1. GlenoHumeral Joint 2. AcromioClavicular Joint 3. SternoClavicular Joint

1. AC - Acromial-Clavicular 2. CA - Coraco-Acromial 3. CC - Coraco-Clavicular

1. Subscapularis 2. Supraspinatus 3. Infraspinatus 4. Teres Minor

Shoulder Flashcards by isabelle hackforth-walker

Bones of the Shoulder

Clavicle
Acromion
Coracoid Process
Humeral Head
Glenoid

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Anterior Ligaments of the Shoulder

Superior GlenoHumeral Ligament
Middle GHL
Inferior GHL
Coraco-Acromial Ligament

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Inferior GHL - 3 facts

Most Important - stability
Strongest
2 bands (Ant & Post Bands) to form Axillary Pouch

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3 Shoulder Joints

GlenoHumeral Joint
AcromioClavicular Joint
SternoClavicular Joint

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3 Shoulder Ligaments

AC - Acromial-Clavicular
CA - Coraco-Acromial
CC - Coraco-Clavicular

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Rotator Cuff Muscles

Subscapularis
Supraspinatus
Infraspinatus
Teres Minor

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What movement does Subscap do?

Internal Rotation

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What movement does Supraspinatus do?

Abduction

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What movement does Infraspinatus do?

External Rotation

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What movement does Teres Minor do?

Adduction

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Steps for positioning Shoulder Portals

Posterior Portal (viewing)
2cm inferior, 1cm medial to Posterior Lateral corner of Acromion
Needle/Scalpel/Cannula/Obturator
Direct towards tip of Coracoid (place finger)
Anterior Portal (viewing & SAD)
Visualisation from Posterior - from safe triangle Glenoid/HH/Subscap
Lateral - SAD
1-2cm distal to lateral edge of Acromion

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3 Types of Sub Acromial Decompression

Type 1 Flat
Type 2 Curved
Type 3 Hooked

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Wands, Blades, Burrs for SAD

Ambient Super TurboVac90
Ambient Super MegaVav50
Flow 50/90
BoneCutter Plat
Incisor Plus Plat
Full Radius Platinum
Synovator Platinum
Stonecutter
Acromioblaster
Acromioniser
Helicut

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Patient Positioning

Beach Chair
Sit upright 70-80degrees
Use T-Max or Spider 2

Lateral Decubitus
10-15lbs traction
15-30 degrees rolled backwards
70 degrees Abduction
Use Lateral Positioner or Spider 2

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Spider 2 Features (x5)

Cordless Battery
Switch drape - distal activation
Battery = 300 activations
Activation button for initial set up
Low Battery alert

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Rotator Cuff - Partial Thickness tear

Fraying of either inferior or superior side of tendon

Rotator Cuff - Full Thickness tear

Complete thickness tear which vary in shape, size and complexity

Rotator Cuff - 3 Tear Patterns

Cresent
L-Shaped
U-Shaped

What is a PASTA tear?

Partial
Articular
Supraspinatus
Tendon
Avulsion

Mechanisms of Rotator Cuff injury

Sports - Chronic & Acute
Impingement Syndrome - Supra/Infra on hooked curved Acromion
SubAcromial Bursitis - inflammation

Rotator Cuff Injury - Symptoms

Pain front and side
Limited ROM
Tenderness at site
Weakness

What is a Transosseous Repair?

Open
Humeral Head decorticated
Bone Holes drilled and sutures through cuff and holes

What is a Single Row repair

One Lateral Row
Usually knotted anchor
Prep hole adjacent to articular margin on Humeral Head
Inser anchor at 45degs - Deadman’s Angle
Pass sutures through cuff and tie off

What is a Double Row repair

One Lateral and One Medial Row
Usually knotted and knotless anchors
Insert Medial Row anchor, pass sutures, insert medial row anchor on lat border of anatomic footprint, sutures through anchor and tensioned.

Anchor Materials

Titanium PEEK PLLA-HA Regenesorb

Titanium Material

eg Twinfix Very Strong & Inert Visible on X-ray -ve Scatter on MRI

PEEK Material

Poly-Ether-Ether-Ketone Very strong Thermoplastic High Impact Strength Revisable

PLLA-HA Material

Poly-L-Lactic Acid + HA Absorbable 24-36m to degrade High Tensile Strength

Regenesorb Material

PLGA 65% B-TCP 15% CaSO4 20% 4-12w Calcium Sulfate Absorbed 18 months - B-TCP PLGA aborbed at same rate as body heals

UltraBraid Features

UHMWPE No solid core White & Co-braid Highest knot tensile strength - 20% higher than Fibrewire Lubricious - ease of knot sliding Does not cut through gloves

UltraTape Features

More contact Improved pressure distribution - Flat, Smooth

Healicoil Knotted Materials? Sizes? Features?

PK - 4.5 and 5.5mm RG - 4.75 and 5.5mm Open Architecture - Ingrowth Less Material - Multiple / Healing Inserter engages full length -Torsional strength 2/3 sutures RG=Double Thread design

Healicoil Knotted Hole Prep?

PK - 3.8mm Gold Awl OR Size specific dilator RG - Size specific dilator

Q-Fix (for RCR) RCR Size? Material? Knotted or Knotless Deployment pressure? Sutures?

2.8mm All suture Magnumwire Knotted 140 N 2 x Magnumwire Sutures

Multifix S Ultra Size? Material? Knotted or Knotless? Bone prep? Tap in or screw in?

5.5 and 6.5mm PEEK Knotless Self tapping Screw in

Healicoil Knotless Size? Material? Knotted or Knotless? Bone prep? Tap in or screw in?

5mm PEEK Knotless 5.5mm RG dilator OR Self Tapping Screw In

Footprint Ultra Anchor Size? Material? Knotted or Knotless? Bone prep? Tap in or screw in?

4.5 and 5.5mm PEEK Knotless 3.8mm Gold Tapered Awl Tap In

FirstPass ST Features (x5)

1. Preloaded, Sterile 2. Round, pre-curved Nitinol Needle 3. Deep Bite 4. Variety of Sutures 5. Std or Self Capture tips