AANA Lab Course 901 - Foundations in Arthroscopy (Resident/Fellow)-How To: Subacromial Arthroscopy: Bursectomy, Acromioplasty, Distal Clavicle Excision, Prepare for Cuff, Sherwin S.W. Ho, MD

How To: Subacromial Arthroscopy: Bursectomy, Acromioplasty, Distal Clavicle Excision, Prepare for Cuff, Sherwin S.W. Ho, MD

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Pdf Summary

This document provides a comprehensive overview of surgical principles and detailed teachings on shoulder arthroscopy, blending life and surgical wisdom with technical instruction.<br /><br />Key “Rules of Surgery” emphasize trust cautiously ("Trust no one; trust but verify"), deliberate purposeful action ("Make haste slowly"), and cautious risk management ("Never risk a big one for a little one"). Attention to detail, staying close to bone, and being deliberate in movement are foundational surgical practices. Daily living advice reminds surgeons to maintain health through good nutrition, exercise, and continual learning.<br /><br />In surgical practice, ongoing hands-on learning is vital. Surgeons are encouraged to practice regularly (e.g., annual cadaver courses), learn from every case, and strive for incremental improvement, aiming always for “textbook” quality outcomes. Documentation such as surgical photography and a perfectionist attitude are advocated. The "Batman Rule" humorously advises surgeons to know their limitations and work within their comfort zones, leaving complex new procedures for lab practice.<br /><br />The course content focuses on shoulder arthroscopy fundamentals, presented by Sherwin Ho, MD. Setup for shoulder arthroscopy involves careful patient positioning (beach chair), dual monitors for surgeon and assistant, and nerve block anesthesia. Key portals for arthroscopy are anterior, lateral, posterolateral, posterior, and anteroinferior, each with specific roles.<br /><br />A detailed arthroscopic shoulder exam includes the rotator cuff bursal tour, emphasizing delicate navigation through the "bursal curtain" without unnecessary shaving, assessing impingement signs on the coracoacromial ligament and cuff surface.<br /><br />Procedures such as subacromial decompression and arthroscopic distal clavicle resection (Mumford procedure) are meticulously explained—highlighting burr placement, decompression depth, ligament removal, and critical caution to protect ligaments.<br /><br />Technical pearls include preoperative marking of landmarks to prevent disorientation and using specialty portals and curved or percutaneous guides for precise anchor placement in labral and rotator cuff repairs. Use of a 70-degree scope for special repairs is noted.<br /><br />Overall, the document merges philosophical guidance, practical surgical strategies, and detailed arthroscopic techniques for educating orthopedic surgeons in shoulder arthroscopy.

Keywords

shoulder arthroscopy

surgical principles

rotator cuff repair

subacromial decompression

arthroscopic distal clavicle resection

surgical photography

patient positioning

portal placement

technical pearls

orthopedic surgery education