Assessment and

Management of Disorders of

the Knee, Shoulder, and Hip

William D. Stanish, MD, FRCS(C), FACS, AOAProfessor Emeritus, Department of Surgery

Dalhousie University, Halifax, Nova Scotia, Canada

Director, Orthopaedic and Sport Medicine Clinic of Nova

Scotia

My Disclosures

The Plan of Attack

1. Introduce the subject

2. Some facts about the area

3. Present the case profile

4. Introduce you to the actual patient

5. Offer some “Take Home Pearls”

My Philosophy

Guiding Principles

Pearl #1“Understand the natural history of

the disorder”

Pearl #2“Always be a skeptic”

Pearl #3“Form follows function”

Hippocrates – 350 BC

The Knee – Facts

1. Knee Fact - Intrinsically

unstable

2. Knee Fact - Easily injured

3. Knee Fact - Slow to heal

Introducing the “Knee

Patient”

Her Story

• Her Examination

33 y.o. Graduate Student

Very active

Injured her right knee in

roller derby

Persisted with “some” pain

Knee Pearls

1. If it hurts – Danger

2. If it swells – Danger

3. Surgery is not always

required

The Shoulder - Facts

1. Shoulder Fact - Intrinsically

unstable

2. Shoulder Fact - Pathology

dictated by age

3. Shoulder Fact - Slow to heal

Introducing the

“Shoulder Patient”

His Story

• His Examination

• 78 y.o. very active

gentleman

• Bilateral shoulder pain

• Difficulty with sleeping

• Rotator cuff tears

Shoulder Pearls

1. Cuff tears are common

2. Surgery is not always

required

The Hip – Facts

1. Hip Fact – Intrinsically stable

2. Hip Fact – Diagnostic Challenge

3. Hip Fact – Usually not surgical

Introducing the “Hip

Patient”

Her Story

• Her Examination

58 y.o Physiotherapist with

periodic hip pain –

sometimes severe!

Hip Pearls

1. Listen to the patient

2. Be prepared to “wait it out”

3. No rush to surgery

“THE PHILOSPHIES OF ONE AGE

HAVE BECOME THE

ABSURDITIES OF THE NEXT”

~ Sir William Osler