Setup, Positioning & Portal Placement

Question 1

What two positions are shoulder arthroscopy preformed in?

Answer 1

Beach chair or lateral decubitus

Question 2

What are the advantages of the beach chair position

Answer 2

Upright, Anatomic position

Ease of preforming a exam under anesthesia

Easy conversion to open procedure

And improved mobility of the arm

Question 3

What are the disadvantages of the beach chair position

Answer 3

Potential mechanical blocks
Obstruction of view
Risk of hypotension,bradycardia which may cause cerebral ischemia

Question 4

What position reduces the risk of cerebral ischemia?

Answer 4

The lateral decubitus position

Question 5

What are the advantages of the lateral decubitus position?

Answer 5

Traction increases space
Fewer barriers to accessibility cautery bubbles move laterally out of view
No increased risk of cerebral ischemia

Question 6

What are the disadvantages of the lateral decubitus position?

Answer 6

Increased risk of traction injury
More difficult to conversion to open
Nonanatomic orientation
Difficult to reach anterior portal

Question 7

What are the standard portal locations for shoulder arthroscopy?

Answer 7

Anterior, Lateral and Posterior

Question 8

What are the accessory portals?

Answer 8

Click on photo

Question 9

Where do all arthroscopic shoulder surgeries start?

Answer 9

The posterior portal , which is the primary viewing portal

Question 10

What areas does posterior port give you access to?

Answer 10

The glenohumeral joint and subacromial space

Question 11

What structures are at risk with a posterior portal?

Answer 11

Suprascapular artery
Suprascapular nerve
Axillary nerve

Question 12

Under direct vision of the posterior portal, the anterior portal is inserted via the________?

Answer 12

The the rotator interval, above the lateral half of the Subscapularis and medial to the long head of the bicep

Question 13

Placement of Anterior/inferior portal

Answer 13

In the rotator interval, above the lateral half of the Subscapularis and medial to the long head of the bicep

Question 14

What structure is at risk of injury in a anteriorsuperior and anteriorinferior portal?

Answer 14

The cephalic vein

Question 15

What can the lateral portal be used for?

Answer 15

As a working and viewing portal

Question 16

Where should a standard lateral portal be placed?

Answer 16

4cm lateral of the acromion, in line with the posterior aspect of the clavicle

Question 17

For the standard lateral portal, which structures are at risk?

Answer 17

The axillary nerve

Question 18

What is a popular working and viewing portal many doctors use?

Answer 18

Antero-superolateral

Question 19

Where doesn’t the anterior-suprilateral port enter?

Answer 19

Enters the Glenohumeral joint through the rotator cuff interval and above the biceps tendon

Question 20

What portal provides a better view of the anterior shoulder

Answer 20

The posterolateral portal

Question 21

What is the Nevisar accessory used for?

Answer 21

Used solely as a working portal for access the the GHJ for slap repair, subacromial space for rotator cuff repair and superior capsular reconstruction

Question 22

What portal can be used for the posterior repair of a slap tear?

Answer 22

Portal of Wilmington

Question 23

What portal is used for accessing the most inferior aspect of the glenoid for laberal repair?

Answer 23

5 O’clock

Question 24

For the 5 O’clock portal, what structures are at risk?

Answer 24

Axillary nerve
Axillary artery

Question 25

What portal is used to access the posterior/inferior glenoid?

Answer 25

The 7 O’clock