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CC BY-NC-ND 4.0 · Joints 2019; 07(02): 046-055
DOI: 10.1055/s-0039-1697606
Review Article
Georg Thieme Verlag KG Stuttgart · New York

Patient Positioning in Shoulder Arthroscopy: Which is Best?

Jorge Rojas 
1   Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland, United States
,
Filippo Familiari 
2   Department of Orthopaedic and Trauma Surgery, “Villa del Sole” Clinic, Catanzaro, Italy
,
Alexander Bitzer
1   Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland, United States
,
Uma Srikumaran
1   Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland, United States
,
Rocco Papalia
3   Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy
,
Edward G. McFarland 
1   Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland, United States
› Author Affiliations Funding None.
Further Information

Publication History

26 May 2018

06 August 2019

Publication Date:
11 October 2019 (online)

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Abstract

When performing diagnostic and surgical arthroscopic procedures on the shoulder, the importance of patient positioning cannot be understated. The optimum patient positioning for shoulder arthroscopy should enhance intraoperative joint visualization and surgical accessibility while minimizing potential perioperative risk to the patient. Most shoulder arthroscopy procedures can be reliably performed with the patient either in the lateral decubitus (LD) or beach chair (BC) position. Although patient positioning for shoulder arthroscopy has been subject of controversy, there is no conclusive evidence to suggest superiority of one position versus another. Each position offers advantages and disadvantages and surgeon's experience and training are pivotal on selecting one position versus another. Regardless of the position, a proper positioning of the patient should provide adequate access to the joint while minimizing complications. The purpose of this review is to summarize setup and technical aspects, the advantages and disadvantages, and the possible complications of the LD and BC positions in shoulder arthroscopy.

Keywords

shoulder - arthroscopy - positioning - complications - beach chair - lateral decubitus - stroke - neuropraxia
 

  • References

  • 1 Li X, Eichinger JK, Hartshorn T, Zhou H, Matzkin EG, Warner JP. A comparison of the lateral decubitus and beach-chair positions for shoulder surgery: advantages and complications. J Am Acad Orthop Surg 2015; 23 (01) 18-28
    CrossrefPubMedGoogle Scholar
  • 2 Association of Surgical Technologists. Guidelines for Surgical Positioning. Available at: http://www.ast.org . Accessed September 1, 2019
    PubMedGoogle Scholar
  • 3 Peruto CM, Ciccotti MG, Cohen SB. Shoulder arthroscopy positioning: lateral decubitus versus beach chair. Arthroscopy 2009; 25 (08) 891-896
    CrossrefPubMedGoogle Scholar
  • 4 Rains DD, Rooke GA, Wahl CJ. Pathomechanisms and complications related to patient positioning and anesthesia during shoulder arthroscopy. Arthroscopy 2011; 27 (04) 532-541
    CrossrefPubMedGoogle Scholar
  • 5 Hamamoto JT, Frank RM, Higgins JD, Provencher MT, Romeo AA, Verma NN. Shoulder arthroscopy in the lateral decubitus position. Arthrosc Tech 2017; 6 (04) e1169-e1175
    CrossrefPubMedGoogle Scholar
  • 6 Murphy GS, Szokol JW, Marymont JH. , et al. Cerebral oxygen desaturation events assessed by near-infrared spectroscopy during shoulder arthroscopy in the beach chair and lateral decubitus positions. Anesth Analg 2010; 111 (02) 496-505
    CrossrefPubMedGoogle Scholar
  • 7 Pant S, Bokor DJ, Low AK. Cerebral oxygenation using near-infrared spectroscopy in the beach-chair position during shoulder arthroscopy under general anesthesia. Arthroscopy 2014; 30 (11) 1520-1527
    CrossrefPubMedGoogle Scholar
  • 8 Selby R. Setup and patient positioning. In: Angelo RL, Esch J, Ryu RKN. , eds. AANA Advanced Arthroscopy. The Shoulder. Philadelphia, PA: Saunders/Elsevier; 2010: 53-58
    Google Scholar
  • 9 Gelber PE, Reina F, Caceres E, Monllau JC. A comparison of risk between the lateral decubitus and the beach-chair position when establishing an anteroinferior shoulder portal: a cadaveric study. Arthroscopy 2007; 23 (05) 522-528
    CrossrefPubMedGoogle Scholar
  • 10 Gross RM, Fitzgibbons TC. Shoulder arthroscopy: a modified approach. Arthroscopy 1985; 1 (03) 156-159
    CrossrefPubMedGoogle Scholar
  • 11 Yokoyama M, Ueda W, Hirakawa M. Haemodynamic effects of the lateral decubitus position and the kidney rest lateral decubitus position during anaesthesia. Br J Anaesth 2000; 84 (06) 753-757
    CrossrefPubMedGoogle Scholar
  • 12 Thompson GE, Miller RD, Stevens WC, Murray WR. Hypotensive anesthesia for total hip arthroplasty: a study of blood loss and organ function (brain, heart, liver, and kidney). Anesthesiology 1978; 48 (02) 91-96
    CrossrefPubMedGoogle Scholar
  • 13 Tuncali B, Karci A, Bacakoglu AK, Tuncali BE, Ekin A. Controlled hypotension and minimal inflation pressure: a new approach for pneumatic tourniquet application in upper limb surgery. Anesth Analg 2003; 97 (05) 1529-1532
    PubMedGoogle Scholar
  • 14 Morrison DS, Schaefer RK, Friedman RL. The relationship between subacromial space pressure, blood pressure, and visual clarity during arthroscopic subacromial decompression. Arthroscopy 1995; 11 (05) 557-560
    CrossrefPubMedGoogle Scholar
  • 15 Blumenthal S, Nadig M, Gerber C, Borgeat A. Severe airway obstruction during arthroscopic shoulder surgery. Anesthesiology 2003; 99 (06) 1455-1456
    CrossrefPubMedGoogle Scholar
  • 16 Antonucci S, Orlandi P, Mattei PA, Amato F. Airway obstruction during arthroscopic shoulder surgery: anesthesia for the patient or for the surgeon?. Minerva Anestesiol 2006; 72 (12) 995-1000
    PubMedGoogle Scholar
  • 17 Hynson JM, Tung A, Guevara JE, Katz JA, Glick JM, Shapiro WA. Complete airway obstruction during arthroscopic shoulder surgery. Anesth Analg 1993; 76 (04) 875-878
    PubMedGoogle Scholar
  • 18 Larsson A, Malmkvist G, Werner O. Variations in lung volume and compliance during pulmonary surgery. Br J Anaesth 1987; 59 (05) 585-591
    CrossrefPubMedGoogle Scholar
  • 19 Andrews JR, Carson Jr WG, Ortega K. Arthroscopy of the shoulder: technique and normal anatomy. Am J Sports Med 1984; 12 (01) 1-7
    CrossrefPubMedGoogle Scholar
  • 20 Ogilvie-Harris DJ, Wiley AM. Arthroscopic surgery of the shoulder. A general appraisal. J Bone Joint Surg Br 1986; 68 (02) 201-207
    PubMedGoogle Scholar
  • 21 Pitman MI, Nainzadeh N, Ergas E, Springer S. The use of somatosensory evoked potentials for detection of neuropraxia during shoulder arthroscopy. Arthroscopy 1988; 4 (04) 250-255
    CrossrefPubMedGoogle Scholar
  • 22 Berjano P, González BG, Olmedo JF, Perez-España LA, Munilla MG. Complications in arthroscopic shoulder surgery. Arthroscopy 1998; 14 (08) 785-788
    CrossrefPubMedGoogle Scholar
  • 23 Ellman H. Arthroscopic subacromial decompression: analysis of one-to three-year results. Arthroscopy 1987; 3 (03) 173-181
    CrossrefPubMedGoogle Scholar
  • 24 Paulos LE, Franklin JL. Arthroscopic shoulder decompression development and application. A five year experience. Am J Sports Med 1990; 18 (03) 235-244
    CrossrefPubMedGoogle Scholar
  • 25 Pavlik A, Ang KC, Bell SN. Contralateral brachial plexus neuropathy after arthroscopic shoulder surgery. Arthroscopy 2002; 18 (06) 658-659
    CrossrefPubMedGoogle Scholar
  • 26 Hennrikus WL, Mapes RC, Bratton MW, Lapoint JM. Lateral traction during shoulder arthroscopy: its effect on tissue perfusion measured by pulse oximetry. Am J Sports Med 1995; 23 (04) 444-446
    CrossrefPubMedGoogle Scholar
  • 27 Yoshimura E, Yano T, Ichinose K, Ushijima K. Airway obstruction involving a laryngeal mask airway during arthroscopic shoulder surgery. J Anesth 2005; 19 (04) 325-327
    CrossrefPubMedGoogle Scholar
  • 28 No MY, Kim PO, Choi WJ. Airway compression after arthroscopic shoulder surgery under general anesthesia. Korean J Anesthesiol 2013; 65 (6, Suppl): S121-S122
    CrossrefPubMedGoogle Scholar
  • 29 Keyurapan E, Hu SJ, Redett R, McCarthy EF, McFarland EG. Pressure ulcers of the thorax after shoulder surgery. Knee Surg Sports Traumatol Arthrosc 2007; 15 (12) 1489-1493
    CrossrefPubMedGoogle Scholar
  • 30 Drummond JC, Lee RR, Howell Jr JP. Focal cerebral ischemia after surgery in the “beach chair” position: the role of a congenital variation of circle of Willis anatomy. Anesth Analg 2012; 114 (06) 1301-1303
    CrossrefPubMedGoogle Scholar
  • 31 Skyhar MJ, Altchek DW, Warren RF, Wickiewicz TL, O'Brien SJ. Shoulder arthroscopy with the patient in the beach-chair position. Arthroscopy 1988; 4 (04) 256-259
    CrossrefPubMedGoogle Scholar
  • 32 Friedman DJ, Parnes NZ, Zimmer Z, Higgins LD, Warner JJP. Prevalence of cerebrovascular events during shoulder surgery and association with patient position. Orthopedics 2009; 32 (04) 1-5
    PubMedGoogle Scholar
  • 33 Terry M, Altchek DW. Diagnostic shoulder arthroscopy technique: beach chair position. In: Tibone JE, Savoie FH, Shaffer BS. , eds. Shoulder Arthroscopy. New York, NY: Springer-Verlag; 2003: 9-15
    CrossrefGoogle Scholar
  • 34 Pohl A, Cullen DJ. Cerebral ischemia during shoulder surgery in the upright position: a case series. J Clin Anesth 2005; 17 (06) 463-469
    CrossrefPubMedGoogle Scholar
  • 35 Bhatti MT, Enneking FK. Visual loss and ophthalmoplegia after shoulder surgery. Anesth Analg 2003; 96 (03) 899-902
    PubMedGoogle Scholar
  • 36 Mumith A, Scadden J. Postoperative vision loss after reverse shoulder arthroplasty. Case Rep Orthop 2014; 2014: 850950
    PubMedGoogle Scholar
  • 37 Higgins JD, Frank RM, Hamamoto JT, Provencher MT, Romeo AA, Verma NN. Shoulder arthroscopy in the beach chair position. Arthrosc Tech 2017; 6 (04) e1153-e1158
    CrossrefPubMedGoogle Scholar
  • 38 Jinnah AH, Mannava S, Plate JF, Stone AV, Freehill MT. Basic shoulder arthroscopy: lateral decubitus patient positioning. Arthrosc Tech 2016; 5 (05) e1069-e1075
    CrossrefPubMedGoogle Scholar
  • 39 Smelt WL, de Lange JJ, Booij LH. Cardiorespiratory effects of the sitting position in neurosurgery. Acta Anaesthesiol Belg 1988; 39 (04) 223-231
    PubMedGoogle Scholar
  • 40 Koh JL, Levin SD, Chehab EL, Murphy GS. Neer Award 2012: cerebral oxygenation in the beach chair position: a prospective study on the effect of general anesthesia compared with regional anesthesia and sedation. J Shoulder Elbow Surg 2013; 22 (10) 1325-1331
    CrossrefPubMedGoogle Scholar
  • 41 Aguirre JA, Märzendorfer O, Brada M, Saporito A, Borgeat A, Bühler P. Cerebral oxygenation in the beach chair position for shoulder surgery in regional anesthesia: impact on cerebral blood flow and neurobehavioral outcome. J Clin Anesth 2016; 35: 456-464
    CrossrefPubMedGoogle Scholar
  • 42 Laflam A, Joshi B, Brady K. , et al. Shoulder surgery in the beach chair position is associated with diminished cerebral autoregulation but no differences in postoperative cognition or brain injury biomarker levels compared with supine positioning: the anesthesia patient safety foundation beach chair study. Anesth Analg 2015; 120 (01) 176-185
    CrossrefPubMedGoogle Scholar
  • 43 van Raamt AF, Mali WPTM, van Laar PJ, van der Graaf Y. The fetal variant of the circle of Willis and its influence on the cerebral collateral circulation. Cerebrovasc Dis 2006; 22 (04) 217-224
    CrossrefPubMedGoogle Scholar
  • 44 Manninen H, Mäkinen K, Vanninen R, Ronkainen A, Tulla H. How often does an incomplete circle of Willis predispose to cerebral ischemia during closure of carotid artery? Postmortem and clinical imaging studies. Acta Neurochir (Wien) 2009; 151 (09) 1099-1105
    CrossrefPubMedGoogle Scholar
  • 45 Salazar D, Sears BW, Aghdasi B. , et al. Cerebral desaturation events during shoulder arthroscopy in the beach chair position: patient risk factors and neurocognitive effects. J Shoulder Elbow Surg 2013; 22 (09) 1228-1235
    CrossrefPubMedGoogle Scholar
  • 46 Chierichini A, Frassanito L, Vergari A. , et al. The effect of norepinephrine versus epinephrine in irrigation fluid on the incidence of hypotensive/bradycardic events during arthroscopic rotator cuff repair with interscalene block in the sitting position. Arthroscopy 2015; 31 (05) 800-806
    CrossrefPubMedGoogle Scholar
  • 47 Holtzman AJ, Glezos CD, Feit EJ, Gruson KI. Prevalence and risk factors for lateral femoral cutaneous nerve palsy in the beach chair position. Arthroscopy 2017; 33 (11) 1958-1962
    PubMedGoogle Scholar
  • 48 Cogan A, Boyer P, Soubeyrand M, Hamida FB, Vannier JL, Massin P. Cranial nerves neuropraxia after shoulder arthroscopy in beach chair position. Orthop Traumatol Surg Res 2011; 97 (03) 345-348
    CrossrefPubMedGoogle Scholar
  • 49 Boisseau N, Rabarijaona H, Grimaud D, Raucoules-Aim M. Tapia’s syndrome following shoulder surgery. Br J Anaesth 2002; 88: 869-870
    CrossrefPubMedGoogle Scholar
  • 50 Mullins RC, Drez Jr D, Cooper J. Hypoglossal nerve palsy after arthroscopy of the shoulder and open operation with the patient in the beach-chair position. A case report. J Bone Joint Surg Am 1992; 74 (01) 137-139
    CrossrefPubMedGoogle Scholar
  • 51 Choi WJ, Shin HK, Kim DO, Park SW, Lee DI, Kim DS. Transient hypoglossal nerve palsy after general anesthesia in beach chair position for shoulder arthroscopic Bankart repair: a case report. Korean J Anesthesiol 2004; 47 (02) 277-280
    CrossrefPubMedGoogle Scholar
  • 52 Hung NK, Lee CH, Chan SM. , et al. Transient unilateral hypoglossal nerve palsy after orotracheal intubation for general anesthesia. Acta Anaesthesiol Taiwan 2009; 47 (01) 48-50
    CrossrefPubMedGoogle Scholar
  • 53 Rhee YG, Cho NS. Isolated unilateral hypoglossal nerve palsy after shoulder surgery in beach-chair position. J Shoulder Elbow Surg 2008; 17 (04) e28-e30
    CrossrefPubMedGoogle Scholar
  • 54 Kim CJ, Oh HS, Park J, Chung MY. Cranial nerve XII (hypoglossal nerve) palsy after arthroscopic shoulder surgery under general anesthesia combined with sono-guided interscalene brachial plexus block: a case report. Anesth Pain Med 2016; 11 (03) 322-325
    CrossrefPubMedGoogle Scholar
  • 55 Park TS, Kim YS. Neuropraxia of the cutaneous nerve of the cervical plexus after shoulder arthroscopy. Arthroscopy 2005; 21 (05) 631
    PubMedGoogle Scholar
  • 56 Joshi M, Cheng R, Kamath H, Yarmush J. Great auricular neuropraxia with beach chair position. Local Reg Anesth 2017; 10: 75-77
    CrossrefPubMedGoogle Scholar
  • 57 Ng AKH, Page RS. Greater auricular nerve neuropraxia with beach chair positioning during shoulder surgery. Int J Shoulder Surg 2010; 4 (02) 48-50
    CrossrefPubMedGoogle Scholar
  • 58 LaPrade CM, Foad A. Greater auricular nerve palsy after arthroscopic anterior-inferior and posterior-inferior labral tear repair using beach-chair positioning and a standard universal headrest. Am J Orthop 2015; 44 (04) 188-191
    PubMedGoogle Scholar
  • 59 Klein AH, France JC, Mutschler TA, Fu FH. Measurement of brachial plexus strain in arthroscopy of the shoulder. Arthroscopy 1987; 3 (01) 45-52
    CrossrefPubMedGoogle Scholar
  • 60 Bonnaig N, Dailey S, Archdeacon M. Proper patient positioning and complication prevention in orthopaedic surgery. J Bone Joint Surg Am 2014; 96 (13) 1135-1140
    CrossrefPubMedGoogle Scholar
  • 61 Songy CE, Siegel ER, Stevens M, Wilkinson JT, Ahmadi S. The effect of the beach-chair position angle on cerebral oxygenation during shoulder surgery. J Shoulder Elbow Surg 2017; 26 (09) 1670-1675
    CrossrefPubMedGoogle Scholar
  • 62 Feldman MD. Editorial commentary: my shoulder feels great, but why is my thigh numb? Lateral femoral cutaneous nerve injury after shoulder arthroscopy in the beach chair position. Arthroscopy 2017; 33 (11) 1963-1964
    CrossrefPubMedGoogle Scholar