|
http://upload.orthobullets.com/topic/12064/images/illustration.arthroscopic approach.aaron bott.jpg
http://upload.orthobullets.com/topic/12064/images/beachchair_moved.jpg
http://upload.orthobullets.com/topic/12064/images/lateraldecub_moved.jpg
http://upload.orthobullets.com/topic/12064/images/labralvariant_moved.jpg
http://upload.orthobullets.com/topic/12064/images/buford_moved.jpg
Indications pagebreak
  • Diagnostic surgery
  • Loose body removal
  • Rotator cuff repair or debridement
  • Labral/SLAP and instability repair
  • Subacromial decompression
  • AC joint pathology
  • Distal clavicle resection
  • Release of suprascapular nerve entrapment
  • Release of scar tissue/contractures
  • Synovectomy
  • Biceps tenotomy/tenodesis
Positioning pagebreak
  • Beach chair
    • advantage of ability to also do deltopectoral approach to shoulder
    • reduces venous pressure and bleeding
  • Lateral decubitus
    • advantage of joint distraction
      • can be associated with neuropraxias from traction
Primary Portals pagebreak
  • Posterior portal
    • function
      • primary viewing portal used for diagnostic arthroscopy
    • location and technique
      • located 2 cm inferior and 1 cm medial to posterolateral corner of acromion
      • portal may pass between infraspinatus (suprascapular nerve) and teres minor (axillary nerve) or pass through the substance of infraspinatus
      • this is usually the first portal placed
      • direct anteriorly towards tip of coracoid
  • Anterior portal
    • function
      • viewing and subacromial decompression
    • location & technique
      • lateral to coracoid process and anterior to AC joint
      • portal passes between pectoralis major (medial and lateral pectoral nerves) and deltoid (axillary nerve)
    • this portal is usually placed under direct supervision from the posterior portal with aid of spinal needle
  • Lateral portal
    • function
      • subacromial decompression
    • location & technique
      • located 1-2 cm distal to lateral edge of acromium
      • portal passes through deltoid (axillary nerve)
Secondary Portals pagebreak
  • Anteroinferior (5 o'clock) portal
    • function
      • placement of anchors in anterior labral repair
    • location & technique
      • located slightly inferior to coracoid
      • this portal is usually placed under direct supervision from the posterior portal with aid of spinal needle
  • Posteroinferior (7 o'clock) portal
    • function
      • placement of anchors for posterior labral repair
    • location & technique
      • this portal is usually placed under direct supervision from the posterior portal with aid of spinal needle
  • Nevasier (supraspinatus) portal
    • function
      • anterior glenoid visualization and SLAP repairs
    • location & technique
      • located just medial to lateral acromion
      • goes through supraspinatus muscle (suprascapular nerve)
  • Port of Wilmington (anterolateral) portal
    • function
      • Used to evaluate/repair posterior SLAP and RTC lesions
    • location & technique
      • just anterior to posterolateral corner of acromium
      • this portal is usually placed under direct supervision from the posterior portal with aid of spinal needle
Diagnostic Scope pagebreak
  • Performed with 30° scope through the posterior portal to identify
    1. Biceps tendon
    2. Supraspinatus
    3. Infraspinatus and teres minor.
    4. Rotator interval (formed by biceps tendon, superior edge of subscapularis, and glenoid)
    5. Anterior ligamentous complex (MGHL, IGHL)
    6. Subscapularis recess (loose bodies)
    7. Anterior labrum
    8. Glenoid
    9. Humeral head
  • Anatomic variations
    • region of anterosuperior labrum and MGHL has wide anatomic variability
      • attached labrum with broad MGHL is most common
      • sublabral hole with cordlike MGHL
      • Buford complex
        • has absent labrum and cordlike MGHL
    • bare areas of cartilage are normal on
      • central glenoid
      • posterior humeral head
Dangers pagebreak
  • Posterior portal
    • axillary nerve 
      • leaves axilla through quadrangular space and winds around humerus on deep surface of the deltoid muscle and passes ~ 7 cm below tip of acromoium
      • at risk if the posterior portal is made too inferior
    • suprascapular nerve
      • runs through supraspinatus fossa and infraspinatus fossa before innervating both of these muscles.
      • at risk if the posterior portal is made too medial 
  • Anterior portal
    • cephalic vein
      • runs in deltopectoral groove & at risk if portal is too lateral
    • musculocutaneous nerve
      • enters muscles 2-8 cm distal to tip of coracoid
      • at risk if anterior portal is made too inferior
  • Anesthesia
    • phrenic nerve
      • with intrascalence block (anesthesia)
 

Please rate topic.

Average 4.2 of 10 Ratings

Questions (1)
EVIDENCE & REFERENCES (6)
VIDEOS (1)
Topic COMMENTS (7)
Private Note