Anatomy and Portals in Shoulder Arthroscopy

Abstract

The arthroscopic technique was anecdotal in treating shoulder joint pathology up to the 1980s. The development of instruments, cannulas, pumps, and improved arthroscopic techniques has led to the recognition of numerous structures and anatomical variants of the shoulder joint and multiple pathologies which were previously unknown.

Although Michael Burman described the observation of joints in the cadaver by arthroscopy in 1931, it was not until 1965 that Andren and Lundberg reported its utility in the treatment of frozen shoulder. And later, the posterior portal (Watanabe et al. Atlas of arthroscopy, 3rd edn. IgakuShoin, New York, 1978) and anterior portal (Conti. Orthop Clin North Am 10(3):709–711, 1979) were described, greatly increasing the ability to observe and understand the intra-articular pathology.

From that moment on, arthroscopic techniques in the shoulder have developed tremendously, especially in the treatment of instabilities and rotator cuff pathology. In recent years, there have been advances in arthroscopic treatment of acromioclavicular pathology and treatment of nerve pathologies such as the suprascapular nerve.

This chapter briefly explains how to prepare and position the patient for shoulder arthroscopy and describes, in further detail, the anatomical references, variants of normal structures, and pathological changes that serve as a guide both inside and outside the shoulder joint allowing the surgeon to navigate with confidence throughout the articulation. It also includes a detailed description of the portals as well as portal selection for specific techniques.