AANA Lab Course 915 - Foundations in Arthroscopy-GLENOHUMERAL AND BURSAL ANATOMY OF THE SHOULDER-John Orwin, M.D

GLENOHUMERAL AND BURSAL ANATOMY OF THE SHOULDER-John Orwin, M.D

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This presentation by Dr. John F. Orwin focuses on the glenohumeral and bursal anatomy of the shoulder, emphasizing systematic diagnostic arthroscopic examination for thorough evaluation. Key points include:<br /><br />1. Diagnostic Exam: Always perform a detailed, systematic arthroscopic exam of the glenohumeral joint through both anterior and posterior portals. Consistency in this approach ensures no pathology is missed.<br /><br />2. Posterior Portal Structures: Includes visualization of the biceps tendon, superior and posterior labrum, inferior recess, glenoid, rotator cuff (specifically supraspinatus tendon or SST), bare area of the humeral head, rotator interval, and key ligaments such as superior and middle glenohumeral ligaments as well as the inferior glenohumeral ligament and anterior inferior labrum.<br /><br />3. Anterior Portal Structures: Visualizes posterior inferior labrum, posterior rotator cuff (infraspinatus tendon or IST), superior labrum, posterior biceps recess, anterior inferior labrum, and ligaments including the inferior glenohumeral ligament (IGHL) and middle glenohumeral ligament (MGHL). Also important are anterior capsular attachments on the humerus, anterior humeral head, subscapularis tendon, and its recess.<br /><br />4. Biceps Tendon and Labral Pathology: Mentioned are types of SLAP lesions (type 2 and 3) involving superior labrum and biceps anchor.<br /><br />5. Subacromial Anatomy: Important structures include the coracoacromial (CA) ligament, bursal surface of the rotator cuff, acromion, and acromioclavicular (AC) joint. Visualization is achieved via anterior, posterior, and mid-lateral portals especially during subacromial decompression.<br /><br />6. Bursa Characteristics: The subacromial bursa is a true anatomic space located anteriorly beneath the anterior third of the acromion, extending anteriorly and laterally to it. Often, it is unnecessary to create the bursal space by shaving tissue.<br /><br />Overall, this systematic approach to shoulder arthroscopy incorporating detailed anatomical knowledge helps clinicians accurately diagnose shoulder pathologies and guide surgical intervention effectively.

Keywords

glenohumeral joint

bursal anatomy

shoulder arthroscopy

diagnostic arthroscopic examination

posterior portal

anterior portal

biceps tendon

labral pathology

subacromial anatomy

SLAP lesions