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DOI: 10.1055/s-0039-1697606
Patient Positioning in Shoulder Arthroscopy: Which is Best?
Funding None.Publikationsverlauf
26. Mai 2018
06. August 2019
Publikationsdatum:
11. Oktober 2019 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00033766/201902/lookinside/thumbnails/10-1055-s-0039-1697606_1800046-1.jpg)
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.
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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
- 2 Association of Surgical Technologists. Guidelines for Surgical Positioning. Available at: http://www.ast.org . Accessed September 1, 2019
- 3 Peruto CM, Ciccotti MG, Cohen SB. Shoulder arthroscopy positioning: lateral decubitus versus beach chair. Arthroscopy 2009; 25 (08) 891-896
- 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
- 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
- 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
- 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
- 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
- 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
- 10 Gross RM, Fitzgibbons TC. Shoulder arthroscopy: a modified approach. Arthroscopy 1985; 1 (03) 156-159
- 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
- 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
- 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
- 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
- 15 Blumenthal S, Nadig M, Gerber C, Borgeat A. Severe airway obstruction during arthroscopic shoulder surgery. Anesthesiology 2003; 99 (06) 1455-1456
- 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
- 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
- 18 Larsson A, Malmkvist G, Werner O. Variations in lung volume and compliance during pulmonary surgery. Br J Anaesth 1987; 59 (05) 585-591
- 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
- 20 Ogilvie-Harris DJ, Wiley AM. Arthroscopic surgery of the shoulder. A general appraisal. J Bone Joint Surg Br 1986; 68 (02) 201-207
- 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
- 22 Berjano P, González BG, Olmedo JF, Perez-España LA, Munilla MG. Complications in arthroscopic shoulder surgery. Arthroscopy 1998; 14 (08) 785-788
- 23 Ellman H. Arthroscopic subacromial decompression: analysis of one-to three-year results. Arthroscopy 1987; 3 (03) 173-181
- 24 Paulos LE, Franklin JL. Arthroscopic shoulder decompression development and application. A five year experience. Am J Sports Med 1990; 18 (03) 235-244
- 25 Pavlik A, Ang KC, Bell SN. Contralateral brachial plexus neuropathy after arthroscopic shoulder surgery. Arthroscopy 2002; 18 (06) 658-659
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 35 Bhatti MT, Enneking FK. Visual loss and ophthalmoplegia after shoulder surgery. Anesth Analg 2003; 96 (03) 899-902
- 36 Mumith A, Scadden J. Postoperative vision loss after reverse shoulder arthroplasty. Case Rep Orthop 2014; 2014: 850950
- 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
- 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
- 39 Smelt WL, de Lange JJ, Booij LH. Cardiorespiratory effects of the sitting position in neurosurgery. Acta Anaesthesiol Belg 1988; 39 (04) 223-231
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 49 Boisseau N, Rabarijaona H, Grimaud D, Raucoules-Aim M. Tapia’s syndrome following shoulder surgery. Br J Anaesth 2002; 88: 869-870
- 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
- 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
- 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
- 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
- 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
- 55 Park TS, Kim YS. Neuropraxia of the cutaneous nerve of the cervical plexus after shoulder arthroscopy. Arthroscopy 2005; 21 (05) 631
- 56 Joshi M, Cheng R, Kamath H, Yarmush J. Great auricular neuropraxia with beach chair position. Local Reg Anesth 2017; 10: 75-77
- 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
- 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
- 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
- 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
- 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
- 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