AANA Middle East Arthroscopy Master Course (International)-Shoulder Arthroscopy

Shoulder Arthroscopy

Pdf Summary

This lecture by Dr. Pietro M. Tonino, Chief of Sports Medicine at Loyola University Chicago, comprehensively covers shoulder arthroscopy principles, preparation, and surgical techniques. The key goals of shoulder surgery are accurate diagnosis and appropriate, precise treatment, whether arthroscopic, open, or combined procedures. Dr. Tonino emphasizes that success hinges on "Proper Preparation Prevents Poor Performance," which begins with detailed history taking, physical examination, and diagnostic tests (radiographs, injections).<br /><br />Common shoulder pathologies discussed include rotator cuff injuries, instability, AC joint disease, and adhesive capsulitis, each with distinct clinical signs and examination tests (e.g., lift-off test for rotator cuff, apprehension test for instability). Selective injections and imaging help localize problems preoperatively.<br /><br />Arthroscopic surgery is often a first step, with readiness to convert to open procedures if needed. Intraoperative considerations include team coordination, anesthesia planning (regional blocks favored), and careful patient positioning (lateral decubitus or beach chair), each chosen based on the pathology treated. Positioning tips stress protection of nerves and skin, and awareness of blood pressure risks in upright positions.<br /><br />Dr. Tonino details arthroscopic portal placement techniques, including posterior, anterior, anterosuperior, Neviaser, Wilmington, and subacromial portals. He stresses marking anatomical landmarks before swelling obscures them. Portal creation methods include outside-in and inside-out techniques for safe, reliable access. A systematic diagnostic examination of the glenohumeral joint is advised, progressing through evaluation of the biceps tendon, labrum, rotator interval, ligaments, and articular surfaces.<br /><br />Subacromial arthroscopy requires essentials such as electrocautery, hypotensive anesthesia, and epinephrine in infusion fluid to control bleeding. Portal triangulation and use of specific portals enable visualization and treatment of bursal inflammation and rotator cuff pathology. Comparison with radiographs aids acromial morphology assessment.<br /><br />Overall, Dr. Tonino concludes that mastery of shoulder arthroscopy demands thorough preparation, understanding of anatomy, technical skill in portal placement, and the flexibility to convert to open surgery when necessary to optimize outcomes.

Keywords

shoulder arthroscopy

Dr. Pietro M. Tonino

sports medicine

shoulder surgery techniques

rotator cuff injuries

shoulder instability

arthroscopic portals

patient positioning in surgery

diagnostic shoulder tests

subacromial arthroscopy