Pre-operative diagnosis:
1. Left shoulder adhesive capsulitis
Post-operative diagnosis: same
Procedure/description:
1. Exam under anesthesia
2. Manipulation under anesthesia
3. Left shoulder capsular release
4. Subacromial decompression / bursectomy
Operative findings:
1. Severe adhesive capsulitis
Specimens: None
Fluids/Blood: 500 ml crystalloid
Estimated Blood Loss: Minimal
Drains/Packs: none
Patient's condition: stable
Anesthesia: General with regional block
Indication for procedure: Patient is a 56 yr old female with history of diabetes and adhesive capsulitis which has failed conservative treatment. She elected to proceed with surgery after a discussion of risks, benefits, and alternatives to the procedures.
SUMMARY:
Patient seen in the holding area. The left upper extremity was identified and marked.
The history and physical was updated.
A regional block was administered by the anesthesia team.
The patient was then brought to the operating room and placed in the supine position. A general anesthetic was administered. The patient was then placed in the beach-chair position with padding under all bony prominences.
Examination of the shoulder showed the following:
Forward flexion with firm endpoint at 90 degrees. External rotation to 5 degrees. 10 degrees of internal rotation in 70 degrees of abduction.
The correct upper extremity was then prepped and draped in the usual sterile fashion. The arm was supported in a mechanical arm holder. A proper timeout was performed marking the correct operative extremity, preoperative antibiotics given, the correct equipment was in the room and sterile, and introduction of all members of the operating room.
An 18-gauge spinal needle was inserted into the joint 1 cm inferior and 1 cm medial to the lateral edge of the acromion. The joint was filled with approximately 10 ml of lactated ringers.
The standard posterior midglenoid arthroscopic portal (PMGP) was established. There was difficulty establishing the portal due to the restricted motion.
The scope was inserted into the shoulder through the posterior portal and diagnostic arthroscopy revealed the following:
Extensive synovitis within the rotator interval.
Normal superior labrum
Normal biceps tendon anchor.
Normal subscapularis tendon (after debridement of the rotator interval).
Thickened middle and inferior glenohumeral ligaments.
No Bankart lesion.
No HAGL lesion.
Normal posterior labrum.
No Hill-Sachs lesion.
The arm was placed in external rotation and abduction and the undersurface of the supraspinatus showed no evidence of tear.
A standard anterior midglenoid portal (AMGP) was established with outside-in technique through the rotator interval. A probe was used to assess the labrum and the biceps anchor.
The shaver and capsular punch were used to debride the rotator interval. The subscapularis tendon was identified and intact. The punch was used to undermine the capsular layer and was extended down to the 6 o'clock position.
Switching sticks were then used to place the camera anteriorly. The posterior capsule was then divided using the shaver and punch. A posterolateral portal (PLP) was established using outside-in technique and the punch was placed in the PLP. The camera was then placed back in the PMGP. The punch and camera were brought to the inferior capsule where the capsule was again divided with the punch meeting the anterior and posterior capsulotomies. The loose capsular tissue was debrided with the shaver.
The scope was then placed in the subacromial space and the following was found:
Extensive bursitis within the gutters. This was debrided after establishing a lateral portal. The camera was put in the lateral portal and the rotator cuff was examined with rotation of the arm and no tears were found.
The arm was taken through a range of motion postoperatively. She had 160 degrees of forward flexion, 80 degrees external rotation and 80 degrees internal rotation in 90 degrees of abduction.
The instruments were removed and the portals closed in the standard fashion with 3-0 nylon sutures. A standard, sterile dressing was applied. The patient was awakened from the anesthetic and transferred to the PACU bed. The patient was then taken to the PACU with stable vital signs. All needle and sponge counts were correct x 2.
Postoperative instructions were provided to the patient and include:
Wound care instructions,
Immediate active shoulder, elbow, wrist, and hand motion multiple times daily.
Order for physical therapy
1. Left shoulder adhesive capsulitis
Post-operative diagnosis: same
Procedure/description:
1. Exam under anesthesia
2. Manipulation under anesthesia
3. Left shoulder capsular release
4. Subacromial decompression / bursectomy
Operative findings:
1. Severe adhesive capsulitis
Specimens: None
Fluids/Blood: 500 ml crystalloid
Estimated Blood Loss: Minimal
Drains/Packs: none
Patient's condition: stable
Anesthesia: General with regional block
Indication for procedure: Patient is a 56 yr old female with history of diabetes and adhesive capsulitis which has failed conservative treatment. She elected to proceed with surgery after a discussion of risks, benefits, and alternatives to the procedures.
SUMMARY:
Patient seen in the holding area. The left upper extremity was identified and marked.
The history and physical was updated.
A regional block was administered by the anesthesia team.
The patient was then brought to the operating room and placed in the supine position. A general anesthetic was administered. The patient was then placed in the beach-chair position with padding under all bony prominences.
Examination of the shoulder showed the following:
Forward flexion with firm endpoint at 90 degrees. External rotation to 5 degrees. 10 degrees of internal rotation in 70 degrees of abduction.
The correct upper extremity was then prepped and draped in the usual sterile fashion. The arm was supported in a mechanical arm holder. A proper timeout was performed marking the correct operative extremity, preoperative antibiotics given, the correct equipment was in the room and sterile, and introduction of all members of the operating room.
An 18-gauge spinal needle was inserted into the joint 1 cm inferior and 1 cm medial to the lateral edge of the acromion. The joint was filled with approximately 10 ml of lactated ringers.
The standard posterior midglenoid arthroscopic portal (PMGP) was established. There was difficulty establishing the portal due to the restricted motion.
The scope was inserted into the shoulder through the posterior portal and diagnostic arthroscopy revealed the following:
Extensive synovitis within the rotator interval.
Normal superior labrum
Normal biceps tendon anchor.
Normal subscapularis tendon (after debridement of the rotator interval).
Thickened middle and inferior glenohumeral ligaments.
No Bankart lesion.
No HAGL lesion.
Normal posterior labrum.
No Hill-Sachs lesion.
The arm was placed in external rotation and abduction and the undersurface of the supraspinatus showed no evidence of tear.
A standard anterior midglenoid portal (AMGP) was established with outside-in technique through the rotator interval. A probe was used to assess the labrum and the biceps anchor.
The shaver and capsular punch were used to debride the rotator interval. The subscapularis tendon was identified and intact. The punch was used to undermine the capsular layer and was extended down to the 6 o'clock position.
Switching sticks were then used to place the camera anteriorly. The posterior capsule was then divided using the shaver and punch. A posterolateral portal (PLP) was established using outside-in technique and the punch was placed in the PLP. The camera was then placed back in the PMGP. The punch and camera were brought to the inferior capsule where the capsule was again divided with the punch meeting the anterior and posterior capsulotomies. The loose capsular tissue was debrided with the shaver.
The scope was then placed in the subacromial space and the following was found:
Extensive bursitis within the gutters. This was debrided after establishing a lateral portal. The camera was put in the lateral portal and the rotator cuff was examined with rotation of the arm and no tears were found.
The arm was taken through a range of motion postoperatively. She had 160 degrees of forward flexion, 80 degrees external rotation and 80 degrees internal rotation in 90 degrees of abduction.
The instruments were removed and the portals closed in the standard fashion with 3-0 nylon sutures. A standard, sterile dressing was applied. The patient was awakened from the anesthetic and transferred to the PACU bed. The patient was then taken to the PACU with stable vital signs. All needle and sponge counts were correct x 2.
Postoperative instructions were provided to the patient and include:
Wound care instructions,
Immediate active shoulder, elbow, wrist, and hand motion multiple times daily.
Order for physical therapy