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Shoulder Arthroscopy: Anterior Portal

- Anterior Portal:
    - anterior portal is usually used for introduction of instruments;
    - this portal is placed under arthroscopic visualization from the posterior portal;
    - the needle is placed halfway between the AC joint and the lateral aspect of the coracoid;
           - this portal pierces the anterior fibers of the deltoid and enters joint in interval between the subscapularis & supraspinatus;
           - the needle should be directed into the anterior triangle formed by the labrum (medial border), biceps tendon (superior border), and subscapularis (inferior border);
           - some surgeons, place the needle more laterally, between the AC joint and the lateral acromial border;
    - due to the thickness of the anterior soft tissues, consider use of a disposable sheath to facilitate passage of instruments;
           - this sheath is usually 4.5 mm w/ a side port for inflow;
    - when this portal is switched into the subacromial space, it often passes directly through the CA ligament;
    - at the site of the anterior portal, the musculocutaneous nerve may be injured by medial portal placement 



Arthroscopy of the shoulder: technique and normal anatomy

A Comparison of Risk Between the Lateral Decubitus and the Beach-Chair Position When Establishing an Anteroinferior Shoulder Portal: A Cadaveric Study.

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