Arthroscopic Subscapular Bursectomy and Superior Angle
Resection
-Patient is placed in lateral decubitus position with bean bag and arm in “chicken
wing”. Inject the bursa with 20cc 0.25% Marcaine with Epinephrine prior to
prepping. The injection is placed superiorly (try to be perpendicular to the rib
cage).
-2 medial portals placed close to the spinous process (very medial to be able to get
under the scapula. The first portal is 2-3cm distal to the spine of the scapula and
the superior portal is at the level of the spine of the scapula. Place the blunt trochar
into the inferior portal, aim down towards chest wall and one through fascia feel
ribs with the scope. Now gently sweep the bursa to develop an area and then use
spinal needle and orange cannula to make the superior portal.
-Place a needle at the superior angle of the scapula for a reference point since you
get lost easily.
-Place the shaver into the superior portal (camera in the inferior portal) and shave
the bursa. If any areas superiorly are “fatty” carefully release with arthrocare in
case the suprascapular nerve is in there. Inferiorly and medially the tissue is safe to
debride but superiorly and laterally is dangerous and bleeding can be encountered
as well as the SSN.
-Use an arthrocare to expose the superior angle of the scapula and then use a burr to
shave down the superior angle.
-40mg Kenalog and Marcaine with Epi injected into area after case.