Date post: | 02-Jul-2015 |
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Health & Medicine |
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Subcoracoidimpingement
Dr. E. GalindoDr. E. Galindo
Definición:Subscapularis tendon impingement between:
Coracoid process. Minor tuberosity.
Definition
Aetiology:
• Idiopathic.• 3 anatomic variants*• Coraco-glenoid space*
*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.
Anterior pain of the shoulder.
Differential diagnosis: Subscapularis tendinitis. SLAP. Biceps tendinitis. Supraspinatus tendinitis.
Clinical manifestations:
Lift-off test*.
Diagnosis:
*Burkhart SS, Tehrany AM. Arthroscopic subscapularis tendon repair: Technique and preliminar results. Arthroscopy. 2002 May-Jun;18(5):454-63.
Napoleon test*
Negative 0º
*Burkhart SS, Tehrany AM. Arthroscopic subscapularis tendon repair: Technique and preliminar results. Arthroscopy. 2002 May-Jun;18(5):454-63.
Diagnosis:
Napoleon test*
Intermediate 30º-60º Positive 90º
*Burkhart SS, Tehrany AM. Arthroscopic subscapularis tendon repair: Technique and preliminar results. Arthroscopy. 2002 May-Jun;18(5):454-63.
Diagnosis:
M.R.I.(axial)
Diagnosis:
Fisiopathology:
Narrowspace
Roller-Wringer
Inflamation
TendinitisTUFF
Subscapularis Rupture
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:
*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
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:
Conservative:
Rest. NEAIs. Rehabilitation:
Short waves.Microwaves.Electrotherapy.
• Infiltrations
Treatment:
Surgically:
• Open surgery.• Subacromial arthroscopy *.• Articular arthroscopy **.
*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:
Gleno-humeral approach:
• Easier technique.• Less invasive.• Correct orientation performing the coracoplasty.• Correct measurement of thenew space (8mm).
Arthroscopic surgery:
Surgical technique:
• Regional anesthesia• Lateral position• Pump (<80mm Hg)
• Lateral position• Pump (<80mm Hg)
Surgical technique:
Artroscopic portals
• Posterior.• Anterosuperior.
Surgical technique:
Posterior portal:
Intra-articular inspection of the Rotator interval.
Surgical technique:
Antero-superior portal:
Osseus Prominence.
Surgical technique:
Surgical technique:
Antero-superior portal:
Osseus Prominence.
VAP ®
Surgical technique:
Surgical technique:
VAP ®
Conjoined tendon
Surgical technique:
Coracoplasty
Surgical technique:
Surgical technique:
Coracoplasty
Measurement of the new space.
Surgical technique:
Conclusion:
This technique, through the rotator interval, allowed us:
• An easily technique.• Secure and reproductible.• Coracoplasty in the subscapularis line.• Measurement of the new space.• Faster rehabilitation.• Minimal complications.
Many thank’s !!!