Positioning

The usual position for shoulder arthroscopy is the lateral decubitus position. A pillow is placed between the legs to prevent undue pressure and the trunk is supported with well-padded surgical posts (see Figure 4.10). If diagnostic arthroscopy alone is being undertaken, there is no need for a shoulder holder to be used, as the surgical assistant can provide distraction when needed. However, if arthroscopic surgery of the shoulder is being undertaken, then the arm should be connected to the shoulder holder using a proprietary traction apparatus.

Skyhar et al[9] have described the use of a 'beach-chair' or sitting position for shoulder arthroscopy. They have used this position for over 50 consecutive patients for arthroscopic debridement, arthroscopic subacromial decompressions and arthroscopic shoulder stabilizations. Matthews[6] also suggests that a 'beach-chair' position be used for subacromial decompression as this increases the subacro­mial space and allows easier access if the shoulder or subacromial space requires open surgery. Gross and Fitzgibbons[7] suggest that the lateral decubitus position should be mod­ified to a semilateral position by letting the patient rotate 30-40 degrees posteriorly. This places the glenoid parallel to the floor, which allows more comfortable arthroscopy and instrumentation.

Even with the use of television apparatus, arthroscopic techniques are not always as aseptic as open orthopaedic procedures. Therefore, if there is a need to proceed to open surgery, it is better to treat the open procedure as an entirely new operation. The patient should be repositioned, reprepared and draped, all instruments should be changed and the surgeon will need to rescrub and gown.