Shoulder Arthroscopy (Beach chair)

Position

  • Beach chair position 60° with the patient positioned laterally to allow access to shoulder
  • Prep & drape arm free

Landmarks

  • Spine of scapular
  • Acromion
  • Coracoid process
  • Soft spot
    • 2cm inferior & 1 cm medial to posterolateral tip of acromion

Incision

  • Posterior
    • Stab incision in soft spot
    • Plane
      • Teres minor
        • Axillary nerve
      • Infraspinatus
        • Suprascapular nerve
  • Anterior
    • Plane
      • Pectoralis major
        • Medial & lateral pectoral nerves
      • Deltoid
        • Axillary nerve

Posterior Portal

  • Palpate coracoid process
  • Insert the trochar & arthroscopic sheath aiming towards coracoid process

Anterior Portal

  • Identify rotator interval between
    • Supraspinatus
    • Subscapularis
  • Insert long hypodermic needle into interval & incise the skin & capsule under direct vision

Structures

  • Biceps tendon
  • Supraspinatus
  • Inferior recess
  • Posterior recess
  • Humeral head
  • glenoid

Dangers

  • Posteriorly
    • Axillary nerve
    • Suprascapular nerve
  • Anteriorly
    • Musculocutaneous nerve