肩關(guān)節(jié)鏡基礎(chǔ)

1、肩關(guān)節(jié)鏡基礎(chǔ),,,stabilization ：bony anatomysurrounding musclescapsular structuresArthroscopy,Anatomy:stabilizer,glenohumeral joint：glenoid fossa of the scapula + head of the humerusLabrum：“bumper”：deepen and enlarg

2、e the glenoid fossa biceps tendon ：is anchored at the superior labrum，a humeral head depressor,Joint capsuleglenohumeral ligaments,rotator cuff muscles: supraspinatus, infraspinatus, subscapularis, and teres mino

3、r,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年齡越大，不穩(wěn)越少見(jiàn),history

4、,Was it a traumatic, nontraumatic, or overuse injury？When and how did the injury occur？Is the patient’s complaint of pain, loss of motion, weakness, or inability to perform sports, activities of daily living, or work？

5、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, clic

6、king, or poppingMultidirectional instability: sulcus sign,imaging,Plain radiographsMagnetic resonance imaging,DIFFERENTIAL DIAGNOSIS,Degenerative arthritisLabral tearBiceps tendon pathologyAdhesive capsulitisRotat

7、or cuff tearImpingement InstabilityAcromioclavicular joint injury or arthritisScapulothoracic dysfunctionCervical or neurologicInfection,NONOPERATIVE MANAGEMENT,RestNSAIDSphysical therapydiagnostic and therapeut

8、ic 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 P

9、lanning,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 s

10、houlder can be freely manipulated throughout the procedurelateral decubitus positionexcellent visualization,Setup and Portal Placement,bony surface anatomy should be outlinedposterior, anterior, and, if necessar

11、y, 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

12、 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 art