Positioning, Arthroscopic portals and diagnostic arthroscopy

Abstract

Basically 3 different positions are possible: supine position, prone position and lateral decubitus position. In all positions both open as well as arthroscopic procedures could be performed. Usually a tourniquet is applied to the proximal upper arm and inflated to a pressure of 250 mmHg.

The supine position is used for open surgical procedures where access to the anterior aspect of the elbow is required. The arm could be positioned on a side table or directly left over the body.

The supine position provides a good access for arthroscopic procedures involving the anterior joint compartment and an easy anatomic orientation, which considerably facilitate the procedure, particularly for the less experienced arthroscopist. For this purpose, the patient’s hand lies freely hanging in an arm holder and the shoulder is abducted 90° and the elbow flexed 90°.

The supine position allows free pronation and supination and decreases tension over the anterior neurovascular bundles, which reduced the risk of iatrogenic neurovascular injuries.

The prone position allows a good access for both open and arthroscopic procedures, particularly to the posterior joint aspect. One advantage of this position is the inherent stability of the elbow. Disadvantages includes the complicated anatomical orientation and the need to reposition the patient after intubation.

The arm is positioned in an arm holder or over an arm board, the shoulder is abducted to 90° and the elbow is flexed to 90°. The chest and pelvis must be adequately padded to secure sufficient ventilation.