Clinical Anatomy of the Shoulder : An Atlas

This book provides detailed information on functional anatomy, physical examination, and clinical radiology of the shoulder with a view to enabling the clinician to identify the most suitable treatment approach to different shoulder joint pathologies. In addition, it describes the arthroscopic treatment techniques most frequently employed in patients with these conditions and presents numerous arthroscopic images detailing characteristic findings. The shoulder is widely regarded as the most complex joint in the human body, displaying the widest range of motion. Knowledge of normal and pathological anatomy, ability to perform a proper physical examination, and appropriate selection of imaging modalities and interpretation of imaging appearances, often in close collaboration with an imaging expert, are all vital for correct diagnosis and choice of treatment approach. Surgeons and trainees will find this richly illustrated book to be an excellent educational guide and an instructive source of stepwise guidance from clinical presentation to achievement of desired treatment outcomes. Preface 6 Contents 7 1: Functional Anatomy of Shoulder 8 2: Arthroscopic Anatomy of Shoulder 24 2.1 Introduction 24 2.2 Surgical Technique 24 3: Shoulder Radiology 31 3.1 Plain Film Radiography of the Shoulder 31 3.2 Computed Tomography of the Shoulder 36 3.3 Magnetic Resonance Imaging of the Shoulder 42 References 62 4: Physical Examination 63 4.1 Neer’s Impingement 63 4.2 Hawkins-Kennedy Impingement Test 64 4.3 Yocum Sign 64 4.4 Coracoid Impingement Sign 64 4.5 Lift-Off Sign 65 4.6 External Rotation Lag Sign 65 4.7 Drop Sign 65 4.8 Speed Test 65 4.9 Whipple Test 66 4.10 Drop Arm Sign 66 4.11 Jobe Sign 66 4.12 Jobe Sign “Full Can” and “Empty Can” 67 4.13 Infraspinatus Strength Testing 67 4.14 Yergason Sign 68 4.15 Load and Shift Test 68 4.16 The Sulcus Sign 68 4.17 Apprehension Test 69 4.18 Adson Test 69 References 69 5: Arthroscopic Knot-Tying Techniques 70 5.1 Introduction 70 5.1.1 Terminology and Basic Concepts 70 5.1.2 Knot Options (Table 5.2) 73 5.1.3 Non-sliding Arthroscopic Knots 73 5.1.4 Sliding Arthroscopic Knots 73 References 76 6: Operation Room Setup and Patient Positioning 77 6.1 Operation Room Setup 77 6.1.1 General Requirements 77 6.1.2 Patient Table and Apparatus 77 6.1.3 Operation Tables 84 6.1.4 Placement of the Surgical Team 85 6.1.5 Arthroscopy Unit Tower 85 6.1.6 Arthroscopic Fluid Pump System 87 6.1.7 Fluid Collection on the Floor 87 6.1.8 Operating Room Personnel 87 6.2 Patient Positioning 88 6.2.1 Beach Chair Orientation 88 7: Shoulder Arthroscopy Portals 91 7.1 Bony Landmarks 91 7.2 Portals 91 7.3 Glenohumeral Joint Portals 91 7.3.1 Posterior Portals 91 7.3.1.1 Posterior Portal (Soft-Spot Portal) 91 7.3.2 Posteroinferior Portal (7 O’clock Portal) 93 7.4 Anterior Portals 93 7.4.1 Anterior Central Portal (Matthews Portal) 93 7.4.2 Anteroinferior Portal (Wolf’s Portal) 94 7.4.3 Anterosuperior Portal 94 7.4.4 Five O’clock Portal 94 7.4.5 Neviaser’s Portal (Supraclavicular Fossa Portal) 95 7.5 Lateral Portals 96 7.5.1 Port of Wilmington 96 7.5.2 Superolateral Portal 96 7.6 Subacromial Portals 96 7.6.1 Posterior Portals 96 7.6.1.1 Posterior Central Portal 96 7.6.2 Posterolateral Portal 96 7.7 Anterior Portal 96 7.8 Lateral Portals 97 7.8.1 Lateral Portal 97 7.8.2 Anterolateral Portal 97 References 98 Front Matter....Pages i-ix Functional Anatomy of Shoulder....Pages 1-16 Arthroscopic Anatomy of Shoulder....Pages 17-23 Shoulder Radiology....Pages 25-56 Physical Examination....Pages 57-63 Arthroscopic Knot-Tying Techniques....Pages 65-71 Operation Room Setup and Patient Positioning....Pages 73-86 Shoulder Arthroscopy Portals....Pages 87-94