Nickolas Garbis, MD

@orthobullets If there is still some cartilage left on the reverse Hill Sachs I’ve had some luck with doing a humeral head osteoplasty. I’ll use allograft chips or cement to backfill the defect after I tamp up articular surface and then try to get everything repaired especially in young pts

If you choose Operative Treatment, what would you do?

Here is a new case by Dr. Hafiz Kassam and @HoagOrthopedic Institute. LOCKED POSTERIOR GLENOHUMERAL FRACTURE-DISLOCATION IN 22M This case will be discussed at the 2025 Critical Concepts in Shoulder & Elbow Surgery course in Las Vegas, Nevada, December 11-13th, 2025. How would you manage this #orthotwitter? Vote on this case for CME: orthobullets.tiny.us/3fk6bbcm

@MikeKnudsenMD @orthobullets @OrthoColumbia @EauClaireOrtho @Shoulder2LeanOn @PeterCoffaro @shoulder_nerd @shoulderMD @DrBryanSaltzman @H2O_SportsMD @SZaildar294488 @AntonLambers I’m not templating fractures either @MikeKnudsenMD. I will also skip simple early irreparable RTC without bony deformity. I do template in some of my smaller women with osteoporosis even w/o bony deformity to help me understand things I can do to try to minimize acromial stress

@NickGarbis @orthobullets @OrthoColumbia @EauClaireOrtho @Shoulder2LeanOn @PeterCoffaro @shoulder_nerd @shoulderMD @DrBryanSaltzman @H2O_SportsMD @SZaildar294488 @AntonLambers Thanks Nick! Are there any cases that you are not templating these days?? I have personally found that there are very few cases that I skip the templating process these days (e.g., reverse for fracture). Curious to hear your thoughts!

Here is a new case by Dr. Michael Knudsen @MikeKnudsenMD and Columbia University Medical Center @OrthoColumbia. PROGRESSIVE SHOULDER PAIN IN 67F This case will be debated at the Mid Atlantic Shoulder & Elbow Society Annual Meeting 2025 in Washington, DC, on September 5, 2025. How would you manage this #orthotwitter? Vote on this case for CME: orthobullets.tiny.us/4ak8mphe

@orthotraumamd @MikeKnudsenMD @orthobullets @OrthoColumbia @EauClaireOrtho @Shoulder2LeanOn @PeterCoffaro @shoulder_nerd @shoulderMD @DrBryanSaltzman @H2O_SportsMD @SZaildar294488 @AntonLambers I think the most important thing is to look at glenoid version, percentage backside contact, lateralization of the joint line using different baseplate thicknesses and glenospheres. Different implants use varied methodologies for fixation and that should also be considered

@MikeKnudsenMD @NickGarbis @orthobullets @OrthoColumbia @EauClaireOrtho @Shoulder2LeanOn @PeterCoffaro @shoulder_nerd @shoulderMD @DrBryanSaltzman @H2O_SportsMD @SZaildar294488 @AntonLambers So for someone not familiar with the templating for shoulders. What are some of the key things you are looking for and teaching residents and fellows.

@DrNickColyvas @orthobullets @PEvansMDPhD @CleveClinicFL @Grant_Garrigues @MDiPaolaMD @londonarmdoc @dave_cloke @DrRobHartzler @CowlingSurgeon @surg4shoulders @Shoulder2LeanOn Yes for sure, you can get it out with a tiny little transverse counter incision at or above the antecubital crease. It makes it easier to suture as well.

@NickGarbis @orthobullets @PEvansMDPhD @CleveClinicFL @Grant_Garrigues @MDiPaolaMD @londonarmdoc @dave_cloke @DrRobHartzler @CowlingSurgeon @surg4shoulders @Shoulder2LeanOn or even a second small incision higher up

Here is a new case by Dr. Peter J. Evans @PEvansMDPhD and Cleveland Clinic Florida @CleveClinicFL. ACUTE BICEPS RUPTURE IN 41M How would you manage this #orthotwitter? Vote on this case for CME: orthobullets.tiny.us/mups5aj5

@robgraymd 💪that’s awesome!!

I was never “work out guy.” I’m a nerd and I just didn’t think that whole thing was part of my world. I didn’t start working out until mid thirties and didn’t get semi-serious (I’m still no power lifter or elite athlete) until about 4y ago. I weigh 183lbs. Today, on a whim set up 2 plates on a bench. Did 6 reps at 225. I would have never dreamt this to be possible. @FitFounder @CoffeeBlackMD @hjluks @BayeDrew I just wanted to thank these folks, among others for motivating me.

@robgraymd I can’t tell you how true this is. I’ve been doing this over the past year and a half and it’s a game changer!

For years, I was grinding it out, fueled by caffeine and will. I was burning it at both ends and was too exhausted to think about exercising. Turns out, I was playing the game on hard mode. Exercising makes the thinking easier and gives more energy. Lift heavy things.

@orthobullets @generalorthomd @itius @JSanchezSotelo @lpcsmd @pmacdonald16 @JacobKirschMD @DrNMaassen @CowlingSurgeon @BrentMorrisMD Nice work! Always challenging cases but can be very satisfying once they clear. How do you manage the deltoid on these long exposures?

Here are the intraoperative images of the Stage 2: Revision RSA with Allograft Prosthetic Composite with plate fixation. Performed after 6 weeks of IV antibiotics.

Here are the intraoperative and postoperative images of a new case by Dr. Hafiz Kassam and Newport Orthopedic Institute. RECURRENT PROSTHESIS LOOSENING S/P RTSA FOR FX IN 68F Procedure: 2-stage Revision Reverse Shoulder Arthroplasty with Allograft Prosthetic Composite and plate fixation. This case will be debated at the Critical Concepts in Shoulder & Elbow Surgery in Las Vegas, Nevada, November 14-16, 2024. How would you manage this #orthotwitter? Vote on this case for CME: orthobullets.tiny.us/2p8pec6c

@BrettLevineMD Congrats Brett!

I am excited to announce that this September I will be transitioning to Medstar Georgetown University Hospital. Very thankful to my co-workers, patients, residents, fellows and students from Rush it has been an amazing 16 years. I look forward to the next chapter in DC!

@generalorthomd A couple years ago I had a similar reviewer deny rotator cuff surgery to a patient who had undergone physical therapy, cortisone shot, and close to a year of conservative care because the full thickness tear on the report was “too small“

The @ABOSortho should look into surgeons with lifetime board certifications working for insurance companies to deny care for patients. Recent insurance denial signed by a 76 yo non-practicing “board certified” orthopedic surgeon who now works for Cigna to deny care.

@orthobullets @RothmanOrtho @shoulder360 @PaulSethiMD @rish_parmar @DrRobHartzler @OrthoStrelzow @AnthonyRomeoMD @H2O_SportsMD @EauClaireOrtho @pmacdonald16 @umasrikumaran @shoulderMD Great case Joe. I find that these post-capsullorhaphy patients have very stiff soft tissue anterior and even if it looks intact sometimes it’s very hard to get a mobile subscapularis MT unit despite all the usual releases. Some cuff atrophy on sag CT. This is a reverse for me.

HPI: A 68-year-old female, right-hand-dominant, presents with severe pain and lack of function in her right shoulder. The pain is constant and progressively getting worse, and now limits many of her activities of daily living. For treatment, she is taking Voltaren and Duexis. She has had several cortisone injections which improved her pain for several weeks to months. She underwent a right shoulder open stabilization Putti-Platt procedure in the 1970s. PMH: Her past medical history is significant for HTN and High Cholesterol. Her past surgical history includes: 1) Lumbar Spine x2 (1988, 2015), 2) L Shoulder open stabilization (1993), 3) R Shoulder open stabilization (1976), and 4) L Clavicle ORIF (2015). PE: On physical exam, her BMI is 30.04. Her height is 5’4”. Her weight is 175 lbs. Her VAS shoulder score is 8. Her ASES shoulder score is 13.33. The patient has very limited ROM with FE of 5 degrees, Abd of 5 degrees, and External rotation of -30 degrees.

@orthotraumamd @orthobullets @OrthoShah @BannerHealth @RachelFrankMD @EauClaireOrtho @AnthonyRomeoMD @OrthoStrelzow @kburnsmd @DrRobHartzler @rish_parmar @PaulSethiMD I usually wait three to six months and make sure I open communication with the neurology team about optimization. The fact that his previous seizure was seven years prior to this incident makes me feel a little bit better.

@NickGarbis @orthobullets @OrthoShah @BannerHealth @RachelFrankMD @EauClaireOrtho @AnthonyRomeoMD @OrthoStrelzow @kburnsmd @DrRobHartzler @rish_parmar @PaulSethiMD How long are you waiting to know that the seizures are under control?

Here is a new case by Dr. Anup Shah (@OrthoShah) and @BannerHealth. SHOULDER INSTABILITY WITH BIPOLAR BONE LOSS SECONDARY TO SEIZURES IN 22M This case will be debated at the 2024 Shoulder360™ in Miami, Florida, May 2-4, 2024. How would you manage this #orthotwitter? Vote on this case for CME: orthobullets.tiny.us/yckztdu3

@drgazihuri Opa reeee

Proud to be elected to American Shoulder and Elbow Surgeons…

@generalorthomd Had this exact same guy about six months ago. I love replacing shoulders but my trauma partner had just done his hip and we elected to see how it goes. I have to say that he did pretty well. Not as good IMO as a good reverse, but certainly better than a bad one.

Here’s a fun one. Healthy 80s male, no medications, active, golfer. Who’s replacing the shoulder regardless vs seeing how he is able to ambulate after hip fixation and replacing if unable to. #orthotwitter

An arthroscope is actually the name of a small camera that fits into the incision to help the surgeon examine and repair tendons in your shoulder. rb.gy/bzwkpw #arthroscopy #arthroscopicsurgery #surgeon #meniscus #shouldersurgery #sportsmed #arthroscopysurgery

Consider your clothing needs before your surgery. You'll want loose-fitting, button-up shirts that you can get into easily. Don't plan on over-the-head t-shirts for a while. rb.gy/bzwkpw

General anesthesia, as well as regional anesthesia, could be used in arthroscopic surgery depending on your medical background. rb.gy/bzwkpw

Patients can expect arthroscopic surgery to last usually anywhere from 30 minutes to 2 hours. Plan on resting in a recovery room for a few hours before having someone drive you home. rb.gy/bzwkpw