AANA Lab Course 902 - Foundations in Arthroscopy (Resident/Fellow)-How To_ Subacromial Arthroscopy_ Bursectomy, Acromioplasty, Distal Clavicle Excision, Prepare for Cuff-Dr. Mary K. Mulcahey, MD

How To_ Subacromial Arthroscopy_ Bursectomy, Acromioplasty, Distal Clavicle Excision, Prepare for Cuff-Dr. Mary K. Mulcahey, MD

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Pdf Summary

Dr. Mary K. Mulcahey’s presentation outlines the surgical management of the subacromial space, focusing on techniques including bursectomy, acromioplasty, distal clavicle excision (DCE), and preparation for rotator cuff repair. The subacromial space, a true anatomical space containing the anterior bursa, is accessed using standard glenohumeral joint portals (posterior, anterior, mid-lateral, and accessory portals). Proper portal placement is critical to avoid complications such as injuring the axillary nerve and to allow optimal visualization and access.<br /><br />Acromion morphology, classified into three types (flat, curved, hooked), guides the need for acromioplasty—reshaping Type 2 (curved) and Type 3 (hooked) acromions into Type 1 (flat) to alleviate impingement. Techniques include arthroscopic subacromial decompression (SAD) using motorized shavers and radiofrequency devices to perform bursectomy and smooth bony edges, with methods like the posterior cutting block technique facilitating bone removal safely.<br /><br />Key steps in SAD focus on controlling bleeding, protecting the deltoid and rotator cuff from injury, and avoiding over-resection which can lead to fractures. The coracoacromial (CA) ligament, with variable morphologies, is also addressed during decompression.<br /><br />The role of SAD combined with rotator cuff repair remains debated; studies show no difference in outcomes at 1 and 2 years. However, SAD may enhance visualization, increase working space, remove external impingement, and improve the biological environment.<br /><br />Distal clavicle excision is indicated preoperatively primarily for AC joint arthritis or pain, performed arthroscopically with attention to sufficient bone resection, smooth margins, and preservation of surrounding structures.<br /><br />Overall, success in these procedures depends on thorough preoperative planning, understanding anatomy and morphology, meticulous technique, and use of proper portals to optimize outcomes in shoulder arthroscopy.

Keywords

subacromial space

bursectomy

acromioplasty

distal clavicle excision

rotator cuff repair

glenohumeral joint portals

acromion morphology

arthroscopic subacromial decompression

coracoacromial ligament

shoulder arthroscopy