- Arthritis
- UltrasoundWorldwide, the number one reason that shoulder replacements fail is that the front rotator cuff tendon, the subscapularis, fails to heal well after it has been detached during the traditional exposure of the shoulder joint. In fact, improper healing of the subscapularis has been noted by ultrasound in up to 50% of total shoulder replacement patients in multiple studies. In 2014, it came to me (in a dream) that an approach to the shoulder might be made between two of the rotator cuff tendons, the subscapularis and the supraspinatus, through the rotator interval where the biceps long head tendon exits the joint. So, I went to the lab and developed the approach, which does not detach any cuff tendons and gives an outstanding view of the glenoid socket. Since October 2014, every one of my hundreds of ‘anatomic’ shoulder replacements has been done using this approach.
- MRITh cervical nerve roots, which are the levels most commonly effected by ruptured discs or pinched nerves. A good history and exam are very helpful in sorting out the problem. MRI is extremely helpful as well, as can be nerve conduction studies.
- OrthopedicsDr. David P. Adkison is a decorated Navy Veteran who served as Chairman of the Department of Orthopedics at the National Naval Medical Center, Bethesda and as Attending Orthopedic Surgeon for the White House Medical Unit and the US Capitol Physician’s Office. His patients have included the President, members of Congress, members of the Cabinet, Supreme Court, foreign dignitaries and elite military warriors. Dr. Adkison’s focus is almost exclusively on treatment of shoulder problems, although he still performs routine arthroscopic knee surgery. He is a member of Alpha Omega Alpha, the national medical honor society. Dr. Adkison has a patent pending on a new technique he developed for total shoulder replacement surgery that allows immediate motion, is much less painful, utilizes a 3 inch incision and yields superior outcomes compared to the traditional approach. He also is the founder and senior surgeon of American Physicians Group practicing at SUHA Hospital in Suzhou, People’s Republic of China.
- ArthroscopyThe referenced article for early motion is: Early Active Motion Versus Sling Immobilization After Arthroscopic Rotator Cuff Repair: A Randomized Controlled Trial. Arthroscopy, Vol 35, No 3 (March) 2019: pp 749-760, Sheps, et.al. This hallmark article is Level 1 evidence (the best scientific high-quality study) that shows no difference in healing rates at 24 months after surgery between the two groups. I have long been an advocate for early motion after rotator cuff and/or labral repair.
- Orthopedic Surgery
- Arthroscopy
- Knee Replacement
- Knee Arthroscopy
- Cyst
- Sports Medicine
- Physical TherapyBecause the rotator cuff is not detached, we can allow people to remove the sling the day after surgery and begin to move the shoulder to the limits of comfort. Physical therapy duration is greatly shortened and many (but not all) people have a normally functioning shoulder with normal range of motion by 6 weeks. Furthermore, the surgical pain is greatly decreased because the muscles are not as traumatized during this approach and a large percentage of people choose to have the replacement done as out-patients. I have designed tools that allow this technique to be performed safely and precisely; patents are pending on the tools and the technique and we have established a program to bring experienced shoulder surgeons to Birmingham to learn the approach and how to properly use the tools.
- Frozen ShoulderFrozen shoulder is one of the most painful problems a person can have with their shoulder. In most cases, there is no known reason that it started, but the problem rather quickly results in painful loss of motion. The lining of the joint becomes intensely inflamed and leads to motion loss, most notably in reaching to the side and reaching behind. While the cause isn’t known, about 75% of people who get frozen shoulder are women, often with some recent hormonal fluctuations, especially associated with menopause. About 20% of people presenting with frozen shoulder are men, but they have often had a recent trauma that jarred the shoulder, probably causing some bleeding into the joint that led to the inflammation. The other group of people prone to develop frozen shoulder are diabetics, possibly because of some degree of neuropathy.
- Shoulder Pain