II Lecture Chapter 21 Short Answer: Shoulder Surgery pp 465

What muscles comprise the rotator cuff? How will a tear of one or more of these muscles or thier tendinous attachments affect the shoulder?

1. Infraspinatus 2. Teres minor 3. Subscapularis 4. Supraspinatus

Name the three joints of the shoulder girdle.

1. glenohumeral joint 2. sternoclavicular joint 3. acromioclavicular (AC) joint

When placing a trocar for the arthroscopic Bankart repair, why type of trocars are used, and why?

Blunt, not sharp, trocars are used. Threaded cannulas should be used to prevent their dislodgement during the surgical procedure.

What are the problems that may commonly be found and treated during the diagnostic shoulder arthroscopy?

Procedures that can be performed include the removal of loose bodies, bursectomy, rotator cuff repairs, labral tear repair, and repair of impingement syndrome.

Once a shoulder arthroscopy has begun, what landmark is used for orientation during the procedure? What instrument is used to palpate the structures to identify any injuries?

The biceps tendon is used as a landmark throughout the procedure. The surgeon uses the arthroscope to examine. The surgeon will place the probe through the anterior portal to examine for labral or SLAP (superior labrum anterior and posterior) tears or synovitis.

What are the bony landmarks that are marked for an arthroscopic acromioplasty?

The humeral head and bony glenoid fossa.

What solution is commonly used for arthroscopy? What may be added to control bleeding? Why are large bags used?

3000 mL bags of lactated Ringer's solution To aid in hemostasis the surgeon may request 1 mL of epinephrine to be added to each 3000-mL bag of lactated Ringer's solution after confirmation with the anesthesia care provider that this can be done. An arthroscopic ESU will also be used. If epinephrine has not been injected into the bags of Ringer's solution, the surgeon may inject the shoulder joint with up to 5 mL of Marcaine with epinephrine to aid in controlling bleeding. At the conclusion of the procedure the surgeon allows plenty of fluid to flow through the joint for irrigation purposes and removal of any loose bodies.

Describe a Bankart lesion.

A Bankart lesion is an avulsion (tear) injury of the anterior capsule and labrum of the glenoid rim known as the inferior glenohumeral ligament. It is usually caused by subluxation (partial dislocation) or luxation (dislocation) of the joint.

The top of the glenoid cavity is formed by the bony point on the top of the shoulder called the acromion process of the ___ .

AC (acromioclavicular) joint The joint cavity is cushioned by articular cartilage covering the head of the humerus and face of the glenoid. The scapula extends up and around the shoulder joint at the rear to form a roof called the acromion, and around the shoulder joint at the front to form the coracoid process.

What is the main function of the rotator cuff?

The main function of the rotator cuff is to provide stability and strength to the shoulder joint.

What type of joint is the shoulder? What bones articulate to form the joint?

The shoulder is a ball-and-socket joint. The shoulder is made up of three bones: 1. Scapula (shoulder blade) 2. Clavicle (collar bone) 3. Humerus (arm bone)

During examination of the shoulder, how is the arm manipulated by the surgical technologist?

The surgical technologist may be asked to rotate the arm for visualization of the shoulder joint. The surgical technologist may be requested by the surgeon to gently manipulate the arm from the extended, externally rotated position in an internally, slightly flexed position. The surgical technologist may be requested by the surgeon to slowly internally and externally rotate rotate the shoulder to view the articular cartilages; the surgical technologist must manipulate the arm slowly to prevent damage to the shoulder joint structures and allow the surgeon to follow along with the arthroscope. The surgical technologist may be requested by the surgeon to internally and externally rotate the shoulder.