Shoulder Arthroscopy positioning and preparation

shoulder arthroscopy

1. Setup and Positioning for Shoulder Arthroscopy Dr Rishi Kiran Doshi Consultant Orthopaedic Surgeon Kolhapur Institute Of Orthopaedics and Trauma Knee Arthroscopy Fellow, Sportsmed Clinic Mumbai Shoulder Arthroscopy Fellow, Italy

2. Today, apart from Shoulder Replacement and major Sho uld er Fractures, nearly all Shoulder Pathology can be treated With arthroscopic techniques

3. Shoulder Arthroscopy the evolution of the technique Diagnostic Tool Final Treatment From tool of the devil , the treatment of choice of most shoulder pathologies

4. Metal Anchors Absorbable Anchors Peek Anchors Single suture Double sutures

5. BASIC ARTHROSCOPIC KIT Arthroscop e Light source and cable Camera system and monitor with recorder Arthroscopic probe Arthroscopic grasper Arthroscopic scissor Arthroscopy FMS pump Arthroscopy RF Arthroscopic Punches (basket forcepes 2.7 mm upcutting right and left Rotatory ) Motorized shaver

6. Arthroscopic grasper

7. Wissinger rod

8. Arthroscopic trocar /Cannula

9. Shoulder Arthroscopy may be done in either the Beachchair, or lateral decubitus positions. Recently there have been modifications of both.

10. Lateral Decubitus Position Standard table Beanbag or support Axillary roll Head positioner Suspension device Limits to traction Limits to Position Side Support

11. Lateral Decubitus

12. By tilting the patient 20 to 30 degrees posteriorly, glenoid will be parallel to the floor Less traction: Decrease the risk of neurapraxia of the brachial plexus Accentuation of tears in the glenoid labrum as it pulled away from their beds Improved arthroscopic access to the inferior third of the glenoid labrum and capsule. Canale, S T, James H. Beaty, and Willis C. Campbell. Campbell's Operative Orthopaedics. Philadelphia, PA: Elsevier/Mosby, 2013

13. Vertical and longitudinal traction, with most of the traction applied vertically to distract the glenohumeral joint without subluxing it inferiorly 4 to 6 kgs of traction is applied 30 to 60 degrees of abduction 20 to 30 degrees of forward flexion 23% and 30%: neurapraxia after excessive arm traction. Canale, S T, James H. Beaty, and Willis C. Campbell. Campbell's Operative Orthopaedics. Philadelphia, PA: Elsevier/Mosby, 2013

14. All pressure points Padded with a pillow Acromion, ASIS, Below knee, lateral malleolus and one or more pillows between the knees and ankles. Canale, S T, James H. Beaty, and Willis C. Campbell. Campbell's Operative Orthopaedics. Philadelphia, PA: Elsevier/Mosby, 2013

15. Beach Chair Standard table with back support Head positioner

16. BEACH CHAIR POSITION The benefits of the “beach chair” position Interscalene block Faster and easier positioning Reduced risk of neurapraxia Less distortion of intra articular capsular anatomy, Improved mobility of the patient’s arm Ease in orientation Surgical manipulation in the subacromial space Ease in conversion to an open surgical procedure.

17. COM P LIC A TIONS Difficulty in working from posterior portals Stroke Death due to hypotensive episodes Canale, S T, James H. Beaty, and Willis C. Campbell. Campbell's Operative Orthopaedics. Philadelphia, PA: Elsevier/Mosby, 2013

18. LATERAL DECUBITUS BEACH CHAIR

19. PIONEER ITALIAN SURGEON DR MARCO MAIOTTI & CARLO MASSONI , ROME WHO DESCRIBED the ASA technique for Anterior Shoulder Instability THANK YOU