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Patient positioning, portal placement, normal arthroscopic anatomy, and diagnostic arthroscopy


OVERVIEW

Chapter synopsis

  • Diagnostic arthroscopy provides the surgeon with an important tool to evaluate the shoulder joint and subacromial space.

  • Potential benefits are numerous and complications infrequent.

Important points

  • Beach chair and lateral decubitus positioning both have advantages and disadvantages; the practitioner should be familiar with both.

  • Proper portal placement is critical.

  • Understanding of normal anatomy allows recognition of pathology.

Pearls

  • Separate portal sites allow superior triangulation.

  • Familiarity with accessory portals can aid in certain procedures.

  • The glenohumeral joint may be palpated and manipulated.

  • The practitioner should have knowledge of anatomic variants.

Pitfalls

  • Landmarks and portal placement sites should be marked before insufflation.

  • Threaded cannulas are used whenever possible.

  • It is important to always visualize the subacromial space.

Shoulder arthroscopy has become an invaluable diagnostic and therapeutic tool for the sports medicine surgeon. Through innovative thinking and technical advancement, there is ongoing refinement of our ability to recognize and treat shoulder disorders with the use of minimally invasive techniques. Shoulder arthroscopy has been shown to be both safe and effective when compared with open surgery. In a series of more than 14,000 procedures, the overall complication rate of shoulder arthroscopy was 0.56%. Arthroscopic surgery offers the potential benefits of reduced operative time, decreased postoperative pain, decreased surgical scarring, improved cosmesis, and the ability to perform outpatient surgery. In addition, complications related to the subscapularis inherent to the deltopectoral open approach can be avoided. Shoulder arthroscopy has demonstrated equivalent or superior outcomes to open procedures for a variety of shoulder conditions.

Enhanced visualization of both the intra-articular and subacromial space, as well as the ability to perform a dynamic intraoperative examination, improves the accuracy of diagnostic shoulder arthroscopy. With advances in surgical techniques and instrumentation, the indications for arthroscopic treatment have also broadened to include rotator cuff pathology, labral and capsular injuries, and diseases of the articular cartilage.

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