Anterior portal selection for shoulder arthroscopy

Subacromial anatomy for the arthroscopist

One of the most significant recent advances in arthroscopic surgery of the shoulder has been in the evaluation of the subacromial space and the anatomical structures within. Arthroscopic visualization of this area provides an unusual perspective of the anatomy that was not heretofore appreciated through open surgical techniques. This study was undertaken to attempt to define better the anatomy of the subacromial space as it pertains to arthroscopic surgery. Clinical arthroscopic evaluation of the subacromial space was correlated with gross anatomical dissections of 12 fresh cadaver shoulders and a review of the pertinent anatomical and surgical literature. By doing so, we have attempted to define better the boundaries of the subacromial space, the portions of the rotator cuff that are readily visualized arthroscopically, as well as those areas that are "blind" to arthroscopic evaluation. In addition, the anatomy of the coracoacromial ligament, the inferior surface of the acromion, and the acromioclavicular (AC) joint as viewed arthroscopically is presented with gross anatomical correlation. We feel that this information will help arthroscopists better understand the advantages as well as the limitation of arthroscopy of the subacromial space.

Shoulder arthroscopy with the patient in the beach-chair position

We evaluated the use of the beach-chair, or sitting, position for arthroscopic shoulder surgery in 50 consecutive patients. Routine arthroscopy, arthroscopic subacromial decompression, and arthroscopic shoulder stabilizations were performed, with no complications. The advantages of this position include ease of setup, lack of brachial plexus strain because no traction is used, excellent intraarticular visualization for all types of arthroscopic shoulder procedures, and ease of conversion to the open approach if needed. The positioning technique is described.