# Help with shoulder scopes



## smcbroom (Mar 10, 2009)

I need some help with this one today.  I'm just not feeling well so I think that's what is blocking my brain.  If anyone can take a look at this op report for me and tell me what you think. I was thinking:
29823
29827
29806
29826
wasn't sure about 23430 or 23440 for the biceps tendon?

POSTOPERATIVE DIAGNOSES:
1.  Left shoulder subscapularis tear.
2.  Bankart lesion.
3.  Biceps subluxation.

PROCEDURES PERFORMED:
1.  Left shoulder arthroscopy with debridement of anterior and posterior labrum, supraspinatus, subscapularis, and bursa.
2.  Arthroscopic subscapularis repair.
3.  Arthroscopic Bankart repair.
4.  Arthroscopic subacromial decompression.
5.  Tenotomy and excision of long head of the biceps tendon.

FINDINGS:
Exam under anesthesia revealed obvious increased external rotation both at the side and in abduction as compared to the opposite side.  There was some generalized hyperlaxity.  Arthroscopic examination of the glenohumeral joint revealed the articular surfaces to be intact.  There was a small posterosuperior Hill?Sachs lesion.  There was an anterior Bankart tear, which was minimally displaced but was unstable to probing.  This extended down to approximately the 7 o'clock position anteroinferiorly.  There was fraying of the superior labrum with the meniscoid type attachment with no pathologic detachment superiorly.  There was a small undersurface partial-thickness tear of the anterior supraspinatus.  The biceps tendon was subluxated medially under the superior portion of the subscapularis tendon.  The superior one?third of the subscapularis tendon was torn to allow the subluxation of the biceps.  Examination of the subacromial space revealed a very small focal anterior acromial hook and no bursal sided cuff tears.

PROCEDURE IN DETAIL:
Following induction of general anesthesia, the patient was placed in the lateral decubitus position with the left shoulder up.  The left shoulder and upper extremity were prepped and draped in the usual fashion and suspended from 8-pound longitudinal traction.  Intermittent lateral traction was also used.  Standard posterior, anterior, and lateral portals were established and diagnostic arthroscopy was performed with the findings as above.  An anteroinferior portal was also established to aid in the Bankart and subscapularis repairs.

The shaver was used to debride the frayed labrum superiorly and posteriorly.  It was also used to debride the partial-thickness tear of the supraspinatus as well as the frayed superior subscapularis.  Biceps tendon was cut and allowed to retract and the stump was excised with the shaver.  The shaver was then used to excoriate and freshen the anteroinferior glenoid neck and to further mobilize the anterior labrum.  A working cannula was placed anteroinferiorly.  A lasso was used to place cinch stitch about the 7 o'clock position at the anteroinferior capsule and labrum.  A PushLock was placed at the 8 o'clock position to repair the labrum and shift the capsule.  Next, a second cinch stitch was placed about 1 cm superior to this through the capsule and labrum and this was shifted up to approximately the 9 o'clock position providing a good solid repair of the anterior labrum with the shift of the capsule and restoration of an anterior bumper.

Next, viewing of the subscapularis footprint was done with the 70-degree scope and the shaver and bur were used to freshen the footprint down to bleeding bone.  A corkscrew anchor was placed in the superior footprint of the subscapularis with two sutures loaded.  One of these sutures was placed through the superior subscapularis in a mattress fashion and the other in a simple fashion.  This appropriately repaired the superior portion of the subscapularis and restored its appropriate tension and position and provided a good solid repair.  This restored the normal appearance of the subscapularis.  Next, the subacromial space was entered.  The bursa was resected with the Vulcan and the shaver.  The coracoacromial ligament was released from the anterior acromion with the Vulcan.  The small anterior acromial hook was resected with the shaver and the shaver was used to smooth the underside of the acromion to do a limited decompression.  The remaining debris was removed with the shaver.  The arthroscope was withdrawn.  The portals were closed with nylon sutures and 30 cc of 0.25% Marcaine with epinephrine was instilled into the subacromial space.  A sterile dressing was applied followed by a sling.  The patient was awakened and extubated in the operating room and transferred to recovery room in stable condition.

I work at an ASC and it's a worker's comp case.
Any help is appreciated.


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## mbort (Mar 10, 2009)

HI Susan...look at for the tenotomy 23405


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## smcbroom (Mar 12, 2009)

thanks Mary, you came through as usual!!!  You need a raise girl


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## JillSmithers (Mar 17, 2014)

What do you use as the Dx for biceps subluxation?


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## amyjph (Mar 17, 2014)

It depends on if it is acute vs. chronic as far as the biceps sublux. dx


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