Page 91 - Clinical Manual of Small Animal Endosurgery

Operative Arthroscopy 79

The patient is generally positioned in lateral recumbency, with the
shoulder to be scoped uppermost. The shoulder should be aseptically
prepared for open surgery in case the arthroscopic procedure must be
abandoned and an open procedure performed. A hanging-limb prepara-
tion with free draping gives maximum access to the joint. First, the egress
portal is established by placing a 40 mm 22–19-gauge needle into the
cranial compartment of the shoulder joint. The shoulder is palpated and
a point that is midway along the superior ridge of the greater tubercle
of the humerus is identified. At this point, the needle is inserted caudo-
medially at approximately 70° from perpendicular, to penetrate the joint
(Fig. 3.12). Following aspiration of joint fluid, which confirms correct

Suprascapular
artery and nerve

1 2

4 3
Axillary
artery and nerve

Fig. 3.12 Shoulder arthroscopy. Line diagram showing portal locations: 1,
egress portal; 2, arthroscopic portal; 3, instrument portal; and 4, portal
used to access the biceps tendon.