Shoulder Anatomy and a preface on the Shoulder Arthroscopy.
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1 Shoulder Anatomy and a preface on the Shoulder Arthroscopy
2 Shoulder Anatomy
3 Shoulder Anatomy 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
4 Shoulder Anatomy Contributors to stability Passive Jt conformity Jt pressure adhesion/cohesion ligament
5 Shoulder Anatomy F-H Offset B-C Head thickness D-E = 8mm Top of humeral head is higher than greater Tuberosity
6 Shoulder Anatomy Glenoid : 2 anteversion 7 retroversion to Humeral Head: retroversion
7 Shoulder Anatomy
8 Shoulder Anatomy
9 Shoulder Stabilizers Rotator Cuff- dynamic stabilizer passive muscle tension ligament tightening compression of articular surface GHL- static stabilizer
10 Ligaments SGLH MGHL IGHL PIGHL CAL CHL
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12 Rotator Cuff
13 Rotator Cuff
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15 Subacromial Bursa
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17
18 MRI for shoulder Axial plane Bankart Lesion, BT Sagital oblique plane Coronal oblique plane Rotator cuff, SLAp
19 Shoulder MRI Coronal Oblique View
20 Shoulder MRI, Sagital Oblique View
21 Shoulder MRI, Axial View
22 Shoulder Arthroscopy Scope; all procedures except Arthroplasty
23 Patient Position Beach chair the most common Lateral
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28 Arthroscopy Equipment Fluid Management System; Arthropompe +Shaver system
29 Arthroscopy Equipment Arthroscopy Elecetrocutery System ArthroCare Coblation VAPR, Depuy Mitek
30 Basic Instrument Arthroscope 30 and 70 scopes Arthroscope sheath with matching sharp and blunt trochars Punches, Graspers, Seizers, Probes Suture passers, Knot pusher
31 Instrumentation #11 scalpel blade Skin marking pencil 18 g. needle 20 cc syringe (if insufflating) 76 mm plastic cannula with a rubber dam Motorized shaver with soft tissue and bone shaving blades Suction punch Suture punch
32 Anchor Sutures Metal Anchor Suture 5, 6.5 Bio Anchor Suture 5, 6.5 Knotless Anchor Suture; push lock
33 Main Providers of Shoulder Arthroscopy Smith&Nephew, MA, USA MITEK Depuy, MA, USA Arthrex, FL, USA
34 Question How common are done shoulder Arthroscopy procedures?
35
36 Shoulder Arthroscopy portals
37 Posterior Portal, A Posterior 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
38 Anterior Portal 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
39
40 Lateral Portal 2-3 cm distal to the lateral border of the acromion Passage through the deltoid muscle Axillary nerve Located approx. 5 cm beyond the acromion Structures at risk: Axillary nerve
41
42 Supraspinatus fossa portal 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
43
44 Arthoscopic surgery for shoulder surgery 1- Arthroscopic Bankart repair (one row repair) 2-Casiope Repair (double Bankart row repair) 3-All arthroscopic Laterjat procedure 4- Capsular shift 5-Rotator interval closure Repair of HAGEL lesion Repair of SLAP lesion
45 Arthroscopic Rotaor cuff Surgery Arthroscopic Subacromion decompression Arthroscopic Acropmioplasty rotator cuff repair -one row -double row
46
47 Actual DOUBLE ROW Technique
48
49 Arthroscopic Brachial plexus surgery Suprascapular nerve release Brachial plexuse nerve release Axilary nerve release Qaudrilateral and triangular release
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51
52
53 Arthroscopic tendon transfer Latissmos dorsi transfer for rotator cuff deficiency, irreparable tears Arthroscopic priscapular bursectomy
54 AC Joint arthroscopic surgery Arthroscopic AC arthroplasty Arthroscopic AC instability reconstruction
55 Pioneers Modern & Advanced Shoulder Surgery
56 Charles Neer NY, US
57 Rockwood Charls JR Texas, US
58 Frederick A. Matsen III, M.D. Seattle, WA, USA TUBS, AMBRI
59 JP Warner Massachusetts, US
60 Joseph IANNOITTI Cleveland Clinic, Ohio, US
61 Louis U. Bigliani NY, US
62 Stephen Bukhart Texas, US
63 Christian Gerber Bern, Swiss
64 Lauren Lafosse & Gill Walch France
65 Peter Hybermeyer Germany
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