Tendon injuries and nerve entrapment of the shoulder and elbow

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Ultrasonography, magnetic resonance imaging, and arthroscopic evaluation are playing increasingly important roles in the assessment of shoulder pathology, particularly in quantifying the size of rotator cuff tears. Management of massive rotator cuff tears remains controversial, for there is now evidence to suggest that elaborate and complicated augmentation of these tears may offer little or no advantage over simple acromioplasty and debridement of the torn cuff. Arthroscopy has also opened up the opportunity for evaluation and treatment of lesions of the superior labrum involving the biceps tendon attachment; these lesions were not previously recognized and are often responsible for symptoms in the throwing athlete. Around the elbow the pathologic features of lateral and medial epicondylitis are better defined as degenerative rather than inflammatory. Surgical management can be beneficial for these conditions, as it is for rupture of the distal biceps. Nerve entrapment syndromes around the shoulder and elbow are uncommon but serious causes of disability. Although often difficult to confirm clinically, they are amenable nonetheless to successful surgical treatment.

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