Final, normal anatomy 2013
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Transcript of Final, normal anatomy 2013
Arthroscopic Shoulder Anatomy
Christopher M. Aland MDRothman Institute, Newtown, PA
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
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
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.
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.
Intra-articular anatomy
• Middle glenohumeral ligament—MGHL
• Variable• Originates
superoglenoid tubercle to inferior aspect of lesser tuberosity
Intra-articular anatomy
• Inferior glenohumeral ligament—IGHL
• Diagonal fold• More prominent in ER• Anterior band part of
“hammock”
Intra-articular anatomy
• Internally rotate arm, follow subscap laterally
• Inspect footprint• Anterior recess
Intra-articular anatomy
• Internally rotate arm, follow subscap laterally
• Inspect footprint• Anterior recess
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
Intra-articular anatomy
• Running across the top of visual field should be biceps tendon
• Look into groove• Sublux into joint• Follow to superior
glenoid
Intra-articular anatomy
• Running across the top of visual field should be biceps tendon
• Look into groove• Sublux into joint• Follow to superior
glenoid
Intra-articular anatomy
• Running across the top of visual field should be biceps tendon
• Look into groove• Sublux into joint• Follow to superior
glenoid
Intra-articular anatomy
• Probe labrum, but remember where attachment really is– Meniscoid– Superior recess
• Follow labrum anteriorly
• Anatomic variants
Intra-articular anatomy
• Inspect the articular surface
• Normal thinning in center
• Look for bony abnormalities
• Drive through sign
Intra-articular anatomy
• Inferior recess• Look for loose bodies• Lax capsule
Intra-articular anatomy
• Abduct arm and roll up posteriorly
• Normal bare area• Undersurface of cuff• Cord and cable
Intra-articular anatomy
• Use switching sticks to rotate camera anteriorly
• Inspect posterior labrum
• Follow around to front to inspect subscap and recess
Intra-articular anatomy
• Use switching sticks to rotate camera anteriorly
• Inspect posterior labrum
• Follow around to front to inspect subscap and recess
Intra-articular anatomy
• Use switching sticks to rotate camera anteriorly
• Inspect posterior labrum
• Follow around to front to inspect subscap and recess
Intra-articular anatomy
• Use switching sticks to rotate camera anteriorly
• Inspect posterior labrum
• Follow around to front to inspect subscap and recess
Bursal anatomy
• Superior cuff• Coraco-acromial
ligament• Bursa—veil of tears• Any previously placed
markers
Common variants
• Don’t fix these• Buford complex• Sublabral foramen• Superior recess
Common variants
• Don’t fix these• Buford complex• Sublabral foramen• Superior recess
Common variants
• Don’t fix these• Buford complex• Sublabral foramen• Superior recess
Common variants
• Don’t fix these• Buford complex• Sublabral foramen• Superior recess
Thank-you