Executive Editor: Joseph Schatzker General Editor: Jonas Andermahr, Michael McKee, Diane Nam

Scapula

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Glossary

Beach chair

Proper patient positioning is crucial as incorrect positioning will keep the surgeon from performing a successful operation.

The beach chair provides anterior and lateral access to the shoulder joint while prohibiting posterior open approaches.


Advantages and disadvantages

Advantages:

  • Use of the image intensifier is facilitated
  • It provides anterior and lateral access to the shoulder joint

Disadvantages:

  • The patient's medical condition may be a contraindication (ie, hypotension)
  • Prohibits posterior open approaches

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Positioning

The patient is seated and the trunk is elevated to an angle of 30-45°. The extremity should be draped free to facilitate motion of the shoulder which may aid in reduction.

The patient should be comfortably positioned with a pillow or wedge under the knee and the sides should be padded.

The head is carefully positioned and secured on a special head rest.

Depending on the part that needs to be imaged, one must move the image intensifier into an appropriate position with radiation hazards in mind.

Note: Hyperextension of the shoulder should be avoided in order to prevent tension on the brachial plexus and rotation of the neck may be limited due to degenerative disk disease.


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Intraoperative imaging

The image intensifier is placed in such a way that imaging of the desired area is possible. The X-ray beam should be centered on the area of interest.

Beam direction for scapular fractures:

  • 45 degree antero-lateral (trans glenoid view or epsilon view)
  • 45 degrees antero-medial (trans scapular view)

If available, a 3D-scan using a 3D-image intensifier will give the most details of the result.


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Alternative inclination

If the beach chair position is to be used for an arthroscopic procedure or an open posterior shoulder approach may be required, a more upright position is preferred with the trunk elevated 70-90 degrees. 

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