Shoulder Arthroscopy Approach
Comprehensive guide to shoulder arthroscopy portal placement, positioning, technique, indications, complications and exam points for Orthopaedic FRACS examination
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SHOULDER ARTHROSCOPY APPROACH
Portal-Based Technique | Beach Chair vs Lateral | Minimally Invasive
Critical Shoulder Arthroscopy Exam Points
Posterior Portal First
Always establish posterior portal FIRST. This is the viewing portal. Locate the soft spot: 2cm medial and 2cm inferior to posterolateral acromion. All subsequent portals are created under direct arthroscopic vision.
Axillary Nerve at Risk
The axillary nerve runs 5-7mm inferior to the glenoid rim as it exits the quadrangular space. It is at highest risk during anterior-inferior capsular release, inferior portal placement, and subscapularis takedown. Protect by staying superior to 5 o'clock position on right shoulder (7 o'clock on left).
Rotator Interval Gateway
The rotator interval between subscapularis and supraspinatus is the safe gateway for the anterior portal. Enter lateral to coracoid, aiming for the biceps tendon. Avoid going too inferior (axillary nerve) or too superior (cuff injury).
Positioning Matters
Beach chair vs lateral decubitus - know both. Beach chair: easier conversion to open, familiar anatomy, lower traction risk. Lateral: better posterior visualization, gravity assists with distraction, preferred by many arthroscopists for labral work.
At a Glance
Shoulder arthroscopy is a portal-based minimally invasive approach requiring precise anatomic knowledge. The posterior portal is established first using the "soft spot" (2cm medial, 2cm inferior to posterolateral acromion)—this is the primary viewing portal. The anterior portal is created under direct arthroscopic vision through the rotator interval (between subscapularis and supraspinatus), entering lateral to the coracoid. The axillary nerve is the structure at highest risk, running 5-7mm inferior to the glenoid rim—stay superior to the 5 o'clock position (right shoulder) or 7 o'clock (left shoulder). Beach chair positioning allows easier conversion to open surgery, while lateral decubitus provides better posterior visualization and is preferred for labral work.
PORTALSPORTALS - Standard Shoulder Arthroscopy Portals
Memory Hook:PORTALS guides you through safe shoulder arthroscopy portal creation
BEACHESBEACHES - Beach Chair vs Lateral Positioning
Memory Hook:BEACHES reminds you of beach chair positioning advantages and risks
DANGERDANGER - Structures at Risk in Shoulder Arthroscopy
Memory Hook:Remember the DANGER zones to avoid complications in shoulder arthroscopy
Overview and Indications
Shoulder arthroscopy is a minimally invasive technique providing diagnostic and therapeutic access to the glenohumeral joint, subacromial space, and acromioclavicular joint. First pioneered in the 1970s, it has become the gold standard for many shoulder pathologies.
Primary indications:
-
Rotator Cuff Pathology
- Rotator cuff repair (partial-thickness and full-thickness tears)
- Subacromial decompression
- Debridement of irreparable tears
-
Shoulder Instability
- Labral repair (Bankart lesion, SLAP tears, posterior labral tears)
- Capsular plication for multidirectional instability
- Hill-Sachs remplissage
-
Biceps Pathology
- Biceps tenodesis
- Biceps tenotomy
- SLAP repair
-
Acromioclavicular Joint
- AC joint excision arthroplasty
- AC joint stabilization
-
Adhesive Capsulitis
- Arthroscopic capsular release
-
Loose Bodies and Synovial Disease
- Loose body removal
- Synovectomy (rheumatoid arthritis, PVNS)
-
Diagnostic
- When imaging inconclusive
- Evaluation of unexplained shoulder pain
Advantages Over Open Surgery
Arthroscopic advantages: (1) Minimally invasive with better cosmesis, (2) Superior visualization of posterior and superior structures, (3) Ability to address multiple pathologies in same setting, (4) Faster rehabilitation for many procedures, (5) Lower infection rates. Disadvantages: Steep learning curve, requires specialized equipment, longer operative time initially, risk of fluid extravasation.
Contraindications:
- Absolute: severe shoulder sepsis (relative if diagnostic arthroscopy for washout), severe osteoarthritis requiring arthroplasty
- Relative: previous surgery with scarring limiting access, inability to tolerate positioning, coagulopathy
Relevant Anatomy and Portal Landmarks
Surface anatomy landmarks:
Key Palpable Landmarks for Portal Placement
Intra-articular anatomy (systematic arthroscopic examination):
- Biceps tendon - long head origin from supraglenoid tubercle, runs in bicipital groove
- Rotator interval - space between subscapularis and supraspinatus, contains coracohumeral ligament and superior glenohumeral ligament
- Subscapularis - anterior rotator cuff, inserts on lesser tuberosity
- Supraspinatus - superior rotator cuff, inserts on greater tuberosity (superior facet)
- Infraspinatus and teres minor - posterior rotator cuff, insert on greater tuberosity (middle and inferior facets)
- Labrum - fibrocartilaginous rim attached to glenoid, deepens socket (superior, anterior, inferior, posterior segments)
- Capsule and ligaments - superior, middle, and inferior glenohumeral ligaments reinforce capsule
Structures at risk:
Neurovascular Structures at Risk by Portal Location
Axillary Nerve Protection
The axillary nerve is the structure at highest risk during shoulder arthroscopy. It exits the quadrangular space posteriorly and wraps around the surgical neck of the humerus, running 5-7mm inferior to the glenoid rim at the anteroinferior capsule. During anterior-inferior capsular release (for instability), Bankart repair, and subscapularis procedures, protect this nerve by staying superior to the 5 o'clock position on the right shoulder (or 7 o'clock on the left shoulder).
Rotator interval anatomy:
The rotator interval is the triangular space bordered by:
- Superiorly: Anterior margin of supraspinatus
- Inferiorly: Superior margin of subscapularis
- Medially: Base of coracoid
- Laterally: Transverse humeral ligament over bicipital groove
This is the safe gateway for the anterior working portal. It contains the coracohumeral ligament and superior glenohumeral ligament. Entry through this interval allows access to the glenohumeral joint while avoiding rotator cuff injury.
Internervous Plane
Key Concept: Shoulder arthroscopy does NOT use a traditional internervous plane.
Unlike open surgical approaches that exploit intervals between muscles supplied by different nerves, arthroscopy uses small stab incisions (portals) through skin, subcutaneous tissue, muscle, and capsule directly into the joint.
Exam Clarification - Portals vs Open Approaches
Traditional Internervous Plane (Open Surgery)
Definition: A surgical plane between muscles supplied by different nerves, allowing muscle separation without denervation.
Examples: Deltopectoral approach (deltoid via axillary nerve, pectoralis major via pectoral nerves), anterior approach to hip (tensor fasciae latae via superior gluteal nerve, sartorius via femoral nerve).
Principle: Muscles are retracted, not divided, preserving their nerve supply.
Arthroscopic Portals (Portal-Based)
No internervous plane: Portals are small stab incisions (5-10mm) that pass directly through muscle and capsule into the joint.
Muscle traversed:
- Posterior portal: infraspinatus (suprascapular nerve)
- Lateral portal: supraspinatus (suprascapular nerve), deltoid (axillary nerve)
- Anterior portal: deltoid (axillary nerve) superficially, then through rotator interval
Key principle: Minimize tissue trauma by using small cannulas, gentle insertion, and precise portal placement under arthroscopic visualization.
Muscles traversed by standard shoulder arthroscopy portals:
Portal Anatomy and Muscles Traversed
Viva Answer - Internervous Plane Question
When asked about internervous planes in shoulder arthroscopy, state: "Shoulder arthroscopy does not use a traditional internervous plane. Portals are small stab incisions that pass through muscles directly to access the joint. The posterior portal traverses infraspinatus, the lateral portal traverses supraspinatus, and the anterior portal passes through the rotator interval between subscapularis and supraspinatus. The key principle is to minimize muscle trauma through small cannulas and precise portal placement under direct arthroscopic visualization. While we pass through muscles, we minimize denervation injury by keeping portals small and avoiding excessive tissue trauma."
Why this matters for the exam:
Traditional open approaches use internervous planes to avoid denervating muscles. Arthroscopy sacrifices this principle for the benefit of minimally invasive access. The trade-off is:
- Advantages: Smaller incisions, less soft tissue dissection, faster recovery, better visualization of intra-articular structures
- Disadvantages: Portal placement through muscle (minimal but present trauma), no true tissue plane to develop
The concept of "internervous plane" in arthroscopy refers more to the anatomic safety zones (e.g., rotator interval for anterior portal) rather than true planes between differently innervated muscles.
Patient Positioning
Beach Chair Position (Most Common in Australia)
Advantages:
- Familiar anatomy - upright orientation matches normal surgical approach
- Easy conversion to open - seamless transition if arthroscopy fails or complications occur
- Better stability assessment - can test shoulder stability intraoperatively with arm manipulation
- Anesthesia access - easier airway management and monitoring
- No traction required - arm is free, reducing brachial plexus traction risk
- Easier for teaching - assistant and observers have better view
Disadvantages:
- Cerebral hypoperfusion risk - requires blood pressure monitoring and maintenance of MAP greater than 70mmHg
- Hypotension - vasovagal response common with upright positioning
- Posterior access - slightly more challenging to access far posterior structures
- Fluid management - extravasation can track to neck and compromise airway
Setup technique:
Beach Chair Setup Steps
Patient supine on operating table with beach chair back attachment. Position patient at top edge of table to allow shoulder to hang free posteriorly. Place pillow under knees.
Elevate backrest to 30-45 degrees. Ensure patient does not slide down table - use beanbag or anti-slide mattress. Check hips and knees are flexed to prevent sliding.
Secure head in padded head holder or horseshoe headrest. Tilt head 10-15 degrees away from operative shoulder to improve surgical access. Avoid excessive rotation to prevent cerebral hypoperfusion.
Arm free-draped and mobile. Use pneumatic arm holder (Spider limb positioner) or have assistant support arm. Arm should be able to move freely for examination and positioning during procedure.
Pad all bony prominences: sacrum, elbows, heels. Ensure no pressure on peroneal nerve. Communicate with anesthesia regarding blood pressure targets (MAP greater than 70mmHg). Apply eye protection.
Cerebral Perfusion in Beach Chair
Maintain mean arterial pressure greater than 70mmHg throughout the procedure. Risk of watershed cerebral infarcts if hypotensive in upright position. Communicate frequently with anesthesia team. Consider invasive arterial monitoring for high-risk patients or lengthy procedures.
Arm positioning during procedure:
- Neutral: for glenohumeral joint examination
- Abduction 20-30 degrees, external rotation 10-20 degrees: optimal for anterior portal creation and anterior labral work
- Extension and adduction: for posterior labral visualization
- "Arm wrestling" position (90 degrees abduction, external rotation): for superior labrum and biceps work
Beach chair positioning is preferred by most Australian surgeons for its familiar anatomy and ease of conversion to open surgery.
Position Choice - Viva Answer
When asked about positioning for shoulder arthroscopy: "Both beach chair and lateral decubitus positions are acceptable and the choice is often surgeon preference. I would use beach chair position because: (1) familiar anatomy orientation, (2) easy conversion to open if needed, (3) better for stability testing, (4) easier anesthesia access. However, I would monitor blood pressure carefully to maintain MAP greater than 70mmHg to prevent cerebral hypoperfusion. Some surgeons prefer lateral decubitus for better posterior access and joint distraction, particularly for labral repairs, but this requires traction setup and makes conversion to open more difficult."
Anatomic Variants
Anatomic Variations Affecting Portal Placement
Posterior Portal Variations:
- Thick infraspinatus: May require longer cannula or more forceful insertion
- Posterior glenoid erosion: Common in posterior instability - alters depth perception
- Posterior osteophytes: May impede arthroscope movement in arthritic shoulders
Anterior Portal Variations:
- Rotator interval contracture: Adhesive capsulitis makes anterior portal entry difficult
- Sublabral foramen: Normal variant (11-15% of population) - superior labrum not attached between 11-1 o'clock position, not pathologic
- Buford complex: Absent anterosuperior labrum with cord-like middle glenohumeral ligament (1.5% prevalence) - normal variant, do not repair
Common Anatomic Variants and Clinical Significance
Portal Classification
Portal Classification Systems
Standard Portals (Used in most procedures):
Standard Shoulder Arthroscopy Portals
Procedure-Specific Portal Configuration:
| Procedure | Portals Required |
|---|---|
| Diagnostic arthroscopy | Posterior (viewing) + Anterior (probe) |
| Bankart repair | Posterior + Anterior + Anteroinferior |
| SLAP repair | Posterior + Anterior + Anterosuperolateral |
| Rotator cuff repair | Posterior + Lateral + Anterolateral |
| Subacromial decompression | Posterior subacromial + Lateral subacromial |
Preoperative Assessment
Preoperative Evaluation for Shoulder Arthroscopy
History Assessment:
- Duration and nature of symptoms: Acute vs chronic, mechanism if traumatic
- Previous surgery: Scarring affects portal placement
- Occupation and sport requirements: Determines rehabilitation goals
- Hand dominance: Important for functional outcome expectations
Physical Examination:
- Range of motion: Active and passive - affects positioning and expectations
- Strength testing: Rotator cuff, deltoid, biceps
- Stability testing: Apprehension, relocation, jerk test, sulcus sign
- Special tests: Specific to suspected pathology (O'Brien's, Hawkins, Neer's, etc.)
Medical Optimization:
- Cardiovascular risk assessment (beach chair position considerations)
- Anticoagulation management (cease appropriately)
- Diabetes optimization (HbA1c ideally less than 8%)
- Smoking cessation counseling
Preoperative Imaging
Standard Imaging for Shoulder Arthroscopy
Plain Radiographs (Essential):
- AP in internal and external rotation: Assess bone quality, Hill-Sachs lesion, arthritis
- Axillary lateral: Glenoid morphology, posterior humeral head subluxation, posterior glenoid erosion
- Scapular Y view: Acromion morphology (Type I-III), os acromiale
- Supraspinatus outlet view: Acromial spurring, outlet impingement
MRI (Standard for most arthroscopic indications):
- Rotator cuff pathology (tear size, retraction, muscle quality)
- Labral pathology (Bankart, SLAP, posterior labral tears)
- Biceps pathology
- Cartilage status
MR Arthrography (Gold standard for labral pathology):
- Superior to standard MRI for labral tears
- Especially useful for SLAP tears and subtle Bankart lesions
- Detects partial articular-side cuff tears
Procedure Selection
Procedure Selection for Shoulder Arthroscopy
Instability Procedures:
| Clinical Scenario | Arthroscopic Procedure | Portal Configuration |
|---|---|---|
| Primary anterior instability, no bone loss | Arthroscopic Bankart repair | Posterior + Anterior + Anteroinferior |
| SLAP tear (symptomatic, young patient) | SLAP repair or biceps tenodesis | Posterior + Anterior + Anterosuperolateral |
| Posterior instability | Posterior labral repair | Posterior + Anterior + Posterolateral |
| Multidirectional instability | Capsular plication | Posterior + Anterior |
Rotator Cuff Procedures:
| Pathology | Procedure | Portal Configuration |
|---|---|---|
| Full-thickness tear | Arthroscopic cuff repair | Posterior + Lateral + Anterolateral |
| Partial articular-side tear greater than 50% | Complete and repair or transtendon repair | Posterior + Lateral + Anterior |
| Subacromial impingement | Subacromial decompression | Posterior subacromial + Lateral subacromial |
Biceps Procedures:
| Pathology | Procedure | Portal Configuration |
|---|---|---|
| Biceps tendinopathy | Tenotomy (older patient) | Posterior + Anterior (simple release) |
| Biceps tendinopathy | Tenodesis (younger, active) | Posterior + Anterior + Anterosuperolateral |
Surgical Technique
Standard Portal Creation Sequence
Principle: Posterior portal ALWAYS first, all other portals under direct vision.
Posterior Portal (Viewing Portal)
Palpate the posterolateral corner of the acromion. This is your reference point. From this bony landmark, measure 2cm medially (toward spine) and 2cm inferiorly (toward axilla). This is the soft spot - a palpable depression.
Mark the soft spot with surgical marker. This portal will pass through infraspinatus muscle and posterior capsule to enter the glenohumeral joint, aiming toward the coracoid process anteriorly.
Insert 18-gauge spinal needle at marked site, aiming toward the coracoid (anterior and slightly superior direction). Angle slightly superior to avoid going inferiorly. You should feel capsule give way as needle enters joint. Inject saline to distend joint (30-60mL).
Remove needle. Make 1cm longitudinal or transverse stab incision with 11-blade at needle entry point. Use blunt dissection with hemostat to spread down to capsule if needed.
Insert blunt trocar with arthroscopic cannula through incision, aiming toward coracoid. Feel the capsule give way with gentle pressure. Do NOT force. Insert trocar/cannula into joint until you feel loss of resistance.
Remove trocar, insert 30-degree arthroscope through cannula. Connect camera, light source, and fluid inflow. Confirm intra-articular position by visualizing humeral head and glenoid. Orient scope so humeral head is on right side of screen, glenoid on left (in beach chair).
Posterior Portal Safety
The posterior portal is the safest portal to create. It passes through infraspinatus muscle and enters the joint posteriorly. The suprascapular nerve is at risk if you go too medial (toward scapular spine), but standard portal placement 2cm medial to posterolateral acromion is safe.
Why posterior portal first?
- Most consistent and safe entry point
- Excellent visualization of glenohumeral joint
- Allows creation of all other portals under direct vision
- Predictable anatomy with low complication rate
The posterior portal is the foundation of shoulder arthroscopy.
Complications and Management
Shoulder Arthroscopy Complications
Fluid Extravasation in Beach Chair
Airway compromise from fluid extravasation is an emergency. Fluid can track from the shoulder to the neck and mediastinum in beach chair position, causing airway edema or compression. Monitor patient airway throughout procedure. If neck swelling noted, inform anesthesia immediately, consider early intubation if not already intubated, expedite procedure completion. Postoperative observation essential.
Prevention strategies:
- Nerve protection: Understand anatomy, respect anatomic danger zones (axillary nerve 5-7mm below glenoid rim), create all portals under direct vision, avoid excessive capsular release
- Minimize pump pressure: Use gravity inflow when possible, limit pump pressure to 40-60mmHg maximum, monitor for extravasation
- Gentle technique: Avoid forceful cannula insertion, use smooth instruments, minimize intra-articular instrument manipulation
- Infection prevention: Standard perioperative antibiotics (cefazolin 2g or vancomycin), minimize OR time, sterile portal creation
- Postoperative care: Early passive ROM per protocol, monitor neurovascular status, appropriate physiotherapy progression
Postoperative Care
Standard Postoperative Protocols
Immediate Postoperative Care:
- Sling immobilization: Procedure-dependent duration (see below)
- Ice/cryotherapy: 20 minutes every 2-3 hours for first 48-72 hours
- Pain management: Multimodal analgesia, minimize opioid use
- Wound care: Portal sites covered, keep dry for 48 hours
- Neurovascular check: Assess hand circulation and motor function
Sling Duration by Procedure:
| Procedure | Sling Duration | Rationale |
|---|---|---|
| Diagnostic arthroscopy | 24-48 hours comfort | Minimal tissue healing required |
| Subacromial decompression | 24-48 hours comfort | Early ROM encouraged |
| Bankart repair | 4-6 weeks | Labral healing time |
| Rotator cuff repair | 4-6 weeks | Tendon-to-bone healing |
| SLAP repair | 4-6 weeks | Superior labral healing |
| Capsular release (frozen shoulder) | 24-48 hours, early aggressive ROM | Prevent recurrence of adhesions |
Early Rehabilitation Principles:
- Pendulum exercises from day 1 (most procedures)
- Passive ROM as per protocol (procedure-specific)
- Active-assisted ROM typically starts week 4-6
- Strengthening typically begins week 8-12
Outcomes
Outcomes by Procedure Type
Arthroscopic Bankart Repair:
- Success rate: 85-95% for primary repairs
- Recurrent instability: 5-15% (higher in young contact athletes)
- Return to sport: 70-90%
- Patient satisfaction: 85-95%
Arthroscopic Rotator Cuff Repair:
- Re-tear rates: 10-40% depending on tear size
- Clinical success: 80-95% (symptoms may improve despite re-tear)
- Healing rates by tear size: Small (less than 1cm) 85-95%, Medium (1-3cm) 70-85%, Large (greater than 3cm) 50-70%
Outcome Summary by Procedure
Evidence Base
Lo et al. - Axillary Nerve Injury in Arthroscopic Bankart Repair
Boardman et al. - Beach Chair vs Lateral Decubitus Positioning
Davidson et al. - Fluid Extravasation During Shoulder Arthroscopy
Exam Viva Scenarios
Practice these scenarios to excel in your viva examination
Scenario 1: Describe Standard Shoulder Arthroscopy Portal Technique
"The examiner asks: 'Describe your technique for establishing portals for diagnostic shoulder arthroscopy.'"
Scenario 2: Intraoperative Complication - Cannot Visualize Glenoid
"During shoulder arthroscopy for anterior instability, after establishing the posterior portal you have poor visualization of the anterior glenoid due to bleeding and cannot see clearly to create your anterior working portal. How do you proceed?"
Scenario 3: Beach Chair vs Lateral Decubitus - Justify Your Choice
"You are planning an arthroscopic Bankart repair for recurrent anterior shoulder instability. The examiner asks: 'Would you use beach chair or lateral decubitus positioning and why?'"
MCQ Practice Points
Posterior Portal Landmarks
Q: What are the correct landmarks for the posterior viewing portal in shoulder arthroscopy?
A: 2cm medial and 2cm inferior to the posterolateral corner of the acromion. This is the "soft spot" and represents the safest and most consistent entry point. The portal passes through infraspinatus muscle and posterior capsule to enter the glenohumeral joint, aiming toward the coracoid process anteriorly.
Axillary Nerve Protection
Q: Where does the axillary nerve run in relation to the glenoid and how do you protect it during shoulder arthroscopy?
A: The axillary nerve runs 5-7mm inferior to the glenoid rim at the anteroinferior capsule. To protect it during arthroscopic Bankart repair and anterior-inferior capsular work, stay superior to the 5 o'clock position on the right shoulder (or 7 o'clock on the left shoulder). Avoid excessive capsular release inferiorly and place anchors superior to this position.
Anterior Portal Gateway
Q: What is the safe anatomic gateway for the anterior working portal and what are its boundaries?
A: The rotator interval is the safe gateway. Boundaries are: superior border of subscapularis (inferior), anterior border of supraspinatus (superior), coracoid base (medial), and transverse humeral ligament over bicipital groove (lateral). The portal enters just lateral to the coracoid, passes through the rotator interval, and enters the joint near the biceps tendon origin.
Beach Chair Cerebral Perfusion
Q: What is the target blood pressure for shoulder arthroscopy in beach chair position and why?
A: Mean arterial pressure should be maintained greater than 70mmHg to prevent cerebral hypoperfusion and watershed infarcts in the upright position. This requires communication with anesthesia and blood pressure monitoring throughout the procedure. Hypotension in beach chair can lead to cerebral ischemia.
Portal Creation Sequence
Q: What is the correct sequence for shoulder arthroscopy portal creation and why?
A: Posterior portal is ALWAYS created first. This is the primary viewing portal and is created using palpable landmarks (2cm medial, 2cm inferior to posterolateral acromion). All subsequent portals (anterior, lateral, etc.) are created under direct arthroscopic visualization from the posterior portal using spinal needle localization. This minimizes risk of iatrogenic injury to neurovascular structures and rotator cuff.
Lateral Portal Anatomy
Q: The lateral (Neviaser) portal passes through which structure and what is the risk?
A: The lateral portal passes directly through the supraspinatus tendon to enter the glenohumeral joint. The risk is iatrogenic injury to the supraspinatus. This is minimized by: (1) creating the portal under direct visualization, (2) using smooth cannula insertion, (3) minimizing the number of passes through the tendon. The lateral portal is primarily used for rotator cuff repairs and superior labral work where access to the cuff tendon is already needed.
Australian Context
Epidemiology:
Shoulder arthroscopy is one of the most commonly performed orthopedic procedures in Australia, with over 40,000 procedures performed annually. The most common indications are rotator cuff repair, subacromial decompression, and anterior shoulder stabilization for instability.
Practice patterns:
- Beach chair positioning is most common in Australian practice (approximately 70% of surgeons), though lateral decubitus has significant representation particularly among high-volume shoulder arthroscopists
- Standard perioperative antibiotics: Cefazolin 2g IV (or vancomycin 15mg/kg if penicillin allergic) within 60 minutes of incision
- Thromboprophylaxis: Generally not required for isolated shoulder arthroscopy unless patient has additional risk factors
Training requirements:
Shoulder arthroscopy is a core skill for Australian orthopedic trainees. Competence in:
- Beach chair and lateral positioning
- Standard portal creation (posterior, anterior)
- Systematic arthroscopic examination
- Diagnostic arthroscopy
These skills are expected for FRACS examination and independent practice.
Medicolegal considerations:
- Obtain informed consent discussing: nerve injury risk (particularly axillary nerve), infection, stiffness, failure of repair, conversion to open surgery
- Document systematic arthroscopic examination findings
- Document all portals created and structures at risk
- Early postoperative assessment of neurovascular function
- Clear documentation if conversion to open required
Australian guidelines:
- RACS guidelines for perioperative antibiotics and VTE prophylaxis
- Australian Orthopaedic Association practice standards
SHOULDER ARTHROSCOPY APPROACH
High-Yield Exam Summary