Coracoplastia, Artroscopia de hombro

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  • Coracoplastia, Artroscopia de hombro

    1. 1. Subcoracoid impingement Dr. E. Galindo
    2. 2. Definición: <ul><li>Subscapularis tendon impingement between: </li></ul><ul><li>Coracoid process. </li></ul><ul><li>Minor tuberosity. </li></ul>Definition
    3. 3. Aetiology: <ul><li>Idiopathic. </li></ul><ul><li>3 anatomic variants* </li></ul><ul><li>Coraco-glenoid space* </li></ul>* Gumina S, Postacchini F , Orsina L, Cinotti G. “204” The morphometry of the coracoid process - its aetiologic role in subcoracoid impingement syndrome. Int. Orthop. 1999 ; 23(4):198-201.
    4. 4. <ul><li>Anterior pain of the shoulder. </li></ul><ul><li>Differential diagnosis: </li></ul><ul><ul><ul><li>Subscapularis tendinitis. </li></ul></ul></ul><ul><ul><ul><li>SLAP. </li></ul></ul></ul><ul><ul><ul><li>Biceps tendinitis. </li></ul></ul></ul><ul><ul><ul><li>Supraspinatus tendinitis. </li></ul></ul></ul>Clinical manifestations:
    5. 5. Lift-off test*. Diagnosis: * Burkhart SS, Tehrany AM. Arthroscopic subscapularis tendon repair: Technique and preliminar results. Arthroscopy. 2002 May-Jun;18(5):454-63.
    6. 6. <ul><li>Napoleon test* </li></ul><ul><ul><ul><li>Negative 0º </li></ul></ul></ul>* Burkhart SS, Tehrany AM. Arthroscopic subscapularis tendon repair: Technique and preliminar results. Arthroscopy. 2002 May-Jun;18(5):454-63. Diagnosis:
    7. 7. <ul><li>Napoleon test* </li></ul><ul><ul><ul><li>Intermediate 30º-60º </li></ul></ul></ul><ul><ul><ul><li>Positive 90º </li></ul></ul></ul>* Burkhart SS, Tehrany AM. Arthroscopic subscapularis tendon repair: Technique and preliminar results. Arthroscopy. 2002 May-Jun;18(5):454-63. Diagnosis:
    8. 8. M.R.I. (axial) Diagnosis:
    9. 9. Fisiopathology: Narrow space Roller-Wringer Inflamation Tendinitis TUFF Subscapularis Rupture
    10. 10. The Roller-Wringer effect * Burkhart SS, Ian K, Lo. The etiology and assessment of subscapularis tendon tears: the Roller-Wringer effect, and TUFF lesions of subscapularis. Arthroscopy. 2003 Dec;19(10):1142-1150. Fisiopathology:
    11. 11. * Burkhart SS, Ian K, Lo. The etiology and assessment of subscapularis tendon tears: the Roller-Wringer effect, and TUFF lesions of subscapularis. Arthroscopy. 2003 Dec;19(10):1142-1150. Fisiopathology: The Roller-Wringer effect
    12. 12. TUFF lesion (Tensile undersurface fiber failure) * Burkhart SS, Ian K, Lo. The etiology and assessment of subscapularis tendon tears: the Roller-Wringer effect, and TUFF lesions of subscapularis. Arthroscopy. 2003 Dec;19(10):1142-1150. Fisiopathology:
    13. 13. <ul><li>Conservative: </li></ul><ul><li>Rest. </li></ul><ul><li>NEAIs. </li></ul><ul><li>Rehabilitation: </li></ul><ul><li>Short waves. </li></ul><ul><li>Microwaves. </li></ul><ul><li>Electrotherapy. </li></ul><ul><li>Infiltrations </li></ul>Treatment:
    14. 14. <ul><li>Surgically: </li></ul><ul><li>Open surgery. </li></ul><ul><li>Subacromial arthroscopy *. </li></ul><ul><li>Articular arthroscopy **. </li></ul>*Karnaugh RD . Arthroscopic treatment of coracoid impingement. Arthroscopy.2001 Sep. **Lo IK, Burkhart SS . Arthroscopic coracoplasty through the rotator interval. Arthroscopy. 2003 Jul-Aug. Treatment:
    15. 15. Gleno-humeral approach: <ul><li>Easier technique. </li></ul><ul><li>Less invasive. </li></ul><ul><li>Correct orientation performing the coracoplasty. </li></ul><ul><li>Correct measurement of the </li></ul><ul><li>new space (8mm). </li></ul>Arthroscopic surgery:
    16. 16. Surgical technique: <ul><li>Regional anesthesia </li></ul><ul><li>Lateral position </li></ul><ul><li>Pump (<80mm Hg) </li></ul>
    17. 17. <ul><li>Lateral position </li></ul><ul><li>Pump (<80mm Hg) </li></ul>Surgical technique:
    18. 18. <ul><li>Artroscopic portals </li></ul><ul><li>Posterior. </li></ul><ul><li>Anterosuperior. </li></ul>Surgical technique:
    19. 19. <ul><li>Posterior portal: </li></ul><ul><li>Intra-articular inspection of the Rotator interval. </li></ul>Surgical technique:
    20. 20. <ul><li>Antero-superior </li></ul><ul><li>portal: </li></ul><ul><li>Osseus Prominence. </li></ul>Surgical technique:
    21. 21. Surgical technique: <ul><li>Antero-superior </li></ul><ul><li>portal: </li></ul><ul><li>Osseus Prominence. </li></ul>
    22. 22. VAP ® Surgical technique:
    23. 23. Surgical technique: VAP ®
    24. 24. Conjoined tendon Surgical technique:
    25. 25. Coracoplasty Surgical technique:
    26. 26. Surgical technique: Coracoplasty
    27. 27. Measurement of the new space. Surgical technique:
    28. 29. Conclusion: <ul><li>This technique, through the rotator interval, allowed us: </li></ul><ul><li>An easily technique. </li></ul><ul><li>Secure and reproductible. </li></ul><ul><li>Coracoplasty in the subscapularis line. </li></ul><ul><li>Measurement of the new space. </li></ul><ul><li>Faster rehabilitation. </li></ul><ul><li>Minimal complications. </li></ul>
    29. 30. Many thank’s !!!

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