Tag Archives: procedures

Reverse Total Shoulder Replacement

The videos on this page can be downloaded upon purchase of a license on Alila medical Media website. Click here!

Reverse Total Shoulder Replacement or Delta Shoulder Replacement is a modification of total shoulder replacement procedure. The conventional procedure has a metal ball on the humerus (replacing the natural humeral head) and a plastic component on the glenoid. The reverse procedure has the reverse positions of the prostheses : the metal ball is now fixed on the glenoid socket and the plastic cup is fixed in place of the humeral head (Fig. 1). This configuration is indicated for people with rotator cuff arthropathy.

Conventional and reverse total shoulder replacement

Fig. 1: Configuration of conventional versus reverse total shoulder replacement. Note the location of the metal head and plastic component in each case. Click on image to see a larger version on Alila Medical Media website where the image is also available for licensing.

Why a conventional total shoulder will not work with rotator cuff arthropathy?

Rotator cuff arthropathy or cuff tear arthropathy (CTA) is shoulder arthritis in a setting of rotator cuff tears. Rotator cuff muscles hold the ball and the socket together and prevent the humeral head from moving out of the socket when the deltoid muscle raises the arm. In people with torn rotator cuff, the head of the humerus moves upwards out of the socket resulting in shoulder instability. Conventional total shoulder preserving the natural configuration of the shoulder joint will encounter the same problem (Fig. 2, left panel).

Fig. 2: Conventional versus reverse total shoulder replacement with torn rotator cuff. The upward force displaces the humeral head in conventional configuration but stabilizes the joint in reverse configuration. Click on image to see a larger version on Alila Medical Media website where the image is also available for licensing.

Why a reverse total shoulder would work?

In reverse total shoulder procedure, the arthritic humeral head is replaced with a plastic cup and the metal ball is fixed onto the glenoid surface. With this configuration, the contraction of the deltoid will move the arm up and compress the socket to the ball at the same time (Fig. 2, right panel). The ball and the socket will fit more snugly together providing stability.

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Shoulder arthritis

The videos on this page can be downloaded upon purchase of a license on Alila Medical Media website. Click here!

Shoulder arthritis refers to loss of cartilage on the surface of the ball (humeral head) and the socket (glenoid) of the shoulder glenohumeral joint. The two bones rub against each other and produce pain, stiffness and difficulty moving an arm.

Types and Causes of Shoulder arthritis

Osteoarthritis (OA) – also called degenerative joint disease (DJD), is the “wear and tear” condition of the joint commonly due to old age. OA is characterized by loss of cartilage, bone spurs (osteophytes) and no major inflammation (Fig. 1).

Fig. 1: Osteoarthritis of the main shoulder joint. Click on image to see a larger version on Alila Medical Media website where the image is also available for licensing.

Rheumatoid arthritis (RA) – Inflammation of the synovium – the membrane that encloses the joint and contains lubricant fluid. Inflammation brings in the cells of the immune system whose inflammatory chemicals damage and destroy the joint. It’s not clear how RA starts but genetic predisposition together with infection of the joint are likely to be among the causes.

Rotator cuff arthropathy or cuff tear arthropathy (CTA) – Shoulder arthritis as a result and in a setting of rotator cuff tears. Rotator cuff muscles hold the ball and the socket together and prevent the humeral head from moving out of the socket when the person raises an arm. In people with torn rotator cuff, the head of the humerus moves upwards and rub onto the acromion. This causes damages to the covering cartilage and eventually arthritis. Combination of cuff tear and arthritis is a devastating condition that seriously compromises function of the shoulder.

Post-traumatic arthritis – arthritis that develops after physical injury to the joint.

Chondrolysis – sudden loss of cartilage that happens occasionally after a shoulder surgery, commonly seen in association with infusion of local anesthetics into the joint for pain management.

Treatments

Non-surgical treatments include shoulder exercises and anti-inflammatory medications.

Surgical treatments include a variety of procedures :

1. Total shoulder replacement surgery : the arthritic humeral head is replaced with a metal ball on a stem that fits inside the humerus, the socket is replaced with a plastic component made of high density polyethylene.

Fig. 2: Total shoulder replacement procedure. Click on image to see a larger version on Alila Medical Media website where the image is also available for licensing.

2. Ream and Run Arthroplasty – a modification of total shoulder procedure above. The metal ball replaces the humeral head but the socket is simply shaped, smoothed to fit the ball and left to heal. No plastic component used. With time, the body grows a cartilage layer on top of the socket. This procedure is recommended for younger and more active individuals.

3. Reverse total shoulder or Delta total shoulder replacement – This is indicated for people with rotator cuff arthropathy (see types of shoulder arthritis above). This procedure reverses the positions of the prostheses : the metal ball is now fixed on the socket and the plastic component is fixed in place of the humeral head. This topic is covered in the next article about reverse total shoulder replacement.
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Benign Prostatic Hyperplasia (BPH)

Below is a narrated animation about BPH and treatments. Click here to license this video on Alila Medical Media website.

Benign prostatic hyperplasia (BPH), also called benign prostatic hypertrophy or enlarged prostate, is a condition in which the size of the prostate gland is increased. It is considered “benign” because it’s NOT a cancer, and it does not increase the risk of cancer. However, when becomes sufficiently large, the prostate tissue may compress the urethra and block the urine flow causing a number of urination problems and urinary tract infection. BPH is very common in aging men: about 50% of men have some degree of BPH by the age of 60.

Anatomy

The prostate is a walnut-size exocrine gland of the male reproductive system. It is located just below the urinary bladder where it wraps around the first part of the urethra – prostatic urethra (see Fig. 1 and 2).

Fig. 1: Male reproductive and urinary organs, mid-sagittal view. Click on image to see a larger version on Alila Medical Media website where the image is also available for licensing.

Prostate gland produces a milky fluid that is expelled into the urethra to mix with spermatozoa during ejaculation. The fluid serves as a lubricant and nutrition for the sperms.

Click here to see an animation of male reproductive system on Alila Medical Media website where the video is also available for licensing.

Click here to see an animation of male urinary system on Alila Medical Media website where the video is also available for licensing.

In BPH, the enlarged prostate presses on the prostatic urethra making it narrower. This affects normal flow of urine (Fig. 2).

Fig. 2: Normal prostate (left) and enlarged prostate (right). Same sagittal view as in Fig. 1 with other organs removed to simplify. The urethra is squeezed narrow in BPH. Click on image to see a larger version on Alila Medical Media website where the image is also available for licensing.

Click here to see an animation of prostate hypertrophy on Alila Medical Media website where the video is also available for licensing.

Causes

BPH is considered a normal part of male aging as a result of hormonal changes. The rate of cell proliferation induced by androgens (male hormones) somehow exceeds the rate of programmed cell death (apoptosis) in aging prostate tissue resulting in enlargement of the prostate.
Severity of BPH (development of symptomatic BPH), however, has been associated with lifestyle. The incidence of clinically significant BPH is notably higher in men who lead a modern lifestyle compared to those who live in rural traditional settings.
About half of men with histopathologic BPH demonstrate clinically significant symptoms.

Symptoms

Obstruction of urine flow makes urine voiding difficult and incomplete. This leads to common symptoms of BPH:
– frequent urination.
– urgency : need to void that can not be deferred.
– urinary hesitation: difficulty to initiate urine stream, weak and interrupted stream.
– straining to void: need to push to completely empty the bladder.
– residual urine: constant feeling of need to void.
– dribbling
Altogether the voiding dysfunction resulted from BPH is called lower urinary tract symptoms (LUTS) – a more recent term for prostatism.

Treatment

Patients with mild symptoms and who are not bothered by their symptoms are usually advised to follow a “watch and see” approach with regular check-up and lifestyle changes such as low-fat diet, reduced consumption of alcohol and caffeine, reduced fluid intake before bedtime, avoidance of certain products and medications such as diuretics,…
1. Medication
There are two main classes of medication:
– alpha-blockers: these drugs relax smooth muscle in the prostate and by doing so relieve blockage of urine flow.
– 5-alpha reductase inhibitors: these inhibit local production of the hormone that is responsible for prostate enlargement.

2. Minimal invasive treatment
These non-surgical therapies use heat to cause cell death (necrosis) in prostate tissue. The heat is delivered in small amount and to a specific location to minimize unwanted damage. Different procedures differ mainly in the type of energy used.
– Transurethral microwave thermotherapy (TUMT): use of microwave energy delivered through a probe inside a catheter inserted into the urethra.
– Transurethral needle ablation (TUNA) : use of radio frequency energy delivered through a transurethral device with needles.
– Photoselective vaporization of the prostate (PVP): use of laser to vaporize prostate tissue.
3. Surgery
Transurethral resection of the prostate (TURP) is a surgical procedure for removal of prostate tissue through the urethra. This procedure has been around for a long time and is still considered gold standard for treatment of severe BPH. Nowadays, it is usually performed when medications and less invasive methods fail.

See all Urology topics

Vertical Sleeve Gastrectomy and Gastric Lap Band Surgeries

This is a continuation to the main article about bariatric surgery .

Below is a narrated animation of Gastric Sleeve and Gastric Lap Band procedures. Click here to license this video on Alila Medical Media website.

Vertical sleeve gastrectomy (VSG)

In this procedure a cut is made vertically and the larger part of the stomach (up to 85% of its volume) is removed from the body. The remaining is closed with staples to create a “new stomach” that is now having the shape of a tube (see Fig. 1). The procedure preserves both sphincters at the two ends of the stomach and therefore has minimum effect on the functioning of the digestive process.This reduces the risk of malabsorptive complications commonly associated with intestinal bypass. The procedure is irreversible.

Click here to see an animation of VSG procedure on Alila Medical Media website where the video is also available for licensing.

Fig. 1: Vertical sleeve gastrectomy procedure. Click on image to see a larger version on Alila Medical Media website where the image is also available for licensing.

VSG procedure is gaining more and more popularity thanks to its simplicity and good results on initial weight loss. However, due to the lack of long-term data, it is yet to be endorsed by bariatric surgery societies and is not covered by some insurance companies.

Adjustable gastric band (Lap band)

In this procedure an inflatable silicon band is placed around the top of the stomach to create a small stomach pouch (Fig. 2). During a meal, the pouch is filled up quickly with a small amount of food and releases it slowly into the lower part of the stomach due to the restriction by the band. As the pouch is full, it gives a feeling of satiety (fullness). Slow passage of the food makes the patient feel full for a longer period of time and thus reduces the amount of food intake. The band is connected to a port placed under skin of the abdomen. Through this port, a saline solution (salt water) is injected to adjust the diameter of the band and thus making the passage between the pouch and the lower part of the stomach smaller or larger accordingly to the needs of patient.

Click here to see an animation of gastric band procedure on Alila Medical Media website where the video is also available for licensing.

Fig. 2: Adjustable lap band procedure. Click on image to see a larger version on Alila Medical Media website where the image is also available for licensing.

As the procedure involves no cutting or stapling of the stomach, it is minimal invasive and reversible. The surgery can be performed laparoscopically (as opposed to open surgery) through small incisions with the aid of a camera. Recovery time is significantly shortened compared to gastric bypass procedures. Also, as there is no intestinal bypass, the risks of nutritional deficiencies, dumping syndrome and other complications associated with it are significantly reduced.
In terms of weight loss efficiency, however, patients who undergo gastric lap band surgery typically lose less weight than those who have had gastric bypass procedures.

> See Gastric bypass procedures

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Bariatric surgery

Below is a narrated animation of body mass index and Roux-en-Y gastric bypass. Click here to license this video on Alila Medical Media website.

Bariatric surgery, or weight loss surgery, refers to a variety of surgical procedures for treatment of morbid obesity. Obesity is determined by Body Mass Index (BMI) which is calculated as the ratio of body weight over square of body height. The higher the BMI the higher the extend of obesity. A normal BMI is between 20 and 25. An individual is considered morbidly obese if he or she has a body mass index of 40 or more, or of 35 or more and with obesity-related health problems such as diabetes, sleep apnea or hypertension.

Weight loss is achieved by reducing the size of the stomach. Smaller stomach makes you feel full faster and therefore makes it easier to reduce the amount of food intake.

Roux en-Y Gastric bypass (RNY)

This is the most commonly performed bariatric surgical procedure and is considered the gold standard for weight loss treatment. This procedure includes two steps:
1. The stomach is divided into two part : one small pouch at the top of the stomach where it is connected to the esophagus (gastric pouch in Fig. 1) and the rest of the stomach which will be “bypassed”, the two parts are separated and stapled.
2. Rerouting of the intestine: the intestine is cut at about 45cm (18in) down from the end of the stomach. The first part of the intestine (the duodenum) will be “bypassed”. The top end of the second part (the jejunum) is pulled up and connected to the gastric pouch created in step 1. The lower end of the duodenum is reconnected to the jejunum at a lower point (Fig.1). The new configuration has a shape of an Y, hence the name of the procedure.

Click here to see a video animation of gastric bypass procedure on Alila Medical Media website where the video is also available for licensing.

Fig. 1: Roux-en-Y gastric bypass diagram. Note the passage of food and digestive juice after surgery. Click on image to see a larger version on Alila Medical Media website where the image is also available for licensing.

How weight loss is achieved?
Firstly, the volume of the stomach is now greatly reduced to a small pouch (usually less than 10% of the original volume) which is filled up fast after a small amount of food intake. This sends a signal to the brain that the stomach is full and generates a feeling of fullness (satiety). This helps to stop eating. Also, if eating continues, vomiting and discomfort may follow. Secondly, as the first part of the intestine (the duodenum) is bypassed, the amount of nutrition absorbed by the body is greatly reduced. In normal digestion, this is where most of the nutrition is absorbed. Malabsorption contributes to weight loss effect.

Complications
While this procedure is proven as an efficient long term weight loss treatment, it associates with significant complication risks. These include: leakage along the staple lines and surgical connections leading to infection and abscess formation; stricture and obstruction of digestive tract due to scar formation; dumping syndrome; nutritional deficiencies; and other general surgical risks due to complexity of the procedure.

Mini Gastric bypass (MGB)

This is a modification of the more common RNY procedure described above. Here are the differences: (see Fig. 2)
1. In step 1 a long tube is created instead of a pouch.
2. In step 2, the intestine is NOT cut, it is pulled up and hooked up with the new stomach tube.

Fig. 2: Mini gastric bypass diagram. Click on image to see a larger version on Alila Medical Media website where the image is also available for licensing.

Click here to see a video animation of mini gastric bypass procedure on Alila Medical Media website where the video is also available for licensing.

This procedure is becoming more and more popular as it produces good weight loss results and is simpler than the original procedure resulting in less complication risks. Less cutting and stapling lowers the risk of leakage and infection. It also reduces the bile reflux possibility as the intestinal rerouting is set at a lower point on the stomach.

> NEXT: Gastric Sleeve and Gastric Lap Band

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GERD and Heartburn (with video)

Gastroesophageal reflux disease

This video and other animations of the digestive system are available for licensing on Alila Medical Media website. Click here!

Gastroesophageal reflux disease (GERD) or gastric reflux disease is a chronic condition where acid from the stomach flows up and damages the mucosa of the esophagus.
At the junction between the esophagus and the stomach is the lower esophageal sphincter (LES). The LES is a ring of muscle that is generally closed tight to prevent stomach acid from coming up. In normal digestion, the LES opens shortly to allow food bolus passing down to the stomach and closes back tight instantly. GERD occurs when the LES is abnormally relaxed and can not close properly (Fig. 1). Heartburn is a burning sensation in the chest associated with each regurgitation of gastric acid and is the most prominent symptom of GERD.

Fig. 1: Abnormal relaxation of the lower esophageal sphincter as cause of GERD. Click on image to see a larger version on Alila Medical Media website where the image is also available for licensing.

Hiatus hernia is believed to be another cause of GERD. Hiatus hernia or hiatal hernia is a condition where the top portion of the stomach is pulled up forming a herniation above the diaphragm. This situation somehow compromises the esophagus – stomach barrier and facilitates acid reflux.

Fig. 2: Types of hiatal hernia. Click on image to see a larger version on Alila Medical Media website where the image is also available for licensing.

Treatment

Treatment includes dieting and medication. Proton-pump inhibitors, which act to reduce gastric acid production, are drugs of choice. If these fail, a surgery may be recommended. In a procedure called Nissen fundoplication, the top portion of the stomach is wrapped around the lower part of esophagus and sewn into place. This way, the muscles in the wall of the stomach reinforce the closure of the esophagus. This surgical procedure is particularly recommended when hiatus hernia is present as this can be fixed at the same time. The procedure can be done with minimal invasive laparoscopic technique through small incisions with the aid of a camera.

Fig. 3: Nissen fundoplication procedure. Click on image to see a larger version on Alila Medical Media website where the image is also available for licensing.

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Common knee injuries and surgical repair, part 2

Knee sprains

Knee sprains refer to injuries in any of the ligaments of the knee. The most commonly injured are medial collateral ligament (MCL) running along the inner side of the knee, lateral collateral ligament (LCL) running along the outer side of the knee and anterior cruciate ligament (ACL) that connects the femur and tibia inside the joint (Fig. 1). For more about knee joint anatomy click here.

Fig. 1: Common types of knee sprain. Click on image to see a larger version on Alila Medical Media website where the image is also available for licensing.

Commonly, injury happens after a direct blow to the knee. When the knee is hit from outside it moves inwards and the ligament on the inside (the MCL) is overstretched and injured. Inversely, when the blow comes from the inside of the knee it’s the outside ligament (the LCL) that is hurt. ACL injuries, on the other hand, are caused by twisting movement of the knee and are most common among athletes in sports that involve sudden rotation movement of lower leg.

Fig. 2: Completely torn ACL. Click on image to see a larger version on Alila Medical Media website where the image is also available for licensing.

Mild sprains (stretched ligament but no tear or small tears) can be treated with rest, knee exercises and physical therapy. Complete tears require surgical repair or reconstruction.

ACL reconstruction surgery

Below is a narrated animation of ACL reconstruction surgery. Click here to license this video and/or other orthopedic videos on Alila Medical Media website.

This procedure is used to replace a severely damaged or completely torn anterior cruciate ligament (ACL) with a graft. The graft is a piece of healthy ligament taken from the same person or a donor. Graft from the same person is called autograft and usually works best. The procedure is detailed in Fig. 3. Autograft is commonly taken from the patellar ligament (one that connects the kneecap to the tibia), but hamstring tendon may also be used. See the figure legends for details of procedure, step 1 is done through open surgery, the rest are done through an arthroscope.

Fig. 3: Steps of arthroscopic knee surgery for reconstruction of anterior cruciate ligament injury: 1. Graft taken from kneecap and patellar ligament; 2. Torn ACL shown; 3. Damaged ACL removed and a channel is drilled through tibia and femur; 4. graft inserted and secured with screws; 5. graft in place. Click on image to see a larger version on Alila Medical Media website where the image is also available for licensing.

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Common knee injuries and surgical repair, part 1

Knee anatomy

The knee has three bones : the femur (the thigh bone), the tibia (the shinbone) and the patella (the kneecap). The femur and the tibia form a hinge joint. The joint is enclosed by the joint capsule at the back and on the sides, and is covered by the patella and patellar ligament in front. The knee joint is stabilized mainly by the tendons of quadriceps femoris muscle in front and semimembranosus muscle (one of the hamstrings) on the back. Strengthening these two muscles therefore helps to reduce the risk of knee injuries.

Fig.1 : Midsagittal section of the knee joint. Click on image to see a larger version on Alila Medical Media website where the image is also available for licensing.

Apart from the regular articular cartilage that cover the end surfaces of the three bones there are two additional pads of cartilage that are unique to the knee joint : medial meniscus and lateral meniscus (Fig. 2 and Fig. 3). The menisci act as shock absorbers to cushion the joint.

Two pairs of ligaments help to stabilize the knee : collateral ligaments run along two sides of the knee (Fig. 2), and cruciate ligaments which connect the femur and tibia in the center of the joint and cross each other in the from of an X (hence the names) : anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) (Fig. 2 and Fig. 3).

Fig. 2 : Front view of the right knee (the kneecap is removed in this picture to show structures behind). Click on image to see a larger version on Alila Medical Media website where the image is also available for licensing.

Fig. 3 : The right knee viewed from top (femur removed to show structures underneath). Click on image to see a larger version on Alila Medical Media website where the image is also available for licensing.

Meniscus tear and repair

Commonly referred to as torn cartilage, torn meniscus is a common sport injury. Mild injuries maybe treated with rest, ice, compression and elevation (the RICE approach). Larger tears may require surgery. The goal of surgery is to remove the damaged tissue which is the source of irritation, pain and possibly inflammation, and attempt to induce healing. Treatments vary depending on the location of the tear. If the tear is located on the outer border of the meniscus (the red zone, see Fig. 3) where there is a good blood supply, the damaged loose tissue will be removed and sutures will be used to tight the cartilage together to facilitate self healing. If the tear is located on the inner part (the white zone, see Fig. 3) where the blood supply is poor and hence healing is unlikely, the damaged part is simply removed (partial meniscectomy) (Fig. 4).

Minimal invasive arthroscopic surgery is commonly used for meniscus repair. In case of large tears, open surgery may be required.

Click here to see an animation of arthroscopic meniscus repair on Alila Medical Media website where the video is also available for licensing.

Fig. 4 : Treatment of meniscus tear depends on its location. Click on image to see a larger version on Alila Medical Media website where the image is also available for licensing.

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Common shoulder injuries and surgical repair (part 1)

Anatomy

There are three bones in the shoulder: the humerus (the bone of the upper arm), the scapula (shoulder blade) and the clavicle (collarbone). Articulations between these bones make up the shoulder joints. The main joint, commonly referred to as “the shoulder joint”, is the joint between the head of the humerus and glenoid cavity of the scapula and is called the humeroscapular or glenohumeral joint. The second joint of the shoulder is formed by the articulation between the clavicle and the acromion (extension of the scapula that forms the top of the shoulder) and is called acromioclavicular joint or AC joint. The two joints are stabilized by associated muscles and ligaments.

Fig.1: Main components of the shoulder joint. Click on image to see a larger version on Alila Medical Media website where the image is also available for licensing.

Shoulder dislocation

Shoulder dislocation occurs when the humeral head slips out of the pocket made by glenoid cavity of the scapula (Fig. 2). This usually happens as a result of trauma (fall, sport injury,..). Dislocation can be anterior where the humerus slips to the front or posterior where it dislocates behind the normal position. Anterior dislocation is more common.

Fig.2 : Types of shoulder dislocation. Click on image to see a larger version on Alila Medical Media website where the image is also available for licensing.

Below is a narrated animation about shoulder dislocation, bankart lesion and repair. Click here to license this video and/or other orthopaedic videos on Alila Medical Media website.

Bankart lesion and shoulder instability

The glenoid cavity has a ring of fibrocartilage tissue called the labrum around it. The labrum makes the cavity deeper and helps to keep the humeral head in place (Fig.3). During anterior shoulder dislocation, the head of the humerus may be pressed against and damages the anterior portion of the labrum. This type of labral tear is called bankart. Damaged labrum makes it easier for the humeral head to slip out of place again. This vicious cycle leads to repeated shoulder dislocation and severely damaged labrum. The condition is called shoulder instability as it feels like slipping out anytime. Treatment includes physical therapy and, in some cases, surgery for bankart repair (see below).

Click here to see an animation of bankart lesion and arthroscopic repair on Alila Medical Media website where the video is also available for licensing.

Fig. 3: Anatomy of the shoulder joint with the humerus slightly abducted to show the glenoid cavity and labrum. Types of labral lesions are shown on the right. Click on image to see a larger version on Alila Medical Media website where the image is also available for licensing.

Bankart repair

During surgery the damaged cartilage is removed, area is cleaned, small holes are then drilled into the bone of glenoid fossa to hold small suture anchors with threads. The threads are attached to the labrum and pulled tightly to hold the labrum to the glenoid (Fig.4). Over time, the labrum will reattach to the glenoid naturally. Physical therapy will be needed to regain the shoulder range of motions and strength.

Fig.4: Steps of bankart repair surgery. See text for details. Click on image to see a larger version on Alila Medical Media website where the image is also available for licensing.

Bankart repair can be done with arthroscopic or open surgery. While arthroscopy is minimal invasive, open surgery maybe recommended for larger tears. In arthroscopic surgery only two or three small incisions are made, an arthroscope is inserted through one of the incision. Arthroscope is an instrument equipped with light and camera which transmits image of the joint to a computer screen. Other small tools are inserted to carry out the repair (Fig.5).

Click here to see an animation of arthroscopic bankart repair.

Fig. 5 : Arthroscopic surgery for bankart repair. Click on image to see a larger version on Alila Medical Media website where the image is also available for licensing.

> See all Orthopedic topics

Medical Information Illustrated

Medical and health topics fully illustrated with pictures and videos for easy understanding.

Tag Archives: procedures

Reverse Total Shoulder Replacement

Why a conventional total shoulder will not work with rotator cuff arthropathy?

Why a reverse total shoulder would work?

Shoulder arthritis

Types and Causes of Shoulder arthritis

Treatments

Benign Prostatic Hyperplasia (BPH)

Anatomy

Causes

Symptoms

Treatment

Vertical Sleeve Gastrectomy and Gastric Lap Band Surgeries

Vertical sleeve gastrectomy (VSG)

Adjustable gastric band (Lap band)

Bariatric surgery

Roux en-Y Gastric bypass (RNY)

Mini Gastric bypass (MGB)

GERD and Heartburn (with video)

Gastroesophageal reflux disease

Treatment

Common knee injuries and surgical repair, part 2

Knee sprains

ACL reconstruction surgery

Common knee injuries and surgical repair, part 1

Knee anatomy

Meniscus tear and repair

Common shoulder injuries and surgical repair (part 1)

Anatomy

Shoulder dislocation

Bankart lesion and shoulder instability

Bankart repair