Lateral Patient Positioning for Shoulder Arthroscopy
Liam A. Peebles; Zachary S. Aman; Matthew T. Provencher, MD
Massachusetts General Hospital
Diagnostic shoulder arthroscopy or arthroscopic shoulder stabilization procedures can be performed with the patient in the beach chair or lateral decubitus (LD) position. Patient positioning may be dictated by surgeon preference or the specific intended procedure; however, LD setup has been found to result in lower rates of recurrent instability in cases of anterior arthroscopic stabilization procedures. The lateral and axial traction provided by the LD setup allows for lower suture anchor placement on the anterior-inferior aspect of the glenoid, as the surgeon has increased visualization and working room within the glenohumeral joint.
Prior to placing the patient in the LD position, meticulous care must be taken to properly position the beanbag device and set up the lateral traction device. Next, a coordinated team approach should be used to roll the patient into the LD position and to ensure that all bony prominences are adequately padded. The shoulder is then placed in 40° of abduction, 20° of forward flexion, with 10–15 pounds of balanced traction. Finally, the shoulder is prepped and draped in the usual sterile fashion and the surgeon is then able to proceed with the necessary arthroscopic procedure.
Elbow Arthroscopy (Cadaver)
Patrick Vavken, MD; Femke Claessen, MD
Smith and Nephew Endoscopy Laboratory
Elbow arthroscopy is a technically demanding procedure but it is very useful to evaluate the entire elbow joint for pathology with minimal surgical exposure and faster recovery than a traditional arthrotomy. The neurovascular structures of the elbow joint are in close proximity to the joint, thus there is a risk of injury to these structures, so care must be taken to fully understand elbow anatomy and to be prepared for aberrations. Elbow arthroscopy can be used diagnostically, as in this video article, or to surgically treat a variety of conditions including ligamentous tears, loose bodies, capsular stiffness, osteochondritis dissecans of the elbow, osteophyte debridement, and lateral epicondylitis. A patient with a previous ulnar nerve transposition is a relative contraindication to elbow arthroscopy, as there is a high risk of injury to the ulnar nerve during portal placement.
Shoulder Arthroscopy (Cadaver)
Patrick Vavken, MD1; Sabah Ali2
1Smith and Nephew Endoscopy Laboratory
2University of Central Florida College of Medicine
Shoulder arthroscopy is one of the most common procedures performed in orthopaedic surgery. It can be utilized to identify various pathologies including rotator cuff tears, degenerative arthritis, subacromial impingement, and proximal humeral fractures. With continued advancement in arthroscopy, patients benefit from smaller incisions, reduced risk of postoperative complications, and faster recovery compared to open surgery.
Shoulder arthroscopy is performed either in the lateral decubitus position or in the beach chair position (BCP) as seen in this video. The BCP provides greater benefits such as decreased neovascularization during portal placement, fewer cases of neuropathies, and reduced surgical time. In addition to position, there are various portals used in shoulder arthroscopy, with the posterior portal being the most common and used in this video. Complication rates from shoulder arthroscopy are low but include shoulder stiffness, iatrogenic tendon injury, and vascular injury. Therefore, proper patient selection, patient positioning, and appropriate portal selection are essential for successful shoulder arthroscopy. This article discusses shoulder arthroscopy and demonstrates the technique on a cadaver shoulder.
Portal Placement for Hip Arthroscopy
Steven D. Sartore1; Scott D. Martin, MD2
1Lake Erie College of Osteopathic Medicine
2Brigham and Women’s/Mass General Health Care Center
Hip arthroscopy is a well-established technique that has become a mainstay in the repair of bony and ligamentous injuries when conservative methods fail to return adequate joint mobility and function. The technique has both diagnostic and therapeutic utility and its use as a minimally invasive orthopedic surgery continues to advance. Several studies have suggested that arthroscopic surgical management has more favorable outcomes in certain circumstances when compared to hip-specific conservative measures.
The approach to establishing adequate sites for portal placement is dependent upon recognizing the pertinent anatomy of the surgical site. At the same time, the operator must be mindful of the desired views once access to the joint space has been obtained. Proper visualization of the desired joint region is critical to reducing the conversion of THAs into inherently riskier total joint procedures. Additionally, the neurovascular landscape of the groin presents technical challenges with the procedural approach, which requires significant skill to avoid vital structures in the area. Acetabular labral tears are frequently repaired with this type of operative management as techniques and approaches become more refined. Here, the authors present the case of a 24-year-old woman who is undergoing an arthroscopic anterior labral repair, highlighting both the anatomical landmarks and the access points for portal placement used in the procedure.
Hip Arthroscopy with Acetabular Osteoplasty and Labral Repair
Scott D. Martin, MD
Brigham and Women’s Hospital
Hip arthroscopy with femoral neck or acetabular osteoplasty with or without labral repair can be used for treatment of femoroacetabular impingement (FAI). Patients may present with insidious onset of hip pain and mechanical symptoms and pain worse with activity and sitting.
On physical exam hip flexion and internal rotation may be reduced and anterior impingement testing will produce groin pain in the majority of patients with FAI. Imaging may demonstrate lesions responsible for cam-type or pincer-type impingement, and MRI may demonstrate labral tear or cartilaginous lesions. Arthroscopic surgical treatment is indicated for patients who have failed conservative treatment.
Diagnostic Hip Arthroscopy
Scott D. Martin, MD
Associate Professor,
Department of Orthopedic Surgery,
Brigham and Women’s/Mass General Health Care Center at Foxborough
Portal Placement for Hip Arthroscopy
Scott D. Martin, MD
Associate Professor,
Department of Orthopedic Surgery,
Brigham and Women’s/Mass General Health Care Center at Foxborough
Diagnostic Shoulder Arthoscopy
Patrick Vavken MD
Orthopedic Surgeon, Children’s Hospital of Boston, Instructor, Harvard Medical School
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