Table 1.

Pearls and Pitfalls of Arthroscopic and Endoscopic Technique for Subcoracoid Synovial Chondromatosis of Shoulder Through Medial Transpectoral Portal

Pearls

Open the RI widely. Create enough room lateral to and in front of the conjoint tendon.

Create a J portal for improved visualization. Use a switching stick to avoid becoming lost during your initial cases.

From the J viewing portal, using an outside-in technique, create an I portal just in front of the tip of the coracoid process.

From the I viewing portal, using an outside-in technique, create the M portal medial to the tip of the coracoid process and in line with the nipple. Use a blunt trocar to dissect the pectoralis major, and aim at the tip of the coracoid process to avoid damaging the brachial plexus.

Switch the camera from the J portal to the I portal. Note that this allows better visualization in front of the coracoid, as well as medially and/or laterally and under it. Use a water pump initially to improve visualization, but do not overuse high pressures. Note that the bleeding areas are commonly on the medial and lateral sides of the base of the coracoid. Use a radiofrequency device facing laterally.

Once you have detached the pectoralis minor tendon, pay attention to the brachial plexus and the artery.

Open the subcoracoid bursa.

Pitfalls

Be aware of not detaching the conjoint tendon from the tip of the coracoid while opening the RI and detaching the coracoacromial ligament.

Create the J and I portals under direct visualization.

Avoid placing the medial portal (M portal) too low. Note that it is usually located around 6-8 cm above the nipple.

Avoid creating the M portal after detaching the pectoralis minor tendon, because it protects the blunt trocar from damaging the plexus and/or artery.

I, portal in front of the coracoid process; J, anteroinferior portal; M, transpectoral medial portal; RI, rotator interval.