Arthroscopy has been one of the major advancements in Orthopaedic Surgery and advanced the knowledge and skills of shoulder surgery over the past decade.
Now the vast majority of elective shoulder surgery can be performed arthroscopically, with significant advantages to the patient and surgeon.
However the skills and equipment are completely different to traditional open surgery.
In this section I have tried to include information that has been difficult to find in the standard literature and some tools and aides to assist with the understanding, training and skills development for arthroscopic surgery.
Shoulder Arthroscopy Guide
When performing shoulder arthroscopy it is essential to have a sytem for diagnostic examination of all the relevant structures of the shoulder joint.
There are many good systems around. I use a simple 10 point system, with ten key areas of the shoulder that need to be viewed and probed during a diagnostic arthroscopy.
From the posterior portal, these areas are, in order:
- Superior Labrum & LHB
- Glenoid, Humeral Head and Posterior Labrum
- Inferior Recess
- Bare area and posterior cuff
- Superior cuff
- LHB entering groove, biceps pulley and SGHL
- Subscapularis, Antero-superior labrum & MGHL
- Antero-inferior labrum, IGHL and anterior capsule
- Acromial surface of bursa and CA ligament
- Bursal surface of rotator cuff
Finding information on suture materials, anchors and knot tying can be difficult. In this section we hope to collate this information, as a quick and ready resource.
Arthroscopy Skills Tests
The increased number of arthroscopies has led to a greater number of formal methods of teaching and assessment. The skills required for arthroscopy differ to that for open surgery. It is recognised that not everyone has the specific abilities to perform arthroscopic surgery and perhaps some medical students have the ability to develop arthroscopic skills more easily than others.
To assess whether performance on 5 specially designed Macromedia MX Flash programs correlated with 3 arthroscopic tasks performed on a synthetic should model, and whether any particular activities or demographics may involve any preconditioning skills for arthroscopy.
32 medical students were asked to complete a questionnaire, list their hobbies, perform 3 arthroscopic tasks (navigation, triangulation, instrumentation) on a shoulder model, and perform 5 Flash tests on a laptop. They were grouped by their sex, hand dominance and if they participated in any of the 9 activity categories.
Navigation score correlated significantly with 4 Flash tests’ scores. Instrumentation score only significantly correlated with 1 Flash test score. Non string instrument players performed significantly better than string instrument players (p=0.033) at instrumentation. Other groups (computer gamers, crafters, drummers, right handers) performed faster than their corresponding groups in all skills, but not significantly.
It appears that there is a role of Flash tests in predicting an individual’s ability to arthroscopic navigation and instrumentation. It would appear that certain hobbies and demographics may have a role in predetermining the skills required for shoulder arthroscopic surgery. Further investigation with larger groups and additional assessment tools is underway.
Since the beginnings of shoulder arthroscopy, much development and advances have proved this to be a useful diagnostic and surgical tool for the orthopaedic surgeon.
It is the only imaging modality that allows the internal anatomy of the shoulder to be directly visualised in the living patient, whereas other imaging techniques allow shoulder anatomy to be viewed from an outside-in perspective.
The introduction of shoulder arthroscopy has meant “…that a thorough knowledge of normal anatomy and its variants are especially important in order to differentiate normal from pathological findings”.
Unfortunately their is no single comprehensive literature source of all the normal and anatomical variants of all the structures seen at arthroscopy from the posterior portal.
We therefore undertook a review of all the available literature, collated the data and then undertook our own study of 132 normal glenohumeral joint arthroscopies. We compared our analysis with an extensive review of the glenohumeral anatomy in the literature. We also identified many previously undescribed variants.