Illustrated Tips & Tricks CH16

Figure 16-1 || Lateral positioning (right shoulder) shown from the head of the table (A) and superior (B) with the patient leaning back 20-30 degrees ensures that there is adequate working space anteriorly. Goggles should be placed before draping, because the instruments for placing anchors in the lesser tuberosity will pass very close to the patient’s face. G, glenoid; H, humeral head.

Monitor

Pump

Tower: Shaver/Burr Electrocautery Camera

Second Surgical Tech

Traction Device

Mayo #2

Drape

Anesthesia

Surgeon

Assistant

Primary surgical Tech

Monitor

Mayo #1

A

Instrument table

Figure 16-2 || Schematic (A) and photo (B) of our standard operating room setup (right shoulder) demonstrates how the second surgical technician can apply the posterior lever push to improve the arthroscopic view ( inset ) of the subscapularis (SSc) and lesser tuberosity. A posterior force is applied to the upper arm ( white arrow ), and an anterior counter force is applied to the lower arm ( green arrow ), H, humeral head.

Figure 16-3 || Left shoulder external view (A) and 70-degree arthroscopic view (B) . The anterosuperior-lateral (ASL) portal (cannulated) is typically located just off the anterolateral corner of the acromion ( blue line ) on the skin. A spinal needle ( white arrow ) shows the location of an accessory anterior portal, which often seems “very medial” but is necessary to gain the correct angle of approach ( white arrow , B ) to the lesser tuberosity (LT). H, humeral head; SSc, subscapularis.