Arthroscopy

 

Lateral Decubitus Shoulder ArthroscopyShoulder Arthroscopy TmaxShoulder Arthroscopy Portals

 

Indications

 

Anterior / posterior labral repair

SLAP repair

Arthroscopic biceps tenodesis

Distal clavicle resection / subacromial decompression

Rotator cuff repair

Washout septic arthritis

 

Patient position

 

Beach chair Lateral decubitus
Patient seated upright Patient on side in beanbag / lateral supports
Head attached / protect eyes / neck in normal position Skin traction to forearm with traction pole / lateral support
Arm free draped on mayo / hydraulic arm holder Arm abducted / lateral traction to glenohumeral joint
Shoulder Arthroscopy Spyder Shoulder Lateral Decubitus Arthrex

 

Glenohumeral joint arthroscopy

 

Posterior glenohumeral joint portals

 

Shoulder Arthroscopy Posterior Portals

                                  

Posterior portal Posterolateral portal

Identify posterolateral corner acromion

2 cm below and 2 cm medial

Feel glenohumeral joint with trochar

Aim towards coracoid

Inferior and lateral to posterior portal

Alows placement of the inferior posterior anchors

Shoulder Arthroscopy Posterior Portal

Shoulder Posterior Portals 2

 

Anterior glenohumeral joint portals

 

anterior

 

Anterosuperior portal Anteroinferior portal

Medial to coracoid / Just below AC joint

High into rotator interval just below biceps

SLAP portal / working portal for anterior labrum

Into rotator interval just above subscapularis

Allows placement of anteroinferior anchors

 

Arthroscopy Anterior Portal Shoulder Scope Low Anterior Portal

 

Additional portals

 

Portal of Wilmington Neviaser portal

Through suprapinatus musculotendinous junction

Anterolateral border of acromion

Access to superior glenoid for slap repair / SCR

Superior portal

Medial to acromion and posterior to clavicle

Access to superior glenoid for slap repair / SCR

Shoulder Scope Port Wilmington  

 

Shoulder arthroscopy

 

Rotator Interval -  triangle of glenoid medial, biceps superior, subscapularis inferior

 

rotator intervalShoulder Arthroscopy Rotator Interval

 

 

Humeral head cartilage

 

Arthroscopy Humeral Head OAGlenoid OA Arthroscopy

 

Glenoid cartilage

 

Shoulder OA Debridement

 

Labrum - anterior / inferior / posterior

 

Arthroscopy Normal Anterior LabrumShoulder Arthroscopy Inferior LabrumShoulder Arthroscopy Posterior Labrum

 

Biceps tendon / insertion

 

Arthroscopy Normal Biceps InsertionArthroscopy Normal Biceps TendonArthroscopy Normal Biceps Tendon 2

 

Subscapularis

 

Arthroscopy Normal SubscapularisSubscapularis Normal Arthroscopy

 

Glenohumeral ligaments

 

Three thickenings of the glenoid capsule: SGHL, MGHL, IGHL

Superior glenohumeral ligament (SHGL) Middle glenohumeral ligament (MGHL)

Origin: Supraglenoid tubercle glenoid and coracoid

Insertion: Proximal aspect medial edge lesser tuberosity of the humerus

Origin: Distal aspect lesser tuberosity of humerus

Insertion: Posterior aspect subscapularis

Runs perpendicular to the middle GHL

Crosses subscapularis vertically

Variable size and shape in different people

Cord like / leaf like / vestigal

Stabilizes the long head of the biceps in its groove

Limits external rotation of the humerus

Limits external rotation with arm by side
Superior Glenohumeral Ligament MGHL Arthroscopy

 

Inferior glenohumeral ligament (IGHL)  

Origin: Inferior 2/3 glenoid and labrum

Insertion: Anatomical neck humerus

 

Anterior band: antero-inferior glenoid to 3 o'clock

Posterior band: postero-inferior glenoid to 9 o'clock

Axillary pouch between two bands

Most important ligament in terms of stability Stabilizes arm at 90 degrees of abduction

Normal IGHL Glenoid Attachment

Anterior IGHL glenoid attachment

Arthroscopy Normal IGHL Humeral Insertion

IGHL humeral attachment

 

Inferior recess

 

Shoulder Loose Body

Loose body in inferior recess

 

Undersurface supraspinatus - abduct arm

 

Supraspinatous Normal ArthroscopySS normal arthroscopySupraspinatous Tendon Normal Crescent Variant

 

Infraspinatus / bare area / Hill Sachs

 

Shoulder Arthroscopy Infraspinatous Insertion

 

Subacromial space

 

Portals

 

Posterior Lateral subacromial portal

Redirect posterior portal

Under acromion

Midportal clavicle

Usually viewing portal

Rotator cuff repair / Subacromial decompression

Distal clavicle resection

Shoulder Arthroscopy Posterior Portals