about releases, I have two talks, so they're a little redundant. So this one will be just on releases and it can apply to cuff and arthritis. And then the second one will be about how to treat it. So why do releases? Well, it improves your visualization, it decreases tension on repairs, it eliminates superior displacement with active patients with arthritis in the shoulder, and can restore normal gliding patterns in the early arthritic and even mid-arthritic shoulder by decreasing joint reaction forces. And here you see us doing a release and preserving the biceps. So what are releases? Well, the removal of abnormal structures, adhesions under the deltoid, scar tissue, selective cutting of normal structures like the capsule, rotator intervals, and the corticohumeral ligament to provide normal gliding patterns of the shoulder. Again, we're trying to restore anatomy. So what can you release in an arthritic shoulder? You can release everything. You can release the capsule, all or some selectively, the capsule, deltoid bursa, very importantly, corticohumeral ligament, rotator interval, posterior interval, questionably, suprascapular nerve, if necessary. So with rotator cuffs, the release is going to increase as the tears increase. So this is an arthritic shoulder with a cuff tear. You can see the contractures on the inferior capsule. I like to use a hook cautery because it's more precise. If you're a little rough with your instruments, then this is not the instrument for you. You should use a side effect. But here you are coming down and you can see how thick that capsule is. And you don't have any chance to restore that gliding pattern unless you can release that capsule. And look at the inflammation back over here as a part of that. We'll move on. You can do intra-articular releases. Again, here's the biceps. And if it's part of the pathology, you want to take it. If it's not part of the pathology, leave it. And you can see the adhesions here in this intact rotator cuff underneath it. And then as we move across to the back, again, multiple more red adhesions. This is all stuck down. So in an arthritic shoulder and a rotator cuff that has these adhesions, you have no chance of winning unless you know to do the releases. If you wonder how much it can do, so we do subacromial releases as well. And you want to stay right on the bone. Slip this down and preserve your medial bursa over here. But all of this tissue is stuck. I would submit when you're going into an arthritic shoulder and a shoulder with a rotator cuff disease, you want to make sure that you're not excising cuff tissue. You want to be above that, not below it, and certainly not into it when you do these because it's a stiff, stuck shoulder. And you can see the amount of adhesions around the back. Take all of that down. Let all the tissue drop down. And then decide what you want to resect later. Subacromially, if you have a cuff tear like this, you release under the cuff and over the cuff to make sure you free it up. We'll skip that part. Bursa releases are very important. How do you get to the coracohumeral ligament? Well, looking from lateral, you want to move to the front. This is not something you can do a complete release on intraarticularly. You really need to move and take all of these adhesions down across the side so that you can come down and find that coracohumeral ligament. And you find this by moving over, finding the conjoined tendon, move it into this area. So you pull the head back just like you would with a subscap. And you'll see this thick structure on the poster side and super side of the coracoid. And you want to take that down all the way, just like Joe Toro talked about, an inter-interval slide. In your arthritic shoulder, in your massive rotator cuff tears, this is stuck down. You have no chance to win this battle unless you take this tissue down completely. And you cannot do a complete release from inside. There are two bands. One goes to the subscap. One goes to the supraspinatus. If you do it correctly, as you move in here, and we'll show you what this looks like in its finished product. When you look back over here, this is the coracoid. This is it slid across. That's the rotator cuff. When you do this correctly, you should be able to pull the head down and everything will come back together for you. So a complete coracohumeral release, again, very important part of this. Joe Toro talked about the inter-interval slide. Again, that's just continuing further over. As you go all the way to the bottom, you'll get all the way to the suprascapular nerve. Here we have a retractor. Here we're releasing it. This is our notch. And here's the artery above. The nerve is going to be below. And you want to take that down. Again, in extreme cases of a lot of scar tissue and multiple previous surgeries, that puts you over here where you can actually see the nerve now and where the ligament's been released. And everything is free and easy to move around and give you a better result. So release techniques are knowing how to do releases. It makes every rotator cuff tear repairable. It gets you all of your motion back in a shoulder. The decision to do these really needs to be a preoperative decision. It's one step in successful management of stiff shoulders. Everything else is also essential. Thank you.

shoulder conditions

cuff tears

arthritis

releases

treatment