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DVD-1090_001 | A | Anterior Portal, Biceps Evaluation and Peel-Back Test

Stephen S. Burkhart

Human

A video recording of a surgical technique on a live patient in an operating room setting or a cadaveric demonstration.

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Anterior Portal, Biceps Evaluation and Peel-Back Test

I'd like to make my portals, all my portals from outside in. So for my interior portal, this will be an anterior midlateral portal. I want to enter over the lateral half of the subscapular, and I want to enter at an angle that I have a good angle of approach toward, about 45 degrees toward the glenoid, and also a good angle of approach at the base of the biceps. I'll leave my spinal needle in while I insert the switching stick, and just sort of walk it down next to the spinal needle, right over the top of the subscapular. We'll put a twist in 8.25mm cannula. So I do want to probe this superior labrum. So there's some discoid labrum. There seems to be good attachment, good carry through of these biceps fibers into the supraglenoid tubercle into the bone. If you can take the root of the biceps and lift it up and just push it all over the place as if it's not even attached anywhere. That's pathologic finding, but this one has good carry through those fibers into the bone. The other sign for a Slap lesion arthroscopically, is this peel back test, where we bring the arm into abduction external rotation, and we see if the root of the biceps peels back over the medial edge of the glenoid. And it doesn't do that. And then the final thing would be whether there's a positive drive through sign. And there's not, of course, looking for instability. But also a lot of patients with Slap lesions will have a very easy drive through sign. And this lady does not. She has a normal drive through.

Anterior Portal, Biceps Evaluation and Peel-Back Test

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