Shoulder Injuries in Throwing Athletes | Peter Millett MD - Shoulder Surgeon Colorado

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Peter Millett MD

Due to the ongoing controversy regarding the exact causes of injury in the thrower's shoulder, the authors will not attempt to provide a single unifying theory. Instead, we will provide an overview clarifying the terminology and describing common pathologic findings, and presenting the various theories on shoulder injuries in throwing athletes. The purpose of this chapter is to discuss the biomechanics, presentation, diagnosis and treatment of common shoulder injuries in overhead throwing athletes. For more studies on athletic shoulder injuries, please visit http://drmillett.com/shoulder-studies

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Shoulder Injuries in Throwing Athletes | Peter Millett MD - Shoulder Surgeon Colorado

Shoulder Injuries in Throwing Athletes | Peter Millett MD - Shoulder Surgeon Colorado

Shoulder Injuries in Throwing Athletes | Peter Millett MD - Shoulder Surgeon Colorado

Shoulder Injuries in Throwing Athletes | Peter Millett MD - Shoulder Surgeon Colorado

Shoulder Injuries in Throwing Athletes | Peter Millett MD - Shoulder Surgeon Colorado

Shoulder Injuries in Throwing Athletes | Peter Millett MD - Shoulder Surgeon Colorado

Shoulder Injuries in Throwing Athletes | Peter Millett MD - Shoulder Surgeon Colorado

Shoulder Injuries in Throwing Athletes | Peter Millett MD - Shoulder Surgeon Colorado

Shoulder Injuries in Throwing Athletes | Peter Millett MD - Shoulder Surgeon Colorado

Shoulder Injuries in Throwing Athletes | Peter Millett MD - Shoulder Surgeon Colorado

Shoulder Injuries in Throwing Athletes | Peter Millett MD - Shoulder Surgeon Colorado

Shoulder Injuries in Throwing Athletes | Peter Millett MD - Shoulder Surgeon Colorado

Shoulder Injuries in Throwing Athletes | Peter Millett MD - Shoulder Surgeon Colorado

Shoulder Injuries in Throwing Athletes | Peter Millett MD - Shoulder Surgeon Colorado

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Colorado shoulder specialist Dr. Peter Millett analyzes a case study of a 48 year-old active male with a supraspinatus tear with Grade 2 atrophy. The goal of arthroscopic rotator cuff repair is to restore the anatomy, biomechanics, shoulder function and promote healing. The advantages of arthroscopic repair is lower complication rates than RSTA and tendon transfer and overall improved functional outcomes. Depending on the type of rotator cuff tear will help establish the reconstruction classification. In Dr. Millett's study from AAOS in 2014 there are four tear pattern recognitions: crescent, L/Reverse L, U-Shape and Massive Contracted. These pattern recognitions are required for modern arthroscopic rotator cuff repair to help facilitate anatomic restoration, optimize biomechanical properties and tendon biology, along with decrease failure rates. For older patients, Dr. Millett conducted a study on the outcomes of rotator cuff repairs in older patients. The study found that the mean patient satisfaction was 9/10 improvement in pain affecting ADLs and ability to participate in sporting activities.

Arthroscopic Rotator Cuff Repair | Colorado Shoulder Specialist | Vail, CO

Arthroscopic Rotator Cuff Repair | Colorado Shoulder Specialist | Vail, CO

Arthroscopic Rotator Cuff Repair | Colorado Shoulder Specialist | Vail, CO

Peter Millett MD

Arthroscopic treatment of bony Bankart lesions can be challenging. We present a new easy and reproducible technique for arthroscopic reduction and suture anchor fixation of bony Bankart fragments. A suture anchor is placed medially to the fracture on the glenoid neck, and its sutures are passed around the bony fragment through the soft tissue including the inferior glenohumeral ligament complex. The sutures of this anchor are loaded in a second anchor that is placed on the glenoid face. This creates a nontilting 2-point fixation that compresses the fragment into its bed. By use of the standard technique, additional suture anchors are used superiorly and inferiorly to the bony Bankart piece to repair the labrum and shift the joint capsule. We call this the “bony Bankart bridge” procedure. Key Words: Arthroscopy—Bony Bankart lesion—Suture bridge—Instability—Shoulder. For more shoulder surgery and shoulder instability studies, visit Dr. Millett, The Steadman Clinic, Greater Denver Area http://drmillett.com/shoulder-studies

The “Bony Bankart Bridge” Procedure Shoulder Instability | Shoudler Surgery |...

The “Bony Bankart Bridge” Procedure Shoulder Instability | Shoudler Surgery |...

The “Bony Bankart Bridge” Procedure Shoulder Instability | Shoudler Surgery |...

Peter Millett MD

Recurrent posterior shoulder instability is an uncommon condition. It is often unrecognized, leading to incorrect diagnoses, delays in diagnosis, and even missed diagnoses. Posterior instability encompasses a wide spectrum of pathology, ranging from unidirectional posterior subluxation to multidirectional instability to locked posterior dislocations. Nonsurgical treatment of posterior shoulder instability is successful in most cases; however, surgical intervention is indicated when conservative treatment fails. For optimal results, the surgeon must accurately define the pattern of instability and address all soft-tissue and bony injuries present at the time of surgery. Arthroscopic treatment of posterior shoulder instability has increased application, and a variety of techniques has been described to manage posterior glenohumeral instability related to posterior capsulolabral injury. For more shoulder surgery and shoulder instability studies, visit Dr. Millett, The Steadman Clinic, Vail Colorado http://drmillett.com/shoulder-studies

Recurrent Posterior Shoulder Instability | Orthopaedic Surgeon | Vail Colorado

Recurrent Posterior Shoulder Instability | Orthopaedic Surgeon | Vail Colorado

Recurrent Posterior Shoulder Instability | Orthopaedic Surgeon | Vail Colorado

Peter Millett MD

Open surgical treatment for primary anterior glenohumeral instability is reliable and time-tested and can yield excellent clinical results. With advancements in arthroscopic technique, there has been a growing trend toward arthroscopic treatment of anterior shoulder instability. In many instances, arthroscopic treatment is preferred by patients and surgeons because it is minimally invasive, obviating the need for releasing and repairing the subscapularis; because it allows better identification and treatment of associated pathological conditions; and because it decreases morbidity and facilitates an outpatient approach. Furthermore, recent studies have demonstrated that the results of arthroscopic treatment of recurrent traumatic anterior instability are comparable with those achieved historically with open procedures. For more shoulder surgery and shoulder instability studies, visit Dr. Millett, The Steadman Clinic, Vail Colorado http://drmillett.com/shoulder-studies

Open Operative Treatment for Anterior Shoulder Instability | Orthopedic Surge...

Open Operative Treatment for Anterior Shoulder Instability | Orthopedic Surge...

Open Operative Treatment for Anterior Shoulder Instability | Orthopedic Surge...

Peter Millett MD

Stability of the shoulder comes from a complex interaction of various factors. Dynamic and static components are provided by soft tissue and bony structures creating joint stability. Recurrent anterior glenohumeral instability can be a difficult problem because there is a wide variety of possible pathologies. For more shoulder surgery and shoulder instability studies, visit Dr. Millett, Orthopedic Surgeon, Vail Colorado http://drmillett.com/shoulder-studies

Open Anterior Capsular Reconstruction of the Shoulder for Chronic Instability...

Open Anterior Capsular Reconstruction of the Shoulder for Chronic Instability...

Open Anterior Capsular Reconstruction of the Shoulder for Chronic Instability...

Peter Millett MD

Traumatic posterior instability may occasionally cause a large osteochondral lesion when the anterior humeral head is compressed against the posterior glenoid rim. This is termed a reverse Hill–Sachs lesion. Such osteochondral defects may be very large in the case of chronic locked dislocations. Even in acute posterior disclocations, closed reduction may be difficult when the humeral head is locked posteriorly over the glenoid. In such cases closed or open reduction under general anesthesia with muscle relaxation may be necessary. In cases where the anterior humeral head defect is large, reconstruction may be necessary to maintain stability. Management must be tailored to the individual patient and depends on several factors, which include the size of the defect, the duration of the dislocation, the quality of the bone, the status of the articular cartilage, and the patient’s overall health. For more shoulder surgery and instability studies, visit Dr. Millett, The Steadman Clinic, Vail Colorado http://drmillett.com/shoulder-studies

Management of Posterior Glenohumeral Instability with Large Humeral Head Defect

Management of Posterior Glenohumeral Instability with Large Humeral Head Defect

Management of Posterior Glenohumeral Instability with Large Humeral Head Defect

Peter Millett MD

The arthroscopic treatment of anterior glenohumeral instability is becoming increasingly accepted as a viable treatment option because reported success rates parallel those of open stabilization techniques. This improved success rate is largely the result of advances in surgical techniques and technology. An improved understanding of the pathoanatomy associated with shoulder instability and continuing education initiatives have also been instrumental in expanding the indications for arthroscopic stabilization of the unstable shoulder. For more shoulder surgery and instability studies, visit Peter Millett, Shoulder Surgeon, Vail Colorado http://drmillett.com/shoulder-studies

Arthroscopic Treatment of Anterior Glenohumeral Instability Indications and T...

Arthroscopic Treatment of Anterior Glenohumeral Instability Indications and T...

Arthroscopic Treatment of Anterior Glenohumeral Instability Indications and T...

Peter Millett MD

Arthroscopic treatment of the unstable shoulder has evolved rapidly and significantly in recent years. Better understanding of the pathoanatomy, advancements in technology, and improved surgical techniques have led to dramatic improvements in outcome. An arthroscopic approach includes significant advantages. Arthroscopy provides better identification of concomitant pathology, lower morbidity, less soft tissue dissection, maximal preservation of motion, shorter surgical time, and improved cosmesis. There is less pain, and many patients have an easier functional recovery, with greater returns in motion compared with traditional open techniques. Finally, some of the inherent risks of open procedures, such as postoperative subscapularis rupture, are virtually eliminated. Surgeons can now routinely expect results that are at least comparable, if not better than, those achieved with open techniques. For more shoulder surgery and instability studies, visit Dr. Millett, Orthopedic Surgeon, Vail Colorado http://drmillett.com/shoulder-studies

Arthroscopic Management of Anterior, Posterior, and Multidirectional Shoulder...

Arthroscopic Management of Anterior, Posterior, and Multidirectional Shoulder...

Arthroscopic Management of Anterior, Posterior, and Multidirectional Shoulder...

Peter Millett MD

Eleven cases of traumatic recurrent anterior instability that required bony reconstruction for severe anterior glenoid bone loss were reviewed. In all cases, the length of the anterior glenoid defect exceeded the maximum anteroposterior radius of the glenoid based on preoperative assessment by 3-dimensional CT scan. Surgical reconstruction was performed using an intra-articular tricortical iliac crest bone graft contoured to reestablish the concavity and width of the glenoid. The graft was fixed with cannulated screws in combination with an anterior-inferior capsular repair. For more shoulder surgery and instability studies, visit Dr. Millett, The Steadman Clinic, Vail Colorado http://drmillett.com/shoulder-studies

Anatomical Glenoid Reconstruction for Recurrent Anterior Glenohumeral Instabi...

Anatomical Glenoid Reconstruction for Recurrent Anterior Glenohumeral Instabi...

Anatomical Glenoid Reconstruction for Recurrent Anterior Glenohumeral Instabi...

Peter Millett MD

A 57-year-old man with type II diabetes mellitus presented with right shoulder pain and weakness. The onset of symptoms was insidious and progressive over a two year period. The patient thought he initially injured his shoulder while swimming but noted that his symptoms had become much worse since re-injuring it while throwing a tennis ball 6 months before presentation. The pain was localized to his right shoulder and often awakened him from sleep. He had taken nonsteroidal anti-inflammatory drugs (NSAIDS) for the 6 months after re-injuring the shoulder and completed an intermittent course of physical therapy that included a rotator cuff strengthening program. He was an active person who enjoyed hunting and fishing but had been unable to do either because of the shoulder problems. For more shoulder surgery and rotator cuff studies, visit Peter Millett, MD, Orthopedic Surgeon, Vail Colorado http://drmillett.com /shoulder-studies

Stiffness After Rotator Cuff Repair | Orthopedic Surgeon | Vail Colorado

Stiffness After Rotator Cuff Repair | Orthopedic Surgeon | Vail Colorado

Stiffness After Rotator Cuff Repair | Orthopedic Surgeon | Vail Colorado

Peter Millett MD

Isolated ruptures of the subscapularis and anterosuperior rotator cuff lesions are encountered more rarely than supraspinatus or anteroposterior rotator cuff tears. In certain circumstances, reconstruction of the tendon may not be possible due to fatty degeneration and atrophy of the subscapularis muscle or poor tendon quality. Tendon transfer may represent the only surgical option for treatment. A pectoralis major tendon transfer is an acceptable salvage option for irreparable subscapularis tendon ruptures. Although limited functional goals may be expected in most cases, the majority of patients obtain a good pain relief, which improves their function below chest level. Addition of the teres major component to the transfer may be beneficial in cases where both the upper and lower portion of the subscapularis muscle is irreparable. For more shoulder surgery and rotator cuff studies, visit Dr. Millett, The Steadman Clinic, Vail Colorado http://drmillett.com/shoulder-studies

Split Pectorales Major and Teres Major Tendon Transfers for Reconstruction of...

Split Pectorales Major and Teres Major Tendon Transfers for Reconstruction of...

Split Pectorales Major and Teres Major Tendon Transfers for Reconstruction of...

Peter Millett MD

Shoulder problems occur frequently in older adults. Four syndromes are particularly frequent, and they all share the common symptom of pain when reaching overhead: (1) rotator cuff tendinitis or impingement syndrome, (2) rotator cuff tear, (3) osteoarthritis, and (4) frozen shoulder. In addition to pain, each can cause significant long-term disability. For more shoulder surgery and rotator cuff studies, visit Dr. Millett, The Steadman Clinic, Vail Colorado http://drmillett.com/shoulder-studies

Shoulder Problems in Older Adults | Rotator Cuff | Sports Medicine Doctor - C...

Shoulder Problems in Older Adults | Rotator Cuff | Sports Medicine Doctor - C...

Shoulder Problems in Older Adults | Rotator Cuff | Sports Medicine Doctor - C...

Peter Millett MD

Shoulder pain is the third most common musculoskeletal symptom encountered in medical practice after back and neck pain, accounting for almost 3 million patient visits each year in the United States. A wide range of potential pathoanatomic entities can give rise to shoulder pain, from simple sprains to massive rotator cuff tears. The majority of these conditions are amenable to conservative treatment. Rotator cuff dysfunction is a particularly important entity because it occurs frequently and may necessitate surgical treatment. This report will provide a critical overview of current diagnostic and treatment techniques for rotator cuff disease. For more shoulder surgery and rotator cuff studies, visit Dr. Millett, shoulder surgeon, Greater Denver http://drmillett.com/shoulder-studies

Rotator Cuff Disorders | Shoulder Surgeon | Greater Denver Colorado

Rotator Cuff Disorders | Shoulder Surgeon | Greater Denver Colorado

Rotator Cuff Disorders | Shoulder Surgeon | Greater Denver Colorado

Peter Millett MD

In an effort to increase the immediate strength of a rotator cuff repair and to simulate the standard open reconstruction with its effective suture fixation, we have developed a novel technique for suture anchor reconstruction of the rotator cuff. The technique, termed mattress double anchor (MDA), is simple and adaptable. It makes use of 2 suture anchors that are placed independently and then connected by a suture loop. The technique produces a repair construct that distributes the stress across 2 anchors. The method also restores a large surface area for healing between the rotator cuff and the tuberosity.

Mattress Double Anchor Footprint Repair | Shouder Surgery | Vail Colorado

Mattress Double Anchor Footprint Repair | Shouder Surgery | Vail Colorado

Mattress Double Anchor Footprint Repair | Shouder Surgery | Vail Colorado

Peter Millett MD

Patients with hyperflexion/hyperabduction injury to the glenohumeral joint are at risk for isolated greater tuberosity fractures, which are often undiagnosed or misdiagnosed. In this case report, we describe the clinical decision-making process that led to the diagnosis of an isolated greater tuberosity fracture and subsequent rotator cuff tear. For more shoulder surgery and rotator cuff studies, visit Dr. Millett, Greater Denver Area http://drmillett.com/shoulder-studies

Patient Management with Greater Tuberosity Fracture and Rotator Cuff Tear | G...

Patient Management with Greater Tuberosity Fracture and Rotator Cuff Tear | G...

Patient Management with Greater Tuberosity Fracture and Rotator Cuff Tear | G...

Peter Millett MD

Twenty fresh-frozen cadaveric shoulders were randomly assigned to 4 arthroscopic repair techniques. The repair was performed as either a single-row suture anchor rotator cuff repair technique or 1 of 3 double-row techniques: diamond, mattress double anchor, or modified mattress double anchor. Angle of loading, anchor type, bone mineral density, anchor distribution, angle of anchor insertion, arthroscopic technique, and suture type and size were all controlled. Footprint length and width were quantified before and after repair. Displacement with cyclic loading and load to failure were determined. For more shoulder surgery and rotator cuff studies, visit Peter Millett, MD, The Steadman Clinic, Vail Colorado http://drmillett.com/shoulder-studies

Arthroscopic Single Row Versus Double-Row Suture Anchor Rotator Cuff Repair |...

Arthroscopic Single Row Versus Double-Row Suture Anchor Rotator Cuff Repair |...

Arthroscopic Single Row Versus Double-Row Suture Anchor Rotator Cuff Repair |...

Peter Millett MD

Pathologic conditions in the shoulder of a throwing athlete frequently represent a breakdown of multiple elements of the shoulder restraint system, both static and dynamic, and also a breakdown in the kinetic chain. Physical therapy and rehabilitation for shoulder injuries should be, with only a few exceptions, the primary treatment for a throwing athlete before operative treatment is considered. Articular-sided partial rotator cuff tears and superior labral tears are common in throwing athletes. Operative treatment for shoulder injuries can be successful when nonoperative measures have failed. Throwing athletes who have a glenohumeral internal rotation deficit have a good response, in most cases, to stretching of the posteroinferior aspect of the capsule. For more studies visit Dr. Millett, orthopedic surgeon, http://drmillett.com/shoulder-studies

Shoulder Injuries | Throwing Athlete | Orthopedic Surgeon Vail Colorado

Shoulder Injuries | Throwing Athlete | Orthopedic Surgeon Vail Colorado

Shoulder Injuries | Throwing Athlete | Orthopedic Surgeon Vail Colorado

Peter Millett MD

Although often perceived as a leisurely activity, golf can be a demanding sport, which can result in shoulder injuries, usually from overuse and sometimes from poor technique. The shoulder is a commonly affected site, with the lead shoulder, or the left shoulder in the right-handed golfer, particularly vulnerable to injury. A thorough understanding of the biomechanics of the golf swing is help- ful in diagnosing and managing these injuries. Common shoulder injuries affecting golfers include subacromial impingement, acromioclavicular arthrosis, rotator cuff tear, glenohumeral instability, and glenohumeral arthrosis. Although the majority of patients with these disorders will respond to nonsurgical treatment, including rest and a structured program of physical therapy, further benefits can be obtained with subtle modifications of the golf swing. Those golfers who fail to respond to nonsurgical management can often return to competitive play with appropriate surgical treatment. For more studies visit Dr. Peter Millett, Orthopedic Surgeon - Vail Colorado http://drmillett.com/shoulder-studies

Golf Shoulder Injuries | Dr. Peter Millett | Orthopedic Surgeon - Vail Colorado

Golf Shoulder Injuries | Dr. Peter Millett | Orthopedic Surgeon - Vail Colorado

Golf Shoulder Injuries | Dr. Peter Millett | Orthopedic Surgeon - Vail Colorado

Peter Millett MD

Dr. Millett is a Partner at the Steadman Hawkins Clinic. An expert in shoulder disorders, he also specializes in disorders of the knee, and elbow as well as all sports-related injuries. He uses advanced open and arthroscopic surgical techniques to restore damaged joints, ligaments, and bones. A focus of his is complex and revision shoulder surgery. He held a faculty appointment at Harvard Medical School, and was formerly Co-Director of the Harvard Shoulder Service, and Co-director of the Harvard Shoulder Fellowship. He also directed the Musculoskeletal Proteomics Research Group at Harvard. His clinical practice in Boston was based at the prestigious Brigham & Women's and Massachusetts General Hospitals. He has authored over numerous peer-reviewed, scientific articles, numerous book chapters, and a review book on orthopaedics. His academic work has been recognized with awards from several international societies. Dr. Millett serves as a shoulder and sports medicine consultant for Bermuda. A member of numerous societies including AAOS, AOSSM, ASES, AANA, and ORS, Dr. Millett has cared for athletes from the NFL, MLB, NHL, USTA, PGA, US ski team, and X-games. Dr. Millett serves as a team physician for the U.S. Ski Team. He is a consultant to the Montreal Canadiens Professional Hockey Club and the Volkl/Marker ski companies. Dr. Millett has performed live surgery for courses in North America (Massachusetts, Florida, California, Colorado, Missouri, Illinois), Europe (Germany, The Netherlands, France) and the Caribbean (Bermuda). A native of Pennsylvania, Dr. Millett received his undergraduate degree from the University of Scranton, and his medical degree from Dartmouth Medical School in Hanover, New Hampshire. He also served as a visiting research scholar at the University of Cambridge in England, where he was awarded a master’s degree in science (M.Sc.) for his work in skeletal biology. Dr. Millett performed his orthopaedic residency training at the Hospital for Special Surgery in New York City, part of Cornell University's Medical School and the oldest and most prestigious orthopaedic residency program in the country. While there, he received the Lewis Clark Wagner Award for excellence in orthopaedic research as well as the American Orthopaedic Association – Zimmer Travel Award, a national award for orthopaedic research. Dr. Millett earned additional subspecialty, fellowship training in sports medicine, knee and shoulder surgery at the internationally renown Steadman Hawkins Sports Medicine Foundation in Vail, CO. While there, he also served as an associate physician for the Denver Broncos professional football team, the Colorado Rockies Major League Baseball team, and the U.S. Ski Team. Specialty: Shoulder, knee, and elbow surgery Sports medicine Orthopaedic trauma Joint replacement surgery Orthopedic Surgery

Peter Millett MD | Orthopaedic Surgeon | The Steadman Clinic Sports Medicine ...

Peter Millett MD | Orthopaedic Surgeon | The Steadman Clinic Sports Medicine ...

Peter Millett MD | Orthopaedic Surgeon | The Steadman Clinic Sports Medicine ...

Peter Millett MD

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