肩关节镜基础-PPT.ppt

肩关节镜基础stabilization：bony anatomysurrounding musclescapsular structuresArthroscopyANATOMY:STABILIZERGLENOHUMERAL JOINT：GLENOID FOSSA OF THE SCAPULA+HEAD OF THE HUMERUSLABRUM：“BUMPER”：DEEPEN AND ENLARGE THE GLENOID FOSSABICEPS TENDON：IS ANCHORED AT THE SUPERIOR LABRUM，A HUMERAL HEAD DEPRESSORJOINT CAPSULEGLENOHUMERAL LIGAMENTSROTATOR CUFF MUSCLES:SUPRASPINATUS,INFRASPINATUS,SUBSCAPULARIS,AND TERES MINORSHOULDER PROPLEM40 years old：symptoms of overuse or instability age 40 years：present more commonly with rotator cuff,impingement,inflammatory,or degenerative joint disease types of symptoms年龄越大，不稳越少见HISTORYWas it a traumatic,nontraumatic,or overuse injury？When and how did the injury occur？Is the patients complaint of pain,loss of motion,weakness,or inability to perform sports,activities of daily living,or work？Is there pain at rest,only with activity,or while sleeping？Are there any neurologic symptoms？PEObservationPalpationPassive and active ROMResistive testingrotator cuff tear:specialized PELabrum:Catching,clicking,or poppingMultidirectional instability:sulcus signIMAGINGPlain radiographsMagnetic resonance imagingDIFFERENTIAL DIAGNOSISDegenerative arthritisLabral tearBiceps tendon pathologyAdhesive capsulitisRotator cuff tearImpingement InstabilityAcromioclavicular joint injury or arthritisScapulothoracic dysfunctionCervical or neurologicInfectionNONOPERATIVE MANAGEMENTRestNSAIDSphysical therapydiagnostic and therapeutic injectionsSURGICAL MANAGEMENTA patient who has failed to respond to nonoperative management and continues to have symptoms consistent with his or her diagnosis is a candidate for shoulder arthroscopy.PREOPERATIVE PLANNINGPatient history and imaging studies are reviewedappropriate equipment and instrumentsAn examination under anesthesia is performed to assess range of motion and stability.POSITIONINGbeach-chair position the shoulder can be freely manipulated throughout the procedurelateral decubitus positionexcellent visualizationSETUP AND PORTAL PLACEMENTbony surface anatomy should be outlinedposterior,anterior,and,if necessary,lateral portalPOSTERIOR PORTAL:2 to 3 cm inferior and 1 cm medial to the posterolateral border of the acromionANTERIOR PORTALCARE MUST BE TAKEN TO ENSURE THAT ALL ANTERIOR PORTALS ARE LATERAL TO THE CORACOID TO AVOID DAMAGE TO THE NEUROVASCULAR STRUCTURES LOCATED MEDIAL TO THE CORACOID.THIS PORTAL IS MARKED JUST LATERAL TO THE TIP OF THE CORACOID PROCESS AND INFERIOR TO THE ANTEROLATERAL ACROMIAL BORDER.DIAGNOSTIC ARTHROSCOPY