Office-Based Needle Arthroscopy: A Standardized Diagnostic Approach to the Shoulder

Abstract

In-office needle arthroscopy offers the potential advantage of reduced injury to intervention time, without the need for advanced imaging. It is particularly appropriate for those with contraindications to advanced imaging and also may reduce the risk of incorrect diagnoses in those situations in which imaging is associated with low sensitivity/specificity. The purpose of this article is to provide a standardized diagnostic approach to needle arthroscopy of the shoulder.

Fig 1

Patient positioned in the seated position with the screen positioned where it can be easily seen by the physician and the patient, during needle arthroscopy of the right shoulder.

Fig 2

Needle arthroscope inserted into the standard posterior portal position of the right shoulder.

Fig 3

Intra-articular image from a posterior viewing portal with the patient in an upright position showing the superior glenoid/labrum of the right shoulder, where the biceps tendon would typically attach. This patient has had a previous biceps tenotomy. The star in the image identifies the humeral head, whereas the triangle identifies is the superior labrum.

Fig 4

Intra-articular image of the right shoulder showing anteroinferior glenoid/labrum from a posterior viewing portal with the patient in the upright position. The star is located on the anteroinferior labrum, and the triangle identifies the glenoid.

Fig 5

Intra-articular image of the right shoulder showing the rotator cuff with partial articular sided tearing from a posterior viewing portal with the patient in an upright position. The star is on the rotator cuff fibers.