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Anatomy of the shoulder and its arthroscopic considerations

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пЃ¬Shoulder
Anatomy and a
preface on the Shoulder
Arthroscopy
пЃ¬-Ebrahimzadeh MH MD
пЃ¬
Shoulder&Knee Surgeon
пЃ¬ Ghaem Hospital,
пЃ¬ Mashad University of Medical Sciences,
Mashad, Iran
Ebrahimzadehmh@MUMS.AC.Ir
Shoulder Anatomy
Shoulder Anatomy
пЃ¬
Greatest ROM
пЃ¬ No inherent bony stability
пЃ¬ Relies on soft tissues for
stability
пЃ¬ Many injuries involve the
soft tissues (rotator cuff,
labrum)
пЃ¬ Little glenoid bone stock
Shoulder Anatomy
пЃ¬
Contributors to stability
пЃ¬
Passive
– Jt conformity
– Jt pressure
– adhesion/cohesion
– ligament
Shoulder Anatomy
пЃ¬
F-H Offset
пЃ¬ B-C Head thickness
пЃ¬ D-E = 8mm
Top of humeral head is
higher than greater
Tuberosity
Shoulder Anatomy
пЃ¬
Glenoid : 2В° anteversion to
7В° retroversion
пЃ± Humeral Head:
20В° - 40В° retroversion
Shoulder Anatomy
Shoulder Anatomy
Shoulder Stabilizers
пЃ¬
Rotator Cuff–
–
–
–
–
пЃ¬
dynamic stabilizer
passive muscle tension
ligament tightening
compression of
articular surface
GHL– static stabilizer
Ligaments
пЃ¬
SGLH
пЃ¬ MGHL
пЃ¬ IGHL
пЃ¬ PIGHL
пЃ¬ CAL
пЃ¬ CHL
Rotator Cuff
Rotator Cuff
Subacromial Bursa
MRI for shoulder
пЃ¬
Axial plane
пЃ¬
Sagital oblique plane
пЃ¬
Coronal oblique plane Rotator cuff, SLAp
Bankart Lesion, BT
Shoulder MRI
Coronal Oblique View
Shoulder MRI,
Sagital Oblique View
Shoulder MRI, Axial View
пЃ¬
Shoulder Arthroscopy
пЃ¬
Scope; all procedures except Arthroplasty
Patient Position
пЃ¬
Beach chair
пЃ¬
Lateral
the most common
Arthroscopy Equipment
пЃ¬
Fluid Management System;
пЃ¬ Arthropompe +Shaver system
Arthroscopy Equipment
пЃ¬
Arthroscopy Elecetrocutery System
пЃ¬
ArthroCareВ® Coblation
пЃ¬
VAPR, Depuy Mitek
Basic Instrument
пЃ¬
Arthroscope
пЃ¬ 30В° and 70В° scopes
пЃ¬ Arthroscope sheath with matching sharp
and blunt trochars
пЃ¬ Punches, Graspers, Seizers, Probes
пЃ¬ Suture passers, Knot pusher
Instrumentation
пЃ¬
пЃ¬
пЃ¬
пЃ¬
пЃ¬
пЃ¬
пЃ¬
пЃ¬
#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
Anchor Sutures
пЃ¬
Metal Anchor Suture 5, 6.5
пЃ¬
Bio Anchor Suture
пЃ¬
Knotless Anchor Suture; push lock
5, 6.5
Main Providers
of Shoulder Arthroscopy
пЃ¬
Smith&Nephew, MA, USA
пЃ¬
MITEK Depuy, MA, USA
пЃ¬
Arthrex, FL, USA
Question
пЃ¬
How common are done shoulder
Arthroscopy procedures?
Shoulder Arthroscopy portals
Posterior Portal, A
пЃ¬
Posterior Portal
пЃ¬
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
пЃ¬
пЃ¬
– 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
пЃ¬
Located one-half the distance between the
coracoid process and the anterolateral edge of the
acromion
пЃ¬ Passage through the skin subcutaneous tissue and
the anterior one-third of the deltoid
пЃ¬
Structures at risk
– Musculocutaneous nerve, normally located 3 cm
inferior and just medial to the coracoid process
Lateral Portal
пЃ¬
2-3 cm distal to the lateral border of the
acromion
пЃ¬ Passage through the deltoid muscle
пЃ¬ Axillary nerve
пЃ¬ Located approx. 5 cm beyond the acromion
пЃ¬ Structures at risk:
– Axillary nerve
Supraspinatus fossa portal
пЃ¬
пЃ¬
пЃ¬
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
пЃ¬
1- Arthroscopic Bankart repair (one row repair)
пЃ¬ 2-Casiope Repair (double Bankart row repair)
пЃ¬ 3-All arthroscopic Laterjat procedure
пЃ¬ 4- Capsular shift
пЃ¬ 5-Rotator interval closure
пЃ¬ Repair of HAGEL lesion
пЃ¬ Repair of SLAP lesion
пЃ¬
Arthroscopic Rotaor cuff Surgery
пЃ¬ Arthroscopic Subacromion decompression
пЃ¬ Arthroscopic Acropmioplasty
пЃ¬ rotator cuff repair
пЃ¬
-one row
пЃ¬
-double row
Actual DOUBLE ROW
Technique
Arthroscopic Brachial plexus
surgery
пЃ¬
Suprascapular nerve release
пЃ¬ Brachial plexuse nerve release
пЃ¬ Axilary nerve release
пЃ¬ Qaudrilateral and triangular release
Arthroscopic tendon transfer
пЃ¬
Latissmos dorsi transfer for rotator cuff
deficiency, irreparable tears
пЃ¬ Arthroscopic priscapular bursectomy
AC Joint arthroscopic surgery
пЃ¬
Arthroscopic AC arthroplasty
пЃ¬ Arthroscopic AC instability reconstruction
Pioneers
пЃ¬Modern
& Advanced
Shoulder Surgery
Charles Neer
NY, US
Rockwood Charls JR
Texas, US
Frederick A. Matsen III,
M.D.
Seattle, WA, USA
пЃ¬
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
Thank you
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