the volume of arthroscopic shoulder surgery
DESCRIPTION
The volume of Arthroscopic Shoulder Surgery. The volume of arthroscopic surgery performed: 2003 E.Wolfson Med Center: 470 Arthroscopic surgical procedures 208 Knee (44.25%) 168 Hand and Wrist (35.74%) 74 Shoulder (15.7%) - PowerPoint PPT PresentationTRANSCRIPT
The volume of Arthroscopic Shoulder SurgeryThe volume of Arthroscopic Shoulder Surgery
The volume of arthroscopic surgery performed: The volume of arthroscopic surgery performed:
2003 E.Wolfson Med Center: 2003 E.Wolfson Med Center:
470 Arthroscopic surgical procedures 470 Arthroscopic surgical procedures
208 Knee (44.25%)208 Knee (44.25%)
168 Hand and Wrist (35.74%)168 Hand and Wrist (35.74%)
74 Shoulder (15.7%)74 Shoulder (15.7%)
18 Ankle (3.8%)18 Ankle (3.8%)
2 Other2 Other
E.Adar M.DE.Adar M.D
Arthroscopic surgery UnitArthroscopic surgery Unit
E.Wolfson Medical CenterE.Wolfson Medical Center
H O L O NH O L O N
Complications Associated With Complications Associated With Arthroscopic Shoulder SurgeryArthroscopic Shoulder Surgery
LiteratureLiterature
First report : 5.3% complication rateFirst report : 5.3% complication rate
Small NC Arthroscopy 1986 2:253-258Small NC Arthroscopy 1986 2:253-258
= =
Relatively SAFE procedureRelatively SAFE procedure
19901990 – – 20012001 5757 articles discussing complicationsarticles discussing complications
11 ) )Review articlesReview articles
22 ) )Studies dealing with specific type of complicationsStudies dealing with specific type of complications
Review articles: early 90Review articles: early 90thth
Bigiliani Orthop Rev 1991 20)9): 743-751Bigiliani Orthop Rev 1991 20)9): 743-751
Curtis Arthroscopy 1992 8)3):395Curtis Arthroscopy 1992 8)3):395
) ) 660660 procedures – 6.5% compprocedures – 6.5% comp) )
late 90late 90thth
McFarlandMcFarland
J South Orthop Assoc 1997;6)3):190-196J South Orthop Assoc 1997;6)3):190-196
Neurologic comp 0-30%Neurologic comp 0-30%
Infection rate 0.04-0.23%Infection rate 0.04-0.23%
Berjano )179 patients)Berjano )179 patients)
Arthroscopy 1998 ; 14)8) : 785-788Arthroscopy 1998 ; 14)8) : 785-788
9.49%9.49% complication ratecomplication rate
These reviews generally correlate These reviews generally correlate the complexity of the procedure the complexity of the procedure with increased complication with increased complication ratesrates
General surgical complications:
Infections 0-3.4%
Anesthesia : Air embolism
Tracheal compression
Temporary blindness
Pneumothorax
Quadriparesis )sitting)
Airway obstruction )fluid)
Pneumomediastinum
Shoulder A-sc complications:
Vascular injury )DVT, Vein laceration)
Neurological injury
Fluid extrvasation
Stiffness
)ONE OF THE MOST COMMON PROBLEMS UP TO 15%)
Tendon injury )RARE )
Complications related to specific procedures:
a. Subacromial surgery
i. Inadequate resection
ii. Fracture
iii. ACJ symptoms
iiii. Heterotopic ossification
Complications related to specific procedures:
b. A-sc R.C repair
i. Failed repair
ii. Hardware problems
iii. Captured shoulder
Complications related to specific procedures:
c. Instability surgery
i. Recurrence
ii. Hardware problems
)1) Metal
)2) Resorbable
iii. Thermal
)nerve injury)
)capsular necrosis)
We are going to discuss the possibility of We are going to discuss the possibility of complications related to the portals and complications related to the portals and patient’s position during arthroscopy of the patient’s position during arthroscopy of the shoulder jointshoulder joint
Commonly, the Commonly, the nerve injuries occur nerve injuries occur secondary to secondary to traction or traction or contusion. These contusion. These are avoided best by are avoided best by careful attention to careful attention to patient positioning, patient positioning, and arm and arm manipulation during manipulation during surgerysurgery . .
Nerve injuries are reported Nerve injuries are reported to occur in 1% to 2% of to occur in 1% to 2% of patients undergoing patients undergoing rotator cuff surgery and rotator cuff surgery and in 1% to 8% of patients in 1% to 8% of patients undergoing surgery for undergoing surgery for anterior instabilityanterior instability
Mainly portal bleedingMainly portal bleeding
Major vascular injuryMajor vascular injury? ?
Chondral and Rotator cuff iatrogenic injuriesChondral and Rotator cuff iatrogenic injuries
Complications related to
COMFORTABLE FOR GHJ PROCEDURESCOMFORTABLE FOR GHJ PROCEDURESCOMFORTABLE FOR TOOLS SWITCHINGCOMFORTABLE FOR TOOLS SWITCHING
COMFORTABLE FOR BEGINNERSCOMFORTABLE FOR BEGINNERS
UNCOMFORTABLE FOR MINI OPEN R.C REPAIRUNCOMFORTABLE FOR MINI OPEN R.C REPAIRUNCOMFORTABLE FOR OPEN PROCEDURESUNCOMFORTABLE FOR OPEN PROCEDURES
Brachial Plexus on the Brachial Plexus on the operated sideoperated side
Brachial Plexus on the Brachial Plexus on the opposite sideopposite side
Possible complications
Peroneal Nerve on the Peroneal Nerve on the opposite sideopposite side
Fluid distention to the neck Fluid distention to the neck and mediastinumand mediastinum
COMFORTABLE FOR GHJ PROCEDURESCOMFORTABLE FOR GHJ PROCEDURESLess COMFORTABLE FOR TOOLS SWITCHINGLess COMFORTABLE FOR TOOLS SWITCHING
Less COMFORTABLE FOR BEGINNERSLess COMFORTABLE FOR BEGINNERS
COMFORTABLE FOR MINI OPEN R.C REPAIRCOMFORTABLE FOR MINI OPEN R.C REPAIRCOMFORTABLE FOR OPEN PROCEDURESCOMFORTABLE FOR OPEN PROCEDURES
Brachial Plexus on the Brachial Plexus on the operated sideoperated side
Ulnar Nerve on the Ulnar Nerve on the opposite sideopposite side
DVT DVT (legs)(legs)
Possible complications
Technical modifications to avoid some of the Technical modifications to avoid some of the complicationscomplications::
The use of beach chair The use of beach chair position, limits the fluid position, limits the fluid distention to the neck and distention to the neck and mediastinummediastinum
Technical modifications to avoid some of the Technical modifications to avoid some of the complicationscomplications::
Application of limited amount of Application of limited amount of traction )less than 3 kg)traction )less than 3 kg)
Lateral tractionLateral traction//
Less longitudinal tractionLess longitudinal traction
Technical modifications to avoid some of the Technical modifications to avoid some of the complicationscomplications::
Limiting the Limiting the degrees of arm degrees of arm flexion and flexion and
abductionabduction . .
Careful neck Careful neck positionposition
Technical modifications to avoid some of the Technical modifications to avoid some of the complicationscomplications::
Avoiding prolong Avoiding prolong surgical timesurgical time
Technical modifications to avoid some of the Technical modifications to avoid some of the complicationscomplications::
CarefulCareful
hemostasishemostasis
Technical modifications to avoid some of the complications:
Controlled Fluid PressureControlled Fluid Pressure
Portal related complications Portal related complications of Shoulder Arthroscopyof Shoulder Arthroscopy
הסבר
הסבר
SupraScapular Nerve and Artery
Teres MinorTeres Minor
Supra SpinatusSupra Spinatus
Infra SpinatusInfra Spinatus
Teres MajorTeres Major
Axillary Axillary NerveNerve
Posterior Posterior Circumflex Circumflex arteryartery
Posterior Posterior Circumflex Circumflex arteryartery
Axillary Axillary NerveNerve
22 CM DISTALLY TO THE POSTERIOR ACROMIAL CORNERCM DISTALLY TO THE POSTERIOR ACROMIAL CORNER
EXCELLENT FOR SUB EXCELLENT FOR SUB ACROMIAL BURSOSCOPYACROMIAL BURSOSCOPY
SUPRA SCAPULAR NERVE IS IN DANGER
ROTATOR CUFF IS IN DANGER
GOOD FOR GOOD FOR ARTHROSCOPIC ARTHROSCOPIC EXCISION OF DISTAL EXCISION OF DISTAL CLAVICLECLAVICLE
SUPRA SCAPULAR NERVE IS IN DANGER
BRACHIAL PLEXUS IS IN DANGER
POSITIONED PROXIMALLY TO THE ACROMIONPOSITIONED PROXIMALLY TO THE ACROMION
POSTERIORELY TO THE CLAVICULAR HEADPOSTERIORELY TO THE CLAVICULAR HEAD
May assist inMay assist in
S.L.A.P. LESIONS REPAIRS.L.A.P. LESIONS REPAIR
A.S.C ASSISTED # FIXATIONA.S.C ASSISTED # FIXATION
RC REPAIRRC REPAIR
PASSES THROUGH THE MUSCLE FIBERS OF SUPRASPINATUSPASSES THROUGH THE MUSCLE FIBERS OF SUPRASPINATUS
10-1110-11 mm DRILL IN THEmm DRILL IN THE
MIDPORTION OF THE ACROMIONMIDPORTION OF THE ACROMION
IMPORTANT IN S.L.A.PIMPORTANT IN S.L.A.P . .
LESIONS REPAIRLESIONS REPAIR
Instruments may damage the Instruments may damage the tendon of supra spinatustendon of supra spinatus
# #of Acromionof Acromion
ASSISTING PORTAL FOR ASSISTING PORTAL FOR R.C. REPAIRR.C. REPAIR
MAY BE USED FOR G.H.J MAY BE USED FOR G.H.J INSPECTION THROUGH INSPECTION THROUGH THE R.C. TEARTHE R.C. TEAR
Instruments may damage the Instruments may damage the tendon of supra spinatustendon of supra spinatus
Assisting portal for sub-acromial Assisting portal for sub-acromial proceduresprocedures
Axillary Nerve is in dangerAxillary Nerve is in danger
Assisting portal for anterior instability repairAssisting portal for anterior instability repair
Thoraco-Acromial Artery is in dangerThoraco-Acromial Artery is in danger
Main portal for anterior Main portal for anterior instability repairinstability repair
Musculo-Cutaneous Nerve Is in dangerMusculo-Cutaneous Nerve Is in danger
Thoraco-Acromial Artery is in dangerThoraco-Acromial Artery is in danger
Assisting portal for Distal ClaviculectomyAssisting portal for Distal Claviculectomy
SUMM
ARY
SUMM
ARY
Although shoulder Although shoulder arthroscopic procedures arthroscopic procedures are not free of are not free of complications, we still complications, we still consider them to be safe consider them to be safe because few of the because few of the complications recorded complications recorded have compromised the have compromised the clinical outcome of the clinical outcome of the patientspatients..
