1. SRS – VERSION 8 UPGRADE
April, 2012

2. Complications of Shoulder
Arthroscopy
Christopher M. Aland MD
Rothman Institute, Newtown, Pa

3. Disclaimer
• I own stock in Arthrocare, and Johnson and
Johnson
• I am on the membership committee of AANA
• I have no conflicts of interest that affect my
ability to teach this course

4. Introduction
 While rates are low, complications do occur.
Awareness is the best preventative measure
 Pre-op factors
 Intra-op factors
 Post op factors

5. Pre op factors
• Misdiagnosis
• Pre op stiffness
• Pumps Patient factors

6. Misdiagnosis
• Is it really shoulder pain?
• Will your procedure address the diagnosis

7. Stiffness
• Pre-op pain may lead to secondary capsulitis
• Treatment of capsulitis may run counter to
intended procedure

8. Patient factors
• Age
• Obesity
• Cigarettes
• History of MRSA
• History of DVT

9. Intra-op factors
• Nerve damage
• Vascular injury
– direct
– indirect
• Hardware related
• Patient positioning
• Thermal
• Fluids
• Rare and unusual

10. Nerve damage
• Usually transient, permanent may occur
• Most common are axillary and
musculocutaneous
• Portal placement is important
• Do you know where your equipment is?
• Patient positioning

11. Vascular
• Fortunately very rare, but can occur with
portal placement
• In general, vessels 2cm away
• Anterior portal: axillary artery, cephalic vein
• Posterior portal: suprascapular artery
• Superior portal: suprascapular artery
• The dreaded red-out

12. Hardware/equipment
• Anchors
• Hand instruments
• Shavers
• Wands
• What the salesman dragged in

13. Patient positioning
• Balanced suspension
• Head and neck position
• Leg and thigh

14. Thermal issues
• Chondrolysis
• Hot water skin burns
• Role of capsular shrinkage
• Axillary roll

15. Fluids
• Most visibly impressive, but least worrisome
– Unless you slip and fall
• May obscure landmarks
• Pain
• Transient neurological issues
• Excess usage/appropriate procedure

16. Rare and unusual
• Air embolism
• Acromial fractures
• Carotid artery compression
• RSD

17. Post-Op factors
• Stiffness
• Infection
• Chondrolysis
• Pain
• DVT

18. Stiffness
Most common complication
Debate re: early v. late Physical Therapy

19. Infection
• Very rare
• Role of propionobacterium acne

20. Chondrolysis
• Role of pain pumps/local anesthetics
• Thermal issues
• Idiopathic

21. Pain
• Usual pain
• Unusual pain

22. DVT
• Very rare
• Should have routine measures, ie: SCDs
• High risk patients

23. Conclusion
• Consider how your pre-op work up will have
an impact on your surgery
• Education as to patient factors, equipment
• Monitor post op status

24. Thank-you

25. Version 8
• Version 8 of SRS provides us with the upgraded software
that will allow the organization to collect the required
data for meaningful use.
• This version will be live in all areas of the RI on April 23,
2012.

26. Has anything changed?
• There are several true “upgrades” to items
that we use today.
• There are many new features that are
required for meaningful use.
• There is one feature that has been removed.

27. New Features
• An “on the fly” selection of a date of service in
the chart list
• Viewing multiple providers in one chart list
• Pharmacy is in view within the clinical summary
• Past and future appointments are in view within
the clinical summary
• Rx favorite list now allows providers to save their
SIG in their favorites and also to a master file.

28. What was removed?
The additional referring provider will no longer
be available with in the summary screen.
• The process will remain the same for adding
additional providers to the patient’s chart.
• That information will now only be viewed in
the same area/tab that is accessed to add an
additional provider.