- See:
shoulder joint menu
- Positioning:
- beach chair position is comfortable for both the patient and the surgeon and allows the option of converting to an open procedure (if necessary);
- patients need to be seated with the torso raised to 70 deg with a foled sheet placed on the medial border of affected scapula (to maximize
posterior exposure)
- complications: hypoglossal nerve injury;
- references:
- Measurements of brachial plexus strain in arthroscopy of the shoulder. AH Klein et al. Arthroscopy 1987. p 345-352.
- Hypoglossal n. palsy after arthroscopy of the shoulder and open operation w/ the patient in the beach chair position. JBJS. 1992. p137-139.
-
Avoiding catastrophic complications of stroke and death related to shoulder surgery in the sitting position.
- Portal Placement:
-
posterior portal:
-
anterior portal:
-
lateral portal:
- Arthroscopic Techniques:
-
arthroscopic acromioplasty
-
arthroscopic glenohumeral reconstruction
-
slap lesions:
- Arthroscopic rotator cuff repair
Multiple techniques
Single row
-one row of anchors is placed in the greater tuberosity usually lateral to the rotator cuff footprint
- Double row
-one row of anchors are placed at the articular margin and the second row is placed lateral to the footprint
- Transosseous equivalent
- one row of anchors is placed at the articular margin then laid down on top of the rotator cuff and secured to a lateral row of anchors.
- differs from double row in that one set of common sutures is shared between the two rows of anchors and it acts to compress the
rotator cuff on the native footprint rather than “spot weld”.
- see:
-
rotator cuff tears
-
management of massive rotator cuff tears:
- visualization thru the posterior portal:
- abduct and externally rotate the shoulder and angle the arthroscope laterally;
- internal impingement: visualized with the shoulder in maximal external rotation and abduction;
Arthroscopy of the shoulder: technique and normal anatomy. JR Andrews et al. Am J. Sports Med. Vol 12: p 1-7, 1984.
Anatomic Risks of Shoulder Arthroscopy Portals: Anatomic Cadaveric Study of 12 Portals.
Effect of Radiofrequency Energy on Glenohumeral Fluid Temperature During Shoulder Arthroscopy
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