Christopher M. Aland MD

DisclaimerI own stock in Arthrocare and Johnson and

JohnsonI have no conflicts that inhibit my ability to

teach this course

Just a word about portals

Marine Corps SloganNo better friend…no worse enemy

Sulla, Rome 73BC Mattis, Fallujah 2004

Aland, AANA, Chicago 2011

Initial Viewing From Posterior:

Subscapularis tendon

MGHLIGHLSubscap insertionSGHL

From Posterior, looking up:Biceps TendonHiatusElbow?Subluxed tendonOrigin on Glenoid

Superior labrumAnterior labrumArticular surface

glenoidArticular surface

humeral headInferior labrum

Inferior recessBare AreaUndersurface cuff

From AnteriorPosterior superior

andPosterior labrumPosterior capsuleAnterior labrumSubscapularis recess

Finish the job, look in the backUse two switching

sticksReorient selfProceed with exam

Videos

What not to fixBuford Complex:

Cordlike MGHL with no labrum beneath

Initially described in 1994, 10% incidence Buford et. Al

Increased incidence of SLAP tears noted Snyder 2003

Don’t fix this eitherSublabral foramen

Common variant10-15% or moreDegenerative?Easy to put an

anchor hereDon’t