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Rotator Cuff Anatomy Dr. XXXXX Hospital XXXXX Date XXXXX.

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Presentation on theme: "Rotator Cuff Anatomy Dr. XXXXX Hospital XXXXX Date XXXXX."— Presentation transcript:

1 Rotator Cuff Anatomy Dr. XXXXX Hospital XXXXX Date XXXXX

2 Rotator Cuff Muscles/Tendons Individual Tendon Components Supraspinatus Anomalies Anterior Fibers of Supraspinatus Infraspinatus Greater Tuberosity Anatomy Bare Area of GT Interdigitation Artifact 4-5 Histologic Layers Cable Crescent Component Teres Minor Subscapularis Rotator Intervals

3 Rotator Cuff Muscles Supraspinatus Infraspinatus Teres Minor Subscapularis

4 Muscular origin Supraspinatus Fossa Inserts on Greater Tuberosity Innervation from Suprascapular Nerve Triple Blood Supply Two and Perhaps three main tendinous components Supraspinatus

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14 Supraspinatus Anomalies Separate Muscular origins from the Supraspinatus fossa, anterior component intramuscular tendon and posterior component lateral tendon Accessory Slip extends to Lesser Tuberosity ????

15 Accessory Anterior Slip of Supra 10/37 cadaveric specimens, 1 with FT RCT

16 Insertional fibers- Rim Rent Tears Critical Zone- Hypovascular Intramuscular/Mus culotendinous Zonal Anatomy of Supraspinatus Tendon

17 Anterior Insertional Fibers

18 Anterior Insertional Fibers/Rim Rent

19 Rim Rent Tears Younger Patents anterior insertional SS tears, frequently with adjacent bone changes

20 Anomalous Supraspinatus Tendon 1

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58 Anomalous Supraspinatus with Prominent RI Slip

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72 Intraspinatus Muscular Origin Infraspinatus Fossa Multicircumpennate Innervated Suprascapular Nerve Inserts on Oblique Facet Greater Tuberosity

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75 Superior/Horizontal FacetAnterior and Mid Fibers of Supraspinatus Middle/Oblique Facet---Upper ½ receives overlapping fibers of Supra and Infraspinatus, Lower ½ Infraspinatus Posterior/Vertical Facet---Teres Minor Greater Tuberosity Anatomy

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77 Interdigitation Artifact August 1, Volume 22, Issue 4 Shoulder MRI refinements: differentiation of rotator cuff tear from artifacts and tendonosis, and reassessment of normal findings. Wright T; Yoon C; Schmit BP Seminars in US, CT, MRI

78 Greater Tuberosity Anatomy

79 Supra, Infra, Bare Area

80 Cystic Lesions in the Posterosuperior Portion of the Humeral Head on MR Arthrography: Correlations with Gross and Histologic Findings in Cadavers Wook Jin1, Kyung Nam Ryu2, Yong Koo Park3, Weon Kyu Lee4, Sung Hye Ko2 and Dal Mo Yang1 AJR 2005; 184: Cystic Changes at Bare Area

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82 4-5 Layers of the Rotator Cuff Clark-5 layers CHL&Rotator Cable 1,4 Capsule 5 3 and 2 differ in orientation Fallons-4 layers Capsule CHL Tendons Attachment Fibrocartilage

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91 Rotator Cuff Cable/Crescent

92 Cable/Crescent Cable component of the CHL (layer 4), thick fibrous tissue visible arthroscopically bounds thinner Crescent shaped portion of the distal cuff Extends from anterior Supra to Infra Functions as Suspension Bridge Shields the thinner crescent from undue stress Limits the degree of retraction of RCT Cable dominant/non dominant shoulders

93 Rotator Cuff Cable/Crescent

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97 Cable Dominant

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108 Cable Dominant PT RCT

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115 Cable Dominant with FT RCT

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117 Teres Minor Originates lower inferior edge of scapula Inserts on Vertical Facet of Greater Tub Innervated by Axillary Nerve May show atrophy/denervation changes Quadrilateral Space Syndrome/Fibrous Bands Isolated Teres Minor abnormality typical--- Nonspecific, d/t prior Trauma, Posterior Dislocation, Instability

118 45 y/o female with Adh Capsulitis, SS PT RCT, Teres Minor Atrophy 3% of Routine Shoulder MRs

119 Subscapularis Broad origin on the ventral surface of the scapula Multicircumpennate similar to infraspinatus Inserts on lesser tuberosity Contributes to transverse humeral ligament Inferior muscular portion that inserts near surgical neck of humerus

120 Subscapularis

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135 History of Dislocation

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146 Rotator Interval(s) Anterior Rotator Interval Medial and Lateral Portions Medially-Fat, RI Capsule, CHL, SGHL Lateral Apex-more complex anatomy, above components plus fibers from Supraspin and Subscapularis Focal RI tears, Site of Fibrosis in Adhesive Capsulitis

147 Posterior Rotator Interval Anatomy of the Posterior Rotator Interval: Implications for Cuff Mobilization. Miller et al.

148 PRI Normal

149 PRI Abnormal

150 Posterior Rotator Interval Findings Site for Arthroscopic Port Placement Normal Joint Recess Potential Space for Perilabral Cysts Adhesive Capsulitis Vessels

151 Biceps Pulley Impingement 25 y/o surfer with pain during paddling and findings of bicipital tendonitis on physical exam

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