Comprehensive Arthroscopic Management | Treatment of Shoulder Osteoarthritis | Shoulder Surgeon скачать в хорошем качестве

Comprehensive Arthroscopic Management | Treatment of Shoulder Osteoarthritis | Shoulder Surgeon

https://drmillett.com In this demonstration, the patient is placed in the beach chair position with a pneumatic arm holder. A fluoroscopic c-arm is draped into the surgical field for visualization and to aid in the resection of the inferior humeral osteophyte. After establishing the standard posterior and anterior superior portals, diagnostic arthroscopy is performed. This confirms end-stage osteoarthritis with degeneration of the labrum. Unstable glenohumeral articular cartilage, degenerative labral tissue, and synovitis are debrided to a stable border with an arthroscopic shaver. The long head of the biceps tendon is released using radiofrequency ablation, while an accessory posterior inferior lateral portal is established under arthroscopic visualization to allow access to the inferior axillary recess, humeral neck, and axillary nerve. First, the spinal needle is inserted which enters the axillary recess just anterior to the margin of the posterior band of the inferior glenohumeral ligament. This is followed by a switching stick being placed bluntly into the axillary pouch to avoid iatrogenic injury to the axillary nerve. A self-retaining cannula is inserted to facilitate insertion and removal of instruments. The intra-articular inferior humeral osteophyte is resected using a shielded arthroscopic burr and arthroscopic shavers. The arm is internally and externally rotated during the procedure to bring all areas of the osteophyte into view of the arthroscope or within the plane of the fluoroscope. Curettes are used to remove hypertrophic bone from areas that are more difficult to reach with motorized instruments. Sufficient resection is verified with a fluoroscopic c-arm. An inferior capsular release is then performed. Performing capsular releases at this point helps prevent excessive fluid extravasation which can occur if the releases are done at the beginning of the procedure. Once the nerve is identified, dissection is carried out from proximal to distal to avoid damage to any branches a multiple arbitrations are not uncommon. Neurolysis is considered complete when the axillary nerve is visible along its entire course without soft tissue adherence or osseous impingement. Anterior and posterior capsular releases are performed after humeral osteoplasty and axillary neurolysis to prevent fluid excursion leading to soft tissue swelling, impeding the following procedures. The arthroscope is then placed into the posterior portal and subacromial space. Arthroscopic subacromial decompression with complete bursectomy is performed. With the rotator cuff visualized, acromioplasty is performed using an arthroscopic burr through the lateral portal. The rotator interval is released at the final stages to minimize fluid extravasation. Immediately after surgery the focus of rehabilitation is on range of motion. Passive range of motion, early continuous passive motion, and cautious stretching is used. At six weeks functional strengthening is begun, and at 3 months strengthening is started followed by a return to normal activities.