AANA Lab Course 902 - Foundations in Arthroscopy (Resident/Fellow)-How To_ Setup, Portals, Anatomy, Risks, Complete Diagnostic Arthroscopy, Removal Loose Bodies-Dr. Mary K. Mulcahey, MD

How To_ Setup, Portals, Anatomy, Risks, Complete Diagnostic Arthroscopy, Removal Loose Bodies-Dr. Mary K. Mulcahey, MD

Pdf Summary

This presentation by Dr. Mary K. Mulcahey from Tulane University details the setup, portal placement, and performance of diagnostic shoulder arthroscopy, focusing on techniques, positioning, and safety considerations.<br /><br />Two main patient positions are discussed: the Beach Chair and the Lateral Decubitus. The Beach Chair position involves sitting the patient upright at 70-80 degrees with neutral neck alignment and operative arm held by devices like the Spider or McConnell. It offers anatomic orientation, easier visualization of the glenohumeral joint (GHJ), and simpler conversion to open surgery but can limit access to the axillary pouch and may require an assistant for arm traction. The Lateral Decubitus position places the patient on their side with traction applied, providing improved visualization of posterior and inferior GHJ areas and accentuation of labral tears but carries a higher risk of nerve injury and non-anatomic orientation.<br /><br />Portals—the key entry points for the arthroscope and instruments—are extensively covered. Primary portals include posterior viewing, anterior-inferior, anterior-superior, and lateral (anterolateral, posterolateral). Accessory portals such as the Neviaser, Port of Wilmington, and 7 o’clock portals are also described for specialized access. Emphasis is placed on marking surface anatomy meticulously and spacing anterior portals adequately to avoid crowding.<br /><br />Practical tips highlight the importance of mastering setup before team involvement, using cannulas for smooth joint access, adjusting portals if necessary, and operating from both anterior and posterior approaches.<br /><br />Additional setup variations like the La Jolla Beach Chair position combine benefits of both traditional positions by allowing traction use with upright anatomy for easier open surgery conversion.<br /><br />In summary, successful diagnostic shoulder arthroscopy requires careful positioning, anatomical landmark identification, strategic portal placement, and adaptability during the procedure to optimize visualization and minimize risks.

Keywords

diagnostic shoulder arthroscopy

patient positioning

Beach Chair position

Lateral Decubitus position

arthroscopic portals

glenohumeral joint visualization

portal placement techniques

safety considerations in arthroscopy

La Jolla Beach Chair variation

shoulder arthroscopy setup