Setup, Positioning & Portal Placement Flashcards
What two positions are shoulder arthroscopy preformed in?
Beach chair or lateral decubitus
What are the advantages of the beach chair position
Upright, Anatomic position
Ease of preforming a exam under anesthesia
Easy conversion to open procedure
And improved mobility of the arm
What are the disadvantages of the beach chair position
Potential mechanical blocks
Obstruction of view
Risk of hypotension,bradycardia which may cause cerebral ischemia
What position reduces the risk of cerebral ischemia?
The lateral decubitus position
What are the advantages of the lateral decubitus position?
Traction increases space
Fewer barriers to accessibility cautery bubbles move laterally out of view
No increased risk of cerebral ischemia
What are the disadvantages of the lateral decubitus position?
Increased risk of traction injury
More difficult to conversion to open
Nonanatomic orientation
Difficult to reach anterior portal
What are the standard portal locations for shoulder arthroscopy?
Anterior, Lateral and Posterior
What are the accessory portals?
Click on photo
Where do all arthroscopic shoulder surgeries start?
The posterior portal , which is the primary viewing portal
What areas does posterior port give you access to?
The glenohumeral joint and subacromial space
What structures are at risk with a posterior portal?
Suprascapular artery
Suprascapular nerve
Axillary nerve
Under direct vision of the posterior portal, the anterior portal is inserted via the________?
The the rotator interval, above the lateral half of the Subscapularis and medial to the long head of the bicep
Placement of Anterior/inferior portal
In the rotator interval, above the lateral half of the Subscapularis and medial to the long head of the bicep
What structure is at risk of injury in a anteriorsuperior and anteriorinferior portal?
The cephalic vein
What can the lateral portal be used for?
As a working and viewing portal
Where should a standard lateral portal be placed?
4cm lateral of the acromion, in line with the posterior aspect of the clavicle
For the standard lateral portal, which structures are at risk?
The axillary nerve
What is a popular working and viewing portal many doctors use?
Antero-superolateral
Where doesn’t the anterior-suprilateral port enter?
Enters the Glenohumeral joint through the rotator cuff interval and above the biceps tendon
What portal provides a better view of the anterior shoulder
The posterolateral portal
What is the Nevisar accessory used for?
Used solely as a working portal for access the the GHJ for slap repair, subacromial space for rotator cuff repair and superior capsular reconstruction
What portal can be used for the posterior repair of a slap tear?
Portal of Wilmington
What portal is used for accessing the most inferior aspect of the glenoid for laberal repair?
5 O’clock
For the 5 O’clock portal, what structures are at risk?
Axillary nerve
Axillary artery
What portal is used to access the posterior/inferior glenoid?
The 7 O’clock
