Dr. Patrick Denard walks through shoulder arthroscopy setup: how you'll be positioned on your side with support, how the surgical team controls bleeding with low blood pressure and epinephrine, and how they drape and isolate the surgical field to prevent infection.
I'm Patrick Denard from Medford, Oregon, and this video demonstrates how people are positioned for shoulder arthroscopy. A lot of people ask this. We wanted to make this video so people could see what it's like in the operating room before they have their shoulder scoped. One thing we do is we maintain hemostasis, that is keep bleeding low, because people are positioned on their sides. We get the blood pressure low. We also use a little epinephrine in the bag that helps keep the vessels constricted. And sometimes we use an IV medication, but that's rarely necessary. We use an IV pump that puts fluid through the shoulder so we can get a clear field of view and see everything we need to see under clear visualization. So we put people on their side, we put pillows under the legs. We usually use 3 pillows. We put 1 pillow under the down leg and then 2 pillows in between. So somebody will go to sleep on the bed. We use a standard bed, and then the person is turned onto their side, and we'll turn them onto the side by using a bean bag. So here we go, flipping onto the side. We use an axillary roll under the armpit that protects the nerves. So we have that protecting under the armpit. And then under the leg to protect the nerve on the down leg. Bean bag is inflated, that keeps the position, and then the down arm, in this case we're working on the right arm, the left arm is out to the side. So it's a pretty comfortable position. We use a little tape to secure in addition to the bean bag so that there's no movement. We make sure that none of the nerves are pinched as we're applying this tape. And this is going to give us good security so we can work on the shoulder. So we use an articulated arm holder. You see there on the left, that's that metal device. That'll be for positioning of the arm, and then we drape the arm. We use a couple of clear plastic drapes. These isolate the field of the arm One goes up around the shoulder blade and another goes across the neck. So now we can clean everything. And we really take infection prophylaxis seriously. We have people use an over-the-counter scrub 3 to 5 days prior to surgery, and then we clean the skin again just prior to surgery with hydrogen peroxide, and then we give IV antibiotics. The first two that we use really help reduce the burden of a bacteria called C. acnes. That's a leading cause of infection in the shoulder. It's very rare in shoulder arthroscopy. It's one in several thousand, but nonetheless, we want to make sure we don't take any risk. So we prep the entire arm. That's what that orange stuff going on is, and then we prep in the articulated arm holder. That allows us again to position the arm in variable positions of abduction, adduction, internal and external rotation, flexion. So we can get full view inside the shoulder through a combination of the scope and this articulator arm holder. Then we use a series of drapes. We put on a down sheet and then there's a sticky U-drape. This goes around the arm. We'll do this, we'll repeat this process again putting another one over the top of the arm. Now the initial field in this case is isolated. Once that initial field is isolated, then what we do is we shed our outer gloves. Again, we're taking every precaution we can to avoid infection. And then we'll put on the final draping, and then the arm goes up in this articulated arm holder. And then finally, we use these IO Band sticky drapes. This helps seal the field. Keeping the drapes down so they don't move as we're moving fluid through with the scope. And we can look at the scope. We have an assistant above the surgeon, and then there's a scrub tech behind that helps us assist, and we're working off using instruments off of both sides. So I hope you find this video informative, helps to give you a little understanding what we're doing in the operating room in terms of positioning for shoulder arthroscopy. Thank you. If you do have any questions, please feel free to reach out to us at www.OregonShoulder.com. We're happy to help you in any way we can, whether it's answering a question about your shoulder or getting you back to doing the things you want to do.
