Basics of Shoulder Arthroscopy Part I: Beach-Chair Patient Positioning and Operating Room Setup

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Abstract

A broad range of shoulder pathologies are treated with shoulder arthroscopy due to its minimally invasive nature. Mastering the fundamentals is critical for high-quality care; this includes patient positioning. Surgeons must consider the advantages and disadvantages of the 2 most prominent patient positions: lateral decubitus and beach chair. The beach-chair position offers an intuitive anatomic view with the advantage of shoulder maneuverability. Understanding the associated pitfalls related to patient hemodynamics; head, neck, and shoulder positioning; and protection of bony prominences can guide the operative care team to obtaining a safe position for the patient. The purpose of this Technical Note and video is to present and demonstrate a reproducible and teachable method for safely positioning a patient in the beach-chair position for shoulder arthroscopy, as well as to describe the associated advantages and disadvantages.

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Most cited references 8

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Cerebral ischemia during shoulder surgery in the upright position: a case series.

D. Cullen, Andrea Pohl (2005)

We report 4 cases of ischemic brain and spinal cord injury after shoulder surgery in the beach chair position, using data from medical legal case reviews. We argue that the correlation between cardiovascular risk factors and cerebral ischemic complications for this type of surgery is poor in these middle-aged patients. Rather, our analysis suggests that the sitting position and the head position create specific physiological conditions that may be conducive to cerebral and spinal cord ischemia during this type of surgery. Thromboembolic events may be an additional cause of adverse neurologic outcomes.

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A comparison of the lateral decubitus and beach-chair positions for shoulder surgery: advantages and complications.

Elizabeth Matzkin, Jon P. Warner, Xinning Li … (2015)

Arthroscopic or open shoulder surgery can be performed using the lateral decubitus or beach-chair position. Advantages of the lateral decubitus position include better visualization and instrument access for certain procedures and decreased risk for cerebral hypoperfusion. Complications associated with this position include traction injuries, resulting in neurapraxia, thromboembolic events, difficulty with airway management, and the potential need to convert to an anterior open approach. One advantage of the beach-chair position is easier setup from a supine to upright position, which allows the surgeon the option to convert to an open procedure if necessary. Although rare, patients in this position may experience cerebral hypoperfusion and complications that range from cranial nerve injury to infarction. Other complications related to this position include cervical traction neurapraxia, blindness, and cardiac and embolic events. The surgeon must be cognizant of the complications associated with both positions and take extra care in the initial patient setup and coordination with the anesthesiologist to minimize the risk of complications and morbidity.

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Pathomechanisms and complications related to patient positioning and anesthesia during shoulder arthroscopy.

G Rooke, Derek D Rains, Markus Wahl (2011)

The lateral decubitus and beach-chair positions each offer unique benefits to the shoulder surgeon with respect to visualization, efficiency, and ease during arthroscopic shoulder procedures. The purpose of this article was to comprehensively review the reports and studies documenting independent and dependent complications related to patient positioning and anesthesia during arthroscopic shoulder surgery. The lateral decubitus position has been associated with the potential for peripheral neurapraxia, brachial plexopathy, direct nerve injury, and airway compromise. The beach-chair position has been associated with cervical neurapraxia, pneumothorax, and the potential for end-organ hypoperfusion injuries (when deliberate hypotension is used). Potentially concerning are hypotensive bradycardic events, which may be relatively common in association with the use of epinephrine-containing interscalene anesthetics in beach chair-positioned patients. Irrigant complications (fluid spread, ventricular tachycardia) are avoidable risks not unique to either specific position. Although minor transient anesthetic- and position-related complications (neurapraxia, hypotension) may occur in as many 10% to 30% of patients, major complications such as end-organ damage or permanent impairments are exceedingly rare. Regardless of position, complications are almost uniformly avoidable if surgeon and anesthetist exercise care and prudent attention to position and anesthetic choices. The purpose of this article is to review the potential for position- and anesthesia-related complications and acquaint the shoulder surgeon with the proposed pathophysiologic mechanisms that can lead to them. Copyright © 2011 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

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Author and article information

Contributors

Christopher L. Camp

Journal

Journal ID (nlm-ta): Arthrosc Tech

Journal ID (iso-abbrev): Arthrosc Tech

Title: Arthroscopy Techniques

Publisher: Elsevier

ISSN (Electronic): 2212-6287

Publication date PMC-release: 01 June 2024

Publication date Collection: October 2024

Publication date (Electronic): 01 June 2024

Volume: 13

Issue: 10

Electronic Location Identifier: 103082

Affiliations

[1]Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, U.S.A.

Author notes

[∗ ]Address correspondence to Christopher L. Camp, M.D., Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, U.S.A. camp.christopher@ 123456mayo.edu

Article

Publisher Item ID: S2212-6287(24)00199-3 Publisher ID: 103082

DOI: 10.1016/j.eats.2024.103082

PMC ID: 11519874

PubMed ID: 39479049

SO-VID: a224d96c-c5c4-4959-8b4b-b990c909c90e

License:

This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Basics of Shoulder Arthroscopy Part I: Beach-Chair Patient Positioning and Operating Room Setup

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Technique Video

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Most cited references 8

Cerebral ischemia during shoulder surgery in the upright position: a case series.

A comparison of the lateral decubitus and beach-chair positions for shoulder surgery: advantages and complications.

Pathomechanisms and complications related to patient positioning and anesthesia during shoulder arthroscopy.

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