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Two standard patient positions for shoulder arthroscopy are the beach-chair and lateral decubitus positions. Both positions have advantages and disadvantages in many aspects. Surgeons choose the position based on their preferences, mainly the orientation of the anatomy. If an operation needs to be converted to an open procedure, a patient who is pl...
Context in source publication
Context 1
... patient is then covered with warming blankets to prevent hypothermia (Bair Hugger lower-body blanket; 3M). The surgical-site skin is prepared and draped in sterile fashion (Fig 4). The arm is covered with a sterile towel, covered by a STaR Sleeve (Arthrex), and connected to a 3-point shoulder distraction system (Arthrex). ...
Similar publications
Arthroscopic rotator cuff repair can be performed with the patient in the beach-chair or lateral decubitus position. Patient positioning in shoulder arthroscopy is a critical step in surgical preparation and remains a debated topic. The lateral decubitus position is a reliable, safe, and effective position in which to perform nearly all types of sh...
Citations
... At the OR, she was anesthetized and the operation begun with a Saber incision from the distal clavicle to the coracoid process using a modified semi-lateral decubitus position [6] . The incision was made through the subcutaneous tissue, deltoid fascia, and anterior deltoid muscle, until the coracoid process was identified. ...
Unlabelled:
A distal clavicle fracture is a common shoulder injury. Coracoclavicular (CC) stabilization is a popular procedure for treating this injury. However, with this method, there is a technical difficulty in looping the suture under the coracoid base with instruments normally available in the operating room (OR). Herein, the authors describe modifying a pelvic suture needle to ease this process.
Case presentation:
An 18-year-old Thai female presented with left shoulder pain after a fall while cycling. The physical examination showed tenderness at the prominent distal clavicle. The radiograph of both clavicles showed a displaced distal clavicle fracture of the left shoulder. After discussing the treatment, she decided to have CC stabilization as the authors recommended.
Clinical discussion:
CC stabilization is one of the main surgical techniques used in treating an acute displaced distal clavicle fracture. The most important but difficult step of the CC stabilization is passing a suture under the coracoid base. To make this step easier, various commercial tools have been created, however, they are expensive ($1400-1500 per piece), and most operating rooms in resource-limited countries do not have them available. The authors modified a pelvic suture needle specifically for use in looping a suture under the coracoid process, which is hard to do with standard surgical tools.
... Consequently, to reduce the complications caused by the BC position, some researchers reported some modified surgical positions for shoulder operations. [21][22][23][24] Are there any surgical positions that are easy, safe, and convenient for not only elderly patients but also orthopedists? ...
Objective
To report a new surgical position of lateral-tilted supine (LTS) for geriatric proximal humeral fracture operations.
Methods
Between January 2016 and December 2020, we adopted the LTS position for operations in 65 geriatric patients with proximal humeral fractures.
Results
Sixty-five patients including 25 males and 40 females aged 80.3 ± 8.5 years. The LTS position could be used for almost all proximal humeral fracture surgeries, such as ORIF with plate, suture anchor, and other fixation in 4 patients, open reduction and internal fixation (ORIF) with multiLoc nailing in 48, and shoulder hemiarthroplasty (SHA) in 13. Surgical position setting times were 11.47 ± 2.14 min. The systolic blood pressure changes before and after positioning were 15.07 ± 8.72 mmHg. All of the C-arm X-ray directions, including the cephalic side, contralateral side, and ipsilateral side, can be used in the LTS position surgeries. No surgical complications or no surgical position-related complications were found in these 65 cases.
Conclusion
The surgical position of LTS is suitable for geriatric proximal humeral fracture operations.
... The choice of beach chair versus lateral decubitus position depends on surgeon preference, surgeon experience, and the specific surgery being performed. 10 Advantages of the beach chair position include better anatomic orientation and ability to convert to an open procedure without reprepping. 10 Disadvantages include proximity of endotracheal tube to the surgical field, poor surgical access to the capsulolabral tissue for instability surgery 10 Venous pooling can also occur in the beach chair position leading to a decrease in cardiac output and hypotension. ...
... 10 Advantages of the beach chair position include better anatomic orientation and ability to convert to an open procedure without reprepping. 10 Disadvantages include proximity of endotracheal tube to the surgical field, poor surgical access to the capsulolabral tissue for instability surgery 10 Venous pooling can also occur in the beach chair position leading to a decrease in cardiac output and hypotension. An understanding of the cardiovascular effects in the beach chair position is important because blood pressure measurements at the level of the arm do not accurately reflect cerebral perfusion, which can cause brain hypoperfusion and postoperative neurologic events. ...
... 10 Advantages of the beach chair position include better anatomic orientation and ability to convert to an open procedure without reprepping. 10 Disadvantages include proximity of endotracheal tube to the surgical field, poor surgical access to the capsulolabral tissue for instability surgery 10 Venous pooling can also occur in the beach chair position leading to a decrease in cardiac output and hypotension. An understanding of the cardiovascular effects in the beach chair position is important because blood pressure measurements at the level of the arm do not accurately reflect cerebral perfusion, which can cause brain hypoperfusion and postoperative neurologic events. ...
Shoulder surgery introduces important anesthesia considerations. The interscalene nerve block is considered the gold standard regional anesthetic technique and can serve as the primary anesthetic or can be used for postoperative analgesia. Phrenic nerve blockade is a limitation of the interscalene block and various phrenic-sparing strategies and techniques have been described. Patient positioning is another important anesthetic consideration and can be associated with significant hemodynamic effects and position-related injuries.
... After anesthesia is administered, the patient's position is changed to the modified semilateral decubitus position (Fig 1 A and B). 3 The patient is prepped and draped using a sterile technique. ...
The acromioclavicular (AC) joint injury is a common shoulder injury in sports medicine. Combined coracoclavicular stabilization with AC capsule repair is 1 of 2 preferred treatments in acute high-grade AC joint injury. In East-Asian populations, the surgeon prefers to pass the first suture under the coracoid base, which is difficult using only basic surgical tools. We propose using a modified K-wire to pass the first suture under the coracoid base.
... After anesthesia is induced, the patient is set in a modified semilateral decubitus position (Fig 1 A and B). 2 The patient is prepped and draped in a sterile fashion. ...
Abstract: The distal clavicle fracture is one of the most common injuries around the shoulder joint. There is no consensus regarding a gold standard treatment. Each technique has advantages and disadvantages. Currently, coracoclavicular (CC) stabilization is one of the most popular techniques because this operative procedure provides good stability of the fracture and has few complications. The CC stabilization is a suspensory fixation that consists of many two-CC-loop arrangements. It is, however, difficult to gain equal tension in both CC loops because one loop is always tighter and has greater action in maintaining bone alignment than the other loop. To solve this problem, we propose a double O loops technique to achieve two equal tension loops.
... Preoperatively, plain radiographs (anteroposterior, Velpeau view) and surface reconstruction computed tomography imaging of the affected shoulder are requested to evaluate the extent of the bony Bankart lesion (Fig 1 A, B). After examination under anesthesia is done, the patient is positioned in the modified semilateral decubitus 3 (Fig 2A). The posterior portal is created at the posterior edge of the acromion, and the routine arthroscopic examination steps are performed: (1) glenoid surface, (2) biceps anchor, (3) biceps sling, (4) supraspinatus tendon, (5) infraspinatus tendon, (6) teres minor tendon, (7) axillary pouch, (8) inferior labrum, (9) posterior labrum, (10) subscapularis tendon, (11) middle glenohumeral ligament, and (12) anteroinferior glenohumeral ligament. ...
Abstract: We propose an arthroscopic technique called “double-row double-pulley” to restore a bony Bankart lesion. This technique is a 2-point fixation construct using the sutures from a medial row anchor at the glenoid neck to wrap around the bony Bankart fragment and tie to the sutures from a lateral row anchor at the glenoid rim with the double- pulley method. This technique may present some difficulty with suture management, but there are several advantages. First, due to the 2-point fixation, the risk of a bone piece fracture from direct penetration is minimized. Moreover, the fragment can be reduced directly due to the multiple knots that are tied sequentially over the bony fragment
