Shoulder Flashcards
Bones of the Shoulder
- Clavicle
- Acromion
- Coracoid Process
- Humeral Head
- Glenoid
Anterior Ligaments of the Shoulder
- Superior GlenoHumeral Ligament
- Middle GHL
- Inferior GHL
- Coraco-Acromial Ligament
Inferior GHL - 3 facts
Most Important - stability
Strongest
2 bands (Ant & Post Bands) to form Axillary Pouch
3 Shoulder Joints
- GlenoHumeral Joint
- AcromioClavicular Joint
- SternoClavicular Joint
3 Shoulder Ligaments
- AC - Acromial-Clavicular
- CA - Coraco-Acromial
- CC - Coraco-Clavicular
Rotator Cuff Muscles
- Subscapularis
- Supraspinatus
- Infraspinatus
- Teres Minor
What movement does Subscap do?
Internal Rotation
What movement does Supraspinatus do?
Abduction
What movement does Infraspinatus do?
External Rotation
What movement does Teres Minor do?
Adduction
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
3 Types of Sub Acromial Decompression
Type 1 Flat
Type 2 Curved
Type 3 Hooked
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
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
Spider 2 Features (x5)
- Cordless Battery
- Switch drape - distal activation
- Battery = 300 activations
- Activation button for initial set up
- Low Battery alert
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)
- Preloaded, Sterile
- Round, pre-curved Nitinol Needle
- Deep Bite
- Variety of Sutures
- Std or Self Capture tips
