Debridement of glenohumeral joint major, anterior, posterior, and superior labrum and partial thickness cuff tear

PREOPERATIVE DIAGNOSES:

1.  Right shoulder osteoarthritis, distal clavicle.

2.  Impingement.

3.  Labral tear.

POSTOPERATIVE DIAGNOSES:

1.  Right shoulder osteoarthritis, distal clavicle.

2.  Impingement.

3.  Labral tear.

OPERATIONS PERFORMED:  Right shoulder arthroscopies:

1.  Arthroscopic subacromial decompression including acromioplasty.

2.  Distal clavicle resection, arthroscopic.

3.  Debridement of glenohumeral joint major, anterior, posterior, and superior labrum and partial thickness cuff tear.

BLOOD LOSS:  Minimal.

FLUIDS:  Crystalloid.

COMPLICATIONS:  None.

INDICATIONS:  The patient is a 38-year-old police officer with right shoulder pain, chronic.  Risks, benefits, and alternatives were discussed.  Preoperative MRI obtained.  The patient wished to proceed with surgery.

PROCEDURE IN DETAIL:  The patient was identified, brought to the operating room, and placed in the supine position on table.  After induction of a general anesthetic, the right shoulder was sterilely prepped and draped.  Shoulder was inflated with saline and portal sites were established.  The findings were as follows:  The patient was noted to have a partial thickness undersurface tear of the supraspinatus and there was evidence of an anteroposterior labral tear and posterior labral tear, which extended to about the 6 o'clock position.  There was evidence of fraying of the anterior labrum at the foramen and just a lobe.  At this point using a full-radius resector, debridement was performed at the glenohumeral joint, anteroposterior labrum, and rotator cuff.  This is a partial cuff tear not requiring repair.  Posterior labrum was debrided back to stable rim.  I felt that debriding it any further, there would not be a much tissue left and in addition I did not think the tissue was repairable.  At this point, we then went from the glenohumeral joint into the subacromial space.

Subacromial space entered.  Severe bursitis is noted.  Another portal was established laterally, we debrided the subacromial space.  The cuff was intact.  We then extended our dissection to the acromioclavicular joint.  We then debrided the acromion first and acromioplasty was performed using 4.0 burr.  We then shifted our anterior portal to allow for debridement of the clavicle.  We debrided the undersurface of the distal clavicle for approximately 6 to 7 mm at most and once we established enough position there, we debrided the AC joint to a direct portal from superior and resected anteroposterior clavicle.  After completion of this, all instruments removed from the shoulder.  The shoulder was closed with simple nylon sutures.  Sterile dressings were applied.  The patient brought to recovery in good condition.  Please note, we injected the shoulder with Marcaine subacromially and in the AC region as well as portal sites, but did not go into the glenohumeral joint itself.