Search
Advertisement
emedsol
Advertisement
Shanghai East Hospital
Advertisement
Renji Hospital
Advertisement
Ciming
Advertisement
aier
Advertisement
medical travel
Tumor Therapy China

Arthroscopic Subacromial Decompression(ASD)

If you are considering arthroscopic subacromial decompression(ASD) in China and would like to get know more information about arthroscopic subacromial decompression(ASD), please complete the inquiry form or email us at info@shmtppp.com

Arthroscopic subacromial decompression may be a difficult technique to learn; good equipment therefore is essential. Everything must be done under direct vision, and hence control of bleeding is an essential requirement. This may be achieved in one of two ways.

  • Increase of intrabursal fluid pressure: this increases postoperative swelling, however.
  • Coagulation diathermy: Initially, use of diathermy was difficult because the inflow fluid had to be changed from saline to either water or glycine. However, commercially available point source diathermy probes are available, and these do not require change of fluid and can be used in the presence of saline.

Procedure

1. Arthroscopic glenohumeral exam. Standard posterior portal 1.5-2.0 cm inferior, 1 cm medial to the posterolateral corner of the acromion directing cannula toward the coracoid tip anteriorly. High anterior portal at anterolateral corner of acromion inside- out with trocar or outside-in with 18 gauge needle.

2. Remove scope and redirect through the same posterior skin incision just at inferior edge of the posterior acromion. Direct cannula anteriorly along the roof of the acromion (inferior surface).

3. Enter bursal chamber under anterior one half of the acromion. Direct blunt trocar /cannula out anteriorly through the previous high anterior portal and retrograde an outflow cannula back into the subacromial space at the anterolateral corner of the acromion.

4. Incise a lateral working portal 2.5-3.0 cm from lateral border of the acromion slightly anterior to the midpoint. Angle slightly upward so shaver/ablater does not impinge on the lateral cortex.

5. Define the anterior one half of the bony acromion with shaver and cautery/ablation from the lateral portal. Debride enough bursa to visualize well. May need to remove some of the “posterior bursal curtain”.

6. Ablate or transect coracoacromial ligament using the cautery unit or shaver. Have cautery ready for the acromial branch of the thoraco-acromial artery.

7. Resect the anterior 3-4mm of acromial bone from anterolateral corner toward the A-C joint using the burr in the lateral portal. Don’t enter the A-C joint if not planning a Mumford. (Figure 1)

8. Thin down lateral border of the anterior ½ acromion starting at the anterolateral corner and proceeding posteriorly tapering to the midpoint. (Figure 1)

Arthroscopic Subacromial Decompression(ASD)

Figure 1. Remove anterior 3-4 mm of acromion from the anterolateral corner to the AC joint, and thin down the lateral border of the anterior ½ of the acromion, tapering posteriorly.

9. Place scope in lateral portal. View arch of acromion.

10. Introduce burr through posterior portal directly on undersurface of posterior ½ of the acromion.

11. Advance burr anteriorly on posterior “cutting block”. Use a sweeping motion medially to laterally as move anterior. (Figure 2)

Arthroscopic Subacromial Decompression(ASD)

Figure 2. The burr is advanced anteriorly using the posterior half of the acromion as a "cutting block" to remove the bone with a sweeping motion medially to laterally.

12. Resect remaining anterior hook of the acromion. (Figure 3)Take care not to advance burr anteriorly into deltoid fibers or fascia.

Arthroscopic Subacromial Decompression(ASD)

Figure 3. The anterior hook of the acromion is resected and the undersurface flattened in the sagittal plane.

13. Flatten the underside of the acromion in the sagittal plane. (Figure 3) Must know the sagittal acromial morphology and thickness preoperatively to avoid excessive resection. (Figure 4)

12. Resect remaining anterior hook of the acromion. (Figure 3)Take care not to advance burr anteriorly into deltoid fibers or fascia.

Arthroscopic Subacromial Decompression(ASD)

Figure 4. Determine shape and thickness of acromion preoperatively to determine if “cutting block” technique or minimal anterior hook resection is warranted.

Arthroscopic Subacromial Decompression(ASD)

14. Place scope posteriorly.

15. View the acromion. Insure it is flat in the medial-lateral plane. If have any residual bone along lateral acromion, use burr from the lateral portal to complete lateral acromial resection. (Figure 5)

Arthroscopic Subacromial Decompression(ASD)

Figure 5. The scope is placed posteriorly to view the acromion and insure that it is flat in the mediolateral plane.

16. Verify appropriate resection – from at least 2 separate portals: enlarge portal and palpate with gloved finger if unsure.

17. Reduce flow pressure. Use the electrocautery unit to obtain hemostasis.

If you are considering arthroscopic subacromial decompression(ASD) in China and would like to get know more information about arthroscopic subacromial decompression(ASD), please complete the inquiry form or email us at info@shmtppp.com