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Patient positioning for shoulder arthroscopic surgery in the supine position. The patient with anteroinferior capsulolabral lesion from recurrent anterior dislocation of the left shoulder is placed supinely on an operating table in the reverse position with the leg plate on the operating side detached (arrow) and the patient's head stabilized with tape.
Source publication
Shoulder arthroscopy is traditionally performed with the patient in either the beach chair position or the lateral decubitus position. Each position has its advantages and disadvantages. The main topics for consideration include ease of surgery, view into the surgical field, risks to the patient, and economics of the setup. In the lateral decubitus...
Citations
... The advantages and disadvantages of these 2 positions have been reported. [1][2][3] For the beach-chair position, the advantages are better anatomic orientation, easy positioning, and the ability to convert to an open surgical procedure without repositioning and re-draping. These advantages make the beach-chair position suitable for extra-articular work such as subacromial surgery (e.g., rotator cuff repair) and open surgery (e.g., fracture fixation and joint replacement). ...
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 placed in the lateral decubitus position might need to undergo repositioning and re-draping, which result in extending the operative time and increasing the risk of infection. For this circumstance, the modified semilateral decubitus position offers the same advantages as the lateral decubitus position and can be adjusted to achieve a more upright position similar to the beach-chair position.
... The structures that are at high risk of being injured during arthroscopy are the suprascapular artery and the axillary and suprascapular nerves (1,3,6,9). Brachial plexus injuries due to traction device and axillary nerve damage are often encountered after shoulder arthroscopy (13,17). Meyer et al. found that the axillary and suprascapular nerves were situated at mean distances of 49 mm and 29 mm from the portals, respectively. ...
Background/aim: The localization of the standard posterior portal of shoulder arthroscopy and landmarks mentioned in the literature are unclear. The purpose of this prospective cadaveric study was to determine the localization of the standard posterior portal and its distance to the neural structures. Materials and methods: One fresh frozen and 10 formalin-fixed adult cadaveric shoulders were dissected. In the beach chair position, a 5-mm trocar was placed anteroposteriorly from the superior edge of the subscapularis muscle, superior to the tip of the coracoid process and tangent to the glenoid. The relevant distances of the posterior exit point were measured. Results: In all specimens, the exit point was a triangular fibrous area, between the posterior and lateral parts of the deltoid. Medial and inferior distances of the trocar to the posterolateral tip of the acromion were 1.88 ± 0.53 cm and 1.35 ± 0.34 cm and distances to the axillary and suprascapular nerves were 4.54 ± 1.08 cm and 2.54 ± 0.85 cm, respectively. Conclusion: The most important finding of this study was the superficial localization of the soft spot between the posterior and lateral parts of deltoid.
Considering shoulder arthroscopy, lateral decubitus and beach chair are the 2 main employed positionings of the patient. Each include advantages and disadvantages. In our center, we perform all shoulder arthroscopy with the patient in supine position. The aim of this work is to present a stepwise approach of the accomplishment of a rotator cuff repair in supine position. Some specific technical notes are given to provide as much information as possible to help orthopaedic surgeons wishing to perform shoulder cuff repair in this position.
