1. Arthroscopic Shoulder Anatomy
Christopher M. Aland MD
Rothman Institute, Newtown, PA

2. Disclaimer
• I own stock in J &J, and Arthrocare
• I am on the Membership committee of AANA
• I have no conflicts which would interfere with
this course

3. Introduction
• The essence of viewing shoulder anatomy in a
reproducible fashion is the consistent use of
portal placement
• Develop YOUR routine and follow it every
time. Using a checklist or cheat sheat is OK

4. Intra-articular anatomy
• Initial portal should be
posterior
• No need to pre inject
joint—ok for bursa
• Subscapularis is a more
consistent anatomic
finding—orient off this
• Establish anterior portal
outside-to-in.

5. Intra-articular anatomy
• Initial portal should be
posterior
• No need to pre inject
joint—ok for bursa
• Subscapularis is a more
consistent anatomic
finding—orient off this
• Establish anterior portal
outside-to-in.

6. Intra-articular anatomy
• Middle glenohumeral
ligament—MGHL
• Variable
• Originates
superoglenoid tubercle
to inferior aspect of
lesser tuberosity

7. Intra-articular anatomy
• Inferior glenohumeral
ligament—IGHL
• Diagonal fold
• More prominent in ER
• Anterior band part of
“hammock”

8. Intra-articular anatomy
• Internally rotate arm,
follow subscap laterally
• Inspect footprint
• Anterior recess

9. Intra-articular anatomy
• Internally rotate arm,
follow subscap laterally
• Inspect footprint
• Anterior recess

10. Intra-articular anatomy
• Superior glenohumeral
ligament-SGHL
• Just anterior to biceps
tendon
• Forms pulley to support
biceps in groove
• Subscap path usually
assoc with SGHL path

11. Intra-articular anatomy
• Running across the top
of visual field should be
biceps tendon
• Look into groove
• Sublux into joint
• Follow to superior
glenoid

12. Intra-articular anatomy
• Running across the top
of visual field should be
biceps tendon
• Look into groove
• Sublux into joint
• Follow to superior
glenoid

13. Intra-articular anatomy
• Running across the top
of visual field should be
biceps tendon
• Look into groove
• Sublux into joint
• Follow to superior
glenoid

14. Intra-articular anatomy
• Probe labrum, but
remember where
attachment really is
– Meniscoid
– Superior recess
• Follow labrum
anteriorly
• Anatomic variants

15. Intra-articular anatomy
• Inspect the articular
surface
• Normal thinning in
center
• Look for bony
abnormalities
• Drive through sign

16. Intra-articular anatomy
• Inferior recess
• Look for loose bodies
• Lax capsule

17. Intra-articular anatomy
• Abduct arm and roll up
posteriorly
• Normal bare area
• Undersurface of cuff
• Cord and cable

18. Intra-articular anatomy
• Use switching sticks to
rotate camera anteriorly
• Inspect posterior
labrum
• Follow around to front
to inspect subscap and
recess

19. Intra-articular anatomy
• Use switching sticks to
rotate camera anteriorly
• Inspect posterior
labrum
• Follow around to front
to inspect subscap and
recess

20. Intra-articular anatomy
• Use switching sticks to
rotate camera anteriorly
• Inspect posterior
labrum
• Follow around to front
to inspect subscap and
recess

21. Intra-articular anatomy
• Use switching sticks to
rotate camera anteriorly
• Inspect posterior
labrum
• Follow around to front
to inspect subscap and
recess

22. Bursal anatomy
• Superior cuff
• Coraco-acromial
ligament
• Bursa—veil of tears
• Any previously placed
markers

23. Common variants
• Don’t fix these
• Buford complex
• Sublabral foramen
• Superior recess

24. Common variants
• Don’t fix these
• Buford complex
• Sublabral foramen
• Superior recess

25. Common variants
• Don’t fix these
• Buford complex
• Sublabral foramen
• Superior recess

26. Common variants
• Don’t fix these
• Buford complex
• Sublabral foramen
• Superior recess

27. Thank-you