Rothman's Dr. Horneff.
To gain the 360-degree access needed during arthroscopies, surgeons
place multiple portal sites posteriorly, anteriorly and laterally.
"The posterior portal is the main access point," says Edward
Westerheide, MD, of Orthopedic Specialists & Sports Medicine in Newark,
Ohio.
Dr. Horneff says seeing and working in and around the shoulder capsule
can prove challenging. "We have specialized cameras with a bit of angula-
tion, which helps visualization," he explains, "but we're also [manipulating
instruments] through an anterior portal. That's why it's important to have
unimpeded access at the front of the joint."
That can be tricky, depending on how the patient is positioned, says Dr.
Westerheide. "As you're maneuvering instruments, they can butt up against
the patient's head," he explains. To prevent this, Dr. Westerheide places the
head in a forward-leaning position, making sure the cervical spine isn't
flexed forward.
There are a number of different shoulder tables available that give your
surgeons extra precision and access. "Most of the good tables have a
hydraulic-assist component," says Dr. Westerheide. "Instead of having to
manually lift up the table while keeping the patient's head stable, a spring-
elevated lever does a lot of the work for you."
The shoulder table Dr. Westerheide uses also has a hydraulic position-
ing component that locks the patient's arm in whatever position he
chooses. "You step on a pedal and place the arm where you want it, then
simply step off the pedal to lock the arm in place," he explains. That easy
maneuverability lets him easily set forward flex and abduction of the
joint.
Dr. Horneff says that during open procedures, such as shoulder replace-
ments, surgeons establish access with an anterior incision and must be
able to move the patient's arm freely in space without worrying about the
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