Positioning for Shoulder Arthroscopy

Christopher M. Aland MD

Rothman Institute, Newtown, Pa

Disclaimer

• I own stock in Arthrocare and Johnson and Johnson

• I am on the Membership committee of AANA• I have no conflicts of interest that affect my

ability to teach this course

Oops, I lied• I am a Membership

committee member• Mission statement is to

educate• Best bargain going• Mumford and Sons– Below my Feet

• “Keep my eyes to serve and hands to learn”

Introduction

• Positioning is basically lateral or beach-chair

• Most procedures can be done easily from either postion

• Specialized equipment is required to facilitate each option

Lateral Decubitus Position• Standard table may be

used– Beanbag or support– Axillary roll– Head positioner– Orthopaediclist.com

Lateral Decubitus

• Supension device– Suspension, not traction

• Side support• Neck support

Lateral Decubitus

Advantages/ Disadvantages

• Can apply traction to increase working space

• Visualization• Bubbles

• Orientation is difficult• Arm holding boom• Rotational issues• Conversion to open

procedure is harder• Anesthesia issues• Nerve injury

Beach chair position• Standard table with

back support– Mechanical– Manual

• Leg support• Head positioner• Table position

Beach chair position• Standard table with

back support– Mechanical– Manual

• Leg support• Head positioner• Table position

Advantages/ Disadvantages• Any discussion fails to

demonstrate clear-cut difference

• Conversion to open procedure

• Anesthesia issue

• Low posterior access• Hypotension issues• Risk of air embolism

Discussion

• Good to be familiar with either positions• Common complications can be avoided with

attention to details• There is a decreased need for hypotensive

surgery

Thank you