Shoulder Arthroscopy techniques may pose surgical risk to vascular structures that may cause active bleeding during surgery. The vascularity of the subacromial structures showed constant patterns of distribution and specific sources of bleeding were analyzed. Knowledge of the vascular anatomy may decrease the bleeding during subacromial arthroscopy surgery.

Shoulder Arthroscopy techniques may pose surgical risk to vascular structures that may cause active bleeding during surgery. A detailed anatomy map of frequent sources of bleeding is more than desired in order to properly identify these bleeding points, and avoid the unnecessary overuse of thermal tools and pressure pumps to control the hemorrhage.

Our purpose is to study the vascular anatomy of the subacromial space, and to map the major sources of expected bleeding during subacromial arthroscopy surgery.

Ten shoulders of five adult cadavers underwent whole body arterial perfusion with a mixture of lead oxide, gelatin and water. The shoulders were dissected, photographed, tissue specimens were radio graphed, scanned and analyzed with a digital software analyzer. Careful dissection of the different arteries of the subacromial bursa, and anatomic landmarks of the walls were documented. Correlations of bleeding areas during subacromial arthroscopic surgery and cadaver dissection were carried out. A vascular map of the bursa was created.

The vascularity of the subacromial structures showed constant patterns of distribution and specific sources of bleeding were analyzed. We divided this space into walls with their major arteries as follows: Anterior wall: Acromial branch of the thoracoacromial artery. Posterior wall: Acromial branch of the suprascapular artery. Medial wall: Anterior and posterior Arteries of the AC joint. Lateral wall: No major arteries identified. Vascularity of the roof and floor is also described.

The subacromial space is highly vascular. Knowledge of the vascular anatomy may decrease the bleeding during subacromial arthroscopy surgery.

The demand for knee arthroplasty (TKR) is increasing yet there are no established criteria for prioritizing patients. We investigated surgeon inter-observer reliability and factors that influenced their prioritization of patients by having three surgeons each independently consult on twelve randomly selected patients waiting for TKR. Surgeons had high reliability and were most influence by the patient’s pain and gait pattern when assigning priority. Surgeon assigned priority also correlated with common subjective outcome metrics. Formalized gait assessment may allow for more objective prioritization of patients waiting for TKR.

The purpose of this study was to investigate the inter-observer reliability of surgeons assessing the priority of patients waiting for elective total knee arthroplasty (TKR) surgery, and to assess the discriminative methodology surgeons employ when assessing patients.

Surgeon’s can reliably assign a priority to their patients waiting for TKR. Surgeons generally consider the patients pain and gait pattern when assigning priority.

Wait lists for elective TKR are increasing and the demand will continue to grow. Objective criteria for prioritizing patients would allow for rational delivery of limited surgical resources.

Surgeons have high inter-observer reliability when assigning patient priority (ICC = 0.86). Pain and gait pattern have a significant impact on the surgeon’s assessment of priority (p=0.25 and p< 0.001, respectively). The oxford twelve most closely correlated to the surgeon’s prioritization (r=0.80).

Twelve patients waiting for TKR were randomly selected from three surgeons wait lists. Each surgeon independently examined all twelve patients and recorded their assessment of the patient’s acuity (priority) on a visual analogue scale. The impact of various aspects of the patient’s presentation on the surgeon’s assessment, such as pain control, function, gait, joint contracture and radiographic appearance, were recorded. All patients completed the SF-36, Oxford twelve and WOMAC questionnaires. Linear regression and Intra-Class Correlation Coefficients were used to assess the data.

Through the complex patient-surgeon interaction during a standard consultation, surgeons are able to prioritize their patient’s with high reliability. Improved objective metrics for prioritizing patient’s may be possible by more formalized methods of gait assessment.