From the Guidelines
A normal preoperative workup for shoulder arthroscopy includes a comprehensive history and physical examination, basic laboratory tests, and imaging studies such as plain radiographs and MRI to evaluate soft tissue structures. The workup should prioritize identifying potential complications, optimizing surgical planning, and reducing perioperative risks to ensure the best possible outcomes for shoulder arthroscopy 1.
Key Components of Preoperative Workup
- Comprehensive history and physical examination to identify any underlying medical conditions or concerns
- Basic laboratory tests, including complete blood count, basic metabolic panel, and coagulation studies
- Imaging studies, such as:
- Plain radiographs of the shoulder to evaluate bone structures and identify any fractures or dislocations
- MRI to evaluate soft tissue structures, including tendons, ligaments, and labrocapular structures 1
- Electrocardiogram for patients over 40 or with cardiac risk factors to assess cardiac function
Preoperative Preparation
- Patients should discontinue antiplatelet medications like aspirin and NSAIDs 7-10 days before surgery and anticoagulants according to their specific medication's protocol
- Preoperative fasting guidelines include no solid food for 8 hours and clear liquids permitted up to 2 hours before anesthesia
- Patients with diabetes should receive specific instructions for medication management on the day of surgery
- Preoperative antibiotics, typically a first-generation cephalosporin like cefazolin 1-2g IV within 60 minutes before incision, are administered to prevent surgical site infections
- Patients should shower with an antiseptic soap the night before and morning of surgery to reduce the risk of surgical site infections 1
Imaging Studies
- MRI is the procedure of choice for evaluating occult fractures and shoulder soft tissues, including tendons, ligaments, muscles, and labrocapular structures 1
- Ultrasound can be used to evaluate the acromioclavicular joint, the tendons of the rotator cuff, and the long head of biceps tendon, and can guide injections and aspirations
- CT without contrast can be useful for characterizing fractures, if more information is needed preoperatively, and CT arthrography can be used to evaluate the rotator cuff in the setting of a previous shoulder arthroplasty 1
From the Research
Preoperative Workup for Shoulder Arthroscopy
The normal preoperative workup for shoulder arthroscopy is crucial for a successful outcome. The following are some key points to consider:
- A complete preoperative evaluation is necessary to identify any concomitant co-pathology that may affect the outcome of the surgery 2
- Diagnostic arthroscopy is an important step in evaluating the shoulder joint and identifying any potential issues 3, 4, 5
- Patient positioning, knowledge of surgical anatomy, and proper portal placement are essential for a successful shoulder arthroscopy procedure 5
- The preoperative workup should also include an evaluation of the patient's medical condition and any medications they are taking, such as anticoagulation therapy 6
- The surgeon should be aware of potential co-pathologies, such as the HAGL lesion, ALPSA lesion, and SLAP tears, that can occur in concert with capsular pathology and present as potential barriers to a successful outcome 2
Key Considerations
Some key considerations in the preoperative workup for shoulder arthroscopy include:
- Evaluating the patient's overall health and medical condition to determine if they are a good candidate for surgery
- Assessing the patient's shoulder joint and identifying any potential issues or co-pathologies
- Developing an effective postoperative therapy program tailored to the repair strategy
- Ensuring that the patient is aware of the potential risks and benefits of the surgery and has given informed consent 2