Shoulder Arthroscopic Portals: Ordinary Versus Unconventional
Due to the development of arthroscopy, it has been replacing most of the conventional open shoulder surgeries and has become the standard modality of treatment of shoulder disease. In shoulder arthroscopy, the proper position of the portal is essential fo
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Shoulder Arthroscopic Portals: Ordinary Versus Unconventional Yang-Soo Kim and Hyo-Jin Lee
4.1
Introduction
Recent improvement of arthroscopy has replaced most of the conventional procedures of shoulder surgery. Being a primary treatment modality of the shoulder, arthroscopy has many advantages over the open conventional surgery. Minimal invasiveness by small incision has enabled less injury to the deltoid muscle, less postoperative pain, and potentially fast recovery after operation [4, 17]. During the process of operation, thorough visualization of the joint has enabled more precise diagnosis along with discovery of concomitant pathology. The appropriate position of the portal is essential for the visualization of the intraarticular surgical field and the approach of the surgical instruments to the lesion. It enables to enhance anatomical reconstruction of the injured tissue and finally achieve a successful surgery. We have described the contents into two parts in this
Y.-S. Kim, MD, PhD (*) Department of Orthopedic Surgery, Seoul St. Mary’s Hospital, The Catholic University of Korea, 505 Banpo-dong, Seocho-gu, Seoul 137-701, Korea e-mail: [email protected] H.-J. Lee, MD Department of Orthopedic Surgery, Wonkwang University Sanbon Hospital, Wonkwang University, Gyeonggi-do, South Korea
chapter: conventional portal placement and unconventional portal placement.
4.2
Ordinary Portal Placement
4.2.1
Posterior Portal
The posterior portal is the first portal made during shoulder arthroscopy. It is the most convenient portal which can be made safely and allows adequate visualization of the entire glenohumeral joint. It enters the soft spot between the humeral head and the glenoid. A vertical, small incision is made 2–3 cm inferior and 1–2 cm medial to the posterolateral corner of the acromion [1]. Some surgeons prefer further inferior placement of the portal as the portal position may move superior as soft tissue swelling increases during the operation. In this case, close proximity with the posterior acromion may provide a poor angle of approach to the subacromial space. For the access into the glenohumeral joint, the direction of the trocar is recommended to aim toward the coracoid process. After the introduction of the trocar through the capsule, a popping sensation can be felt as the joint is entered. Localizing the joint line by palpating the humeral head and glenoid allows the correct placement of the portal within the glenohumeral joint. After proper placement of the trocar, diagnostic arthroscopy can be performed. Even though the posterior portal can be established safely, there still lies the risk of injury on the
J.-Y. PARK (ed.), Sports Injuries to the Shoulder and Elbow, DOI 10.1007/978-3-642-41795-5_4, © Springer-Verlag Berlin Heidelberg 2015
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Y.-S. Kim and H.-J. Lee
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nearby nerves or vessels. The axillary nerve and suprascapular nerve are the most common nerves that can be damaged during the portal establishment. The average distance of the posterior soft spot portal insertion site
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