Right shoulder arthroscopy

PREOPERATIVE DIAGNOSES:

1.  Right shoulder rotator cuff tear.

2.  Possible biceps tear.

POSTOPERATIVE DIAGNOSES:

1.  Right shoulder rotator cuff tear, full thickness.

2.  Biceps tenosynovitis.

3.  Impingement.

4.  Anterior and posterior labral tears.

5.  Early frozen shoulder.

OPERATION PERFORMED:  Right shoulder arthroscopy with,

1.  Rotator cuff repair.

2.  Arthroscopic subacromial decompression including acromioplasty.

3.  Debridement of glenohumeral joint, major, right shoulder.

4.  Manipulation of right shoulder under anesthesia.

SURGEON:  Howard Gelb, MD

ASSISTANT:  Jessica Wheeler, PA-C

BLOOD LOSS:  Minimal.

FLUIDS:  Crystalloid.

COMPLICATIONS:  None.

INDICATIONS FOR SURGERY:  The patient is a 70-year-old gentleman with right shoulder pain and weakness.  Risks, benefits, and alternatives discussed.  The patient wished to proceed with surgery.

PROCEDURE IN DETAIL:  The patient was identified, brought to the operating room, and placed in supine position on the table.  After induction of a general anesthetic and a scalene block, the right shoulder was sterilely prepped and draped in the usual fashion.  Shoulder was inflated with saline.  Portal sites were established.  The findings were as follows:  The patient was noted to have an anterior and posterior labral tear.  The patient was noted to have stiffness of the shoulder.  The shoulder was gently manipulated just at the beginning of the case.  The patient was noted to have biceps tenosynovitis at the periphery, but the central portion at the biceps anchor was grossly intact.  I did not feel this required a biceps tenodesis based on this and the fact that the biceps was just somewhat freed, again required debridement.  Debridement was performed using a full-radius resector.  We also resected anterior and posterior labral tears as well as tears of the rotator cuff.  At this time, the patient’s subacromial space was entered and the findings were as follows:  The patient was noted to have a full-thickness cuff defect involving the supraspinatus.  Subacromial space had a bone spur.  The AC joint was evaluated, but was not resected.  At this point, decompression performed using full-radius resector followed by ArthroCare and a bur.  Decompression performed to smooth the undersurface of the acromion.  The cuff was then repaired as follows:  We gently debrided the greater tuberosity.  We then passed multiple sutures through the cuff.  Total of eight sutures were passed through the cuff in a modified technique giving us a mattress suture.  The suture was then brought out laterally.  The 8 mm cannula was placed and we then used the Arthrex anchors with a closed-loop Swivel-Lock.  These were _____ anchors.  One was placed posteriorly placing four sutures through the central portion and the second screw was placed more anteriorly with again four sutures placed through it.  The screws were then placed down into the humeral head at the deadman’s angle and tensioned appropriately.  The cuff was then firmly affixed to the humeral head using eight sutures.  Once this was completed, the shoulder was taken through range of motion and cuff repair was satisfactory.  The instruments were then removed from the shoulder.  Shoulder was closed with simple nylon sutures.  Sterile dressings were applied.  The patient was then brought to recovery room in good condition.  My assistant was essential during this very complicated case.