to open rotator cuff repai
  2. 周文毅、郭繼陽（高雄長庚醫院）
  64 y/o female, malunited right proximal humerus fracture with irrepairable, massive rotator cuff tear and severe deltoid atrophy due to fracture fixation anterolateral approach. Rt shoulder near complete disability. What is the next step?
  3. 洪立維、釋高上、侯勝茂（新光醫院）
  70 y/o woman, anterior deltoid detachment after previous open rotator cuff repair. The result after reverse total shoulder arthroplasty.
• Elbow injury－Part III、Moderator：沈培弘
  陳勇璋、張至宏（亞東醫院）
  A 61 year-old man had paraplegia because of TB spine, and he needed crutches for 6 years. He suffered from left elbow pain after a forceful push-up. He underwent LUCL and UCL repair and then the elbow was immobilized with a splint. The plain films showed elbow subluxation after splinting for 2 weeks. He underwent second surgery. In addition to reinforcing the repairment of LUCL and UCL ligaments, an external fixator was used. The external fixator was removed 6 weeks later, the plain
  films still showed elbow subluxation.
• Massive RCT with pseudoparalysis (if time allowed)
  1. 79 y/o female, right shoulder pain for years with ROM limitation; active abduction: 70 degrees, FF:45 degrees, external rotation with arm at the side: 15 degrees, internal rotation: L5 level
  2. 59 y/o male, right shoulder with ROM limitation: active abduction: 60 degrees, FF: 80 degrees, ext. rotation with arm at the side: 0 degree, internal rotation: S1 level
  3. 74 y/o female, right shoulder pain for months; active abduction: 70 degrees, FF: 50 degrees, ext.
  rotation with arm at the side: 0 degree, internal rotation: S1 level