肩关节镜基础

肩关节镜基础,stabilization ：bony anatomysurrounding musclescapsular structuresArthroscopy,Anatomy:stabilizer,glenohumeral 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 depressor,Joint capsuleglenohumeral ligaments,rotator cuff muscles: supraspinatus, infraspinatus, subscapularis, and teres minor,Shoulder proplem,40 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,history,Was 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？,pe,ObservationPalpationPassive and active ROMResistive testingrotator cuff tear: specialized PELabrum : Catching, clicking, or poppingMultidirectional instability: sulcus sign,imaging,Plain radiographsMagnetic resonance imaging,DIFFERENTIAL DIAGNOSIS,Degenerative arthritisLabral tearBiceps tendon pathologyAdhesive capsulitisRotator cuff tearImpingement InstabilityAcromioclavicular joint injury or arthritisScapulothoracic dysfunctionCervical or neurologicInfection,NONOPERATIVE MANAGEMENT,RestNSAIDSphysical therapydiagnostic and therapeutic injections,SURGICAL MANAGEMENT,A 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 Planning,Patient history and imaging studies are reviewedappropriate equipment and instrumentsAn examination under anesthesia is performed to assess range of motion and stability.,Positioning,beach-chair position the shoulder can be freely manipulated throughout the procedurelateral decubitus positionexcellent visualization,Setup and Portal Placement,bony surface anatomy should be outlinedposterior, anterior, and, if necessary, lateral portal,Posterior portal,:2 to 3 cm inferior and 1 cm medial to the posterolateral border of the acromion,Anterior portal,Care 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 m