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Arthroscopic Anterior Shoulder Stabilization: Pearls and Pitfalls in Patient Positioning

March 15, 2015

Contributors: Maristella F. Saccomanno, MD; Nikhil N Verma, MD; Brian J Cole, MD, MBA; Bernard R Bach Jr, MD; Anthony A Romeo, MD; CAPT (Ret) Matthew T. Provencher, MD MC USNR; Rachel M Frank, MD; Rachel M Frank, MD

Glenohumeral instability remains one of the most common shoulder pathologies in the athletic patient population. The most common underlying pathology is capsule and/or labral damage. Arthroscopic anterior shoulder stabilization can be performed in either the beach chair (BC) position or the lateral decubitus (LD) position. Surgeon preference, experience level, and the specific intended procedure often dictate which position is utilized. With appropriate set-up and positioning, both techniques are reliable with low complication rates. The BC position offers the advantage of easy conversion to open techniques, while the LD position may allow for lower suture anchor position on the glenoid. In contrast, the BC position has been associated with hypotension and cerebral ischemia, while the LD position has been associated with postoperative nerve traction injury. Regardless of the position, it is absolutely paramount that the patient be positioned carefully, with proper padding, head placement, and appropriately balanced suspension forces to minimize the occurrence of potentially devastating positioning complications. This video reviews technical pearls for patient positioning in both the BC and LD positions, and utilizes a case-based approach to outline specific pathologies that may be best treated with one approach versus the other. Common complications associated with each position, and ways in which these complications may be avoided, are discussed in detail. Finally, clinical outcomes following anterior, posterior, and multidirectional shoulder stabilization procedures in each position are reviewed in detail.

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