Positioning the patient may seem trivial, but if done inappropriately, it may aggravate cervical spine, lumbar spine, or other patient pathology. In addition, poor positioning adds to the difficulty of the procedure.
Patients may be positioned in either the lateral decubitus or beach chair position. Other positions have been described including hybrids of the beach chair and lateral decubitus posi-tions.1 We perform all shoulder arthroscopy in the beach chair position.
A Schloein positioner (Orthopedic Systems, Union City, CA) is used to support the patient in a seated position (Fig. 17-1). The design of the Schloein allows easy access to the posterior aspect of the shoulder. Once the patient is asleep, the back of the Schloein is lifted to place the patient in a seated position. The bed controls are adjusted to flex the torso at the waist and lower the legs slightly. A pillow is placed beneath the knees to minimize strain on the lower back. The headrest is adjusted and foam is placed behind the head if necessary to keep the neck in a neutral position in the sagittal plane. A forehead strap and chin strap with Velcro control the head and a chest strap, waist strap, and leg strap control the torso. These steps are essential to allow for ease of arthroscopy while minimizing stress on the patient's cervical or lumbar spine during the procedure. If the patient is not secure or is leaning to one side, the procedure becomes significantly more difficult and a successful shoulder proce
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