0:00

Okay, so this is a 30 5-year-old man.

0:04

Um, I don't know what the mechanism of injury was.

0:10

Let's look at the aal.

0:11

I'm gonna blow it up a little bit to make it easier for you.

0:16

Let's go through that process of, uh,

0:20

describing the anatomy.

0:22

So we've got the hylan cartilage back here and the bone,

0:25

and we haven't really, we haven't lost any bone.

0:30

There's a little cartilage flap right here that is naked.

0:35

So there, there's a tiny cartilage abnormality.

0:37

Let's go to the periosteum.

0:39

The periosteum is intact,

0:40

but it's elevated in an AA like fashion.

0:44

So we've got a second problem. We have a third problem.

0:48

We're a elaborated, no, not from drinking alcohol.

0:51

It's from the loss of the labrum, which is stuck to the back

0:55

of the capsular perote reflection.

0:57

And we have another, another structure right here,

1:00

which represents a piece of labrum.

1:02

So we actually have a comminuted labral tear.

1:06

So we've got a, a minor cartilage problem.

1:08

No bony problem, a periosteal problem,

1:12

a labral problem, and we're not done yet.

1:14

We haven't done the capsule. So what about the capsule?

1:18

Well, as Dr. Resnick, as Don described yesterday,

1:21

the fosbury flop, you know,

1:23

flopping over backwards like this, over the, uh,

1:27

over the high jump bar.

1:28

Here we have the middle glen

1:29

of humeral ligament doing a fosbury flop.

1:32

So the middle glen of humeral ligament is torn.

1:35

And not only is it torn in its mid substance,

1:37

it doesn't make its way to the, to the middle facet

1:41

of a lesser tuberosity.

1:43

So it is delaminating at its attachment.

1:46

Oh, but we're not done yet.

1:48

Let's go up a little higher

1:49

and check out the rest of the glenohumeral ligaments.

1:53

We've got a nice big, fat juicy biceps that's coming back

1:57

to the posterior biceps, uh, labral anchor and tubercle.

2:02

But we also have this structure, which is a big fat, two fat

2:07

superior glenohumeral ligament, which does not attach

2:10

to the anterior aspect of the labrum.

2:12

So we have an S-G-G-H-L detachment.

2:15

Here's your caracal humeral ligament.

2:17

This is your anterior rotator interval area.

2:20

Then let's drop back down

2:22

and look at the, um, look at the status of our IGHL.

2:27

Here's our anterior bundle of our IGHL. Looks pretty good.

2:31

Let's go to the coronal projection

2:33

to check out our IGHL friends, both anterior,

2:38

posterior, and axillary.

2:40

We're in the back right now.

2:41

You can see the axillary distended by fluid.

2:44

Here we are in the mid portion, still intact,

2:48

and here we are anteriorly still intact.

2:50

Although, uh, Dr.

2:51

Resnick identified earlier in our, our prior discussion,

2:55

perhaps a little tear right there at the anterior bundle

2:58

Of the IGHL.

3:00

So a complex case.

3:02

We've got combination of the labrum,

3:04

we've got periosteal stripping, we've got tears

3:07

of the glenohumeral ligaments,

3:09

including the IGHL attachment, the MGHL interstitial

3:14

and at its attachment,

3:16

and the SGHL at its base in this patient

3:20

who is a dislocated.