SHOULDER ANATOMY Karl Wieser, MD Department of Orthopedics, University of Zurich, Balgrist, Switzerland
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1 20th Course in Shoulder Surgery Balgrist SHOULDER ANATOMY Karl Wieser, MD Department of Orthopedics, University of Zurich, Balgrist, Switzerland
2 ANATOMY OVERVIEW courtesy of Georg Lajtai
3 BONY LANDMARKS
4 - origin: - clavicular - acromial - spinous DELTOID MUSCLE - insertion: deltoid tuberosity - innervation: axillary nerve (C5, C6)
5 - posterior cord AXILLARY NERVE - quadrilateral space - level of coracoid - around surgical neck
6 - Pars clavicularis - Pars sternalis - Pars abdominalis PECTORALIS MAJOR - insertion: lat. lip of bicipital groove - med. and lat. pectoral nerve - flexion, adduction and IR
7 DELTOPECTORAL APPROACH Surgical Exposures, S. Hoppenfeld 3 rd Edition
8 CEPHALIC VEIN - Indicates the deltopectoral interval - absent in 4 % - feeder vessels lat > med retract vein laterally Radkowski CA, CORR 442: 139, 2006
9 EXTENDED DELTOPECTORAL ANATOMY courtesy of Georg Lajtai
10 DELTOID SPLITTING APPROACH AXILLARY NERVE Surgical Exposures, S. Hoppenfeld Cetik O, JBJS(Am) 11: 2395, 2006
11 ARTHROSCOPY AXILLARY NERVE arm in adduction arm in abduction Jae Chul Yoo, Arthroscopy, 23: 1271, 2007
12 SUPRASCAPULAR NERVE - upper trunk of brachial plexus C5/(C6) - under transverse scapular lig. - around spinoglenoid notch - Supraspinatus - Infraspinatus
13 Nerve injury: SUPRASCAPULAR NERVE - Ossified transverse scapular ligament - Hypertrophied spinoglenoid ligament - SLAP lesion - Ganglion cyst - Traction injury ISP (+/- SSP) Atrophy
14 ROTATOR CUFF
15 SUBSCAPULARIS MUSCLE - origin: subscapularis fossa - insertion: lesser tuberosity - innervation: - 2 branches (C5,C6) sup. subscapular nerve inf. subscapular nerve Frick, Thieme, 1980 Bouchet, Simep, 1990
16 SUBSCAPULARIS MUSCLE function: internal rotation (lift-off test) Gerber, JBJS (Br), 73(3):389, 1991
17 SUPRASPINATUS MUSCLE - origin: supraspinatus fossa - insertion: greater tuberosity - suprascapular nerve (C5,C6) - function: abductor (Jobe test)
18 - origin: infraspinatus fossa laterale margin - insertion: greater tuberosity - suprascapular nerve (C5,C6) - axillary nerve (C5, C6) - function: external rotation INFRASPINATUS AND TERES MINOR MUSCLE
19 external rotation lag in adduction INFRASPINATUS AND TERES MINOR MUSCLE external rotation lag in abduction (Horn blower sign) Arthuis M., Rev Chir Orthop Reparatrice Appar, 58:124, 1972
20 POSTEROSUPERIOR ROTATOR CUFF courtesy of Georg Lajtai
21 ROTATOR CUFF courtesy of Georg Lajtai
22 GLENOHUMERAL LIGAMENTS - GH joint capsule superior, anterior, inferior reinforced with glenohumeral ligaments: - superior (SGHL) - middle (MGHL) - inferior (IGHL) - posterior: thin capsule, no ligaments
23 SGHL ~ 1/3-2/3 of thickness of long biceps - in 42 % only thin / rudimentary - origin: labrum / supraglenoidal tubercle - insertion: above lesser tuberosity Warner JP, Am J Sports Med, 1992 Jost B, JSES, 2000
24 ROTATOR INTERVAL ANTERIOR PULLEY
25 - very variable - in 55 % thin Warner JP, Am J Sports Med, in % absent DePalma, AAOS, 1949 O'Brien, Saunders, 1990 MGHL - origins: - glenoid rim adjacent below SGHL - insertion: - medially of lesser tuberosity - subscapularis tendon (fused) - stabilizes: - against ER / ant. translation in neutral rotation - against inferior translation in ER
26 MGHL (ANTERIOR LABRUM) ANATOMIC VARIATIONS 12% 1.5% Williams M, Snyder S, and Buford D. Arthroscopy, 1994
27 - always present O'Brien, Saunders, consists of: - anterior band - axillary recess - posterior band IGHL - stabilizes: - against a.p and inf. GH translation in Abd
28 GLENOHUMERAL LIGAMENTS courtesy of Georg Lajtai
29 Thank you!!! courtesy of Georg Lajtai
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