SHOULDER ARTHROSCOPY = from Miller Review 2012


      A        Portals

      1        Standard portals

      ?        Posterior portal (2 cm distal and medial to the posterolateral border of the acromion, used primarily for viewing)

      ?        Anterior portal (just anterior to the acromioclavicular joint)

      ?        Lateral portal (1 to 2 cm distal to the lateral acromial edge)


      2        Additional portals

      ?        Supraspinatus (Neviaser) portal for anterior glenoid visualization (through the supraspinatus fossa)

      ?        Anterolateral and posterolateral portals (Port of Wilmington, just anterior to the posterolateral corner of the acromion) are useful for labral tears or tears of the superior labrum from anterior to posterior (SLAP) and rotator cuff repair

      ?        Anteroinferior (5 o’clock position) portal for Bankart repair and stabilization procedures

      ?        Posteroinferior (7 o’clock position) portal for stabilization procedures



      B        Technique

      1        Intraarticular structures should be systematically evaluated.

      2        As the number and variety of arthroscopic procedures increase, so does the opportunity for iatrogenic injury.

      3        Maintaining adequate visualization through hemostasis, avoiding chondral abrasion, maintaining adequate flow with thermal devices, and preventing fluid extravasation by preserving muscle fascial layers help minimize the risk.