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zShoulder Anatomy and a preface on the Shoulder Arthroscopy www.fisiokinesiterapia.biz Shoulder Anatomy Shoulder Anatomy z z z z z Greatest ROM No inherent bony stability Relies on soft tissues for stability Many injuries involve the soft tissues (rotator cuff, labrum) Little glenoid bone stock Shoulder Anatomy z Contributors to stability z Passive – Jt conformity – Jt pressure – adhesion/cohesion – ligament Shoulder Anatomy z F-H Offset z B-C Head thickness z D-E = 8mm Top of humeral head is higher than greater Tuberosity Shoulder Anatomy z Glenoid : 2° anteversion 7° retroversion Humeral to Head: 20° - 40° retroversion Shoulder Anatomy Shoulder Anatomy Shoulder Stabilizers z Rotator Cuff– dynamic stabilizer – passive muscle tension – ligament tightening – compression of – articular surface z GHL– static stabilizer Ligaments z SGLH z MGHL z IGHL z PIGHL z CAL z CHL Rotator Cuff Rotator Cuff Subacromial Bursa MRI for shoulder z Axial plane z Sagital Bankart Lesion, BT oblique plane z Coronal oblique plane Rotator cuff, SLAp Shoulder MRI Coronal Oblique View Shoulder MRI, Sagital Oblique View Shoulder MRI, Axial View z Shoulder z Scope; Arthroscopy all procedures except Arthroplasty Patient Position z Beach chair z Lateral the most common Arthroscopy Equipment z Fluid Management System; z Arthropompe +Shaver system Arthroscopy Equipment z Arthroscopy Elecetrocutery System z ArthroCare® z VAPR, Coblation Depuy Mitek Basic Instrument z Arthroscope z 30° and 70° scopes z Arthroscope sheath with matching sharp and blunt trochars z Punches, Graspers, Seizers, Probes z Suture passers, Knot pusher Instrumentation z #11 scalpel blade z Skin marking pencil z 18 g. needle z 20 cc syringe (if insufflating) z 76 mm plastic cannula with a rubber dam z Motorized shaver with soft tissue and bone shaving blades z Suction punch z Suture punch Anchor Sutures z Metal z Bio Anchor Suture Anchor Suture z Knotless 5, 6.5 5, 6.5 Anchor Suture; push lock Main Providers of Shoulder Arthroscopy z Smith&Nephew, z MITEK z MA, USA Depuy, MA, USA Arthrex, FL, USA Question z How common are done shoulder Arthroscopy procedures? Shoulder Arthroscopy portals Posterior Portal, A z Posterior z z z Portal 3 cm inferior and 1 cm medial to the posterolateral corner of the acromion Passage to the posterior one-third of the deltoid and an interval between infraspinatus and teres minor Structures at risk – Quadrangular space - posterior humeral circumflex artery and axillary nerve – Triangular space - scapular circumflex artery – Both spaces are 7-8 cm inferior to the posterior border of the acromion Anterior Portal z z z Located one-half the distance between the coracoid process and the anterolateral edge of the acromion Passage through the skin subcutaneous tissue and the anterior one-third of the deltoid Structures at risk – Musculocutaneous nerve, normally located 3 cm inferior and just medial to the coracoid process Lateral Portal z 2-3 cm distal to the lateral border of the acromion z Passage through the deltoid muscle z Axillary nerve z Located approx. 5 cm beyond the acromion z Structures at risk: – Axillary nerve Supraspinatus fossa portal z z z Soft spot bordered anteriorly by the posterior margin of the clavicle, lateral by the medial border of the acromion, posteriorly by the scapular spine Passage through the trapezius and the muscle belly of the supraspinatus Structures at risk – Suprascapular nerve and artery – Located in the fossa approx. 3 cm medial to the portal Arthoscopic surgery for shoulder surgery z 1- Arthroscopic Bankart repair (one row repair) z 2-Casiope Repair (double Bankart row repair) z 3-All arthroscopic Laterjat procedure z 4- Capsular shift z 5-Rotator interval closure z Repair of HAGEL lesion z Repair of SLAP lesion z Arthroscopic Rotaor cuff Surgery z Arthroscopic Subacromion decompression z Arthroscopic Acropmioplasty z rotator cuff repair z -one row z -double row Actual DOUBLE ROW Technique Arthroscopic Brachial plexus surgery z Suprascapular nerve release z Brachial plexuse nerve release z Axilary nerve release z Qaudrilateral and triangular release Arthroscopic tendon transfer z Latissmos dorsi transfer for rotator cuff deficiency, irreparable tears z Arthroscopic priscapular bursectomy AC Joint arthroscopic surgery z Arthroscopic AC arthroplasty z Arthroscopic AC instability reconstruction Pioneers zModern & Advanced Shoulder Surgery Charles Neer NY, US Rockwood Charls JR Texas, US Frederick A. Matsen III, M.D. Seattle, WA, USA z TUBS, AMBRI JP Warner Massachusetts, US Joseph IANNOITTI Cleveland Clinic, Ohio, US Louis U. Bigliani NY, US Stephen Bukhart Texas, US Christian Gerber Bern, Swiss Lauren Lafosse & Gill Walch France Peter Hybermeyer Germany
