Coracoplastia, Artroscopia de hombro
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Coracoplastia, Artroscopia de hombro

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Coracoplastia, Artroscopia de hombro Coracoplastia, Artroscopia de hombro Presentation Transcript

  • Subcoracoid impingement Dr. E. Galindo
  • Definición:
    • Subscapularis tendon impingement between:
    • Coracoid process.
    • Minor tuberosity.
    Definition
  • Aetiology:
    • Idiopathic.
    • 3 anatomic variants*
    • Coraco-glenoid space*
    * 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.
    • Anterior pain of the shoulder.
    • Differential diagnosis:
        • Subscapularis tendinitis.
        • SLAP.
        • Biceps tendinitis.
        • Supraspinatus tendinitis.
    Clinical manifestations:
  • Lift-off test*. Diagnosis: * Burkhart SS, Tehrany AM. Arthroscopic subscapularis tendon repair: Technique and preliminar results. Arthroscopy. 2002 May-Jun;18(5):454-63.
    • Napoleon test*
        • Negative 0º
    * Burkhart SS, Tehrany AM. Arthroscopic subscapularis tendon repair: Technique and preliminar results. Arthroscopy. 2002 May-Jun;18(5):454-63. Diagnosis:
    • Napoleon test*
        • Intermediate 30º-60º
        • Positive 90º
    * Burkhart SS, Tehrany AM. Arthroscopic subscapularis tendon repair: Technique and preliminar results. Arthroscopy. 2002 May-Jun;18(5):454-63. Diagnosis:
  • M.R.I. (axial) Diagnosis:
  • Fisiopathology: Narrow space Roller-Wringer Inflamation Tendinitis TUFF Subscapularis Rupture
  • 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:
  • * 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
  • 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:
    • Conservative:
    • Rest.
    • NEAIs.
    • Rehabilitation:
    • Short waves.
    • Microwaves.
    • Electrotherapy.
    • Infiltrations
    Treatment:
    • Surgically:
    • Open surgery.
    • Subacromial arthroscopy *.
    • Articular arthroscopy **.
    *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:
  • Gleno-humeral approach:
    • Easier technique.
    • Less invasive.
    • Correct orientation performing the coracoplasty.
    • Correct measurement of the
    • new space (8mm).
    Arthroscopic surgery:
  • Surgical technique:
    • Regional anesthesia
    • Lateral position
    • Pump (<80mm Hg)
    • Lateral position
    • Pump (<80mm Hg)
    Surgical technique:
    • Artroscopic portals
    • Posterior.
    • Anterosuperior.
    Surgical technique:
    • Posterior portal:
    • Intra-articular inspection of the Rotator interval.
    Surgical technique:
    • Antero-superior
    • portal:
    • Osseus Prominence.
    Surgical technique:
  • Surgical technique:
    • Antero-superior
    • portal:
    • Osseus Prominence.
  • VAP ® Surgical technique:
  • Surgical technique: VAP ®
  • Conjoined tendon Surgical technique:
  • Coracoplasty Surgical technique:
  • Surgical technique: Coracoplasty
  • Measurement of the new space. Surgical technique:
  •  
  • Conclusion:
    • This technique, through the rotator interval, allowed us:
    • An easily technique.
    • Secure and reproductible.
    • Coracoplasty in the subscapularis line.
    • Measurement of the new space.
    • Faster rehabilitation.
    • Minimal complications.
  • Many thank’s !!!