29806
OR 29806 & 29807
Confused :?
j,CCS,CPC
PREOPERATIVE DIAGNOSIS:
right posterior Bankart plus SLAP tear.
POSTOPERATIVE DIAGNOSIS:
Same
PROCEDURE:
1. Arthroscopic right capsulorrhaphy/posterior Bankart repair.(29806)
2. Arthroscopic right SLAP repair.(29807)
, MD
ASSISTANT:
xxxPA was crucial for the entirety of the case, and no
qualified resident was available.
ANESTHESIA:
General with a block.
ESTIMATED BLOOD LOSS:
50cc
INTRAVENOUS FLUIDS:
1400cc
INDICATION FOR PROCEDURE:
is a 23 y.o. xxx is a 23-year-old male who had a long history of right
shoulder pain and was diagnosed with a strain in the military.
At that time, he could move his arm above 90 degrees. He had
physical therapy and then back training very quickly. He has
now had right shoulder pain for the last 2 years. He has got
full range of motion, but is painful with lifting 20 pounds
over his head. He reports he has had repetitive subluxation
events. This happened 1-1/2 months ago in the gym. He has a
constant instability with using weights. He has never had a
full dislocation that need to be reduced in the emergency
room. He currently reports a dull posterior pain that become
sharp with activity. He has got no alleviating symptoms to
this point. He has had physical therapy and occupational
therapy. There has been no help. He had an injection 3
months ago that made it worse. . He had a physical exam and MRI consistent with a SLAP/postrior Bankart tear. He was advised of the risks and benefits of operative versus nonoperative treatment. He understood those risks and benefits and agreed to proceed with surgery today.
PROCEDURE:
The patient brought to the operating room and placed supine on the OR
table. He underwent general anesthesia without difficulty. Preop timeout
identifying hisright shoulder as the operative shoulder. He was given preoperative antibiotics and a block in the holding area. He was placed in
a lateral decubitus position with all bony prominences padded, prepped and
draped in sterile fashion using ChloraPrep. Standard diagnostic
arthroscopy was begun using a posterior portal. We immediately proceeded
to the rotator cuff interval, made our outside-in portal and began the
diagnostic arthroscopy with the following findings. His biceps tendon was
intact without tearing or instability; there was a negative peel back sign. His anterior glenoid had no labral tear
But the superior and posterior labrum were torn from the 12 o'clock all the way down to the 6 o'clock position.
There was no bony deficiency, but there was a labral tear posteriorly and superiorly. The remainder of the labrum was intact anteriorly. The subscapularis and the supraspinatus were intact.
We prepared the glenoid by mobilizing the labrum with the arthroscopic liberators and then abraded the glenoid with the oscillating shaver for capsulorrhaphy. We then placed a
7 o'clock portal with a 6:30 anchor and 2 simple stitches from
a double-loaded anchor with good capsular shift proximally, then again 7:30
and 9:00 on the posteriorglenoid with good shifting of tissue and good
restoration of soft tissue over the posterior glenoid rim. We then turned our attention to the SLAP tear. 2 pushlock anchors with labral teape were placed at 11 and 10 o'clock respectively with good repair of the SLAP tear. The drive-through sign was eliminated. His shoulder had better stability
from his preoperative examination under anesthesia which revealed a soft
end point to load and shift. We removed the arthroscopic tools from the
joint and closed the portals using interrupted 3.0 nylon stitches in a
simple fashion. Xeroform, dressing sponges, ABD, foam tape and a sling
were applied. The patient tolerated the procedure well, was transferred to
the recovery room in stable condition.
Postoperatively, he will be in a sling for a total of 4 weeks. We will see
him back in clinic in 2 weeks for repeat evaluation and suture removal. At
that time, we will order physical therapy on my SLAP and Bankart repair
protocol.
OR 29806 & 29807
Confused :?
j,CCS,CPC
PREOPERATIVE DIAGNOSIS:
right posterior Bankart plus SLAP tear.
POSTOPERATIVE DIAGNOSIS:
Same
PROCEDURE:
1. Arthroscopic right capsulorrhaphy/posterior Bankart repair.(29806)
2. Arthroscopic right SLAP repair.(29807)
, MD
ASSISTANT:
xxxPA was crucial for the entirety of the case, and no
qualified resident was available.
ANESTHESIA:
General with a block.
ESTIMATED BLOOD LOSS:
50cc
INTRAVENOUS FLUIDS:
1400cc
INDICATION FOR PROCEDURE:
is a 23 y.o. xxx is a 23-year-old male who had a long history of right
shoulder pain and was diagnosed with a strain in the military.
At that time, he could move his arm above 90 degrees. He had
physical therapy and then back training very quickly. He has
now had right shoulder pain for the last 2 years. He has got
full range of motion, but is painful with lifting 20 pounds
over his head. He reports he has had repetitive subluxation
events. This happened 1-1/2 months ago in the gym. He has a
constant instability with using weights. He has never had a
full dislocation that need to be reduced in the emergency
room. He currently reports a dull posterior pain that become
sharp with activity. He has got no alleviating symptoms to
this point. He has had physical therapy and occupational
therapy. There has been no help. He had an injection 3
months ago that made it worse. . He had a physical exam and MRI consistent with a SLAP/postrior Bankart tear. He was advised of the risks and benefits of operative versus nonoperative treatment. He understood those risks and benefits and agreed to proceed with surgery today.
PROCEDURE:
The patient brought to the operating room and placed supine on the OR
table. He underwent general anesthesia without difficulty. Preop timeout
identifying hisright shoulder as the operative shoulder. He was given preoperative antibiotics and a block in the holding area. He was placed in
a lateral decubitus position with all bony prominences padded, prepped and
draped in sterile fashion using ChloraPrep. Standard diagnostic
arthroscopy was begun using a posterior portal. We immediately proceeded
to the rotator cuff interval, made our outside-in portal and began the
diagnostic arthroscopy with the following findings. His biceps tendon was
intact without tearing or instability; there was a negative peel back sign. His anterior glenoid had no labral tear
But the superior and posterior labrum were torn from the 12 o'clock all the way down to the 6 o'clock position.
There was no bony deficiency, but there was a labral tear posteriorly and superiorly. The remainder of the labrum was intact anteriorly. The subscapularis and the supraspinatus were intact.
We prepared the glenoid by mobilizing the labrum with the arthroscopic liberators and then abraded the glenoid with the oscillating shaver for capsulorrhaphy. We then placed a
7 o'clock portal with a 6:30 anchor and 2 simple stitches from
a double-loaded anchor with good capsular shift proximally, then again 7:30
and 9:00 on the posteriorglenoid with good shifting of tissue and good
restoration of soft tissue over the posterior glenoid rim. We then turned our attention to the SLAP tear. 2 pushlock anchors with labral teape were placed at 11 and 10 o'clock respectively with good repair of the SLAP tear. The drive-through sign was eliminated. His shoulder had better stability
from his preoperative examination under anesthesia which revealed a soft
end point to load and shift. We removed the arthroscopic tools from the
joint and closed the portals using interrupted 3.0 nylon stitches in a
simple fashion. Xeroform, dressing sponges, ABD, foam tape and a sling
were applied. The patient tolerated the procedure well, was transferred to
the recovery room in stable condition.
Postoperatively, he will be in a sling for a total of 4 weeks. We will see
him back in clinic in 2 weeks for repeat evaluation and suture removal. At
that time, we will order physical therapy on my SLAP and Bankart repair
protocol.