arthroscopy with subacromial debridement

PREOPERATIVE DIAGNOSES:  Right shoulder rotator cuff tear and history of instability.

POSTOPERATIVE DIAGNOSES:

1. Rotator cuff intact with anterior and posterior labral tear.

2. Synovitis and bursitis, right shoulder.

PROCEDURE:

1. Right shoulder arthroscopy with subacromial debridement, decompression.

2. Debridement of glenohumeral joint, anterior and posterior labrum, _____.

BLOOD LOSS:  Minimal.

FLUIDS:  Crystalloid.

COMPLICATIONS:  None.

INDICATIONS FOR SURGERY:  A 19-year-old female with multiple shoulder surgeries sustained another injury to the right shoulder.  Risks, benefits, and alternatives were discussed. The patient wished to proceed with surgery as that her parents.

OPERATIVE PROCEDURE:  The patient was identified, brought to the operating room, and placed in the supine position.  After induction of a general anesthetic, the right shoulder was sterilely prepped and draped.  Shoulder was inflated with saline.  Portal sites established.  Findings as follows:  The patient was noted to have intact rotator cuff.  A small anterior labral tear was identified, which flapped into the joint.  Posterior labral tear was also identified and debrided using full-radius.  The inferior labrum was grossly intact with the sutures being evident and intact. There was a small notch superiorly, but it did not impinge in the joint.  This was checked and then just gently trimmed using the basket forceps.  Posterior aspect was intact.  The glenohumeral joint showed no evidence of major arthrosis with minimal fraying of the articular cartilage.  I carefully inspected the entire cuff in the undersurface, did not notice any full-thickness defect.  We then went to the subacromial space, we switched off the cannulas.  We went superiorly using a full-radius resector and debridement performed of the thickened bursal tissue and scar tissue.  No full-thickness defects were again noted.  We then trimmed the undersurface of the acromion using a full radius resector, and after this, we removed all instruments from the shoulder.  The shoulder was closed with simple nylon sutures.  Sterile dressing applied.  The patient tolerated the procedure well.  My assistant was essential in this case.