肩关节镜基础

单击此处编辑母版标题样式,单击此处编辑母版文本样式,二级,三级,四级,五级,*,*,肩关节镜基础,stabilization,：,bony anatomy,surrounding muscles,capsular structures,Arthroscopy,Anatomy:,stabilizer,glenohumeral joint,：,glenoid fossa of the scapula+,head of the humerus,Labrum,：,“,bumper”,：,deepen,and enlarge the glenoid fossa,biceps tendon,：,is,anchored at the superior labrum,，,a,humeral head depressor,Joint,capsule,glenohumeral 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,Observation,Palpation,Passive and active,ROM,Resistive testing,rotator cuff tear:,specialized,PE,Labrum,:,Catching, clicking, or popping,Multidirectional instability:,sulcus sign,imaging,Plain radiographs,Magnetic resonance imaging,DIFFERENTIAL DIAGNOSIS,Degenerative,arthritis,Labral tear,Biceps tendon,pathology,Adhesive capsulitis,Rotator cuff,tear,Impingement,Instability,Acromioclavicular,joint injury or,arthritis,Scapulothoracic,dysfunction,Cervical or neurologic,Infection,NONOPERATIVE MANAGEMENT,Rest,NSAIDS,physical therapy,diagnostic 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 reviewed,appropriate equipment and instruments,An examination under anesthesia is performed to assess range of motion and stability.,Positioning,beach-chair position,the shoulder can be,freely,manipulated,throughout,the procedure,lateral,decubitus,position,excellent visualization,Setup and Portal Placement,bony surface anatomy should be outlined,posterior, 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 marked just lateral to the tip of the coracoid process and inferior to the anterolateral acromial border.,Diagnostic,arthroscopy,