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The patient is moved into the upright beach chair position in conjunction with the anesthesia staff to ensure that the patient does not become hypotensive during this positioning maneuver. We recommend cycling the blood pressure before raising the head to have accurate and current blood pressure data. Attention is then turned to the contralateral arm, which is placed in a padded arm holder LPS Arm Support, Arthrex to ensure that the wrist is in a neutral position and avoids compression of the ulnar nerve.

The positioner should allow for adequate external rotation of the operative shoulder. Once the patient is properly positioned , a final preparation timeout is performed to confirm the operative side for patient safety. Next, sterile preparation and draping can proceed. The operative extremity is prescrubbed with chlorhexidine solution. The forearm of the operative extremity is held while the surgeon cleans the skin with sterile 3M ChloraPrep CareFusion, San Diego, CA from the axilla to the hand and nipple to the medial border of the scapula.

The surgeon uses a sterile stockinette 3M Health Care, St. Paul, MN to cover the hand. A sterile plastic blue U-Drape U-drape, 3M Health Care is placed across the neck and down the chest and back to isolate the sterile field, followed by a second plastic blue U-Drape U-drape, 3M Health Care across the axilla and up the chest and back. A sterile drape with an arthroscopic fluid collection pocket and associated drain is then used 3M Health Care.

This drape will isolate anesthesia from the sterile field.

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The surgeon will then use a pen on the skin for landmarks of the acromion, clavicle, and coracoid to determine the positions of the portals. Once these landmarks have been identified, one sheet of Ioband 3M Health Care is cut into quarters, and fixed to the edges of the operative area to prevent the drapes from pulling away from their position.

At the conclusion of patient positioning, the surgical team should change gloves and conduct a final preincision timeout. Arthroscopic shoulder surgery is highly effective at treating shoulder pathology and continues to grow in popularity because of its success.

Shoulder Arthroscopy

Arthroscopy offers several advantages versus open procedures including decreased morbidity, length of hospital stay, and postoperative pain, in addition to improved cosmesis. The 2 positions that may be used when performing shoulder arthroscopy are the beach chair and lateral decubitus positions. The position chosen is chiefly dependent on surgeon preference and neither has been shown to be superior to the other. Cerebral hypoperfusion is a recognized and catastrophic complication of the beach chair position. However, Pohl and Cullen 15 reported that hyperextension and rotation or tilt of the head can decrease vertebral artery flow, resulting in infarcts in the distribution of the posterior cerebral artery.

Furthermore, Park and Kim 22 reported a case series of neuropraxia thought to have been caused by malposition of the head and neck in the beach chair position resulting in excess pressure on superficial nerves. Thus, the surgeon must be vigilant in assuring proper head alignment during patient positioning as well as proper padding of bony prominences. Finally, during sterile preparation of the surgical field, care should be taken to isolate the surgical field while maintaining satisfactory area to place the relevant portals.

The advantages of the beach chair position have been outlined in the literature as having a lower incidence of neuropathies, decreased risk of neurovascular complications during portal placement, decreased surgical time, easier conversion to an open procedure, and better visualization of the joint. Free Preview.

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Principles and Practice

A system-atic review. J Orthop Traumatol. Passive mobilization af-ter arthroscopic rotator cuff repair is not detrimental in the early postoperative peri-od. A preopera-tive scoring system to select patients for arthroscopic subacromial decompression. J Shoulder Elbow Surg.

Frozen shoulder after simple arthroscopic shoulder procedures: What is the risk?

Basic Shoulder Arthroscopy: Beach Chair Patient Positioning

The morphology of the acromion and its relationship to rotator cuff tears. Orthop Trans. Clinical Inquiry: Is arthroscopic subacromial de-compression effective for shoulder im-pingement? J Fam Pract. The role of acromio-plasty for rotator cuff problems. Orthop Clin North Am. Lenich A, Imhoff AB. Acromion reconstruc-tion after arthroscopic subacromial decom-pression and iatrogenic acromial destruc-tion. Oper Orthop Traumatol. J Bone Joint Surg Am. Arthro-scopic subacromial decompression is effec-tive in selected patients with shoulder im-pingement syndrome.

J Bone Joint Surg Br. Calcific tendinitis of the rotator cuff: man-agement options. J Am Acad Orthop Surg. Neer CS. Anterior acromioplasty for the chronic impingement syndrome in the shoulder: a preliminary report.

Surgical Technique

J Bone Joint Surg. Signifi-cant benefit for older patients after arthro-scopic subacromial decompression: a long-term follow-up study.


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  5. Int Orthop. Comprehensive Arthroscopic Management CAM procedure: clinical results of a joint-preserving arthroscopic treatment for young, active patients with advanced shoulder osteoarthritis. Current trends in rotator cuff repair: surgical technique, set-ting, and cost. Safety and efficacy of arthrosco-py in the setting of shoulder arthroplasty. Curr Rev Musculoskelet Med. Rotator cuff tears after 70 years of age: a prospective, randomized, comparative study between decompression and arthroscopic repair in patients. Prognostic factors for recovery after arthroscopic rotator cuff re-pair: a prognostic study.

    Sub-acromial decompression: lateral and poste-rior cutting block approach.

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    Operative Arthroscopy. Rotator cuff tears: An evidence based approach. World J Orthop. Does arthroscopic subacromial decompres-sion improve quality of life.