Prone  -  Arms  Cephalad


Positioning of the arms while in the ventral decubitus position along side of the head to prevent against injury, nerve damage, vessel compression, pressure ulcers or other trauma during the procedure.


  • surgeon desires access to the middle to lower spine
  • procedures involving the sacral, perianal or perineal area
  • procedures involving posterior iliac crests for bone harvesting
  • procedures of posterior thighs or hips


  1. The patient is first placed in the Basic - Prone Position after induction and intubation.  (Click here to link back to "Basic - Prone Position" page).

  2. The head is either positioned neutrally along the sagittal plane, using a foam prone-cutout pillow, Mayfield tongs or a horseshoe headrest, or can positioned laterally, using a gel donut and/or blankets.  Eyes, ears, and nose should be checked to assure they are free from pressure.  The c-spine should be in neutral alignment.  The ETT should be checked for kinking or traction.

  3. Arm boards are secured to the table on either side and padded with egg crate, pillows, or blankets.  The arms are then carefully pulled away from the body in abduction, with elbows bent to 90 degrees, and placed in supination (palms down) along side of the head on the arm boards.  (Supination of the arms is the best way to prevent against ulnar nerve injury). 

  4. Arm rests devices that attach to and hang below the level of the table can also be used in the same fashion. These allow for a more normal relaxation of the spine by dropping the arms and shoulders.

  5. Attention is made to ensure that the IV of other lines are not lying against the skin (pad between arms and lines if necessary with soft gauze).  Egg crate, pillows or towels can be used to support the natural resting point for the arm in that position, so that extremities do not dangle (especially important in patients with arthritis or contractures). 

  6. Place a towel over the arm and use Velcro straps or tape over the towel to loosely secure the arm to the arm board.  Check to make sure at least two fingers can be slid underneath of the towel to prevent undue compression.   The arm boards are then positioned so that the arms are less than 90 degrees from the axilla and shoulder to prevent brachial plexus stretch injury.

  7. The legs are maintained in the long axis of the body with pillows placed under the calves and feet as described in the Prone - Basic Position page. 

  8. The patient is still secured to the table with tape or a belt across the thighs immediately under the buttocks.




Arm Boards


Arm Rests


Egg Crate


Foam  Pillows






Velcro Straps





  • Compression ulcers:  orbits, ears, nose, chin, iliac crests, knees, breasts

  • Pressure ulcers:  bony prominences at shoulder, elbows, wrists, and hands

  • Nerve damage:  brachial plexus, long thoracic, axillary, radial, ulnar, popliteal

  • Thoracic outlet syndrome

  • Neck injury or strain

  • Breast trauma

  • Unstable chest wall

  • Vessel compression:  axillary, subclavian, brachial