Doctor Bruce Ellison Palo Alto Calif 94305 Discusses Shoulder Arthroscopy

-

BEACH-CHAIR POSITION

Dr. Ellison uses the beach chair position almost exclusively. Beach-chair position provides faster and easier patient positioning, reduces risk of neurapraxias because traction is not used. There is reduced distortion of intraarticular capsular anatomy, improved mobility of the patient's arm, and easier conversion to open surgery since repositioning and repreparation is not required.

In the beach-chair position, either general anesthesia or interscalene block can be used. Interscalene block allows the patient to be awake and can assist in controlling the posotion of the head. The knees are flexed to provide counterpressure against the posterior thigh, which will reduce the tendency to slide off the table during surgery. Flexion also decreases tension on the posterior neurovascular structures of the legs. The affected shoulder is brought off the side of the table for access during the procedure.

The head is supported in a neurosurgical headrest and reinforced with coban which is secure without being restrictive. Additional tape reinforces the thorax as necessary. The arm hangs free but support on a Mayo stand as necessary. The patient is draped for routine shoulder surgery.

Once the patient has been positioned, prepared, and draped, the bony anatomical landmarks and proposed portal sites are identified and outlined. Bony sites marked are the anterior, lateral, and posterior outline of the acromion, the acromioclavicular joint, and the coracoid process. The usual portal sites marked are the posterior, anterior, and lateral portals.

As in the knee, a 4-mm, 30-degree oblique arthroscope, with a short bridge that allows fluid inflow and interchangeable cannulas, is used for routine arthroscopy. This arthroscope allows viewing of the entire shoulder joint with manipulation of the arm.

Control of Bleeding During Arthroscopy

Bleeding can be an annoying obstacle during shoulder arthroscopy because the tissue planes penetrated by the arthroscope and instruments are much thicker and more vascular than those in the knee. Also, no tourniquet can be used during shoulder arthroscopy. In addition to using an arthroscopic electrocautery device, an arthroscopy pump for inflow, maintaining a constant fluid flow and pressure minimizes bleeding. The inflow can be through the arthroscopy sheath or a separate inflow cannula for the arthroscopy pump is occasionally placed. Often with "beach-chair" positioning, hypotensive anesthesia is also used. All of these techniques minimize bleeding.

Comments

tahera said…
I was looking for some information related to shoulder replacement alternatives. Thank you for sharing this post.
July 13, 2012 at 10:41 AM
Post a Comment

Popular posts from this blog

Complex Regional Pain Syndrome (CRPS) / Reflex Sympathetic Dystrophy (RSD)

-
  Complex regional pain syndrome ( CRPS ), previously referred to as reflex sympathetic dystrophy (RSD),  is a condition resulting in burning pain, stiffness, swelling, and discoloration of the hand. CRPS includes other medical diagnoses, including causalgia, Sudeck's atrophy, and shoulder-hand syndrome.   CRPS occurs as result of abnormally overactive sympathetic nervous system that controls the blood flow and sweat glands in an extremity.   A burning pain, swelling, and warmth are felt in the affected extremity.   If not treated, CRPS can cause stiffness and a loss of use of the affected extremity.  In the worse cases, the results can be permanent The cause of CRPS is frequently unknown.  CRPS is felt to occur as the result of stimulation of sensory nerve fibers. Those regions of the body rich in nerve endings such as the fingers, hands, wrist, and ankles are most commonly affected.  Often, an injury can cause CRPS, especially when placing pr...
Read more

Dr. Bruce E. Ellison, Orthopaedic Surgeon, discusses ConFormis Bone Sparing Minimally Invasive Knee Replacement

-
Osteoarthritis of the knee is a degenerative condition affecting millions of Americans. Though often associated with the aging, osteoarthritis involves an overproduction of degradation enzymes which attack and destroyed cartilage. Healthy joints, including the knee, are covered by a layer of articular cartilage. The cartilage acts as a cushion providing for smooth gliding surface during range of motion. The articular cartilage has no nerves, and thus there is no pain with activity. However as anyone who has broken a bone knows, there are abundant nerves and pain receptors at the bone. In the knee with osteoarthritis, the cartilage wears away and becomes roughened. If the wear becomes significant, the rubbing a one rough bony surface on another can result in debilitating pain, with resulting stiffness and swelling. Nonoperative treatment options include behavior modification, drug therapies including hyaluronic acid and steroid injections, braces and electrical stimulation. Oper...
Read more