AANA Lab Course 912 - Arthroscopic Shoulder Solutions-Shoulder Arthroscopy Basics

Shoulder Arthroscopy Basics_ Beach Chair-Larry D. Field, M.D.

Pdf Summary

This presentation by Dr. Larry D. Field reviews the use of the beach chair position for shoulder arthroscopy, comparing it primarily with the lateral decubitus position. Both positions are widely accepted, with surgeon experience and preference guiding choice. The beach chair position, described in the 1980s to reduce brachial plexus traction injuries, offers several advantages: it provides an anatomic orientation beneficial for procedures involving the subacromial space, creates a favorable teaching environment by aligning "up" with the surgeon’s perspective, allows easy arm manipulation, facilitates conversion to open surgery (e.g., Latarjet, subscapularis repair, biceps tenodesis), and enables regional anesthesia with better airway access. Setup includes elevating the bed to about 70 degrees, padding bony prominences, securing the head with minimal neck rotation, and ensuring patient safety with straps and face protection.<br /><br />Disadvantages of the beach chair position include the rare risk of cerebral hypoperfusion and associated hypotension, requiring careful blood pressure monitoring at heart level, and challenges in accessing the inferior glenohumeral joint. In contrast, the lateral decubitus position offers improved access to the inferior glenohumeral joint and lower hypotension risk but is less anatomical, requires more effort to position and reposition for open surgeries, and carries a risk of neuropraxia from excessive traction.<br /><br />In summary, both positions have merits: the beach chair position excels in anatomical orientation, conversion ease, and airway management, while lateral decubitus provides better inferior joint access and reduces hypotensive anesthesia risks. Ultimately, surgeon training, comfort, and specific procedural needs determine the optimal patient positioning for shoulder arthroscopy.

Keywords

beach chair position

shoulder arthroscopy

lateral decubitus position

brachial plexus traction injury

subacromial space

regional anesthesia

cerebral hypoperfusion

inferior glenohumeral joint access

neuropraxia risk

surgeon preference