final, normal anatomy 2013
TRANSCRIPT
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Arthroscopic Shoulder Anatomy
Christopher M. Aland MDRothman Institute, Newtown, PA
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Disclaimer
• I own stock in J &J, and Arthrocare• I am on the Membership committee of AANA• I have no conflicts which would interfere with
this course
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Introduction
• The essence of viewing shoulder anatomy in a reproducible fashion is the consistent use of portal placement
• Develop YOUR routine and follow it every time. Using a checklist or cheat sheat is OK
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Intra-articular anatomy
• Initial portal should be posterior
• No need to pre inject joint—ok for bursa
• Subscapularis is a more consistent anatomic finding—orient off this
• Establish anterior portal outside-to-in.
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Intra-articular anatomy
• Initial portal should be posterior
• No need to pre inject joint—ok for bursa
• Subscapularis is a more consistent anatomic finding—orient off this
• Establish anterior portal outside-to-in.
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Intra-articular anatomy
• Middle glenohumeral ligament—MGHL
• Variable• Originates
superoglenoid tubercle to inferior aspect of lesser tuberosity
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Intra-articular anatomy
• Inferior glenohumeral ligament—IGHL
• Diagonal fold• More prominent in ER• Anterior band part of
“hammock”
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Intra-articular anatomy
• Internally rotate arm, follow subscap laterally
• Inspect footprint• Anterior recess
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Intra-articular anatomy
• Internally rotate arm, follow subscap laterally
• Inspect footprint• Anterior recess
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Intra-articular anatomy
• Superior glenohumeral ligament-SGHL
• Just anterior to biceps tendon
• Forms pulley to support biceps in groove
• Subscap path usually assoc with SGHL path
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Intra-articular anatomy
• Running across the top of visual field should be biceps tendon
• Look into groove• Sublux into joint• Follow to superior
glenoid
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Intra-articular anatomy
• Running across the top of visual field should be biceps tendon
• Look into groove• Sublux into joint• Follow to superior
glenoid
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Intra-articular anatomy
• Running across the top of visual field should be biceps tendon
• Look into groove• Sublux into joint• Follow to superior
glenoid
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Intra-articular anatomy
• Probe labrum, but remember where attachment really is– Meniscoid– Superior recess
• Follow labrum anteriorly
• Anatomic variants
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Intra-articular anatomy
• Inspect the articular surface
• Normal thinning in center
• Look for bony abnormalities
• Drive through sign
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Intra-articular anatomy
• Inferior recess• Look for loose bodies• Lax capsule
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Intra-articular anatomy
• Abduct arm and roll up posteriorly
• Normal bare area• Undersurface of cuff• Cord and cable
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Intra-articular anatomy
• Use switching sticks to rotate camera anteriorly
• Inspect posterior labrum
• Follow around to front to inspect subscap and recess
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Intra-articular anatomy
• Use switching sticks to rotate camera anteriorly
• Inspect posterior labrum
• Follow around to front to inspect subscap and recess
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Intra-articular anatomy
• Use switching sticks to rotate camera anteriorly
• Inspect posterior labrum
• Follow around to front to inspect subscap and recess
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Intra-articular anatomy
• Use switching sticks to rotate camera anteriorly
• Inspect posterior labrum
• Follow around to front to inspect subscap and recess
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Bursal anatomy
• Superior cuff• Coraco-acromial
ligament• Bursa—veil of tears• Any previously placed
markers
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Common variants
• Don’t fix these• Buford complex• Sublabral foramen• Superior recess
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Common variants
• Don’t fix these• Buford complex• Sublabral foramen• Superior recess
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Common variants
• Don’t fix these• Buford complex• Sublabral foramen• Superior recess
![Page 26: Final, normal anatomy 2013](https://reader031.vdocuments.us/reader031/viewer/2022032012/55be7fd1bb61eb00488b47a3/html5/thumbnails/26.jpg)
Common variants
• Don’t fix these• Buford complex• Sublabral foramen• Superior recess
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Thank-you