Shoulder arthroscopy: surgical technique

Arthroscopic techniques for shoulder arthroscopy have evolved and been refined constantly over the last decade. Significant advances have been made, compared to the first arthroscopic intraarticular examinations on cadavers by Takagi in 1918. Advances in fiberoptics, computer technology, and surgical instrumentation, coupled with innovative ideas and improved operative skills, have opened a new era in the orthopedic evaluation of intraarticular structures and treatment of pathology by the orthopedic surgeon. Arthroscopic examination of the glen humeral joint and sub acromial bursa permits the surgeon to visually assess, document, and treat shoulder pathology in an injury specific manner. Critical to effective use of this technology and skill is a comprehensive and reproducible system for thorough examination and documentation, so that no abnormality is inadvertently overlooked and treatments are effectively performed. In this fashion, standardization is developed for evaluating surgical treatments and providing a common base for professional communication and continued education within the orthopedic community. At the Southern California Orthopedic Institute, a comprehensive 15-point glenohumeral and 8-point subacromial examination from both posterior and anterior portals has been developed and is widely accepted in most arthroscopic forums. The operating room set-up, instrumentation, patient positioning, and the authors' preference for systematic glenohumeral arthroscopy and bursoscopy will be described. Specific methods for-arthroscopic subacromial decompression, distal clavicle resection, and evaluation of the rotator cuff will be outlined. It is imperative that the surgeon have a complete knowledge of normal shoulder anatomy and common variants.