Shoulder Arthroscopy (Beach Chair)

Patient seated in the beach chair position for right shoulder surgery, with the head supported and the arm resting at the side — Patient seated in the beach chair position for right shoulder surgery, with the head supported and the arm resting at the side. The surface landmarks around the acromion and clavicle are marked before draping. Image from Bouloudhnine M. The Acromioclavicular-Distal Clavicle 3-Dimensional All-Suture Stabilization Technique Without Need for Fluoroscopy and Without Metallic Hardware. Arthrosc Tech. 2026, 15(8), e70185. CC BY 4.0.

Position

Beach chair position 60° with the patient positioned laterally to allow access to shoulder
Prep & drape arm free

Landmarks

Spine of scapula
Acromion
Coracoid process
Soft spot
- 2cm inferior & 1 cm medial to posterolateral tip of acromion

Incision

Posterior
- Stab incision in soft spot
- Plane
  - Teres minor
    - Axillary nerve
  - Infraspinatus
    - Suprascapular nerve
Anterior
- Plane
  - Pectoralis major
    - Medial & lateral pectoral nerves
  - Deltoid
    - Axillary nerve

Posterior Portal

Palpate coracoid process
Insert the trochar & arthroscopic sheath aiming towards coracoid process

Anterior Portal

Identify rotator interval between
- Supraspinatus
- Subscapularis
Insert long hypodermic needle into interval & incise the skin & capsule under direct vision

Structures

Biceps tendon
Supraspinatus
Inferior recess
Posterior recess
Humeral head
glenoid

Dangers

Posteriorly
- Axillary nerve
- Suprascapular nerve
Anteriorly
- Musculocutaneous nerve

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.