Shoulder Arthroscopy in the Lateral Decubitus Position

Abstract

Arthroscopic shoulder surgery can be performed in both the beach chair and lateral decubitus positions. The lateral decubitus position allows for excellent exposure to all aspects of the glenohumeral joint and is therefore frequently employed in procedures such as stabilization, in which extensive visualization of the inferior and posterior aspects of the joint is required. Improved visualization is imparted due to applied lateral and axial traction on the operative arm, which increases the glenohumeral joint space. To perform arthroscopy surgery in the lateral decubitus position successfully, meticulous care during patient positioning and setup must be taken. In this Technical Note, we describe the steps required to safely, efficiently, and reproducibly perform arthroscopic shoulder surgery in the lateral decubitus position.

Fig 1

(A) Operating table with beanbag device (Olympic Vac-Pac System, Natus Medical, San Carlos, CA) and traction device (Spider 2 Limb Positioner, Smith and Nephew, Andover, MA) secured to table prior to the start of the procedure. (B) Examination under anesthesia on the right arm for evaluation of range of motion in all planes. (C, D) The surgical and anesthesia teams roll the patient to the lateral decubitus position with the operative shoulder up. (E) Both knees are bent, and padding (i.e., pillow or foam pad) is placed under the down knee as well as in between the knees to protect the fibular head and avoid pressure injuries to the common peroneal nerve. (F) A surgical table strap (Bryton Corporation, Indianapolis, IN) and multiple pieces of adhesive tape spanning the width of the operating table are used to secure the patient within the beanbag and to the table.

Fig 2

(A) The operative arm (right side) is placed in a sterile stockinette (Smith and Nephew, Andover, MA) and then wrapped with Coban (3M, St. Paul, MN) making sure to keep the hand open for placement into the arm holder device (Spider 2 Limb Positioner, Smith and Nephew). (B) The head is stabilized at all times by the anesthesia team and can be maintained in the neutral position with a foam pad and towels if necessary. (C) The arm holder (Smith and Nephew) is secured around the operative arm with Velcro straps, and then Coban (3M) is applied circumferentially for further security. (D, E) The arm is then placed into the traction device (Spider 2 Limb Positioner) and traction is applied with a maximum of 10 pounds. (F) Operative arm (right arm) placed in lateral traction device (Spider 2 Limb Positioner) wrapped in Coban for securement of the operative arm after sterile preparation and subsequent draping. (G, H) Example of the Arthrex (Naples, FL) commercially available arm holder for securement of the operative arm after sterile preparation and draping.

Fig 2

(A) The operative arm (right side) is placed in a sterile stockinette (Smith and Nephew, Andover, MA) and then wrapped with Coban (3M, St. Paul, MN) making sure to keep the hand open for placement into the arm holder device (Spider 2 Limb Positioner, Smith and Nephew). (B) The head is stabilized at all times by the anesthesia team and can be maintained in the neutral position with a foam pad and towels if necessary. (C) The arm holder (Smith and Nephew) is secured around the operative arm with Velcro straps, and then Coban (3M) is applied circumferentially for further security. (D, E) The arm is then placed into the traction device (Spider 2 Limb Positioner) and traction is applied with a maximum of 10 pounds. (F) Operative arm (right arm) placed in lateral traction device (Spider 2 Limb Positioner) wrapped in Coban for securement of the operative arm after sterile preparation and subsequent draping. (G, H) Example of the Arthrex (Naples, FL) commercially available arm holder for securement of the operative arm after sterile preparation and draping.

Fig 3

Operative arm (right arm) placed in lateral traction device (Spider 2 Limb Positioner, Smith and Nephew, Andover, MA) with anticipated portal sites marked using bony landmarks, including the acromion, clavicle, acromioclavicular joint, and coracoid process. Here the posterior portal (P) and posterolateral portal (PL) are marked.