I'll ask a question to Brian. Brian, you said something about not taking out the distal clavicle because of the osteolysis, but if you do, in your technique, when you're dealing with contact athletes, you're not drilling holes, so you're kind of mitigating that risk. When you do drill the holes and put the graft through the clavicle, do you think that taking out a centimeter of the distal clavicle decreases the transmission of force, it could decrease the fracture risk, because you're not likely to transmit force through the AC joint in that way. So, any thoughts on that? Yeah, I guess I haven't thought about it that way. I think there's been some shift, you know, certainly when Gus first described this, we always took out a centimeter, you know, it was just kind of part of it, but I think more often than not, the clavicle is still in pretty good shape that you could put it back, and I used to worry about that, that all these people are going to advance on to arthritis with their AC joint, I've just not seen that over 20 years. So I, personally, I will reshape the clavicle a little bit, and not get too terribly aggressive with resection, because I do think some of just getting that, the bones closer together, I think has been, it has a little bit of a stabilizing effect. That would be my thoughts, so again, whether they're contact or non-contact, I try to not take a lot of bone laterally, unless I have to. Right. Chris, I had a case I wanted to show, we're obviously not going to get to cases, so I wanted to ask you one question. An athlete or younger patient that has combined pathology like you talked about, so a snapping scapula and let's say a slap tear in an athlete who's been dealing with it for a while, how do you address that surgically? Are you going to just address the slap tear, and see if the scapula gets better, or if their primary complaint's the scapula, you're going to try to address both of those at the same time? I will try and address the primary intra-articular process first, and then we focus on PT to hopefully get them to retrain their scapula to behave better. And if they're still having symptomatic snapping, then we would do a secondary scope. I just had a patient like that. We did his primary surgery three months ago. He's had bad snapping for over a year, and I saw him at his three-month follow-up. He still is snapping a little bit, but not to the same degree. And in fact, at this point, it doesn't bother him, and he's feeling so much better from the other issues. Quick question, Kev. Would you let a person with an arthroplasty play a contact sport? A contact sport, I'd probably have some concerns. Obviously, we've seen some high-level lifters. We had the talk on Total Shoulder, but we've seen high-level lifters with these inlay glenoids. That would be the direction I would go, would be an inlay glenoid, and in that case, I would consider it, but it wouldn't be something I would be super excited about. Do you consider hockey a contact sport? Absolutely. I have a shit ton of hockey players with Total Shoulders and reverses. Yeah, so that was rugby, hockey, football, high contact. Hey, Chris, you intimated that if you want to, you could shave the underside of the scapula for snapping. Do you get to do that? I'm in the camp of I don't do bony work there unless I have to, but what's your thoughts on that? So it's rare for me to actually do a true bony superior medial resection or take down any bone from the scapula and snapping scapula. Because generally speaking, it is a soft tissue problem. So I try and avoid doing that. And partly is because, again, I am unfortunately a scapular pain referral guy. And I've seen plenty of people that have had open or other types of bony resections of their scapulas and not do well with them. So I try and avoid it whenever possible. That case that I showed is probably one of only two true bone resections that I've done in 17 years. Yeah, it never made sense to me because I agree it's a soft tissue problem most of the time. And you shave bone and all of a sudden you just have something else bleeding on this area. You just cleaned out and filling it up with scar tissue. Well, thanks you guys. Brian, thank you guys very much for being here and appreciate y'all's attendance.

surgical techniques

shoulder injuries

distal clavicle removal

force transmission

fracture risk