PREOPERATIVE DIAGNOSIS:
GIRD (glenohumeral internal rotation deficit) with posterior
capsular contracture and instability anteriorly, right
shoulder.
POSTOPERATIVE DIAGNOSIS:
GIRD (glenohumeral internal rotation deficit) with posterior
capsular contracture and instability anteriorly, right
shoulder.
PROCEDURES:
1. Arthroscopic capsulorrhaphy, mini-plication anteriorly,
right shoulder
2. Arthroscopic extensive debridement, right shoulder
including posterior capsular release as well as debridement of
labrum, glenoid, and rotator cuff
SURGEON:
ASSISTANT:
ANESTHESIA:
General with a block.
ESTIMATED BLOOD LOSS:
Minimal.
INTRAVENOUS FLUIDS:
1000 mL.
INDICATIONS FOR PROCEDURE:
is a 16-year-old right-hand dominant pitcher for
High School with a longstanding history of right
shoulder pain and dysfunction that precluded him from
pitching. He had failed extensive conservative treatment
including 2 glenohumeral injections and significant sleeper
stretches on his right upper extremity. He and his parents
understood the risks and benefits of operative intervention
and agreed to proceed with surgery today.
DESCRIPTION OF PROCEDURE:
The patient was brought to the operating room, placed supine
on the OR table, underwent general anesthesia without
difficulty. Preop time-out was done identifying his right
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 his right shoulder up. His
preoperative internal rotation was approximately 10 degrees
with a firm endpoint. We began by prepping and draping the
patient in a sterile fashion using ChloraPrep. We began the
diagnostic arthroscopy through a posterior portal. We
immediately proceeded to the rotator cuff interval and made
our outside-in portal in the standard fashion. Diagnostic
arthroscopy was performed with the following findings. His
biceps tendon was intact. There was no evidence of a SLAP
tear superiorly. He had a negative peel back sign. There was
some fissuring at the junction of the glenoid and labrum, but
no frank tearing of the labrum. His labrum was also intact
anteriorly, inferiorly and posteriorly as well. He had
significant fraying of his posterior capsule that was debrided
back to stable rim using oscillating shaver. He also had some
minor fraying on his glenoid that was debrided back to stable
rim using oscillating shaver and some minor fraying of his
posterior rotator cuff that was also debrided back to stable
rim using oscillating shaver. Otherwise, the remainder of his
rotator cuff was intact and firmly attached to the greater
tuberosity. We then made an accessory anterior portal for
viewing of the posterior capsule. We switched the camera to
the anterior portal for better visualization of the posterior
capsular structures. We then used the hooked electrocautery
to release the posterior capsule in a sequential layered
fashion from 6 o'clock to 9 o'clock. We did this
approximately 1-2 cm from the labrum to avoid labral injury
and get a good posterior capsular release.
Once this was done, we turned our attention to the anterior
shoulder and using a rasp, we abraded the anterior capsule
just medial to the labrum in order to promote healing. We
then used a curved suture lasso to place 2 plication stitches
through the capsule and labrum, using a curved suture lasso
and a 0 Maxon stitch. This gave us a good mini-plication
anteriorly and reduced the capsular volume anteriorly while we
had released the capsule posteriorly and this helped balance
the humerus back in the center of the glenoid properly. Once
this was done, we measured his postoperative range of motion.
His internal rotation increased to approximately 60 degrees.
We then closed all the portals using interrupted 3-0 nylon
stitches. Xeroform dressing, sponges, ABD, foam tape and a
sling were applied. The patient tolerated the procedure well
and transferred to recovery room in stable condition.
Postoperatively, he will follow up with us in 10-14 days for
repeat evaluation and suture removal. He is to start physical
therapy early next week with in . He is
to begin with immediate passive external rotation with his arm
at the side as well as sleeper stretches starting on
postoperative day #1. He has been instructed how to do those
as well. We will give him a detailed rehab protocol to be
delivered to his therapist, and see
him back in clinic in 10-14 days for repeat evaluation at that
time.
GIRD (glenohumeral internal rotation deficit) with posterior
capsular contracture and instability anteriorly, right
shoulder.
POSTOPERATIVE DIAGNOSIS:
GIRD (glenohumeral internal rotation deficit) with posterior
capsular contracture and instability anteriorly, right
shoulder.
PROCEDURES:
1. Arthroscopic capsulorrhaphy, mini-plication anteriorly,
right shoulder
2. Arthroscopic extensive debridement, right shoulder
including posterior capsular release as well as debridement of
labrum, glenoid, and rotator cuff
SURGEON:
ASSISTANT:
ANESTHESIA:
General with a block.
ESTIMATED BLOOD LOSS:
Minimal.
INTRAVENOUS FLUIDS:
1000 mL.
INDICATIONS FOR PROCEDURE:
is a 16-year-old right-hand dominant pitcher for
High School with a longstanding history of right
shoulder pain and dysfunction that precluded him from
pitching. He had failed extensive conservative treatment
including 2 glenohumeral injections and significant sleeper
stretches on his right upper extremity. He and his parents
understood the risks and benefits of operative intervention
and agreed to proceed with surgery today.
DESCRIPTION OF PROCEDURE:
The patient was brought to the operating room, placed supine
on the OR table, underwent general anesthesia without
difficulty. Preop time-out was done identifying his right
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 his right shoulder up. His
preoperative internal rotation was approximately 10 degrees
with a firm endpoint. We began by prepping and draping the
patient in a sterile fashion using ChloraPrep. We began the
diagnostic arthroscopy through a posterior portal. We
immediately proceeded to the rotator cuff interval and made
our outside-in portal in the standard fashion. Diagnostic
arthroscopy was performed with the following findings. His
biceps tendon was intact. There was no evidence of a SLAP
tear superiorly. He had a negative peel back sign. There was
some fissuring at the junction of the glenoid and labrum, but
no frank tearing of the labrum. His labrum was also intact
anteriorly, inferiorly and posteriorly as well. He had
significant fraying of his posterior capsule that was debrided
back to stable rim using oscillating shaver. He also had some
minor fraying on his glenoid that was debrided back to stable
rim using oscillating shaver and some minor fraying of his
posterior rotator cuff that was also debrided back to stable
rim using oscillating shaver. Otherwise, the remainder of his
rotator cuff was intact and firmly attached to the greater
tuberosity. We then made an accessory anterior portal for
viewing of the posterior capsule. We switched the camera to
the anterior portal for better visualization of the posterior
capsular structures. We then used the hooked electrocautery
to release the posterior capsule in a sequential layered
fashion from 6 o'clock to 9 o'clock. We did this
approximately 1-2 cm from the labrum to avoid labral injury
and get a good posterior capsular release.
Once this was done, we turned our attention to the anterior
shoulder and using a rasp, we abraded the anterior capsule
just medial to the labrum in order to promote healing. We
then used a curved suture lasso to place 2 plication stitches
through the capsule and labrum, using a curved suture lasso
and a 0 Maxon stitch. This gave us a good mini-plication
anteriorly and reduced the capsular volume anteriorly while we
had released the capsule posteriorly and this helped balance
the humerus back in the center of the glenoid properly. Once
this was done, we measured his postoperative range of motion.
His internal rotation increased to approximately 60 degrees.
We then closed all the portals using interrupted 3-0 nylon
stitches. Xeroform dressing, sponges, ABD, foam tape and a
sling were applied. The patient tolerated the procedure well
and transferred to recovery room in stable condition.
Postoperatively, he will follow up with us in 10-14 days for
repeat evaluation and suture removal. He is to start physical
therapy early next week with in . He is
to begin with immediate passive external rotation with his arm
at the side as well as sleeper stretches starting on
postoperative day #1. He has been instructed how to do those
as well. We will give him a detailed rehab protocol to be
delivered to his therapist, and see
him back in clinic in 10-14 days for repeat evaluation at that
time.