Technique
Position
- beach chair / lateral
- water pump, adrenaline in bags
- block pre-op useful as easier to control BP
- often inject the SAD with combination of LA with A prior to scope
Posterior portal
- 2 cm inferior, 1 cm medial
- soft spot between IS and Tm
Enter subacromial space
- sweep to clear adhesion
- saline on pump at 30 - 40 - 50
- keep BP 100 - 110
- can increase pump pressure to 60 - 80 if needed in short bursts
Midlateral portal
- spinal needle
- 3cm distal to anterior acromion
- midpoint clavicle
- slightly lower to aim up
Bursectomy
- with shaver
Electrocautery / Shaver
- clear periosteum / coracoacomial Ligament off acromion
- avoid deltoid as bleeders
- beware thoroaco-acromial artery in CA ligament medial and inferior to acromion
- spinal needle ACJ to mark medial limits
- need to see anterior and lateral acromion
Acromioplasty
- 5.5mm burr
- multiple techiques
- 5mm deep resection at midpoint clavicle
- taper anteriorly
- must ensure lateral edge is cleared
