General Problems and Complications

  • Malte Holschen
  • Jens Agneskirchner


General complications in arthroscopic shoulder surgery involve the risk of cerebral hypoperfusion, which is encountered more frequently in the beach chair position when compared to the lateral decubitus position. Optimal patient selection, patient positioning, monitoring and anesthesia minimize the risk for severe complications caused by cerebral oxygen desaturation.

Intraoperatively high blood pressure, insufficient equipment and vessel injuries may lead to poor visualization, which may even force the surgeon to convert to open surgery.

Early postoperative complications are often caused by severe pain, while infections are rare. Postoperative pain may be treated with adequate medication as well as nerve blocks.

Further postoperative complications are related to pain, weakness and stiffness of the shoulder. These complications are usually caused by sterile inflammation. If an infection is suspected, revision arthroscopy aids surgical debridement and gathering of tissue samples.


Arthroscopic visualization Cerebral hypoperfusion Postoperative pain Postoperative infection Patient positioning Near infrared spectroscopy 


  1. 1.
    Shields E, Thirukumaran C, Thorsness R, Noyes K, Voloshin I. An analysis of adult patient risk factors and complications within 30 days after arthroscopic shoulder surgery. Arthroscopy. 2015;31(5):807–15.CrossRefGoogle Scholar
  2. 2.
    Cancienne JM, Brockmeier SF, Carson EW, Werner BC. Risk factors for infection after shoulder arthroscopy in a large medicare population. Am J Sports Med. 2018;46(4):809–14.CrossRefGoogle Scholar
  3. 3.
    Higgins JD, Frank RM, Hamamoto JT, Provencher MT, Romeo AA, Verma NN. Shoulder arthroscopy in the beach chair position. Arthrosc Tech. 2017;6(4):e1153–e8.CrossRefGoogle Scholar
  4. 4.
    Salazar D, Hazel A, Tauchen AJ, Sears BW, Marra G. Neurocognitive deficits and cerebral desaturation during shoulder arthroscopy with patient in beach-chair position: a review of the current literature. Am J Orthop (Belle Mead NJ). 2016;45(3):E63–8.Google Scholar
  5. 5.
    Li R, Lall A, Lai E, Gruson KI. Tension pneumothorax after ultrasound-guided interscalene block and shoulder arthroscopy. Am J Orthop (Belle Mead NJ). 2015;44(10):E407–10.Google Scholar
  6. 6.
    Hussain N, Goldar G, Ragina N, Banfield L, Laffey JG, Abdallah FW. Suprascapular and interscalene nerve block for shoulder surgery: a systematic review and meta-analysis. Anesthesiology. 2017;127(6):998–1013.CrossRefGoogle Scholar
  7. 7.
    Fielmuth S, Szalata M, Sievert H, Beier D, Rehberg S, Hahnenkamp K, Mauermann K, Meissner K. Electric nerve stimulation does not correctly predict needle-nerve distance and potential local anesthetic spread for interscalene brachial plexus blockade. Anesth Analg. 2017;125(2):632–4.CrossRefGoogle Scholar
  8. 8.
    Fredrickson MJ, Leightley P, Wong A, Chaddock M, Abeysekera A, Frampton C. An analysis of 1505 consecutive patients receiving continuous interscalene analgesia at home: a multicentre prospective safety study. Anaesthesia. 2016;71(4):373–9.CrossRefGoogle Scholar
  9. 9.
    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(9):1670–5.CrossRefGoogle Scholar
  10. 10.
    Hamamoto JT, Frank RM, Higgins JD, Provencher MT, Romeo AA, Verma NN. Shoulder arthroscopy in the lateral decubitus position. Arthrosc Tech. 2017;6(4):e1169–e75.CrossRefGoogle Scholar
  11. 11.
    Bauer T, Boisrenoult P, Jenny JY. Post-arthroscopy septic arthritis: current data and practical recommendations. Orthop Traumatol Surg Res. 2015;101(8 Suppl):S347–50.CrossRefGoogle Scholar
  12. 12.
    Horneff JG 3rd, Hsu JE, Voleti PB, O’Donnell J, Huffman GR. Propionibacterium acnes infection in shoulder arthroscopy patients with postoperative pain. J Shoulder Elbow Surg. 2015;24(6):838–43.CrossRefGoogle Scholar
  13. 13.
    Moen TC, Rudolph GH, Caswell K, Espinoza C, Burkhead WZ Jr, Krishnan SG. Complications of shoulder arthroscopy. J Am Acad Orthop Surg. 2014;22(7):410–9.CrossRefGoogle Scholar
  14. 14.
    Aboalata M, Plath JE, Seppel G, Juretzko J, Vogt S, Imhoff AB. Results of arthroscopic bankart repair for anterior-inferior shoulder instability at 13-year follow-up. Am J Sports Med. 2017;45(4):782–7.CrossRefGoogle Scholar
  15. 15.
    Agout C, Berhouet J, Bouju Y, Godeneche A, Collin P, Kempf JF, Favard L. Clinical and anatomic results of rotator cuff repair at 10 years depend on tear type. Knee Surg Sports Traumatol Arthrosc. 2018;26:2490–7.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Malte Holschen
    • 1
  • Jens Agneskirchner
    • 2
  1. 1.RaphaelsklinikMünsterGermany
  2. 2.Klinik für Gelenkchirurgie und Orthopädie (GOH)HannoverGermany

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