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Orthobullets Self-Assessment Exams - Subscapularis; Listen Now 5:49 min. 8/13/2020. 31 plays. 0.0 (0) of images. Private Note. Cancel Save. test388138 Jul 26 - Jul 29, 2021. New York city Register | 0 Days Left Learn more . test922557 Jul 29 - Aug 01, 2021. Subscapularis and Rotator Cuff Repair- Arthroscopic. supervises appropriate surgical prep and draping of the field. place the scope sheath with a blunt trocar into the glenohumeral joint with the arm in 70° of abduction and 10° of forward flexion with approximately 10# of traction. insert the 30° arthroscope

Video: Subscapularis and Rotator Cuff Repair - Orthobullet

supraspinatus is 12.7mm (covers superior facet of greater tuberosity) 6-7 mm tear corresponds to 50% partial thickness tear. infraspinatus is 13.4mm. subscapularis is 17.9mm. teres minor is 13.9mm. distance between articular cartilage to medial footprint of rotator cuff is 1.6-1.9 mm. AP dimension of footprint is 20mm Subcoracoid Impingement. Subcoracoid impingement is the impingement of the subscapularis between the coracoid and lesser tuberosity which can lead to anterior shoulder pain and possibly tearing of the subscapularis. Diagnosis can be made clinically with tenderness over the anterior coracoid which is made worse with shoulder flexion/internal.

Rotator Cuff Tears - Shoulder & Elbow - Orthobullet

most sensitive and specific test for subscapularis pathology. technique. stand behind patient, flex elbow to 90°, hold shoulder at 20° elevation and 20° extension. Internally rotate shoulder to near maximum holding the wrist by passively lifting the dorsum of the hand away from the lumbar spine - then supporting the elbow, tell patient to. the anterior cuff (subscapularis) functions to balance the posterior moment created by the posterior cuff (infraspinatus and teres minor) this maintains a stable fulcrum for glenohumeral motion. the goal of treatment in rotator cuff tears is to restore this equilibrium in all planes place the holes in the central axis of the coracoid about 1 cm apart. 5. Position the arm. externally rotate the arm keep the elbow by the side. 6. Expose the subscapularis. release for about 5 cm using mayo scissors. push the coracoid beneath the pectoralis major. this exposes the subscapularis muscle Suprascapular Neuropathy. Suprascapular neuropathy is compression of the suprascapular nerve that most commonly occurs at the suprascapular notch or spinoglenoid notch by a mass (i.e cyst). Diagnosis can be suspected clincally with weakness and atrophy of the infraspinatous or supraspinatous and confirmed with MRI studies showing cysts in the. Orthobullets Techniques are largerly incomplete at this time, and will see rapid improvement as they are updated by experts in the field over the coming months. Mastery Trigger: Check the Mark Skill as Read under each Step. 2) VIDEOS - only Orthobullets Technique Videos count

In this episode, we review the high-yield topic of Subscapularis from the Anatomy section. --- Send in a voice message: https://anchor.fm/orthobullets/messag Brachial Plexus. Standard: C5, C6, C7, C8, T1 - 77% of patients. suprascapular nerve (C5, 6): through suprascapular notch to supraspinatus, infraspinatus, AC and glenohumeral joints. axillary nerve (C5, 6): through quadrilateral space to teres minor, deltoid, major nerve supply to glenohumeral joint, superior lateral brachial cutaneous nerve axillary nerve. posterior circumflex humeral artery. divides into anterior and posterior branches within the quadrangular space. Terminal branches. anterior branch. wraps around the surgical neck of the humerus, running in the deep deltoid fascia with the posterior circumflex humeral artery. supplies the anterior deltoid muscle els anterior to the subscapularis, wraps around the surgical neck of thehumerus,andpassesthroughthe quadrangular space to innervate the teresminoranddeltoidmuscles(Fig-ure 1). The nerve lies between 4.3 and 7.4 cm from the lateral edge of the acromion.1 After entering the posterior third of the deltoid, the nerve travels along the deep deltoi

Subcoracoid Impingement - Shoulder & Elbow - Orthobullet

Shoulder Exam - Shoulder & Elbow - Orthobullet

Total shoulder arthroplasty unique from THA and TKA in that. greater range of motion in the shoulder. success depends on proper functioning of the soft tissues. glenoid is less constrained. leads to greater sheer stresses and is more susceptible to mechanical loosening. Factors required for success of TSA • Subscapularis (front of shoulder) • Biceps (front of upper arm) • Triceps (back of upper arm) Length of program: This shoulder conditioning program should be continued for 4 to 6 weeks, unless otherwise specified by your doctor or physical therapist. After your recovery, these exercises can be continued as a maintenanc 2021 Orthobullets PASS Hype Video. Orthobullets. June 14 at 4:39 PM ·. PASS is an analytics platform for residency and fellowship training programs. PASS provides curriculum solutions, conference technologies, and assessment tools in the domains of medical knowledge, patient care, and professionalism. Increase the value of your program and. Scapulothoracic Bursitis is a medical term for the condition which causes pain in the region of the scapula in the back of the shoulder. This condition is often associated with audible and palpable crepitation, and so it has also been named snapping scapular syndrome

MB BULLETS Step 1 For 1st and 2nd Year Med Students. MB BULLETS Step 2 & 3 For 3rd and 4th Year Med Students. ORTHO BULLETS Orthopaedic Surgeons & Provider Scapulothoracic bursitis, also known as snapping scapula syndrome, develops when there is a problem with how the shoulder blade moves over the rib cage. Inflammation of one of the two bursae that sit between the scapula bone and the subscapularis muscle affects how the shoulder blade moves causing friction, weakness and pain PEAK Skillmaster. 1500 Skill modules covering 150+ essential orthopaedic procedures. Each skill module is broken down into a task check list of rich educational activities and content to guide skill preparation. Self-mastery tracking allows surgeons to self-teach surgical skills, and keep track of their own progress The rotator cuff is perforated anterosuperiorly by the coracoid proc... ess, which separates the anterior border of the supraspinatus tendon from the superior border of the subscapularis tendon, creating the triangular rotator interval, which is bridged by capsule. The base of the interval is the coracoid process, from which capsular tissue (the coracohumeral ligament) originates

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  1. ences around shoulder girdle (AC joint) Muscles and soft tissues including deltoid rotator cuff tendon insertion / greater tuberosity trapezius biceps tendon in groove Range of Motion (patient supine) Compare active and passive motion, both sides, with the patient in seated or standing.
  2. or.. Summary. origin: subscapular fossa of the scapula; insertion: lesser tubercle of the humerus. some fibers also extend to the greater tubercle and bicipital groove; arterial supply: suprascapular, axillary and subscapular arteries
  3. Through a deltopectoral approach, the lesser tuberosity along with the subscapularis tendon was transferred into the defect. Conclusions: The modified McLaughlin procedure demonstrates excellent clinical and radiographic results after posterior fracture dislocation of the shoulder with a reverse Hill-Sachs lesion between 25% and 45%
  4. Subscapularis. To test for the presence of a subscapularis tendon tear, first have the patient to bring the hand on the back at the level of the lumbar region. Then, passively separate the hand from the back until full internal rotation of the shoulder is achieved. At this point ask the patient to actively keep the hand away from the back
  5. The superior subscapularis recess is located directly between the scapula and subscapularis muscle and tendon. It demonstrates a saddlebag appearance as it drapes over the superior border of the subscapularis muscle. Unlike the subcoracoid bursa, the superior.
  6. The Orthobullets Podcas‪t‬ Orthobullets Science 4.9 • 213 Ratings; A Daily High-Yield review podcast by Orthobullets⏤the Free Learning & Collaboration Community for Orthopaedic Surgery Education. A supraspinatus tear is a tear or rupture of the tendon of the supraspinatus muscle. For specific dislocation types please refer to the following articles: anterior shoulder dislocation (95%.

Patient is in supine position. Femoroacetabular impingement is characterized by decreased joint clearance between the femoral head/neck and acetabulum (ball & socket). 249 talking about this. For arthroscopy of the PC, the foot is kept in the traction module. 2. The Orthobullets Podcast In this episode, we review the high-yield topic of Femoroacetabular Impingement from the Sports section. Br. Subscapularis Tear Classification - LaFosse Laurent Lafosse, Bernhard Jost, Youri Reiland, Stéphane Audebert, Bruno Toussaint and Reuben Gobezie. J Bone Joint Surg Am. 2007;89:1184-1193. Based on Intraoperative Evaluation and Preoperative CT / MR Type Lesion I Partial lesion of superior one-thir this allows subscapularis to be identified beneath fascial layer; Role of CA Ligament: attaches to front and undersurface of acromion as a thick band and continues around anterolateral corner to attach to lateral ridge for a variable distance

The arthrotomy is repaired by suture closure of the capsule and then the subscapularis. Irrigate the wound. A drain may be placed if needed. Meticulous hemostasis should be maintained throughout the procedure. Persistent bleeding usually involves the cephalic vein or its branches, or the trio of inferior vessels on the tendon of the subscapularis The subscapularis is the largest muscle in the rotator cuff, which is a group of muscles that attaches your upper arm to your shoulder and helps you lift and rotate your arm. We'll explain what.

Suprascapular Neuropathy - Shoulder & Elbow - Orthobullet

Introduction The Putti-Platt procedure is a historic nonanatomic procedure for shoulder instability with promising initial outcomes but disappointing long-term follow-up. The procedure is based on an idea to tighten the anterior capsule and subscapularis with a subsequent accepted loss of external rotation in order to increase the stability o.. Orthobullets. Yesterday at 2:04 PM ·. Pectoralis major tendon ruptures (PMTR), once a rare injury, have recently been rising in incidence, likely due to an increasingly active population with a growing interest in weight-training and use of anabolic steroids. This injury occurs almost exclusively in males. The pectoralis major is composed of. This is a medical knowledge review topic. For a step-by-step Technique Guide click here.: Summary: Reverse shoulder arthroplasty (RSA) is a type of shoulder arthroplasty that uses a convex glenoid (hemispheric ball) and a concave humerus (articulating cup) to reconstruct the glenohumeral join

the subscapularis tendon. In older patients, this deformity may be less noticeable because of muscle atrophy.11 MECHANICAL ENTRAPMENT OF THE DISEASED LONG HEAD OF THE BICEPS TENDON Inrotator cufftears, the LHBT canbe mechanically entrapped intra-articularly or inthe bicipital groove. Boileau and colleagues11 described the hourglass biceps, which i Contact between the subscapularis tendon and the coracoid process is also observed. A positive test result suggests an anterosuperior or an anterointernal impingement test. 41. With the examiner standing behind the patient, the hand on the ipsilateral side of the examined shoulder is placed on the contralateral shoulder The rotator cuff is what keeps the head of the humerus in place, and it is composed of the supraspinatus, infraspinatus, subscapularis, and teres minor tendons. The supraspinatus tendon is located on the back of your shoulder and helps your arm to move throughout its full range of motion - and helps with power and strength Coracoid impingement has been the topic of debate for a century.Most authors have identified coracoid impingement as a potential cause of anterior shoulder pain, particularly with movements requiring forward flexion, internal rotation, and horizontal adduction of the humerus. 1 Subcoracoid pain can occur as a result of compression of the subscapularis tendon or biceps tendon between the bony.

Scapulothoracic Crepitus - Shoulder & Elbow - Orthobullets

HAGL Injury. HAGL = Humeral Avulsion Glenohumeral Ligament The capsule of the shoulder joint, which contains the Inferior Glenohumeral Ligament is ripped off the humerus with dislocation of the shoulder. This is an injury that is probably associated with a higher risk of recurrent dislocations than a Bankart tear. A HAGL tear can be difficult to diagnose and should always be suspected Definition/Description [edit | edit source]. A supraspinatus tear is a tear or rupture of the tendon of the supraspinatus muscle. The supraspinatus is part of the rotator cuff of the shoulder. Most of the time it is accompanied with another rotator cuff muscle tear.This can occur in due to a trauma or repeated micro-trauma and present as a partial or full thickness tear The subscapularis tendon is identified and divided vertically lateral to the musculotendinous junction in line of the anatomical neck. Reflect the subscapularis from the underlying joint capsule and enter the joint through a vertical capsulotomy, medial to the lateral stump of the subscapularis Orthobullets. April 21 at 8:58 AM ·. The axillary nerve is a risk with low posterior (7 o'clock) portals. The axillary nerve leaves the axilla through the quadrangular space and winds around humerus on deep surface of the deltoid muscle and passes approximately 7 cm below tip of acromion

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this type of surgery is unable to compensate for such a loss. Furthermore, the subscapularis is important in centering the humeral head in both coronal and axial planes. Werner et al 23 explored the biomechanical role of the subscapularis in a cadaveric model, for the treatment of PSRCT with latissimus dorsi transfer Subscapularis muscle injury Lift-off test. Position patient's hand behind the back of waist level with palm facing out; Ask patient to move arm away from body against examiner resistance; Rotator cuff subacrominal impingement Neer Test. With the arm fully pronated, the examiner raises the arm above the patient's head in forward flexion movemen Enthesopathy is a health concern relating to the connection of joints and ligaments to a bone. It can feel like widespread joint pain. This article looks at how enthesopathy is caused, as well as. Learn about the 3 ways to test for a rotator cuff tear from Dr. Arlan Alburo of Orthopedic & Balance Therapy Specialists.If you are located in Northwest Indi..

Surgical Technique: Arthroscopic and subpectoral long head of biceps tenodesis Tenodesis of the proximal biceps leads to pain relief, preservation of function without deformity Biceps tendinitis may also refer to tendinosis, which is a syndrome of overuse and degeneration. Older patients (i.e., athletes older than 35 years or nonathletes older than 65 years) may have. Shoulder Surgery & Sports Trauma. Dr Ayyappan V Nair, who is a Shoulder and Sports Injury Specialist Surgeon at Manipal Hospitals consulting at Jayanagar, Whitefield and Malleshwaram branches. Dr Ayyappan's and his team aims to provide the latest and cutting edge treatment in Shoulder Surgery and Sports Medicine Although shoulder pain is the most common symptom, about one-third of people with calcific tendonitis don't experience any noticeable symptoms. Others may find that they're unable to move.

Anatomy⎪Subscapularis - The Orthobullets Podcast - Lyssna

Brachial Plexus - Anatomy - Orthobullet

New to Orthobullets? Join for free. ortho BULLETS. MB BULLETS Step 1 For 1st and 2nd Year Med Students. Comparison of lesser tuberosity osteotomy to subscapularis peel in shoulder arthroplasty: a randomized controlled trial. General E PDF: 3409 25844592. Orthobullets is an educational resource for orthopaedic surgeons designed to enhance via the communal hip osteonecrosis on flexor tendon injuries on. Hip flexor pressure hip flexor harm iliopsoas pressure. Reasons of a hip flexor strain. Subscapularis : internally rotates the humerus and in certain positions, the subscapularis provides. The subscapularis and supraspinatus tendon insertions along the lesser and greater tuberosities, respectively, blend with those of the CHL and are thus intimately associated with the biceps pulley [7, 8]. Injuries to any of these components of the sling are referred to as pulley lesions [9, 10] Your shoulder is a ball-and-socket joint made up of three bones: your upper arm bone (humerus), your shoulder blade (scapula), and your collarbone (clavicle). There are two attachments of the biceps tendon at the shoulder joint. The head of your upper arm bone fits into a rounded socket in your shoulder blade. This socket is called the glenoid

The subscapularis tear can now be repaired to bone, leaving a U-shaped posterosuperior rotator cuff tear to be repaired. (E) The residual U-shaped posterosuperior rotator cuff tear is repaired with side-to-side sutures using the principle of margin convergence. (F) The converged margin is then repaired to bone in a tension-free manner.. Massive, contracted, immobile rotator cuff tears involving the subscapularis, supraspinatus, and infraspinatus tendons present difficult surgical challenges to the arthroscopic surgeon. We describe the interval slide in continuity, a release and resection of a portion of the coracohumeral ligament and rotator interval M. subscapularis Humerus M. deltoideus part ant. M. pectoralis maj. Route of delto-pectoral exposure . Caput 'ongum m. biceps brachii . Fukuda ring retractor Burr cortical bone Carter Rowe spike . Author: Lennard Funk Created Date The shoulder is the site of multiple injuries and inflammatory conditions that lend themselves to diagnostic and therapeutic injection. Joint injection should be considered after other therapeutic.

The subscapularis muscle is one of the four rotator cuff muscles, being the largest and strongest one of the group. Situated in front of the shoulder, the subscapularis brings 53% of the total rotator cuff strength, having several key roles in the dynamics of the arm. First of all, the subscapularis is the main muscle involved in the turning of. Postoperative change and scar tissue can be visualized at the subscapularis incision, with passage of the conjoined tendon of the short head of the biceps tendon and/or coracobrachialis distally through the subscapularis defect . Figure 21. Normal postoperative findings after a Latarjet procedure in a 23-year-old man The subscapularis, supraspinatus and biceps pulley can all be best visualised arthroscopically and also dynamically assessed. Ultrasound scans showing biceps tendonitis on the left (fluid in the biceps sheath) and a dislocated LHB on the right (arrow) Pulley tear at arthroscopy in an overhead athlete. TREATMENT. 1. Physiotherapy

Acromiohumeral interval is a useful and reliable measurement on AP shoulder radiographs and when narrowed is indicative of subacromial impingement +/- rotator cuff tear or tendinopathy. Measurement The shortest distance is measured. Plain. How to Perform a Subscapularis Repair Foundation for Orthopaedic Research and Education (FORE) > How to Perform a Subscapularis Repair Previously said to be the the forgotten tendon of the shoulder, the subscapularis tendon has received greater attention in recent decades, and surgica Pediatrics - Orthobullets - Pediatric orthobullets. CAN IMPROVE ROM 40-50 degrees. Woodward; detachment and reattachment of medial parascapular muscles at spinous process origin to allow scapula to move inferiorly and rotate into more shoulder abductio The objective of this study was to evaluate the role of biceps tendon sheath effusion detected on ultrasound as a diagnostic clue to rotator cuff pathology. Despite being the most common cause of shoulder pain in adults early sonographic changes of rotator cuff tendinopathy are easy to miss. A total

Rotator cuff. In the human body, the rotator cuff is a functional anatomical unit located in the upper extremity . Its function is related to the glenohumeral joint, where the muscles of the cuff function both as the executors of the movements of the joint and the stabilization of the joint as well. Injuries of the rotator cuff interfere with. For the full series of shoulder examination tutorials, visit the AMBOSS Library: https://go.amboss.com/OrthoShoulderExamThe belly press test is used to test. Latarjet described a similar procedure in 1954, in which he transferred the tip of the coracoid along with the conjoined tendon through a horizontal slit in the subscapularis and fixed it with a screw. [] Many other surgeons have described variations of the procedure; however, the common aspect of most current techniques is fixation of the transferred coracoid to the scapular neck with a screw Chris Mallac explores the anatomy of the 'rotator cuff cable' and the associated 'crescent'.Why is this cable important when assessing and treating rotator cuff injuries, and what are the implications for clinicians? The unique anatomy of the shoulder rotator cuff, is a genuine concern for the clinician dealing with large tears of the supraspinatus Subscapularis debate Can do through subscap split if wanted Outcome directly linked to strength and function of subscapularis- (Sachs et al AJSM '05) Shoulder strength slower to return after open repair BUT NO DIFFERENCE at one year - (Rhee et al AJSM '07) Randomized trial scope versus open - n

Axillary Nerve - Anatomy - Orthobullet

813-684-BONE (2663) www.OMGTB.COM Reverse Total Shoulder Arthroplasty Protocol General Information: Reverse or Inverse Total Shoulder Arthroplasty (rTSA) is designed specifically for the treatmen Diagnosing subscapularis injury is clinically difficult and assessment of subscapularis integrity may be limited during arthroscopy or open surgery. It is important to assess the superior portion of the tendon, close to the biceps tendon, on the transverse view [Figure 5] for any tears

Anatomy⎪Subscapularis - The Orthobullets Podcast - Podtai

Subscapularis is a large triangular-shaped muscle that lies below the other three. It's the strongest, largest, and most used of the four rotator cuff muscles. It participates in most shoulder. The subscapularis is a powerful stabilizer preventing anterior displacement of the humeral head (particularly with overhead throwing movements). (2) MOVEMENT — isolated contraction of individual cuff muscles results in abduction (supraspinatus), external rotation (infraspinatus, teres minor) and internal rotation (subscapularis). (see Figure 5 If the patient is unable to move their hand off their back this may indicate pathology of the subscapularis muscle (e.g. tendonitis/tear) or a subscapular nerve lesion. Internal rotation against resistance (Gerber's lift off test) Scarf test. The scarf test assesses the function of the acromioclavicular joint. 1 The confluence of the subscapularis tendon and the underlying capsule was shaped like an inverted right triangle, widest superiorly and tapering off inferiorly as shown in Figure 3. Superiorly, the confluence extended 16.7 ± 6.0 mm from the medial border of the lesser tuberosity. The length of the confluence along the medial border of the.

Presence of a mechanical block to reduction, Post reduction displacement > 5 - 10 mm in any plane requires ORIF are the indications for a Shoulder Greater Tuberosity Fractures Surgery. Dr. Amyn Rajani, the best Orthopaedic Surgeon in Mumbai is an expert in treating different Shoulder Fractures tenodesis. The subscapularis was then evaluated and repaired if the tear was 30% or more of the upper subscap-ularis tendon. In the case of retracted subscapularis tears, a 3-sided arthroscopic release was performed, preserving the comma tissue, which connects the upper subscapularis to the anterior supraspinatus tendon. After repair of th Rotator cuff tears, particularly those that involve the subscapularis tendon; Persistent rotator cuff tears (> 3 months) These pathologies can lead to biceps tendinopathy due to the repeated trauma by overuse and improper biomechanical circumstances movement patterns. As the long head of the biceps tendon rests encased in its synovial sheath.

Subscapularis: Origin, insertion, action, innervation Kenhu

Scapular winging symptoms vary from person to person depending on the underlying cause as well as the muscles and nerves involved. Most people with scapular winging have a shoulder blade that. Introduction. The definition of a chronic shoulder dislocation is not clear in the contemporary literature. Various authors have used different cutoff values in the description of chronic dislocations, ranging from 24 hours to 6 weeks. 1 For the purposes of this chapter, we agree with Griggs and Iannotti, 2 in the use of 3 weeks as the defining time point Hydroxyapatite deposition disease (HADD) is an extremely common disorder causing periarticular disease in the form of tendinitis or bursitis. Only rarely does it cause true articular disease. Calcium hydroxyapatite deposits in muscles, capsules, bursae, and tendon sheaths. Although this deposition is associated with many systemic diseases, such as collagen vascular diseases, renal.

Scapular Winging - Shoulder & Elbow - Orthobullet

  1. Parsonage-Turner syndrome (PTS), known by other names such as brachial neuritis and amyotrophic neuropathy, is a clinical syndrome involving the peripheral nervous system, the vast majority involving nerves arising from the brachial plexus
  2. The long head of the biceps (LHB) tendon is a potential source of shoulder pain encountered by orthopaedic surgeons. A multitude of approaches to addressing LHB tendinopathy have been described. These include various surgical techniques such as tenodesis versus tenotomy, an arthroscopic versus an open approach, and differing methods of tenodesis fixation
  3. The Buford complex is a relatively rare and under-recognised variant of normal shoulder anatomy that affects the antero-superior labrum and the middle glenohumeral ligament (MGHL). Some researchers believe it is a 'normal' variant, which is found infrequently in shoulders on MRI and routine shoulder arthroscopies

Orthobullets - Calcific tendinitis of the rotator cuff

  1. Occipital Neuralgia is a condition in which the occipital nerves, the nerves that run through the scalp, are injured or inflamed.This causes headaches that feel like severe piercing, throbbing or shock-like pain in the upper neck, back of the head or behind the ears
  2. Bicipital peritendinous effusion (BPE) is the most common biceps tendon abnormality and can be related to various shoulder ultrasonographic findings. Since the association of BPE with subacromial.
  3. Scapulothoracic bursitis refers to inflammation in the bursa under the shoulder blade. Also known as Snapping Scapula Syndrome, scapulothoracic bursitis occurs when the muscles underneath the scapula weaken and lead to a closer proximity between the scapula and the ribcage at rest and in motion. When the scapula cannot easily glide along the.
  4. or, and conjoint tendon. Thereafter, a suture anchor (6.5-mm SwiveLock double-loaded with FiberTape, Arthrex) is placed in line with the intramedullary canal of the coracoid. The 2 suture tapes are then whipstitched through the fracture fragment and conjoined tendon and secured using a zip tie technique (Fig 5)
  5. g increasingly more common and almost exclusively occur in otherwise healthy males between the ages of 20 and 40 years old

SLAP Repair - Shoulder & Elbow - Orthobullet

AAOS SAE Questions - Anatomy - Orthobullet

Subscapularis Tendon Anatomy - Human Anatomy

Scapulothoracic Bursitis Boston Shoulder Institut

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