This document provides an overview of shoulder arthroscopy procedures including patient positioning, room setup, skin marking of bony landmarks, creation of portals, and navigation of the glenohumeral joint and subacromial space. It discusses the lateral decubitus position as the preferred approach and describes skin marking for the basic posterior, anterior superior, anterior inferior, and posterior lateral portals. Key steps are outlined including insertion of the arthroscope through the posterior portal for initial visualization of the glenohumeral joint.

1. Shoulder Arthroscopy:
Basic Portals – Landmarks –
Navigation
Nikolaos Tzanakakis
Orthopedic Surgeon
2nd Orthopedic Dept.
Center for Shoulder Arthroscopy
IASO General Hospital
Athens, Greece

2. Topics
 Patient positioning
 Room set-up
 Landmarks - Skin Marking
 Creating portals
 Glenohumeral Joint Navigation
 Subacromial Space Navigation
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3. Topics
 Patient positioning
 Room set-up
 Landmarks - Skin Marking
 Creating portals
 Glenohumeral Joint Navigation
 Subacromial Space Navigation
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4. Patient Positioning: Beach Chair
can easily convert to open surgery…
ask your instructors later today
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5. Patient Positioning:
Lateral Decubitus
Our preferred position
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6. Lateral Decubitus positioning
30° backward inclination
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7. Padding bony prominences
Adequate patient stabilization
Beware of the neck
Patient Positioning:
Lateral Decubitus
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8. Arm Draping
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9. Traction: NO more than 4 Kgrs
Axonal traction:
3.2 Kg for body weight<65 Kg
4.0 Kg for body weight>65 Kg
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10. Choose patient positioning
Beach chair VS. Lateral decubitus
 Are equally useful and promising
 Have the same landmarks
 Decision depends on surgeon’s training
and preferences
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11. Topics
 Patient positioning
 Room set-up
 Landmarks - Skin Marking
 Creating portals
 Glenohumeral Joint Navigation
 Subacromial Space Navigation
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12. Room Set up
Lateral decubitus allows easy access to the
anterior and posterior part of the joint
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13. Keep the operating room cold
to avoid fogging
but
Keep the
patient warm
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14. Instruments in side pocket –
easily available
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15. The arthroscopic tower opposite
the surgeon
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16. Is everything ready
BEFORE starting ?
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17. Commonly used tools arranged
by the scrub nurse
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18. Topics
 Patient positioning
 Room set-up
 Landmarks - Skin Marking
 Creating portals
 Glenohumeral Joint Navigation
 Subacromial Space Navigation
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19. Skin Marking – Bony Landmarks
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20. Skin Marking – Basic Portals
P
AS
AI
PL
L
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21. Topics
 Patient positioning
 Room set-up
 Landmarks - Skin Marking
 Creating portals
 Glenohumeral Joint Navigation
 Subacromial Space Navigation
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22. Before Entering the Scope
Spinal Needle
insertion
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23. Saline Backflow
Saline in
Before Entering the Scope
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24. Arthroscope in GH joint
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25. Topics
 Patient positioning
 Room set-up
 Landmarks - Skin Marking
 Creating portals
 Glenohumeral Joint Navigation
 Subacromial Space
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26. First view from posterior portal
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27. View from posterior portal
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28. Checking Rotator cuff
PASTA
Full RC tear
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29. Creating Anterior Portals
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30. Creating Anterior Superior Portal
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31. Switching stick into AS portal
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32. Scope into Anterior Superior portal
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33. View from Anterior Superior portal
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34. View from Anterior Superior portal
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35. Creating Anterior Inferior portal
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36. Three main portals for GH arthroscopy
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37. Topics
 Patient positioning
 Room set-up
 Landmarks - Skin Marking
 Creating portals
 Glenohumeral Joint Navigation
 Subacromial Space Navigation
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38. Creating the PosteroLateral
portal
1cm distal, 1cm posterior to PL acromion corner
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39. Two posterior portals:
better view & better suture management
Portals for Subacromial arthroscopy
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40. Portals for Subacromial arthroscopy
 Scope into Posterolateral portal
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41. Portals for Subacromial arthroscopy
 Create the Lateral portal
 3-4cm distal to the lateral acromion
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42. Don’t Worry…be happy
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43. Find a good pump,
good anesthesiologist,
good head scrub nurse.
It is better to have them friends!!!
The most difficult thing…
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44. Bleeding control
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45. Bursa removal
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46. Uncovering acromion
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47. AC joint – Auxiliary portal
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48. Checking Rotator Cuff Pathology
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49. Thank you for your attention
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