so now we're going to start doing a uh arthroscopic biceps tenodesis it's going to be a super PEC technique so as opposed to an open sub PEC or an arthroscopic intraarticular or even an arthroscopic in the groove this is going to be a super PEC technique which really is important to use ultrasound for the techniques have been described very well have been to go in find the actual biceps intractically using spinal needles and set what they call goal posts and then go into the subacriminal space and find then unroof it the problem with that is you can easily hurt and damage the supraspinatus tendon this way the biceps come through the Notch and actually exits the Notch and actually exits all the soft tissue just before it Dives under the PEC so we can take advantage of that and go directly to the spot so here's the thing if in fact we're Superior we see the biceps there we see the groove there and if we follow it down you see it flattens out and exits the groove there and then we start seeing the peck arrive there so we need a spot between that pack and that Notch which is actually right there so we know there's our spot that's the spot we want to be in that's going to be not where the pack is and not where the notch is and I'm going to just change the orientation a bit so I move the arm a little bit of extra rotation so I can see a little bit better so it's more in Foss and so coming up there's the notch there's Notch very clearly there and we're going to follow it down and that's pretty much where we want to be so there's our spot as it exits the notch so notch no notch so that's gonna be our spot right there so that's actually how we're going to make our incisions kind of the uh pen please so we know right under that spot is where we want to be so that's where we actually want to make our incisions so we're going to make our decisions here and here that are basically surrounding because our biceps 10 is going to be running right there in that Center area and we know because we set the arm in position we have this true mono one to make sure we're in the right spot so now we have our position we can wipe off all the gel we can make our incisions we can go and undermine the deltoid so we can get in and create a space in that area thank you so now I've created a potential space where I can see create an arthroscopic space and I just make sure I can see it really nicely and I can clear it out now we can come in with our scope and take a look and there you go you can see it pretty pretty quickly right there I'm going to go ahead and clear out the area of some soft tissue and we should fall right on the biceps right there boom there it is you can see the biceps instantly so you can see there's no guessing there's no messing around about where I am where I need to be here's your biceps and what we can do for the tenodesis is I can move it over to the side and then go and make our hole and then basically we're just going to take our forked swivel lock in here right there Kelly see right there I need you to hold the camera okay okay so once I have that I've grabbed my tissue I first it into the hole Kelly right there buddy and then basically I'm just going to screw in the screw into the hole to Tina these the biceps into the humerus there we go perfect good you can see that the biceps is into the hole there but this was something that only can be done with ultrasound to be able to identify where it was to be able to fall in so quickly and easily to find it foreign
