Application of beach chair position and lateral decubitus position in shoulder arthroscopy

Abstract

The clinical application of arthroscopic minimally invasive treatment of shoulder joint disease technology has become a routine, and it has been widely carried out around the world. Compared with the traditional open surgery, it only needs to establish a few channels in the shoulder and then the diagnosis and treatment of the structure under the acromion and glenoid joint internal lesions can be completed through the arthroscopic technique under direct vision, of course, including local collection of pathological specimens. Shoulder arthroscopic surgery has the advantages of simple operation technique, small economic burden of patients, small tissue trauma, quick recovery and high accuracy of disease diagnosis. At present, there are two main options for shoulder arthroscopy: the beach chair position (BCP) and the lateral decubitus position (LDP). The choice of surgical position for surgeons is closely related to the intraoperative operation, the risk of complications, the effi-cacy of surgery, and the cost of setting the posture. Shoulder arthroscopy of these two positions have their own advantages and disadvantages: in the BCP, the surgeon gets a better anatomical operation experience, if necessary, can be converted into open surgery at any time. Without continuous traction, upper limb nerve and vascular damage caused by traction can be avoid. But the incidence of cerebral ischemic events in patients may increase in the BCP. There is also possibility of the nerve damage of the pillow small nerve, great auricular nerve, lateral femoral cutaneous nerve and other nerves. In theory the risk of air embo-lism in the patients will increase in the BCP, and the cost of setting the position is also higher than the LDP. While in the LDP due to the patient's forearm continuous traction, the surgeon can get a more extensive operating space, and the occur-rence of cerebral ischemic events is very rare. In the treatment of anterior shoulder instability after shoulder arthroscopic sur-gery, there is a lower recurrence rate in the LDP. The cost of setting the position is also significantly lower than the BCP. Of course, the disadvantages of the LDP is also obvious. In the LDP, the brachial plexus and other nerves or vascular injury may increase due to the continuous traction of the forearm. Meanwhile sustained traction in the LDP is also a risk factor for throm-bosis, and so on. Therefore, there is still a debate about the optimal location of the shoulder arthroscopy. Many clinicians choose shoulder arthroscopic position based on their own experience and habits.