Diagnostic and Therapeutic Shoulder Arthroscopy Using a Small-Bore Needle Arthroscope

Abstract

As resolution and image quality improve, several potential advantages make needle arthroscopy (NA) appealing for broader therapeutic applications in the operating room. Smaller camera size and weight allow for a minimally invasive approach with smaller incisions than standard arthroscopy and decreased use of arthroscopic fluid. Differences in the technology, such as a 0° optic and less rigid instrumentation, necessitate a modified technique to accommodate thorough diagnostic arthroscopy as well as modified approaches to therapeutic procedures. This article introduces our preferred approach to diagnostic arthroscopy of the glenohumeral joint and subacromial space with needle arthroscopy and small-bore instruments. This technique could increase efficiency and decrease operative time with certain arthroscopic procedures, and it may improve patient outcomes.

Fig 1

The needle arthroscopy set (Nanoscope; Arthrex, Naples, FL) includes a 0° arthroscope with power cord, monitor, and sharp and blunt trochars with corresponding sheaths, including inflow portals and assorted instruments.

Fig 2

(A) External view, left shoulder, beach chair position, depicting camera sheath inserted into the posterior glenohumeral portal. (B) Arthroscopic view, same left shoulder, from the posterior portal showing the view upon entry of the camera into the glenohumeral space.

Fig 3

(A) External view, left shoulder, beach chair position, showing insertion of the second cannula from the anterior portal with the assistance of the sharp trochar under direct arthroscopic visualization. (B) Arthroscopic view, same left shoulder, beach chair position, depicting the view from the posterior portal after insertion of the anterior sheath. At this point, the inflow tubing may be moved to the anterior sheath to facilitate insufflation and improve visualization.

Fig 4

Arthroscopic view, left shoulder, beach chair position, from the posterior portal examining the superior surface of the long head of the biceps tendon. The anterior sheath may be used as a probe to manipulate the biceps and provide a dynamic examination by drawing the tendon into the joint.

Fig 5

Arthroscopic view, left shoulder, visualizing the insertion of the supraspinatus tendon onto the greater tuberosity from the articular side of the tendon. Slight external rotation and abduction can facilitate this view. The anterior sheath can be used to lift the cuff tissue to better visualize the insertion.

Fig 6

(A) External view, left shoulder, beach chair position, depicting the needle arthroscope in the anterior sheath. If necessary, the inflow tubing may be moved to the posterior sheath to promote insufflation and improve visualization. (B) Arthroscopic view, same left shoulder, the posterior labrum, glenoid, and humeral head are seen.

Fig 7

Arthroscopic view, left shoulder, with the camera in the anterior sheath. By bringing the arm into slight internal rotation, a bird's-eye view of the articular surface can be obtained, including the central portions of the humeral head and glenoid and the anterior and posterior labrums.

Fig 8

Arthroscopic view, left shoulder, with the camera in the posterior sheath, which has been redirected into the subacromial space. The anterior sheath is redirected, under direct arthroscopic visualization, into the anterior subacromial space. With dedicated inflow tubing on the anterior sheath, excellent visualization can be obtained in the subacromial space. The anterior sheath may also be used as a probe to evaluate the bursal side of the rotator cuff and its insertion on the greater tuberosity.