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1. Αρθροσκόπηση Ώμου
και άμεση μετεγχειρητική
παρακολούθηση
Μάνος Αντωνογιαννάκης
Διευθυντής Κέντρου Αρθροσκοπικής
Χειρουργικής Ώμου
ΙΑΣΩ General

2. The Shoulder
 Greatest Range of Motion in the Body
 Motion in all 3 planes of movement
 Prone to injuries
 8-20% of all sports injuries

3. History
• 1931 First Cadaver Shoulder Arthroscopy Burman
• 1974 First Shoulder Arthroscopy in vivo Johnson LL
• 1982 First Arthroscopic repair Johnson LL
of Shoulder Instability

4. Diagnostic arthroscopy
The way everything began!!

5. Light General Anesthesia
with Laryngeal Mask

6. Plus Local Anesthesia
Scalene Block

7. Patient Positioning
Padding bony prominences
Beware of the neck

8. Room Set up
Lateral decubitus allows easy access to the
anterior and posterior part of the joint

9. Keep the operating room cold
to avoid fogging
but
Keep the
patient warm

10. Basic Arthroscopic Tools
Have them all ready from the beginning

11. Cannulated Tools

12. Draping

13. Arm Draping
Be careful with traction

14. Traction:
NOT more than 4 Kgrs

15. Skin Marking

16. Before Entering the Scope
Saline Backflow
Saline in

17. Making the scope portal

18. 30º Scope Entrance

19. Diagnostic Arthroscopy
• Distinguish Normal Anatomy
• Anatomic Variants
• Variation of GHLs
• Sublaral Hole
• Cord-like middle GHL
• Buford Complex
• Rotator Crescent Sign (cuff “ridge”)
• SLAP lesions
• Bursal side RC tears
• Internal Impingement

20. Shoulder Arthroscopy
the evolution of the technique
Diagnostic
Tool
Final
Treatment
From tool of the devil the treatment of choice of most shoulder
pathologies

21. Therapeutic Arthroscopy
• Rotator Cuff disease
• Tears (Full, Partial, Intratendonious)
• Calcifying Tendonitis
• Instability
• Anterior, Posterior, Multidirectional
• Bony Bankart lesions
• Glenoid defects
• HAGL and reverse HAGL lesions

22. Therapeutic Arthroscopy
• SLAP lesions
• Frozen Shoulder
• AC joint
• Arthritis
• Dislocation
• Biceps Pathology

23. Rotator Cuff
Massive Tears

24. Rotator Cuff
Massive Tears

25. Rotator Cuff
Subscapularis Tear

26. Rotator Cuff
Subscapularis
Tear

27. Rotator Cuff
Calcifying Tendonitis

28. Rotator Cuff
Calcifying Tendonitis

29. Frozen Shoulder

30. AC Joint
Distal Clavicle Excision

31. AC Joint
Distal Clavicle Excision

32. AC Joint
• Dislocation

33. Shoulder Instability

34. Arthroscopic success rate
• Savoie 1997 93%
• Burchart, De Bear 2000 96%
• J Tauro 2000 93%
• Kim 2003 96%
• Snyder 2006 93%
• Fabbriciani 2004 100%

35. Thank you