Needle guide in shoulder arthroscopy – a technique
© Sidharthan et al; licensee BioMed Central Ltd. 2009
Received: 28 February 2009
Accepted: 24 April 2009
Published: 24 April 2009
Distension of joint with fluid is often used to facilitate insertion of arthroscope. This may prove difficult at times in the shoulder joint, as unlike the knee, it is deeply situated, making extravasation of fluid outside the capsule, a common occurrence. This is especially true in very tight joints and is often a problem for beginners. We describe here a very effective and simple technique where a needle is used to distend the shoulder before the insertion of the arthroscope.
Unlike the knee joint, the shoulder is deeply situated with prominent muscular enclosure. Distension of the joint with saline is often used as a means to facilitate insertion of arthroscope. However, this may prove difficult at times especially in tight joints and for beginners. Inadvertent extravasation of saline into the soft tissues around the capsule may often occur as a result. Subsequent introduction of scope is difficult as the landmarks are obscured. A very effective and reliable technique to distend the shoulder joint is described here that can be used as a guide in the accurate placement of arthroscope in the joint.
The intra-articular pressure inside the shoulder is slightly negative . It produces the suction effect that is encountered as soon as the needle enters the joint. This is further accentuated by the external traction employed at the joint. The technique provides a reliable means of locating the position of the joint even before actually distending the joint with the fluid. It nearly eliminates the possibility of distorting the landmarks with inadvertent injection of fluids in the soft tissues around the shoulder. The accurate position can be further verified by the free back flow of the fluid. The needle also provides a reliable means to fine-tune the direction of the portal entry. The subsequent placement of the arthroscope is made easier by the distended joint capsule. Once the joint is distended with fluid it widens the joint space and creates a cystic expansion of the redundant capsule. This provides a larger target with a firmer stretched capsule to aim at. That is why subsequent placement of the arthroscope is easier and more forgiving with the direction aimed.
We believe the technique that has been described provides a reliable and accurate means to locate the shoulder joint and distend the capsule with fluid. Subsequent introduction of the arthroscope is made a lot easier. It is therefore a useful aid for beginners and in very tight joints.
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