Shoulder arthroscopy: A modified approach

This paper proposes a modification of the classical position for shoulder arthroscopy. Two changes are proposed to improve visualization, accentuate pathology, and give better access to the inferior one half to one third of the shoulder joint. The direct lateral position is changed to a semilateral position in which the patient is allowed to rotate 30 to 40 degrees posteriorly, thus putting the shoulder joint on a horizontal plane. This allows for more comfortable arthroscopy and instrumentation. Also, if capsulorrhaphy is desired, better penetration of the scapula is possible since the scapula is vertical; thus, the angle of the approaching staple is less severe. The second change is to apply traction in a plane perpendicular to the long axis of the humerus rather than parallel to it. This modification elevates the humerus out of the glenoid rather than distracts the humerus into a subluxed position. The result accentuates labral pathology and gives a significantly improved view of the inferior one half to one third of the glenoid capsule. This new plane of traction allows excellent visualization with very little traction; thus, the problem of traction neuropraxia has been eliminated.