lateral shoulder arthroscopy

Outcomes of arthroscopic posterior shoulder stabilization in the beach-chair versus lateral decubitus position: A . . However, there have been reports in the literature of complication rates as high as 10.6%. Shoulder Holder Shoulder Stabilization Kit Lateral Jack Aggressive physical therapy is essential to restoring the shoulder's full range of motion. Epub 2008 Nov 28. Review. . It provides simple patient set-up, access and adjustability. The procedure usually takes less than an hour. Joint space width, procedure time, and visibility and palpability of the intra-articular structures were assessed during the arthroscopy. Appropriate lateral decubitus positioning for shoulder arthroscopy with careful attention to detail will promote ease of surgical intervention and minimize complications. The advantages and disadvantages of both positions for shoulder arthroscopy have been described in detail.1, 2 One of the most significant advantages of the LD position is increased visualization and working space within the glenohumeral joint with instrumentation. In this position the patient lies on his or . The beach chair position and lateral decubitus position are standard options for arthroscopic shoulder surgery. Rotator cuff tears, labral tears, proximal biceps dysfunction, loose bodies, . 1,787 views May 28, 2018 18 ; 01:19. Distal Clavicle Excision is a procedure used to treat impingement in the shoulder. Phase III: Strengthening a return to activities (>6 weeks) May discontinue wrist splint and wear counterforce brace until asymptomatic with full ROM and normal strength. Smith & Nephew Shoulder Holder offers ideal limb positioning solutions for shoulder arthroscopy procedures. Simple longitudinal traction ablated the oxygen saturation in only 1 of 30 patients. The systematic approach detailed here will help facilitate complete and consistent evaluation of the glenohumeral joint during these procedures. 4. Following anaesthetic, the patient is positioned supine on the operating table to allow examination of both shoulders. SchureMed Bi-Lateral Leg Prepper . . This is also used in knotless repairs such as the Speed Bridge Technique. 2. Shoulder arthroscopy has been performed since the 1970s. It permits ideal shoulder positioning for improved access to the anterior glenohumeral joint. The integrated positioning switch rids you of tedious manual adjustments and readjustments during surgery. portal may pass between infraspinatus (suprascapular nerve) and teres minor (axillary nerve) or pass through the substance of infraspinatus. The lateral decubitus is the traditional positioning for the shoulder arthroscopy, allowing excellent access and visualisation without the need of an assistant when balanced traction is applied. 2-3 cm proximal to olecranon and just lateral to tricepscenter of anconeus triangle. 3. Shoulder arthroscopy is typically performed in either the beach chair position or the . Standard lateral shoulder arthroscopy was performed with or without the use of the Leipzig distractor (n = 15 each). During this time, a physiotherapist can outline appropriate exercises that encourage increasing the range of motion of the shoulder. Shoulder arthroscopy rotator cuff repair recovery and rehabilitation. The classic posterior portal is 2 cm distal and 1 cm medial to the posterolateral corner of the acromion [ 1, 4, 5 . . Avoid pain. Moreover, the operation of shoulder arthroscopy is complicated and involves the establishment of working channels, the proficiency of arthroscopy operation techniques and the . Initial Steps in Arthroscopic Acromioplasty. SHOULDER Indications for shoulder arthroscopy 1. shoulder arthroscopy. It has made diagnosis, treatment, and recovery from surgery easier and faster than was once thought possible. In this position the patient lies on his or . Burkhart et al 1 state in The Cowboy's Companion that "for the surgeon to become an advanced shoulder arthroscopist, he or she should use the lateral decubitus position exclusively." However, Wahl and Warren 2 state that they "exclusively use the beach-chair . Shoulder impingement is a painful condition in which the space between structures in a joint narrows, causing parts to rub or pinch that normally would not, which is very painful for the patient. The 2 common positions for shoulder arthroscopy are the beach chair position and lateral position. • All arthroscopic shoulder procedures can be performed from this position, with posterior shoulder stabilization a little easier . Arthroscopic shoulder surgery can be performed in both the beach chair and lateral decubitus positions. Outcomes of arthroscopic posterior shoulder stabilization in the beach-chair versus lateral decubitus position: A . Lateral decubitius position. Elbow 20-30 deg flexion (to relax triceps) Best access to posterior compartment, radiocapitellar joint (debridement of OCD capitellum), olecranon fossa and posterior structures. Outcomes of arthroscopic anterior shoulder instability in the beach chair versus lateral decubitus position: A systematic review and meta- regression analysis. portal passes between pectoralis major (medial and lateral pectoral nerves) and deltoid (axillary nerve) We studied the effect of three methods of shoulder trac tion during arthroscopy on arterial oxygen saturation measured by a pulse oximeter applied to the fingertip of the arm in traction. Posterior: The posterior portal is the primary viewing portal and the first portal established in diagnostic shoulder arthroscopy. Attached fluid collection pouch; Hook and loop tube and line control; 2.5 in. Shoulder arthroscopy is one of the most commonly performed orthopaedic procedures and it is often done with the patient in the upright, or beach chair position (BCP). Another challenge is that once the capsule is cut, the body responds by making new scar tissue. 5. Fig. 1 , 4 , 5 , 6 This note focuses on the lateral decubitus patient positioning. Shoulder arthroscopy can be performed with the patient in either the lateral 51 decubitus or the beach chair position. In the lateral decubitus position, the obese portions of her thigh drooped down to expose a prominent greater trochanter. Positioning: - beach chair position is comfortable for both the patient and the surgeon and allows the option of converting to an open procedure (if necessary); - patients need to be seated with the torso raised to 70 deg with a foled sheet placed on the medial border of the affected scapula …. We studied the effect of three methods of shoulder trac tion during arthroscopy on arterial oxygen saturation measured by a pulse oximeter applied to the fingertip of the arm in traction. A third position is briefly examined, the supine position, which was recently described to combine the advantages of both the lateral decubitus and beach chair with minimal disadvantages. The beach chair and lateral decubitus positions are both reliable methods to accomplish effective arthroscopic shoulder procedures. Abstract Since the introduction of the beach chair position for shoulder arthroscopy, orthopaedic surgeons have debated whether the beach chair or lateral decubitus is superior. Intercondylar notch 5. We report the case of a 65-year-old female treated with an arthroscopic rotator cuff repair who had significant extravasation of arthroscopic fluid causing severe facial and neck swelling. Medicare edits bundle Procedure 29823 (Arthroscopy, shoulder extensive debridement) into Procedure 29824 (Arthroscopy, shoulder, surgical; distal claviculectomy) at this time but allows for a modifier if the debridement is performed separate and distinct from the distal claviculectomy. 3.TUBS Tie a successful sliding and non-slid-ing knot using arthroscopic tools on a knot tying station with a passing proficiency score. You may find it best to "stay ahead" of the pain levels before the block wears off. Lateral decubitus: Advantage of joint distraction: can be associated with neuropraxias from traction. Frozen Shoulder Surgery. Alternatively, consider using the modified lateral decubitus position which aligns the glenoid surface horizontal. It can be a challenging procedure to do, as the space inside the joint becomes extremely tight. The majority of arthroscopic shoulder procedures can be performed in either the beach chair or lateral decubitus position; however, surgeon training, joint positioning, and orientation may favor one position over the other. Using the traction unit in lateral decubitus, the surgeon is able to apply precise traction and rotation when and where needed. Clayton Alexander and Uma Srikumaran Summary Arthroscopic shoulder surgery complications are considered rare occurrences. Shoulder arthroscopy positioning: lateral decubitus versus beach chair. This versatile system provides safe, effective, and easy positioning of the shoulder during all types of arthroscopic or open shoulder surgery performed in the lateral decubitus position. Wide 4-inch sling should be used; amount of traction and length of procedure should be monitored. Arthroscopy. Both positions have their merits ( Table 2) and selection is largely based on surgeon preference. Arthroscopic positioners are used during scope surgeries in order to be minimally invasive on the patient. This is used in lateral row repairs where no knot is necessary (so the suture is cut flush to the anchor & bone. In addition, you may receive a nerve block. The first patient in whom we performed arthroscopy with the lateral approach was a massively obese woman with hip pain in whom Dr. Glick had previously performed arthroscopy without success in the supine position. - Lateral portal: - used for visualization of, or for insertion of instruments into, subacromial space, (usually for arthroscopic acromioplasty or for calcific tendinitis ); calcific tendinitis); - the key to lateral portal placement is that it must allow triangulation . The patient was placed in a lateral position (Figure 1A, B), the limbs were disinfected, and the arm traction was 3-5 kg. AssistArm can also be used in knee arthroscopy (ACL, meniscus, trauma . . Level the upper border of the bean bag with the patient's upper thorax yet not protrude into the axilla. View more content on shoulder arthroscopy View more content on the SPIDER Limb Positioner This procedure treats impingement in the acromioclavicular (AC . Simple longitudinal traction ablated the oxygen saturation in only 1 of 30 patients. Via this portal the following can be done: a. Typically, the block wears after the night after the surgery. Draw the anatomical skin landmarks and portal sites on the shoulder spec-imen. 11 views March 15, 2018 . Medial gutter 3. The 53 Her right shoulder is visualized in the lateral decubitus position, viewing from the posterolateral portal. McCarty E.C., et al. There are 2 options for shoulder arthroscopy patient positioning: the beach chair and the lateral decubitus positions. . Basic Set up for Shoulder Arthroscopy in Lateral decubitus position. The two most common patient positions for arthroscopic shoulder surgery are: Beach chair position. Shoulder arthroscopy is a minimally invasive surgery to treat shoulder problems, including shoulder impingement and rotator cuff tears. Shoulder Arthroscopy OR Set Up. 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 . Rob Hunter demonstrates the SPIDER Limb Positioner including OR setup, sterile preparation and patient setup, positioning and use for lateral decubitus surgery, and Lateral Jack secondary humeral head distraction. The arm is slightly forward flexed and abducted 50 degrees with 10 to 15 lb of longitudinal suspension applied from a traction tower. Arthroscopy 2009;25:891-896. 6. The lateral decubitus and beach chair postures have both been demonstrated to be comfortable and successful, therefore patients' posture is essentially an issue of doctor opinion. The tear can be assessed for . Episode 161: Postoperative Stiffness and Pain After Arthroscopic Labral Stabilization: Consider Anchor Arthropathy Robert A. Waltz, Jeffrey Wong, Annalise M. Peebles, Petar Golijanin, Joseph J. Ruzbarsky, Justin W. Arner, and others Arthroscopy 2022;37:3266-3274 Featuring: Jon Goden, MD | Podcaster: Travis Dekker MD Related Article; Transcript Shoulder arthroscopy has been performed since the 1970s. Shoulder Arthroscopy Rotator Cuff Repair. The patient can be positioned in either the lateral decubitus or the beach chair position. From within the GHJ, the supero-lateral can be created from outside-in. Berjano and colleagues 2 reported on 179 shoulder arthroscopic procedures, noting an overall complication rate of 9.49%. The arm is placed in a shoulder traction and rotation (STaR) sleeve and then connected to the 3-Point Shoulder Traction Tower. Lateral decubitus position. The lateral decubitus position allows for excellent exposure to all aspects of the glenohumeral joint and is therefore frequently employed in procedures such as stabilization, in which extensive visualization of the inferior and posterior aspects of the joint is required. 2. After arthroscopic shoulder decompression, the sling is removed after 2 days, and early . Shoulder Arthroscopy: Lateral Portal. . 2009 Aug;25(8):891-6. doi: 10.1016/j.arthro.2008.10.003. This is a semi-seated position similar to sitting in a reclining chair. Suture Retriever, used to grasp & retrieve sutures. The AssistArm limb positioner can be used in arthroscopic and open shoulder surgeries, upper-limb trauma, and total shoulder arthroplasty. Posterior antebrachial cutaneous. medial and lateral parapatellar arthroscopic , 111 patella and bone marrow stimulation , 54 posterior portals , 268 270 posterolateral , 23 . Suprapatellar pouch and patellofemoral joint 2. Orthopedics. They stated that in procedures that combined arthroscopy with an open procedure, the complication rate was 5.26% versus 10.63% in arthroscopic procedures alone. Lateral decubitus position. The surgeon should be well versed in shoulder arthroscopy, be knowledgeable about the arthroscopic equipment, and ideally have a well-trained assistant prior to embarking on this proce. Since the introduction of the beach chair position in 52 the 1980's, orthopaedic surgeons have debated which patient position is superior. Lateral compartment 7. It has made diagnosis, treatment, and recovery from surgery easier and faster than was once thought possible. Although rare, there are potentially life-threatening risks such as fluid extravasation causing airway compromise. The AssistArm™ delivers unparalleled precision for beach chair and lateral decubitus shoulder procedures. A skin incision is made, followed by a blunted arthroscopic obturator and its sheath directed toward the coracoid tip. Alan Reznik Universal Arm Holder. For the first 4-6 weeks after the operation, the arm needs to be in a sling to protect it from regular use. This lasts 12-24 hours, and helps decrease pain after surgery. The use of shoulder surgery devices also provides the physician with easy, efficient, and comfortable access to the surgical site. The lateral decubitus position allows for appropriate circumferential access of the labrum. Diagnostic shoulder arthroscopy or arthroscopic shoulder stabilization procedures can be performed with the patient in the beach chair (BC) or lateral decubitus (LD) position. When determining the entry point of this portal, the posterolateral corner of the acromion is used as guide. Arthroscopic shoulder surgery can be performed in both the beach chair and lateral decubitus positions. reported with shoulder arthroscopy.3 Neurologic injury is the most com-mon finding. fracture are the muscle forces pulling the medial fragment superiorly and posteriorly and the weight of the arm on the shoulder girdle pulling the lateral fragment inferiorly and . 1, 2 One of the most significant advantages of the LD position is increased visualization and working space within the glenohumeral joint with instrumentation. Lateral Decubitus Shoulder 7210576 Lateral Shoulder Connection Bar (2 units) 7210577 TENET Traction Accessory (2 recommended . . FEATURING Pinkawas Kongmalai, Rami Alrabaa, William Levine. . . Recovery. 6. This versatile system provides safe, effective and easy positioning of the shoulder during all types of arthroscopic or open shoulder surgeries performed in the lateral decubitus position. An arthroscopy is a type of keyhole surgery used to diagnose and treat problems with joints. LATERAL DECUBITIS KNEE PROCEDURES ANKLE ARTHROSCOPY Shoulder - Beach chair and lateral decubitus Tactile feel during arm movement is essential to assess ligament and muscle tension, as well as validate range of motion. Improvements to shoulder arthroscopy occur every year as new instruments and techniques are developed. This tower attaches easily to the standard O.R. Abstract. 1. Interestingly, they did not define shoulder stiffness as a . . Shoulder Arthroscopy Drape, 160 in. A novel surgical technique for arthroscopic fixation of lateral end clavicle fracture using FiberWire and FiberTape. Plan and anticipate specific patient challenges for positioning. Silver Handle Instruments x 2 are the 20° & 45° elevators. 2008;24:481-2. Shoulder arthroscopy positioning: Lateral decubitus versus beach chair. Posteromedial compartment 6. shoulder arthroscopy is a common orthopaedic procedure. If exercises are causing pain, drop back to early phase until pain free. Landmarks and Incision Primary Portals in Arthroscopic Approach to the shoulder: Posterior portal: Function: primary viewing portal used for diagnostic arthroscopy. houlder arthroscopy is a common orthopaedic procedure.1-3its popularity can be attributed to the evolving technology, instrumentation, and expanding surgical indications for arthroscopic shoulder procedures.3the evolution of shoulder arthroscopy has directly led to the expansion of surgical interven- tion from a purely diagnostic tool to the … S houlder arthroscopy is a. Shoulder instability (recurrent dislocation of shoulder) 2. 4. MSRP $549.00 MSRP $549.00 $513.00. Increased risk of cerebral hypo-perfusion compared to lateral position. It's most commonly used on the knees, ankles, shoulders, elbows, wrists and hips. Arthroscopic or open shoulder surgery can be performed with the patient in the beach-chair or lateral decubitus position. The Lateral Decubitus Shoulder Traction Tower allows for abduction, forward flexion and traction during open and arthroscopic procedures. A thorough under-standing of shoulder anatomy is es-sential to minimize the risk of complications. . . conformable, tear-drop fenestration; Instrument pad fabric reinforcement; 89490 - 2-Piece Shoulder Arthroscopy Drape Pack, Sterile . It is located 2 cm inferior and 1-2 cm medial to the posterolateral corner of the acromion. Figure 18-16 A and B, Anteroposterior and axillary lateral radiographs of a shoulder with metal suture anchors (arrows) placed too far medially. For smaller children, the lateral decubitus is clearly preferable, because positioning and securing the cervical spine and legs can be difficult with a small child on a standard bed (Fig. A rehabilitation plan, which usually includes . Shoulder arthroscopy is one of the most popular orthopedic surgery in the world. See Shoulder arthroscopy Anterior cruciate ligament (ACL) reconstruction. The anesthesiologist will numb up the shoulder before surgery. Shoulder arthroscopy is a safe and effective procedure with a low complication rate. J Arthrosc Surg Sports Med 2020;1(2):199-206. . The shoulder is made up of: the upper arm bone (humerus), shoulder blade (scapula), collarbone (clavicle), and shallow socket (glenoid). Abstract: Shoulder arthroscopy offers a minimally invasive surgical approach to treat a variety of shoulder pathol-ogies. 2-3 cm proximal to olecranon and just lateral to tricepscenter of anconeus triangle. This note and accompanying video describe the operating room setup for shoulder arthroscopy in the lateral decubitus position, Papadonikolakis A, Wiesler ER, Olympio MA, et al. Ensure that all required equipment setup is available and properly working. Shoulder Arthroscopy Anatomy The shoulder is a complex, ball-and-socket joint that rotates through a greater range of motion than any other joint in the body. Many people can go back to work or school in a few days. Peruto CM, Ciccotti MG, Cohen SB. Improvements to shoulder arthroscopy occur every year as new instruments and techniques are developed. table Clark Rail. This procedure is reported with CPT® +29826 Arthroscopy, shoulder, surgical decompression of subacromial space with partial acromioplasty, with coracoacromial ligament (ie, arch) release, when performed (List separately in addition to code for primary procedure). Shoulder arthroscopy positioning: lateral decubitus versus beach chair. 89070 - Shoulder Arthroscopy Drape, Sterile 79070 - Shoulder Arthroscopy Drape, Non-Sterile. Lateral gutter and posterolateral compartment 80. 1. The lateral decubitus position allows for excellent exposure to all aspects of the glenohumeral joint and is therefore frequently employed in procedures such as stabilization, in which extensive visualization of the inferior and posterior aspects of the joint is required. Lateral working portals placed in the "safe zone" (located within 3 cm of the lateral border of the acromion) avoid the . After the arthroscopic evaluation, each shoulder joint was disarticulated to assess the . In addition, some arthroscopists find it . The single boom arm can be easily adjusted with two independent hand cranks for simplified intraoperative adjustment. Properly cadaveric specimen for beach chair and lateral decubitus shoulder arthroscopy. Continue with ROM and add strengthening exercises starting with isometrics. Most surgeons use the same patient position to perform all of their arthroscopic shoulder procedures, regardless of the pathology. Posterior antebrachial cutaneous. Elbow 20-30 deg flexion (to relax triceps) Best access to posterior compartment, radiocapitellar joint (debridement of OCD capitellum), olecranon fossa and posterior structures. Diagnostic shoulder arthroscopy is frequently used to evaluate and treat several shoulder conditions including rotator cuff tears, labral tears, adhesive capsulitis, and subacromial impingement. Patient Positioning and Anesthesia Shoulder arthroscopy is performed with the patient in either the lateral decubitus position (LDP)4 (Figure 1, LATERAL DECUBITUS POSITION Dual traction for distraction of glenohumeral joint with minimal inferior subluxation. Open in figure viewer PowerPoint. The lateral decubitus position allows for appropriate circumferential access of the labrum. See injury ACL Arteriovenous malformations , 136 Arthro brosis elbow radiographs , 327 non-displaced supracondylar fracture . 3 the evolution of shoulder arthroscopy has directly led to the expansion of surgical intervention from a purely diagnostic tool to … 5. In this position, the patient lies on his side on an operating table. . CPT® made +29826 an add-on code several years ago, which means it must be . It is recommended that the posterior portal be shown as the last step in the shoulder arthroscopy training process [ 5 ]. Arthroscopy. McCarty E.C., et al. Shoulder arthroscopy is currently one of the mainstay procedures for the treatment and diagnosis of shoulder disorders. Arthroscopic shoulder surgery can be performed in both the beach chair (BC) and lateral decubitus (LD) positions. Her right shoulder is visualized in the lateral decubitus position, viewing from the posterolateral portal. 2009;25:891-6. CrossRef PubMed Google Scholar. The SPIDER2 Limb Positioner allows proper patient positioning for shoulder, knee and small joint arthroscopy. Shoulder Arthroscopy: Indications & Approach. Arthroscopy 2014;30:1349-1365. x 102 in. The first patient in whom we performed arthroscopy with the lateral approach was a massively obese woman with hip pain in whom Dr. Glick had previously performed arthroscopy without success in the supine position. 1). Dr Burns demonstrates an educational look at the inside of a shoulder joint, including an arthroscopic evaluation, subacromial decompression, rotator cuff de. For more complex surgeries, recovery may take longer. Arthroscopy equipment is very small, so only small cuts in the skin are needed. Sort by: . In the lateral decubitus position, the obese portions of her thigh drooped down to expose a prominent greater trochanter. Providing you with easy set-up and minimal components, the Shoulder Holder allows you to add the amount of weight you desire for optimal traction during lateral decubitus procedures. Each position has some slight advantages. Avoiding catastrophic complications of stroke and death related to shoulder surgery in the sitting position. The advantages and disadvantages of both positions for shoulder arthroscopy have been described in detail. 1, 2, 3 its popularity can be attributed to the evolving technology, instrumentation, and expanding surgical indications for arthroscopic shoulder procedures. - See: Arthroscopic Acromioplasty. Medial compartment 4. This means it has some advantages over "open" surgery, including: Key steps for patient positioning in the lateral decubitus position 1. Arthroscopy. My preference is the beach chair position, which offers the advantage of being more anatomical.