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The 7-o’clock Posteroinferior Portal for Shoulder Arthroscopy

From Tampa Bay Orthopaedic Specialists, St. Petersburg, Florida

Address correspondence and reprint requests to Philip A. Davidson, MD, Tampa Bay Orthopaedic Specialists, 4000 Park Street North, St. Petersburg, FL 33709

Background: Access to the inferior glenohumeral joint of the shoulder is very limited through the traditional 2- or 3-o’clock anterior portals.

Hypothesis: The 7-o’clock posteroinferior portal offers an excellent alternative approach.

Study Design: Descriptive anatomic study.

Methods: Six paired cadaveric shoulders were used to arthroscopically develop and test a 7-o’clock posteroinferior portal. The distances between the portal and the subscapular and axillary nerves were measured with the arm in six different positions, combining flexion, extension, abduction, and adduction.

Results: The distance from the 7-o’clock posteroinferior portal to the axillary nerve was 39 ± 4 mm and to the suprascapular nerve was 28 ± 2 mm. There was no statistically significant nerve-to-portal differential distance when the arm was placed in flexion, extension, abduction, or adduction. The inside-to-outside technique produced a 7-o’clock posteroinferior portal approximately 5 mm further from both the axillary and suprascapular nerves than did the outside-to-inside method. The angle of divergence from the 7-o’clock posterior portal skin incision to the axillary nerve was 47° and to the suprascapular nerve was 33°.

Conclusions: The 7-o’clock portal affords safe, direct working access to the inferior capsular recess of the glenohumeral joint.

Clinical Relevance: The 7-o’clock portal is a safe and effective technique for use by shoulder surgeons.

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				T. Brown, R. S. Barton, and F. H. Savoie III Reverse Humeral Avulsion Glenohumeral Ligament and Infraspinatus Rupture With Arthroscopic Repair: A Case Report Am. J. Sports Med., December 1, 2007; 35(12): 2135 - 2139. [Full Text] [PDF]