APEX Foundations in Arthroscopy Basic Lectures-Arthroscopic Shoulder Portals

Video Transcription

Video Summary

Dr. John Orwin from the University of Wisconsin-Madison presents on arthroscopic shoulder portals, emphasizing correct patient positioning and precise anatomical landmark marking. He describes five classic shoulder portals—posterior, anterior, anterior inferior, superior, and lateral—with the first three being primary for most procedures. The posterior portal is typically established first, using careful palpation and a spinal needle to avoid damaging key structures. The anterior portal is often created via an inside-out technique through the rotator interval, while the anterior inferior portal uses an outside-in approach, crucial for stabilization surgeries. The lateral portal offers optimal visualization of the rotator cuff and is important for subacromial procedures. Dr. Orwin underscores the importance of spacing between portals to facilitate instrument maneuvering and avoiding nerve injury, such as to the suprascapular and axillary nerves. He notes variations in portal placement depending on patient anatomy and positioning, such as lateral decubitus versus beach chair positions. The talk concludes with a discussion of nerve and vascular risks and the essential nature of a thorough diagnostic exam before proceeding with surgery.

Asset Caption

Dr. John Orwin

Keywords

arthroscopic shoulder portals

patient positioning

anatomical landmarks

posterior portal

anterior portal

nerve injury prevention