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