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Subcoracoid impingement Dr. E. Galindo
Definición: <ul><li>Subscapularis tendon impingement between: </li></ul><ul><li>Coracoid process. </li></ul><ul><li>Minor ...
Aetiology: <ul><li>Idiopathic. </li></ul><ul><li>3 anatomic variants* </li></ul><ul><li>Coraco-glenoid space* </li></ul>* ...
<ul><li>Anterior pain of the shoulder. </li></ul><ul><li>Differential diagnosis: </li></ul><ul><ul><ul><li>Subscapularis t...
Lift-off test*. Diagnosis: * Burkhart SS, Tehrany AM.  Arthroscopic subscapularis tendon repair: Technique and preliminar ...
<ul><li>Napoleon test* </li></ul><ul><ul><ul><li>Negative 0º </li></ul></ul></ul>* Burkhart SS, Tehrany AM.  Arthroscopic ...
<ul><li>Napoleon test* </li></ul><ul><ul><ul><li>Intermediate 30º-60º </li></ul></ul></ul><ul><ul><ul><li>Positive 90º </l...
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...
* Burkhart SS, Ian K, Lo.  The etiology and assessment of subscapularis tendon tears: the Roller-Wringer effect, and TUFF ...
TUFF lesion  (Tensile undersurface fiber failure) * Burkhart SS, Ian K, Lo.  The etiology and assessment of subscapularis ...
<ul><li>Conservative: </li></ul><ul><li>Rest. </li></ul><ul><li>NEAIs. </li></ul><ul><li>Rehabilitation: </li></ul><ul><li...
<ul><li>Surgically: </li></ul><ul><li>Open surgery. </li></ul><ul><li>Subacromial arthroscopy *. </li></ul><ul><li>Articul...
Gleno-humeral approach: <ul><li>Easier technique. </li></ul><ul><li>Less invasive. </li></ul><ul><li>Correct orientation p...
Surgical technique: <ul><li>Regional   anesthesia </li></ul><ul><li>Lateral position </li></ul><ul><li>Pump (<80mm Hg) </l...
<ul><li>Lateral   position </li></ul><ul><li>Pump (<80mm Hg) </li></ul>Surgical technique:
<ul><li>Artroscopic portals </li></ul><ul><li>Posterior. </li></ul><ul><li>Anterosuperior. </li></ul>Surgical technique:
<ul><li>Posterior portal: </li></ul><ul><li>Intra-articular inspection of the Rotator interval. </li></ul>Surgical techniq...
<ul><li>Antero-superior  </li></ul><ul><li>portal: </li></ul><ul><li>Osseus Prominence. </li></ul>Surgical technique:
Surgical technique: <ul><li>Antero-superior  </li></ul><ul><li>portal: </li></ul><ul><li>Osseus Prominence. </li></ul>
VAP  ® Surgical technique:
Surgical technique: VAP  ®
Conjoined tendon Surgical technique:
Coracoplasty Surgical technique:
Surgical technique: Coracoplasty
Measurement of the new space. Surgical technique:
 
Conclusion: <ul><li>This technique, through the rotator interval, allowed us:   </li></ul><ul><li>An easily technique. </l...
Many thank’s !!!
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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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