elbow and shoulder arthroscopy

Question 1

Discuss the portals for a shoulder arthroscopy?

Answer 1

• Posterior portal
  
  • 2cm inferior and medial of edge of posterior acomium
  • inject with needle into bursa first- easy
  • then new need into joint and aim to coracoid- should inflate and move the needle
  • stab 1cm incsion, trochear towards coracoid avoid humeral head- push the trochar medially
• Anterior portal- medial of coroacoid- view under direct vision when using knife to widened entry point then remove needle and knife. trochar again aiming slightl lateral .
• Lateral portal 1 cm lateral form tip of acromium thru deltoid- again using spinal needle and check position directly with arthroscopy camera

Question 2

What are the contraindications for elbow arthrosocpy?

Answer 2

• Prior trauma
• sugical scarring
• previous ulna transposition
  
  • Ulna nerve subluxation is not contraindication

Question 3

What are the indication of elbow arthroscopy?

Answer 3

• loose body removal
• osetophyte debridment
• synovectomy
• capsular release for stiffness
• OC dissecans of capitellum
• lateral epicondylitis

Question 4

Decribe the postion of portals in the elbow?

Answer 4

• establish anterior portals with elbow flexed 90o
• establish posterior portals with som extension
• straight posterior
  
  • gd for removing olecarnon osteophytes, loose bodies form posteriomedial compartment
  • 3cm proximal to olecranon, triceps midline
  • injury to posterior antebrachial cutaneous branch andn ulna n
• direct lateral
  
  • soft spot portal in traingle formed form olecrnaon, radial head and epicondyle
  • initial site for joint distension before scope inserted
  • see posterior comparmtment
  • realtively safe - lateral antebrachial cutaneous branch
• Anteromedial- 2cm anterior and 2cm distal to medial epicondyle
• place under direct vision
• risk to medial antebrachial cutaneous n and median n
• never use the posteromedial port due to risk to ulnar nerve

Question 5

What are the complications of ebow arthroscopy?

Answer 5

• Nerve palsy 1%
  
  • greatest risk RA, elbow contraction
  • transient ulnar n palsy -common
  • radial n plasy - 2nd common
• joint ankylosis/Heterophic ossifcation
  
  • less than open surgery
  • minimise bleeding
• Infection
  
  • sinus tract formation- posterolateral port