Cadmore media player playing video Shoulder approaches for Orthopaedic Fellowship Examination
Video Player
Accessibility
Using forms mode, you can utilize keyboard shortcuts to make usability more efficient.
Space bar will play and pause the video. Pressing escape will close all displays and pressing it again will jump to the end of the player.
You can press A to open the Keyboard Shortcut Dialog which also provides an audio description of the player and all of its features.
Language
1x
Play Speed
Adjust Volume
Transcript
Search
Result Count
of
Click to jump to result
Search
Re-center
Segments
Result Count
of
Click to jump to result
Search
Name:
Shoulder approaches for Orthopaedic Fellowship Examination
Description:
Shoulder approaches for Orthopaedic Fellowship Examination
Thumbnail URL:
https://cadmoremediastorage.blob.core.windows.net/08555a7b-0154-431e-83e4-84c796b60501/videoscrubberimages/Scrubber_1.jpg
Duration:
T00H22M13S
Embed URL:
https://stream.cadmore.media/player/08555a7b-0154-431e-83e4-84c796b60501
Content URL:
https://cadmoreoriginalmedia.blob.core.windows.net/08555a7b-0154-431e-83e4-84c796b60501/Shoulder approaches for Orthopaedic Fellowship Examination.mp4?sv=2019-02-02&sr=c&sig=4HQ3GchkYXEgVFujNx3UOoazsGhwM4SxmgQ3aArXTew%3D&st=2024-12-04T08%3A17%3A04Z&se=2024-12-04T10%3A22%3A04Z&sp=r
Upload Date:
2024-05-31T00:00:00.0000000
Transcript:
Language: EN.
Segment:0 .
Look, guys, onto tonight's teaching or from our first mentor group, I hope you can all hear me well, thank you everyone for attending. If there are any issues, technical issues, please write me a message on the chat option. If you have any questions, also please write me a message on the chat option or next to your name.
You can find an option to raise your hand, so please raise your hand if you have any questions. Tonight we have two sessions all upper limb theme. First session will be delivered by David and second by kashif. Achieve very good. They are prepared. Very good talks, very specific if RCS talks and we're very grateful for the time they dedicated for this. So you have with us also schwann, who is also supporting us without any undue delay.
I will leave you with the speakers tonight. Go ahead, David, please. Thank you. All right. So today I'm going to talk a bit about surgical approaches, and we're going to talk about surgical approach to the shoulder. And specifically, I'm going to focus on two common ones, which come in the exam.
The anterior deltopectoral approach and the posterior approach. Now just some basic principles when you're thinking of the approach, which you can apply to any approach, I do recommend the book by Alex Trump to their links on. There'll be links on the telegram for group about this. But when you're talking about approach, these are the basic principles you should think about the position of the patient anatomical landmarks, the enteric nervous plane or into muscular plane.
And so in some instances, structures at risk. And if it's an extent, small or limited approach and also some tips as well. And I'm going to focus on some pitfalls that can happen, particularly with the anterior deltopectoral approach and also one of the reasons why they talk about the posterior approach in the exam. So starting off, so the Delta petrol approach typically used in arthroplasty a stabilization procedures, proximal humeral fractures.
So it's very popular on the trauma table as well as the sort of basic anatomy I had on the basic anatomy line with fractures and combined procedures. So in terms of position, so we have the classic beach chair position as demonstrated here, so thank you to the show you some of their pictures have between the shoulder blades held head to the way and access fluoroscopy for philosophy. Also sort of knees bent, stop the patient slipping down and making sure they're secured.
This position is more for an anterior humerus or mid humerus, but some surgeons will come from the other side with the fluoroscopy, so it just means that you're thinking about it from a trauma point of view. So it's worth mentioning. So but. So let me get back.
So landmarks, so in terms of basic anatomy, the key landmark is you feeling for the coracoid process and the deltopectoral grew and it's typically sort of can if you want to extend, you also will follow along the lateral border of biceps brachii. In terms of the enteric nervous plane, you want to think of the picture of this major, which is supplied by the medial, lateral and pectoral nerves and the deltoid which is applied by the axillary nerve.
These are all sort of key phrases that you need to sort of have on the tip of your tongue when talking about this approach. Now, we can't talk in detail about what you actually do, but the reality is by this stage of the exam is probably a little bit bored, so they want to know that you understand what the key problems are, so structure is at risk.
So one of the key first structure you'll come across will be at risk is the Catholic lisvane. And I've asked a lot of my senior colleagues, what do you do about it? Some say tie it off. Some say take it naturally. Some say take it immediately. There's no real common consensus. And to be honest, for most of the times that I've done it, when you look at the cephalic vein at the end of the operation, where have you it immediately or naturally, you might as well have tied it off because it's being battered and bruised by the retractors.
Now, the other structural risk that commonly at risk with this one is the musculocutaneous nerve. This is approximately. So this is a classic way of doing it where people take the conjoined tendon off the coracoid process and reflect it down for repair afterwards. Some people even make a little drill hole in order to make an interruptus repair. And there you can see that there.
OK so these are things that you need to be wary of. So again, who is going to be injured is going to be injured with retractors. Now, more importantly, because this will come up in a trauma session. Viva the axilo ulnar nerve. So this is going to be an issue. And you can see it just here now. Why is this an issue?
Oh, sorry. Well, as we'll talk about a little bit later on, one of the things with this approach. This is where we tend to make mistake when we talk about this approach. We start talking about the section. We've got to this point where we've exposed the capsule and subscapularis, and we're really going for it.
And now we're going to start talking about exposing the glenoid explosion, a joint for an arthroplasty operation when actually the question was, you've got proximal humeral fracture. How are you going to approach it? So in this situation, you need to stop and need to think so. We need to identify the tip that long ahead of price steps in this group, and this will help us ID credit tuberosity and the lesser tuberosity.
We do not want to describe the division of the capsular, the capsule and subscapularis, particularly subscapularis as in trauma, the letter goes with subscapularis. So we want to protect that. We don't want to cut that. And this is for an elective surgery, not for trauma. This is I remember my first survivor doing this, describing it brilliantly. And thinking, wow, really done it.
Brilliant and they were smiling at me. But then afterwards, it dawned on me. They asked about trauma, didn't they? They didn't ask about elective. So this is where we're going. We're looking at this bit here, so this is long head of biceps in its groove. So this is a great cancer. This is a lesser tuberosity tuberosity.
This is the lesser tuberosity, so we want to go here to fix that proximal humeral fracture. So this is where we might consider. Extending our approach along the lateral border of biceps brachii iron ore to expose it, and this is when we have to make sure that we have to be very careful with the axilo ulnar nerve because that can be at risk at this stage.
OK, so I just say this is just one of the things I want to make sure you're aware of when you're thinking about talking about the Delta deltopectoral approach. It is for trauma. You can talk about it in detail, but reality is it's only going to be the last few minutes at the last minute of your question on the Viva table. Now, posterior approach. That's a lot more popular exam question, although it's a very rare one.
Why do we do it? We tend to do it for posterior capsule or posterior Benoit. Fractures and posterior DNA is very, very rare injuries that very rarely get attacked because no one does the posterior approach on a regular basis. However, it's popular because it's a test of the anatomy of the spaces and the triangles in on a basic science table.
So they do like it again in terms of principles. We have to think of oh, sorry. Position so natural to hubertus, position of a patient. It can follow a shoulder arthroscopy, so if you're working for a consultant who does their shoulder arthroscopy laterally on the lateral position, so it may be, they start off to a scope and then put them into this position in order to get access to the posterior part of the shoulder.
It is also key when you're talking about this, you have to remember we protect the non operative side, so lots of padding because sometimes these operations are very long and people can get problems down and you need to will be annoyed. Again, this is all demonstrating that you've got an idea. You've done this, maybe done this before and you're thinking about the patient as well, as well as about the operation.
And also make sure you position the arm and drape it. So it's free again to allow access for X-rays as well. So landmarks, the key landmark is going to be the chromium and the spine of the scapular. So some text talk about doing your incision, going along the spine scapula, I would say going down. I mean, it does depend on what you're doing. If you're trying to get access to the scapular and maybe the glenoid a bit more immediately than you would go along the spine of the scapular.
But a lot of surgeons might have seen it done have gone down in the groove sort of axillary groove in the way. All right. My mouse is a bit sensitive. Apologies about this. OK so it's a nervous plane. So you've now done your incision.
You've gone. You see you deal deltoid, which you're going to sort of retract laterally and then you got your nervous plane, which is between interest and which is supplied by the SLAP ulnar nerve and terez minor, which is supplied by the axilo in that, to be honest, at this point. Again, the exam is going to be quite bored because they want to know, do you know, what do you know?
What structures are at risk? And the key thing is main structures at risk are going to be the Super SLAP ulnar nerve, if you're ever retracting on them from spin 8es and then the axillary nerve because you may have gone may have identified terrorism major and gone into the quadrangle, quadrangle or space. However, as I say then at this point, this is when they start talking about the anatomy a bit more because this is what this is, the meat of this part of the Bible.
They want you to talk about the quadrangle, the different spaces. So here's a nice sort of picture. So we've got a triangular space quadrangular space and are triangular interval. They do love this because it's quite easy to get these two, these all confused. So I'm going to start off the triangular space. So this is the most medial of the space of the rules and the boundary superior areas is the inferior border of terrorism, minor inferior.
The superior border of Terra's major eye, then naturally is the medial border of long head of triceps. It doesn't sound great, does it, when you say it like that, but those are the key things that are going to be interested in and contents. Second, flex SLAP the artery and vein. And this is important, particularly if you're trying to treat any injury around the scapular. Again, it's more of an issue for the safer anatomy as a point of interest.
And you could quite easily have a picture of the section section to show you. OK the next one is going to be the. Quadrangular space. So the superior border is the inferior border of terrorist minor, the inferior border is the superior border of tiers major. As I say, it does sound a bit of a mouthful there immediately.
You've got the medial sort of lateral border of long head of triceps and. Lateral border is the shaft of the shaft of humerus, the contents are the axillary nerve and posterior artery and vein. This again, is important, particularly if you're doing a posterior approach. So this is where the temptation is. You've seen what looks like terrorism terrorism major.
Sorry, Sarah's minor and you've gone before it and that you've made your interval there rather than there. OK, so that's when that nerve can get injured. Now, next, last interview was going to be the triangular interval. So the key features are to think of the superior border at this time is terrorism.
The inferior edge of it immediately. Again, it's the long head of triceps and naturally it's the shaft of humus. The contents are the radial artery and profundo brachial artery. This becomes more important when you're doing a posterior approach to the shaft of humerus and is a good way of identifying where your radial artery starts. Before you sort of start developing your pain deeper, ok?
Right so sorry, that was a little bit bigger than I thought it would be, but any questions that people would like to ask. I haven't received any questions, David, I think there was a question about the radial ulnar nerve from Amjad, and I'm not sure what exactly he wants to know, but possibly, I presume you want to know the cause of the radial nerve, and I wasn't sure if he was part of.
You will talk to the tonight. Sorry, I think you misspoke. You've said radial artery, let's say radial artery, I won't say so, ray. So where are we? Let's go back. Previous all right, and Joe, let me go to that segue that there's a better picture of it.
So here we are. So if I put this back on the screen. So you can just about see it here right enough, so this is the triangular interval. And so it's coming in theory, it's coming from just below the inferior edge of terror is made of Terra's major towards the shaft, so it's going from medial lateral. And then you will start the spiral groove.
So it starts about there and it's underneath the. Remember, it's not long headed triceps. It's natural head of triceps, so natural had a triceps. So it comes in underneath natural hair, triceps and into the spinal groove sort of just roughly where my arrow is. And then here is the breakout artery, which will follow the neurovascular bundle there, and that wraps around the front, as you would in terms of anatomy.
Yeah thank you. Thank you, David. I think I'm just trying to say just I think in the presentation, it's this artery instead of nerve. Oh, don't say artery. But we all know what you mean. I apologize. I misspoke.
I'm not quite. I'm not doing George bush, but I did misspeak. Speak, then you're doing very well. Excellent I think it's very good. And I think that David's covered very nicely the excellent and very important exam topic approaches in general, how to answer any approaches question. He covered all the main components of how do you answer?
If you ask about any approach, how do you explain the indications to the examiners, the positioning of the patient, the landmark, your incision, your nervous plain and the anatomical hazards? And his presentation could be used like really as a guide to answer any question about approaches and approach, particularly the deltopectoral approach very commonly asked question. So I think that's and then if you get asked about the spaces in the shoulder, that's also very nicely covered here, and you can explain that very nicely based on this talk.
So I just want to stress, I mean, in terms of we get very worked up about anatomy and approaches for when we come up to the exam, when reality is, it's quite simple. I made this mistake at the beginning, and so I was trying to recreate and filled word for word. When reality is, you don't need to do it, you don't have time to do it in the Viber section or in if you get to the point in a short case or intermediate case, these are the key things that the examiner wants to know of position landmarks into nervous open muscular flying structures at Risk Center in any sort of tips.
As I said, I recommend Alex trumpeter's little book on trauma class. Yet it has all the major approaches that you will need to know in this situation. It's only it has all those major approaches, maybe on or five pages. So that's all you really need to know. So you don't have to be so descriptive as we end up being, as I say it does.
You can overdo it and you only have a short space of time. You want to do it. Maybe in 30 seconds to a minute. And if you can get all of that in the minute, you've got all the marks you're going to get on approach. Great I think we had one question from Usman, and I think it's quite an advanced question. I think if you get asked this in the exam, you will be doing extremely well.
Yeah, I think you say from the superior margin of the Sergeant major, as you mentioned, this is quite advanced question. If you are getting that question, either you are doing very, very well or you are doing very bad. Yeah so what's your onset again? How would you say it's a superior version of the spectrum major? So yeah, I think it's a 2.5 centimeter, I think as long as I can remember.
So you use the superior margin of the pec major as your landmark weight and height of your implants should be 2.5 centimeters superior to that if I'm not wrong. Oh, is this for a position for the use of proximal humeral plate? No, it's not for it's for the replacement. Humeral head replacement. Oh, humeral head replacement.
If you dig that arthroplasty, how you're going to judge that your position of the humeral head, it correct level, correct level. He has mentioned for the heavy artillery as far as the reason for the heavy. How how to judge the plot. When you're doing the heaviest velocity of the shoulder, you will unlikely. Yes, that is a very advanced question.
You're unlikely to get asked that question in the exam. Yeah, yeah, they want. The reality is you've got if you can understand the principle that the retroversion of the humeral head or all the positions, the glenoid, that's more important, I feel. But yeah, in some implants have got different specifications as to where they go. So I know there's going to there'll be a bit of an argument from the point of view of the shoulder surgeon as to what position.
It should be. But roughly, I think, yeah, I think I find the answer. I think that this stems from the top of the prosthesis. The upper border of the major should be centimeters centimeters. Yeah, Yeah. So two inches in a bit. But the major Yeah. Yeah, Yeah.
So thank you for that question. I think is there any more questions from participants? These are all the questions I received. Anyone from the mentors would like to add anything. And just to reinforce David's last point, which I think is incredibly valuable, and I think you guys need to take this on board, his headings are perfect.
Just reiterate or you're heading in a fully consented market and property consent to market patient where anesthesia on board. My position is my landmarks are my structures at risk are just hit them with those. Sorry, I apologize. Internet-based pain is my structures at risk is and so, so on. Hit them with those points.
My bullet points don't bother trying to have a conversation. Just hit them with those phones because the market is in that. Once you get to the tips and techniques, but you're now in the discussion about what you do really in the operation and what to watch out for. What are the other things to do? So David really highlighted that really well. I just want to make sure everyone pays attention to that part.
Team egawa test. And we do that later. So, yeah, we'll do that.
Segment:0 .
Look, guys, onto tonight's teaching or from our first mentor group, I hope you can all hear me well, thank you everyone for attending. If there are any issues, technical issues, please write me a message on the chat option. If you have any questions, also please write me a message on the chat option or next to your name.
You can find an option to raise your hand, so please raise your hand if you have any questions. Tonight we have two sessions all upper limb theme. First session will be delivered by David and second by kashif. Achieve very good. They are prepared. Very good talks, very specific if RCS talks and we're very grateful for the time they dedicated for this. So you have with us also schwann, who is also supporting us without any undue delay.
I will leave you with the speakers tonight. Go ahead, David, please. Thank you. All right. So today I'm going to talk a bit about surgical approaches, and we're going to talk about surgical approach to the shoulder. And specifically, I'm going to focus on two common ones, which come in the exam.
The anterior deltopectoral approach and the posterior approach. Now just some basic principles when you're thinking of the approach, which you can apply to any approach, I do recommend the book by Alex Trump to their links on. There'll be links on the telegram for group about this. But when you're talking about approach, these are the basic principles you should think about the position of the patient anatomical landmarks, the enteric nervous plane or into muscular plane.
And so in some instances, structures at risk. And if it's an extent, small or limited approach and also some tips as well. And I'm going to focus on some pitfalls that can happen, particularly with the anterior deltopectoral approach and also one of the reasons why they talk about the posterior approach in the exam. So starting off, so the Delta petrol approach typically used in arthroplasty a stabilization procedures, proximal humeral fractures.
So it's very popular on the trauma table as well as the sort of basic anatomy I had on the basic anatomy line with fractures and combined procedures. So in terms of position, so we have the classic beach chair position as demonstrated here, so thank you to the show you some of their pictures have between the shoulder blades held head to the way and access fluoroscopy for philosophy. Also sort of knees bent, stop the patient slipping down and making sure they're secured.
This position is more for an anterior humerus or mid humerus, but some surgeons will come from the other side with the fluoroscopy, so it just means that you're thinking about it from a trauma point of view. So it's worth mentioning. So but. So let me get back.
So landmarks, so in terms of basic anatomy, the key landmark is you feeling for the coracoid process and the deltopectoral grew and it's typically sort of can if you want to extend, you also will follow along the lateral border of biceps brachii. In terms of the enteric nervous plane, you want to think of the picture of this major, which is supplied by the medial, lateral and pectoral nerves and the deltoid which is applied by the axillary nerve.
These are all sort of key phrases that you need to sort of have on the tip of your tongue when talking about this approach. Now, we can't talk in detail about what you actually do, but the reality is by this stage of the exam is probably a little bit bored, so they want to know that you understand what the key problems are, so structure is at risk.
So one of the key first structure you'll come across will be at risk is the Catholic lisvane. And I've asked a lot of my senior colleagues, what do you do about it? Some say tie it off. Some say take it naturally. Some say take it immediately. There's no real common consensus. And to be honest, for most of the times that I've done it, when you look at the cephalic vein at the end of the operation, where have you it immediately or naturally, you might as well have tied it off because it's being battered and bruised by the retractors.
Now, the other structural risk that commonly at risk with this one is the musculocutaneous nerve. This is approximately. So this is a classic way of doing it where people take the conjoined tendon off the coracoid process and reflect it down for repair afterwards. Some people even make a little drill hole in order to make an interruptus repair. And there you can see that there.
OK so these are things that you need to be wary of. So again, who is going to be injured is going to be injured with retractors. Now, more importantly, because this will come up in a trauma session. Viva the axilo ulnar nerve. So this is going to be an issue. And you can see it just here now. Why is this an issue?
Oh, sorry. Well, as we'll talk about a little bit later on, one of the things with this approach. This is where we tend to make mistake when we talk about this approach. We start talking about the section. We've got to this point where we've exposed the capsule and subscapularis, and we're really going for it.
And now we're going to start talking about exposing the glenoid explosion, a joint for an arthroplasty operation when actually the question was, you've got proximal humeral fracture. How are you going to approach it? So in this situation, you need to stop and need to think so. We need to identify the tip that long ahead of price steps in this group, and this will help us ID credit tuberosity and the lesser tuberosity.
We do not want to describe the division of the capsular, the capsule and subscapularis, particularly subscapularis as in trauma, the letter goes with subscapularis. So we want to protect that. We don't want to cut that. And this is for an elective surgery, not for trauma. This is I remember my first survivor doing this, describing it brilliantly. And thinking, wow, really done it.
Brilliant and they were smiling at me. But then afterwards, it dawned on me. They asked about trauma, didn't they? They didn't ask about elective. So this is where we're going. We're looking at this bit here, so this is long head of biceps in its groove. So this is a great cancer. This is a lesser tuberosity tuberosity.
This is the lesser tuberosity, so we want to go here to fix that proximal humeral fracture. So this is where we might consider. Extending our approach along the lateral border of biceps brachii iron ore to expose it, and this is when we have to make sure that we have to be very careful with the axilo ulnar nerve because that can be at risk at this stage.
OK, so I just say this is just one of the things I want to make sure you're aware of when you're thinking about talking about the Delta deltopectoral approach. It is for trauma. You can talk about it in detail, but reality is it's only going to be the last few minutes at the last minute of your question on the Viva table. Now, posterior approach. That's a lot more popular exam question, although it's a very rare one.
Why do we do it? We tend to do it for posterior capsule or posterior Benoit. Fractures and posterior DNA is very, very rare injuries that very rarely get attacked because no one does the posterior approach on a regular basis. However, it's popular because it's a test of the anatomy of the spaces and the triangles in on a basic science table.
So they do like it again in terms of principles. We have to think of oh, sorry. Position so natural to hubertus, position of a patient. It can follow a shoulder arthroscopy, so if you're working for a consultant who does their shoulder arthroscopy laterally on the lateral position, so it may be, they start off to a scope and then put them into this position in order to get access to the posterior part of the shoulder.
It is also key when you're talking about this, you have to remember we protect the non operative side, so lots of padding because sometimes these operations are very long and people can get problems down and you need to will be annoyed. Again, this is all demonstrating that you've got an idea. You've done this, maybe done this before and you're thinking about the patient as well, as well as about the operation.
And also make sure you position the arm and drape it. So it's free again to allow access for X-rays as well. So landmarks, the key landmark is going to be the chromium and the spine of the scapular. So some text talk about doing your incision, going along the spine scapula, I would say going down. I mean, it does depend on what you're doing. If you're trying to get access to the scapular and maybe the glenoid a bit more immediately than you would go along the spine of the scapular.
But a lot of surgeons might have seen it done have gone down in the groove sort of axillary groove in the way. All right. My mouse is a bit sensitive. Apologies about this. OK so it's a nervous plane. So you've now done your incision.
You've gone. You see you deal deltoid, which you're going to sort of retract laterally and then you got your nervous plane, which is between interest and which is supplied by the SLAP ulnar nerve and terez minor, which is supplied by the axilo in that, to be honest, at this point. Again, the exam is going to be quite bored because they want to know, do you know, what do you know?
What structures are at risk? And the key thing is main structures at risk are going to be the Super SLAP ulnar nerve, if you're ever retracting on them from spin 8es and then the axillary nerve because you may have gone may have identified terrorism major and gone into the quadrangle, quadrangle or space. However, as I say then at this point, this is when they start talking about the anatomy a bit more because this is what this is, the meat of this part of the Bible.
They want you to talk about the quadrangle, the different spaces. So here's a nice sort of picture. So we've got a triangular space quadrangular space and are triangular interval. They do love this because it's quite easy to get these two, these all confused. So I'm going to start off the triangular space. So this is the most medial of the space of the rules and the boundary superior areas is the inferior border of terrorism, minor inferior.
The superior border of Terra's major eye, then naturally is the medial border of long head of triceps. It doesn't sound great, does it, when you say it like that, but those are the key things that are going to be interested in and contents. Second, flex SLAP the artery and vein. And this is important, particularly if you're trying to treat any injury around the scapular. Again, it's more of an issue for the safer anatomy as a point of interest.
And you could quite easily have a picture of the section section to show you. OK the next one is going to be the. Quadrangular space. So the superior border is the inferior border of terrorist minor, the inferior border is the superior border of tiers major. As I say, it does sound a bit of a mouthful there immediately.
You've got the medial sort of lateral border of long head of triceps and. Lateral border is the shaft of the shaft of humerus, the contents are the axillary nerve and posterior artery and vein. This again, is important, particularly if you're doing a posterior approach. So this is where the temptation is. You've seen what looks like terrorism terrorism major.
Sorry, Sarah's minor and you've gone before it and that you've made your interval there rather than there. OK, so that's when that nerve can get injured. Now, next, last interview was going to be the triangular interval. So the key features are to think of the superior border at this time is terrorism.
The inferior edge of it immediately. Again, it's the long head of triceps and naturally it's the shaft of humus. The contents are the radial artery and profundo brachial artery. This becomes more important when you're doing a posterior approach to the shaft of humerus and is a good way of identifying where your radial artery starts. Before you sort of start developing your pain deeper, ok?
Right so sorry, that was a little bit bigger than I thought it would be, but any questions that people would like to ask. I haven't received any questions, David, I think there was a question about the radial ulnar nerve from Amjad, and I'm not sure what exactly he wants to know, but possibly, I presume you want to know the cause of the radial nerve, and I wasn't sure if he was part of.
You will talk to the tonight. Sorry, I think you misspoke. You've said radial artery, let's say radial artery, I won't say so, ray. So where are we? Let's go back. Previous all right, and Joe, let me go to that segue that there's a better picture of it.
So here we are. So if I put this back on the screen. So you can just about see it here right enough, so this is the triangular interval. And so it's coming in theory, it's coming from just below the inferior edge of terror is made of Terra's major towards the shaft, so it's going from medial lateral. And then you will start the spiral groove.
So it starts about there and it's underneath the. Remember, it's not long headed triceps. It's natural head of triceps, so natural had a triceps. So it comes in underneath natural hair, triceps and into the spinal groove sort of just roughly where my arrow is. And then here is the breakout artery, which will follow the neurovascular bundle there, and that wraps around the front, as you would in terms of anatomy.
Yeah thank you. Thank you, David. I think I'm just trying to say just I think in the presentation, it's this artery instead of nerve. Oh, don't say artery. But we all know what you mean. I apologize. I misspoke.
I'm not quite. I'm not doing George bush, but I did misspeak. Speak, then you're doing very well. Excellent I think it's very good. And I think that David's covered very nicely the excellent and very important exam topic approaches in general, how to answer any approaches question. He covered all the main components of how do you answer?
If you ask about any approach, how do you explain the indications to the examiners, the positioning of the patient, the landmark, your incision, your nervous plain and the anatomical hazards? And his presentation could be used like really as a guide to answer any question about approaches and approach, particularly the deltopectoral approach very commonly asked question. So I think that's and then if you get asked about the spaces in the shoulder, that's also very nicely covered here, and you can explain that very nicely based on this talk.
So I just want to stress, I mean, in terms of we get very worked up about anatomy and approaches for when we come up to the exam, when reality is, it's quite simple. I made this mistake at the beginning, and so I was trying to recreate and filled word for word. When reality is, you don't need to do it, you don't have time to do it in the Viber section or in if you get to the point in a short case or intermediate case, these are the key things that the examiner wants to know of position landmarks into nervous open muscular flying structures at Risk Center in any sort of tips.
As I said, I recommend Alex trumpeter's little book on trauma class. Yet it has all the major approaches that you will need to know in this situation. It's only it has all those major approaches, maybe on or five pages. So that's all you really need to know. So you don't have to be so descriptive as we end up being, as I say it does.
You can overdo it and you only have a short space of time. You want to do it. Maybe in 30 seconds to a minute. And if you can get all of that in the minute, you've got all the marks you're going to get on approach. Great I think we had one question from Usman, and I think it's quite an advanced question. I think if you get asked this in the exam, you will be doing extremely well.
Yeah, I think you say from the superior margin of the Sergeant major, as you mentioned, this is quite advanced question. If you are getting that question, either you are doing very, very well or you are doing very bad. Yeah so what's your onset again? How would you say it's a superior version of the spectrum major? So yeah, I think it's a 2.5 centimeter, I think as long as I can remember.
So you use the superior margin of the pec major as your landmark weight and height of your implants should be 2.5 centimeters superior to that if I'm not wrong. Oh, is this for a position for the use of proximal humeral plate? No, it's not for it's for the replacement. Humeral head replacement. Oh, humeral head replacement.
If you dig that arthroplasty, how you're going to judge that your position of the humeral head, it correct level, correct level. He has mentioned for the heavy artillery as far as the reason for the heavy. How how to judge the plot. When you're doing the heaviest velocity of the shoulder, you will unlikely. Yes, that is a very advanced question.
You're unlikely to get asked that question in the exam. Yeah, yeah, they want. The reality is you've got if you can understand the principle that the retroversion of the humeral head or all the positions, the glenoid, that's more important, I feel. But yeah, in some implants have got different specifications as to where they go. So I know there's going to there'll be a bit of an argument from the point of view of the shoulder surgeon as to what position.
It should be. But roughly, I think, yeah, I think I find the answer. I think that this stems from the top of the prosthesis. The upper border of the major should be centimeters centimeters. Yeah, Yeah. So two inches in a bit. But the major Yeah. Yeah, Yeah.
So thank you for that question. I think is there any more questions from participants? These are all the questions I received. Anyone from the mentors would like to add anything. And just to reinforce David's last point, which I think is incredibly valuable, and I think you guys need to take this on board, his headings are perfect.
Just reiterate or you're heading in a fully consented market and property consent to market patient where anesthesia on board. My position is my landmarks are my structures at risk are just hit them with those. Sorry, I apologize. Internet-based pain is my structures at risk is and so, so on. Hit them with those points.
My bullet points don't bother trying to have a conversation. Just hit them with those phones because the market is in that. Once you get to the tips and techniques, but you're now in the discussion about what you do really in the operation and what to watch out for. What are the other things to do? So David really highlighted that really well. I just want to make sure everyone pays attention to that part.
Team egawa test. And we do that later. So, yeah, we'll do that.
Form Title Download
Transcript
Form Title Bookmark
Entire Media
Segment(s)
Custom Clip
Start At:
End At:
Form Title Share
Entire Media
Segment(s)
Custom Clip
Start At:
End At:
Form Title Accessibility and Keyboard Shortcuts
The cadmore media player is a professional video and audio player experience designed to deliver media as well as relevant transcript, segmentation, and metadata. On the screen is a traditional html video player with buttons such as play, pause, forward, captioning, language and play speed selection and more. Adjacent to the video player are generally tabs, one of which shows a scrolling transcript of the video and the other shows any segmentation of the media, sometimes referred to as chapters. At the top of the video is a menu bar containing an Explore button and Tools button. The Explore button allows you to dig deeper into the video by opening up an explore dialog which contains tabs for a visual navigation of the video using thumbnails, an about tab which contains rich metadata about the media, a segments tab which contains further information about the video, and a related tab which contains links to other media related to this media. The tools button opens a menu with options for sharing the media on social media, creating bookmarking links, creating embed codes for your website, generating citations, and more.
Keyboard Shortcuts
Keyboard shortcuts only work while you are in forms mode. By entering forms mode, you will be able to quickly access portions of the media player with single key commands.
Spacebar: Play/Pause Toggle
I: Info Menu,
O: Tools Menu
T: Transcript Tab,
S: Segments Tab
F: Forward 15,
R: Rewind 15
L: Languages,
P: Playspeed
M: Mute Toggle,
V: Volume Bar
N: Video Only Toggle,
B: Full Screen Toggle
C: Captions Toggle
Escape: Closes dialogs and menus / Exits Player
Z: Next Transcript Chapter
X: Previous Transcript Chapter
Q: Next Transcript Paragraph
W: Previous Transcript Paragraph
Entire Media
Segment(s)
Custom Clip
Start At:
End At:
Embed Size
-
You Size - Responsive
-
We Size - Responsive
-
Picture Overlay Popup
-
400 x 225
-
512 x 288
-
400 x 700
-
768 x 1024
-
1024 x 512
-
1280 x 608
Form Title Cite
No citation provided.
Info
Segments
Related
Thumbnails
Exit Clip Mode
You have requested to see a portion of the video outside of the clip.
Click OK to switch to the full video or click if you would like to stay inside the clip. You can always go back to the clip with Tools and Clip Mode