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1、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 depr
2、essor,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 disea
3、se 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,
4、 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,DIFFERENTI
5、AL 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 diagnost
6、ic 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 appropr
7、iate 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 sur
8、face 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,
