Shoulder Work Ahead E-Book

Mohy Taha

• Herausgeber: BoD - Books on Demand
• Kategorie: Ratgeber
• Sprache: Englisch

Seitenzahl: 177

Veröffentlichungsjahr: 2025

Beschreibung

Surgeons are familiar with researching and publishing articles in scientific journals. Often, however, such publications are worded in a complicated manner and are not easily understood. The goal of this book is to successfully educate readers about the shoulder and familiarize them with this complex joint. While surgeons support patients in decision-making, ultimately, consent to therapy is in the hands of the patient. This book provides information on the various causes of shoulder pain and possible therapies. Empowering patients to make informed decisions.

Leseprobe

Abbreviations

Abbreviations are often used in the medical field. Here is a list of abbreviations that can be found in this book:

AC

Acromioclavicular

AO

Association for the Study of Osteosynthesis

ASES

American Shoulder Elbow Society Score

CC

Coracoclavicular

CHF

Confoederatio Helvetica Franc

CSA

Critical Shoulder Angle

CT

Computed Tomography

EBM

Evidence Based Medicine

EMG

Electromyography

GTA

Greater Tuberosity Angle

GP

General Practitioner

HIV

Human Immunodeficiency Virus

MD

Doctor of Medicine

MPA

Medical Practice Assistants

MRC

Medical Research Council

MRI

Magnetic Resonance Imaging

MTT

Medical Training Therapy

NSAID

Non-Steroidal Anti-Inflammatory Drugs

OP

Operation

OR

Operating Room

PASTA

Partial Articular Supraspinatus Tendon Avulsion

PROMS

Patient Related Outcome Measurements

PRP

Platelet Rich Plasma

RC

Rotator Cuff

ROM

Range Of Motion

SAMW

Swiss Academy of Medical Sciences

SLAP

Superior Labral Tear from Anterior to Posterior

SSV

Subjective Shoulder Value

TEAM

Together Each Achieves More

TENS

Transcutaneous Electrical Nerve Stimulation

VAS

Visual Analog Score

Table of contents

Abbreviations

Tables and figures

Foreword

Acknowledgements

Introduction

Chapter 1 From medical student to fellowship trained consultant

Chapter 2 Mentors

Chapter 3 Symptoms - MRI - Diagnosis - Now what?

Chapter 4 To operate or not to operate

Chapter 5 Shoulder Anatomy

The 8 common causes

Chapter 6 Rotator Cuff Tear

Chapter 7 Arthritis

Chapter 8 Impingement / Bursitis Subacromialis

Chapter 9 Biceps Tendon

Chapter 10 Calcific Tendinopathy

Chapter 11 Frozen Shoulder / Adhesive Capsulitis

Chapter 12 Shoulder Instability

Chapter 13 AC Dislocation

Patient Satisfaction

Chapter 14 Patients

Chapter 15 General practitioners

Chapter 16 Surgeons

Chapter 17 OP staff

Chapter 18 Implants

Chapter 19 Hospital staff

Chapter 20 Hospital kitchens

Chapter 21 Physiotherapy

Chapter 22 Infrastructure

Chapter 23 Insurance

Chapter 24 Administration

Closing Words: Formula for success 1+1=11

Glossary: Shoulder surgery in English

Tables and figures

Introduction

Fig.1: Dr. Taha and PD Dr. Lädermann

Fig 2: Dr. Taha and Prof. Athwal

Fig. 3: Dr. Taha around the globe on his fellowships with colleagues

Chapter 1: From medical student to fellowship trained consultant

Fig. 4: Medical Career Success Path

Chapter 3: Symptoms - MRI - Diagnosis - Now what?

Fig. 5: Conventional course of treatment

Fig. 6: Suggested course of treatment

Tab. 1: Clinical standard function test

Chapter 5: Shoulder Anatomy

Fig. 7: Anatomy of the shoulder from the front

Fig. 8: Bone structures of the shoulder

Fig. 9: Cartilage structures of the shoulder

Fig. 10: Joint lip (labrum)

Fig. 11: Shoulder joint

Fig. 12: Joint capsule

Fig. 13: a) RC from the front; b) RC from behind

Fig. 14: Biceps muscle and tendon attachment close to the body

Fig. 15: Ligaments of the acromioclavicular joint (AC joint)

Fig. 16: Bursa (subacromial bursa)

Chapter 6: Rotator Cuff Tear

Fig. 17: a) Intact RC; b) RC with tear

Tab. 2: Classification of tendon retraction according to Patte

Tab. 3: Classification of the degree of fatty infiltration of muscles according to Fuchs or Goutallier

Tab. 4: Classification of types of lesions according to Lafosse

Tab. 5: Summary of surgery and therapy for RC tears

Chapter 7: Arthritis

Fig. 18: a) Intact shoulder joint; b) Shoulder joint with arthritis

Fig. 19: Anatomical prosthesis

Fig. 20: Reversed (inverse) prosthesis

Tab. 6: Summary of surgery and therapy for arthritis

Chapter 8: Impingement / Bursitis Subacromialis

Fig. 21: Impingement (pinching)

Tab. 7: Summary of surgery and therapy for impingement

Chapter 9: Biceps Tendon

Fig. 22: a) Intact long biceps tendon; b) Torn long biceps tendon

Fig. 23: a) Articular lip chamfered; b) Articular lip lifted; c) lip torn like a ‘basket handle’, tendon attachment intact; d) Tear extends into the biceps tendon.

Tab. 8: Summary of surgery and therapy for biceps tendon rupture

Chapter 10: Calcific Tendinopathy

Fig. 24: Calcific tendinopathy; calcium deposits on the tendon

Tab. 9: Summary of surgery and therapy for calcific tendinopathy

Chapter 11: Frozen Shoulder / Adhesive Capsulitis

Fig. 25: a) Intact joint capsule; b) Adhesive joint capsule

Fig. 26: Pain and mobility of a frozen shoulder

Tab. 10: Summary of surgery and therapy for frozen shoulder

Chapter 12: Shoulder Instability

Fig. 27: a) Intact shoulder joint; b) Dislocated shoulder joint to the rear; c) Dislocated shoulder joint anteriorly and inferiorly

Fig. 28: a) Intact labrum; b) Operated labrum (Bankart surgery)

Fig. 29: Severed and refixed coracoid process (Latarjet surgery)

Tab. 11: Classification of shoulder dislocation according to Gerber

Tab. 12: Summary of surgery and therapy for shoulder instability

Chapter 13: AC Dislocation

Fig. 30: Type I - VI Classification according to Rockwood

Fig. 31: Surgery: AC joint stabilization with suture cerclage

Tab. 13: Summary of surgery and therapy for AC joint dislocation

Chapter 23: Insurance

Fig. 32: Model cycle: Patient-Physician-Health insurance

Foreword

Fig.1: Dr. Taha and PD Dr. Lädermann

Foreword by PD. Dr. A. Lädermann

Shoulder pain is a widespread and disabling complaint with a lifetime prevalence of up to 70%. Knowledge of the eight common shoulder conditions has increased tremendously over the last decades. General practitioners and occasionally specialists use acquired knowledge and their experience and clinical judgment to identify which investigations or treatments are clinically appropriate and likely to result in overall benefit. Unfortunately, even if doctors explain the options to the patients, setting out each option's potential benefits, burdens, and risks, patients' understanding of their conditions remains aleatory. One of the reasons is the complexity of the different pathologies faced.

The popularization of medicine is one of the United Nations Educational, Scientific and Cultural Organization (UNESCO)'s oldest programs, with the Kalinga Prize for popularizing science celebrating its 70th anniversary. When so many decisions are being made based on science, informing the public about the issues at stake is becoming increasingly important and a crucial component of informed consent.

Mohy Taha, like Ana Monnar, understood from the beginning of his medical career that "sharing will enrich everyone with more knowledge" and may bring patient empowerment. According to the World Health Organization, the latter is "a process through which people gain greater control over decisions and actions affecting their health." Care providers can increase their patients' involvement in many ways, such as sharing patient education materials. Consequently, this book is not only dedicated to health care professionals but also to patients.

I am very fortunate to count Mohy Taha as both a dedicated colleague and friend. I have learned considerably from him during presentations and discussions. I trust this book will become another bestseller and assist anyone interested in the shoulder to discover more about this unique human joint with its complex functional structure and interrelations.

Alexandre Lädermann, MD, Honorary Lecturer

Founder of BeeMed

Orthopaedic Surgeon FMH

Shoulder and Elbow Surgery Traumatology

Sports Medicine SSMS

Geneva, Switzerland

Foreword

Fig 2: Dr. Taha and Prof. Athwal

Foreword by George S Athwal

The shoulder is one of the most complex joints in our body. It is an amalgamation of bones, tendons, muscles, and nerves that work in concert to provide a stable foundation to the upper extremity and the greatest range of motion. This complex intricate joint, however, is prone to injury and degeneration. Typically, injury or degeneration to the shoulder presents as pain however it can also present as stiffness, weakness, or instability. To identify the etiology of shoulder symptoms with the goal of treating them can be challenging.

This wonderful book, authored by Dr Mohy Taha, is the traveler's guide to negotiating shoulder pain. Dr Taha is an expert shoulder surgeon with an international reputation, who has an amazing ability to explain complex conditions in simple ways that are easy to understand. In reading this book, it is as though the reader is having a fireside casual chat with Dr Taha. I can almost imagine him sitting in a Baroque-style high back chair, explaining shoulder pain and its aetiologies, using his distinctive hand gestures for emphasis. This book is a treat to read.

In this text, Dr Taha breaks down the 8 common causes of shoulder pain. He discusses presentation, examination, investigations and treatments. Additionally, he highlights the pertinent anatomy and important take away messages. As such, this book is very well suited to primary care physicians as well as sports physicians, physiotherapists, nurse practitioners, medical students, residents and fellows.

In addition to the topic of shoulder pain, a hidden gem in this book is the chapter on mentors. Dr Taha outlines the importance of mentors, the influence mentors have had on him, and gives advice on how to become a great mentor. This chapter is a must read for any person responsible to learners. Finally, the second half of this text is dedicated to patient satisfaction. This section does not only apply to shoulder pain, but is applicable to all aspect of medical care. Dr Taha explains the importance of several factors as they relate to patient satisfaction. Additionally, several often under recognized factors, such as the hospital kitchen, administration, insurance, and implants are discussed. I congratulate Dr Taha on this great accomplishment. Happy reading!

George S Athwal

Professor of Shoulder & Elbow Surgery

St Joseph’s Health Care

University of Western Ontario, Canada

Acknowledgments

"To be a master, you need a master".

Big thanks to Katharina Ottinger, Isidora Ceculovic, and Jasmin Gwynne. Without their help/support and excellent work, this book would not have been finished.

Many thanks to George Athwal, MD, Mohit Bhandari, MD, David O’Briain, MD, John Erickson, MD, Natalia Ipatow, PhD, Dominique Nigg, and Madleina Taha-Ludwig, MD, for their valuable feedback.

A thousand thanks to Madleina (my wife), Loay (son), and Safeya (daughter) for supporting me and for doing without me while I work and write this book.

Furthermore, if I am good, it is partly due to the excellent mentors who believed in me and supported me over the years. They have guided me, given me insights, and shared their experiences, which have undoubtedly helped to accelerate my career. Without them, I would not be where I am now.

Last but not least, I would like to thank my mother (Samia), my brother (Shady), my in-laws (Annelis and Christian) and my friends/colleagues who are always there when I need them.

Introduction

Fig. 3: Dr. Taha around the globe on his fellowships with colleagues

01

From medical student to fellowship-trained consultant

I was born with a fascination for medicine. Inspired by my mother, who worked as a pediatrician, I enrolled in human medicine studies in Cairo in 2000. Two years later, I quickly realized that I wanted to go on to specialize in orthopedics.

This decision was based on an event that happened when I was nine years old. While playing football, I suddenly experienced pain in my knee. As a result, I went to see an orthopedic surgeon. Through his advice and the physical therapy exercises, the pain disappeared. This experience had such a profound impact on me and paved the way for my decision to become an orthopedic surgeon.

Back then, orthopedics in Germany had an outstanding reputation in the Middle East with many successful football players and politicians treated there.

My desire to improve professionally in this field was strong, so the idea of learning from the specialists in Germany seemed obvious. In 2003, I went to Germany and did a one-month internship at the Charité Berlin.

This internship reinforced my dream of becoming a specialist in the field of orthopedics. Although I did not speak German, the hospitality and warmth of my colleagues and supervisors made me feel so comfortable that one thing quickly became clear: I wanted to come back.

Back in Cairo, I continued my studies and became head of the exchange program for international students. As luck would have it, that's how I met my wife - she was a medical student in Switzerland doing an exchange program in Cairo.

Pretty soon, I wondered how I was going to continue my journey. To be closer to my wife and save myself expensive plane tickets, I decided to return to Europe. Since I hardly knew anyone in Switzerland but had had good experiences in Berlin, I contacted my supervisors from Charité Berlin.

This allowed me to cut thousands of kilometers down to just a few hundred. To be closer to my wife, I decided six months after my first stay in Germany to stay on and complete my research and PhD thesis there.

Coming from the Arabic-speaking world, the German language was a challenge. Since I didn't speak German but wanted to learn it, I decided to ‘kill two birds with one stone’. For a whole year, I worked in the lab from 8am to 5pm then spent three more hours (6pm to 9pm) five days a week in a German language course.

I dedicated this time and seized every opportunity to realize my dream, even when it meant doing my German homework on the metro. After a year of gritting my teeth, my diligence paid off and I was able to successfully pass the German language exam for university enrollment.

Although I planned to finish my PhD and studies in Germany, the many requirements and hurdles for foreign students blocked my plans. But where there's a will, there's a way and after the interim year in Germany, I returned to Egypt in 2005 to complete my studies two years later.

After graduation, I went to Switzerland in 2008 and started my practical year. In 2009, I specialized in orthopedics and traumatology of the musculoskeletal system during my internship. While studying at Balgrist University Hospital in Zurich, I met Prof. Christian Gerber, a renowned shoulder and elbow specialist. This encounter inspired me profoundly and led to choosing shoulder and elbow surgery as my specialty in 2013.

After finishing my internship in 2015, I completed a series of fellowships in other countries. I learned from many specialists in Australia, working for a year in Sydney in shoulder and elbow surgery and six months in Brisbane in shoulder and elbow traumatology.

From 2017 to 2020, I worked as a senior physician for shoulder and elbow surgery at the University Hospital Basel under Prof. Andreas Müller.

To further deepen my knowledge in shoulder and elbow surgery and learn from the best of the best all over the world, I also completed various training courses on almost every continent between 2013 and 2020.

Despite the plethora of digital opportunities nowadays such as online congresses, online videos, online meetings etc. surgery is a craft that is difficult to learn digitally.

Would you fly with a pilot who only learned to fly online? Likewise, the surgeon needs hands-on practice in order to provide the best medical care.

Motivated to become a consistently better surgeon, I traveled the world, learning the most recent techniques, examining the latest medical research findings, and connecting with numerous people. I did so because I am convinced that to become a master, you have to learn from the masters:

In North America: Mark Morrey and Bassem Elhassan at the Mayo Clinic, Minnesota; Luke Oh and Jon Warner at Harvard, Boston; Mark Frankle in Tampa, Florida and George Athwal in Ontario, Canada.

In Europe: Jean Marc Glasson and Laurent Lafosse in France; Florian Drumm, Peter Habermeyer and Borris Hollinger in Germany; Mathias Zumstein, Ralf Hertel, Karl Wieser, Alexandre Lädermann and Gregory Cunningham in Switzerland.

In Australia: Allan Young, David Sonnabend, Jeff Hughes, Benjamin Cass in Sydney; Alok Jhamb, Mark Robinson, Greg Couzens, Steven Frederiksen, Phil Duke and Mark Ross in Brisbane.

My time abroad and interaction with experienced teachers and surgeons significantly enriched me and I aspired to make my experiences accessible to surgeons, students, specialists, and many others.

This mindset prompted me in 2019 to launch www.myfellowship.com to connect people who are looking for a fellowship with those who have completed or are offering them, regardless of field of expertise. This platform provides everyone the opportunity to make contacts and search for suitable fellowships.

In my best-selling book "The Swiss Made Egyptian", I described the journey from medical student to trained senior physician - how to pave your medical career success path.

Fig. 4: Medical Career Success Path

Since November 2020 I have been running my own practice in Aarau and Rothrist in Switzerland.

www.shouldersurgeon.ch

I have met and continue to meet many beautiful people on my career path whom I consider mentors. The longer I think about it, the more I realize how significant mentors and role models have been in my life. I would like to share some of the things I have learned with you so that you too can grow and, should you ever think you have to give up at any point, I strongly advise you to ask for help.

# Never_stop_learning

02

The importance of mentors in life

Throughout my life, I’m always looking for mentors - people who have achieved the goals I have in mind for myself. Because of my mentors, I have been able to achieve my goals, and it is with their continued support that I aim to continue achieving them.

At this point, I would like to mention some significant mentors of mine: Philip Stahel, Dr. Nikolaus Renner, Prof. Laurent Audige, Prof. Christian Gerber and Prof. Andreas Müller.

As I see it, mentors help you when you encounter obstacles on your medical career path and they also point out new opportunities. They play pivotal roles in our development as competent and caring physicians, so we should do what we can to nurture the mentor relationships we have in our lives and cultivate new ones.

While I concentrate on mentors within the medical field in this book, I should point out that you can have great mentors or role models who are not in this field. Friends, family members, teachers, coaches or even famous people that you’ve never met but whose books you read - these people can all teach and guide you. Someone, who you might initially not expect to be an excellent guide for you, could teach you something insightful. I like to think that I’m providing you a kind of mentorship as well, through this book, even if we don’t know each other beyond these pages.

Mentors can be very helpful in life. Here are some of the main advantages.

Key Support in Hard Times

Something we return to, again and again, in this book is the concentrated, dedicated effort it takes to get into medical school and pass through all the stages to emerge as a fellowship-trained consulting physician. I also argue against a tunnel-vision focus on studying, studying, studying during medical school. I want you to broaden your horizons to not only do all the studying and passing of tests and do it well, but to add on to that clerkships, internships, observerships, and fellowships with other doctors in other countries. But to accomplish all that I challenge and urge you to go for, there will be setbacks along the way. You will experience times when you feel overwhelmed and something doesn’t go your way. Perhaps you don’t land that internship at the clinic you wanted, or you don’t pass a critical test. When you encounter these inevitable failures and defeats, this is when you need a mentor. Whether in the medical field or outside it, your mentor will listen to you and, when you are ready, give you the perspective you need to see the bigger picture. And they will remind you of all your other successes, which will provide you with the confidence to make it past the temporary defeat or failure.

Recognition of Your True Potential

Similar to the point above, it can be your mentor who recognizes your talents, abilities, and gifts much more than you do. I remember when I felt buried beneath and utterly defeated by the amount of paperwork I had to get translated and certified from medical school in Egypt to only possibly qualify for continuing my studies in Europe. And there were the costs too. I simply didn’t think it was possible. I was feeling totally dejected. I distinctly remember my mother looking me in the eye and telling me, “Son, if there’s anyone in the whole world who can make this happen, it is you. This is just jumping through bureaucratic hoops. You’ve navigated more difficult obstacles. I know you can do this too. Simply be persistent.” Her belief in me in that moment gave me the energy and confidence boost I needed. That’s what a mentor can do for you.

A Good, Hard, Honest Look