cclarson
Guru
Hello everyone, I'm having trouble deciphering whether or not the slap tear was repaired, or just the anterior section of the labrum. Also, what ICD-10 code would best fit for a bankart fx? Or would I code it as a dislocation code? Any help would be greatly appreciated!
POSTOPERATIVE DIAGNOSES:
1. Right shoulder anterior labral tear with Bankart fracture.
2. Right shoulder SLAP tear type II with anterior extension
3. Right shoulder synovitis.
PROCEDURES PERFORMED:
1. Right shoulder arthroscopic labral repair with capsulorrhaphy..
2. Right shoulder bicep tenodesis arthroscopic.
3. Arthroscopic debridement of synovitis.
INDICATIONS:
This is a 56-year-old with a work-related injury to her right shoulder. Her MRI indicated findings consistent with a dislocation of the shoulder with spontaneous reduction as well as anterior Bankart fracture. Given her findings she failed conservative measures after a long period of conservative measures she elected to proceed with surgery. The risks, benefits, and alternatives were discussed. Informed consent was obtained.
DESCRIPTION OF PROCEDURE:
The patient was identified in the preoperative holding area. The right shoulder was marked as the operative site. She received standard preoperative antibiotics, taken to the operating suite and placed in supine position. General anesthesia was given. She was placed in the lateral decubitus. Exam revealed a 1+ load and shift anterior, negative sulcus, no posterior instability. The right arm was then placed into an arm holder with 10 pounds of traction. It was then prepped and draped in the usual sterile fashion. Time out was performed prior to incision. Once all had agreed we proceeded. Posterior portal was created. The scope was placed into the glenohumeral joint. Outside in technique was used establish the anterior portal.
The bicep had some tearing at its insertion with instability of the superior labrum with tearing off the labrum. This extended along the anterior labrum down all the way around to the approximately 8 o’clock 9 o’clock position on the posterior labrum. There was a small Hill-Sachs lesion which was not engaging. Articular cartilage otherwise was normal. There did appear to be some bony Bankart involvement off the anterior inferior glenoid less than 10% width of the glenoid by estimation. The rotator cuff was intact. At that point a shaver was brought in. Extensive debridement of the synovitis in the interval as well as capsule was then performed. We then planned for first a bicep tenodesis. We used a loop and tack technique on the bicep to place a #2 SutureTape around the tendon in a lasso fashion. The suture was then dunked into the tendon. The tendon was pierced distal to the loop and then the suture was brought in for a secure loop and tack fixation. This was then loaded into a 4.75 BioComposite SwiveLock anchor. The tendon was then cut from its insertion and then the anchor was then driven down just off the articular surface at the groove to perform a tenodesis. The stump was then debrided. We then planned for a labral repair given her instability. The labrum was freed up off of its scarring down on the medial neck. There was small bony involvement. This was debrided with a shaver. Once we had freed up the labrum to be able to view the subscapularis underneath. We had good mobility to it. We placed a #2 SutureTape in a lasso fashion at approximately the 5:30 position. A short 2.9 PushLock anchor was then loaded, pilot hole was drilled and our first suture was then placed with good tensioning. We then placed three additional sutures at the anterior glenoid margin for a good repair. We then switched the scope to the anterior portal. Viewing posteriorly there were some nondisplaced tears extending up along the 8 or 9 o’clock position on the labrum. Two sutures were placed in similar fashion from the anterior labrum with short 2.9 BioComposite PushLock anchors. The anchors were driven down. We had a good repair posteriorly. At that point I was satisfied with our repair.
POSTOPERATIVE DIAGNOSES:
1. Right shoulder anterior labral tear with Bankart fracture.
2. Right shoulder SLAP tear type II with anterior extension
3. Right shoulder synovitis.
PROCEDURES PERFORMED:
1. Right shoulder arthroscopic labral repair with capsulorrhaphy..
2. Right shoulder bicep tenodesis arthroscopic.
3. Arthroscopic debridement of synovitis.
INDICATIONS:
This is a 56-year-old with a work-related injury to her right shoulder. Her MRI indicated findings consistent with a dislocation of the shoulder with spontaneous reduction as well as anterior Bankart fracture. Given her findings she failed conservative measures after a long period of conservative measures she elected to proceed with surgery. The risks, benefits, and alternatives were discussed. Informed consent was obtained.
DESCRIPTION OF PROCEDURE:
The patient was identified in the preoperative holding area. The right shoulder was marked as the operative site. She received standard preoperative antibiotics, taken to the operating suite and placed in supine position. General anesthesia was given. She was placed in the lateral decubitus. Exam revealed a 1+ load and shift anterior, negative sulcus, no posterior instability. The right arm was then placed into an arm holder with 10 pounds of traction. It was then prepped and draped in the usual sterile fashion. Time out was performed prior to incision. Once all had agreed we proceeded. Posterior portal was created. The scope was placed into the glenohumeral joint. Outside in technique was used establish the anterior portal.
The bicep had some tearing at its insertion with instability of the superior labrum with tearing off the labrum. This extended along the anterior labrum down all the way around to the approximately 8 o’clock 9 o’clock position on the posterior labrum. There was a small Hill-Sachs lesion which was not engaging. Articular cartilage otherwise was normal. There did appear to be some bony Bankart involvement off the anterior inferior glenoid less than 10% width of the glenoid by estimation. The rotator cuff was intact. At that point a shaver was brought in. Extensive debridement of the synovitis in the interval as well as capsule was then performed. We then planned for first a bicep tenodesis. We used a loop and tack technique on the bicep to place a #2 SutureTape around the tendon in a lasso fashion. The suture was then dunked into the tendon. The tendon was pierced distal to the loop and then the suture was brought in for a secure loop and tack fixation. This was then loaded into a 4.75 BioComposite SwiveLock anchor. The tendon was then cut from its insertion and then the anchor was then driven down just off the articular surface at the groove to perform a tenodesis. The stump was then debrided. We then planned for a labral repair given her instability. The labrum was freed up off of its scarring down on the medial neck. There was small bony involvement. This was debrided with a shaver. Once we had freed up the labrum to be able to view the subscapularis underneath. We had good mobility to it. We placed a #2 SutureTape in a lasso fashion at approximately the 5:30 position. A short 2.9 PushLock anchor was then loaded, pilot hole was drilled and our first suture was then placed with good tensioning. We then placed three additional sutures at the anterior glenoid margin for a good repair. We then switched the scope to the anterior portal. Viewing posteriorly there were some nondisplaced tears extending up along the 8 or 9 o’clock position on the labrum. Two sutures were placed in similar fashion from the anterior labrum with short 2.9 BioComposite PushLock anchors. The anchors were driven down. We had a good repair posteriorly. At that point I was satisfied with our repair.
