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Normal anatomy final

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Normal anatomy final

  1. 1. Christopher M. Aland MD
  2. 2. Disclaimer <ul><li>I own stock in Arthrocare and Johnson and Johnson </li></ul><ul><li>I have no conflicts that inhibit my ability to teach this course </li></ul>
  3. 3. Just a word about portals
  4. 4. Marine Corps Slogan No better friend…no worse enemy Sulla, Rome 73BC Mattis, Fallujah 2004 Aland, AANA, Chicago 2011
  5. 5. Initial Viewing <ul><li>From Posterior: </li></ul><ul><ul><li>Subscapularis tendon </li></ul></ul><ul><ul><li>MGHL </li></ul></ul><ul><ul><li>IGHL </li></ul></ul><ul><ul><li>Subscap insertion </li></ul></ul><ul><ul><li>SGHL </li></ul></ul>
  6. 6. <ul><li>From Posterior, looking up: </li></ul><ul><ul><li>Biceps Tendon </li></ul></ul><ul><ul><li>Hiatus </li></ul></ul><ul><ul><li>Elbow? </li></ul></ul><ul><ul><li>Subluxed tendon </li></ul></ul><ul><ul><li>Origin on Glenoid </li></ul></ul>
  7. 7. <ul><li>Superior labrum </li></ul><ul><li>Anterior labrum </li></ul><ul><li>Articular surface glenoid </li></ul><ul><li>Articular surface humeral head </li></ul><ul><li>Inferior labrum </li></ul>
  8. 8. <ul><li>Inferior recess </li></ul><ul><li>Bare Area </li></ul><ul><li>Undersurface cuff </li></ul>
  9. 9. <ul><li>From Anterior </li></ul><ul><li>Posterior superior and </li></ul><ul><li>Posterior labrum </li></ul><ul><li>Posterior capsule </li></ul><ul><li>Anterior labrum </li></ul><ul><li>Subscapularis recess </li></ul>
  10. 10. Finish the job, look in the back <ul><li>Use two switching sticks </li></ul><ul><li>Reorient self </li></ul><ul><li>Proceed with exam </li></ul>
  11. 11. Videos
  12. 12. What not to fix <ul><li>Buford Complex: </li></ul><ul><ul><li>Cordlike MGHL with no labrum beneath </li></ul></ul><ul><ul><li>Initially described in 1994, 10% incidence </li></ul></ul><ul><ul><ul><li>Buford et. Al </li></ul></ul></ul><ul><ul><li>Increased incidence of SLAP tears noted </li></ul></ul><ul><ul><ul><li>Snyder 2003 </li></ul></ul></ul>
  13. 13. Don’t fix this either <ul><li>Sublabral foramen </li></ul><ul><ul><li>Common variant </li></ul></ul><ul><ul><li>10-15% or more </li></ul></ul><ul><ul><li>Degenerative? </li></ul></ul><ul><ul><li>Easy to put an anchor here </li></ul></ul><ul><ul><li>Don’t </li></ul></ul>

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