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 |
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Glenohumeral joint arthroscopy
Posterior glenohumeral joint 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 |
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Anterior glenohumeral joint portals
| 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
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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 |
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Shoulder arthroscopy
Rotator Interval - triangle of glenoid medial, biceps superior, subscapularis inferior
Humeral head cartilage
Glenoid cartilage
Labrum - anterior / inferior / posterior
Biceps tendon / insertion
Subscapularis
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 |
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Runs perpendicular to the middle GHL |
Crosses subscapularis vertically Variable size and shape in different people Cord like / leaf like / vestigal |
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Stabilizes the long head of the biceps in its groove Limits external rotation of the humerus |
Limits external rotation with arm by side |
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| Inferior glenohumeral ligament (IGHL) | |
|---|---|
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Origin: Inferior 2/3 glenoid and labrum Insertion: Anatomical neck humerus
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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 |
|
Anterior IGHL glenoid attachment |
IGHL humeral attachment |
Inferior recess
Loose body in inferior recess
Undersurface supraspinatus - abduct arm
Infraspinatus / bare area / Hill Sachs
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 |
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