Unsure if this should be 29828, 29823 or 29828, 29826.
Can the removal of spur from the subacromial space be used as the 3rd debridement of the shoulder.
Postoperative Diagnosis:
1.Partial rotator cuff tear, right shoulder.
2.Labral tear anterior, posterior and superior labral complex.
3.Biceps partial tear/tendinitis.
4.Impingement syndrome.
Procedure Performed:
1.Arthroscopic surgery of the right shoulder with debridement of the rotator cuff and anterior, posterior, and superior labral complex.
2.Biceps tenodesis arthroscopically.
3.Subacromial decompression with release of the CA ligament.
4.Application of Breg SlingShot sling.
Description of Procedure: The patient was brought to the operating room. A time-out procedure was performed as per our protocol. Antibiotics were infused as per our protocol. The right shoulder was prepped and draped in the usual sterile fashion. All bony prominences had been well padded and the neck was placed in neutral position. The eyes were protected and sealed very nicely. It should be noted that an interscalene block had been performed by the department of anesthesia for postoperative pain control at my request. Portals were pre-injected with 2 mL of Marcaine each. Posterior portal was made. A 15-point inspection was performed. Type 1 labral tearing anterior, posterior, and superior labral complexes were debrided through a 7-mm Arthrex cannula with a 3.5 straight shaver until there were no loose edges or transition zones. At this point, the glenohumeral joint was assessed. There was no significant degenerative changes in the glenohumeral joint. There were no loose pieces. The rotator cuff was intact from the articular standpoint. The biceps tendon showed considerable fraying and inflammation. A Loop 'N' Tack was selected from Arthrex and the FiberWire was placed and looped up with the piercing device from Arthrex through the 7-mm Arthrex cannula. The loop was placed securely in the biceps tendon itself. Secure fixation was obtained with a FiberWire and using an ArthroCare type wand, the biceps was released. A shaver was used to debride the stump of the biceps until it was very smooth. At this point, our attention turned to a small incision made percutaneously. A longitudinal split in the rotator cuff was very small and this was over the bicipital groove. A 4.75 SwiveLock was inserted and the biceps was tenodesed nicely into this bicipital groove arthroscopically. Excellent secure fixation was obtained on the biceps itself. At this point, our attention turned to subacromial space where a thick bursitis was noted. A rather large anterolateral spur was noted as well. A subacromial decompression was performed removing all of the bursitis, removing the spur using a cutting block type technique. The CA ligament was released with an ArthroCare type wand. All loose pieces were removed. The rotator cuff showed minimal fraying from a bursal standpoint. This was debrided with a 3.5 straight shaver until there were no loose edges or transition zones. This was done without difficulty. At this point, a copious amount of irrigation was utilized. Hemostasis was maintained throughout the case with an ArthroCare type wand. At this point, 10 mL of 0.25% Marcaine was injected intra-articularly. The portals were closed with 4-0 nylon in simple interrupted fashion, followed by sterile dressings, followed by shoulder tape, followed by a Breg SlingShot sling. At this point, the patient was transferred to the recovery room in stable and satisfactory condition having tolerated the procedure well. There were no complications.
Can the removal of spur from the subacromial space be used as the 3rd debridement of the shoulder.
Postoperative Diagnosis:
1.Partial rotator cuff tear, right shoulder.
2.Labral tear anterior, posterior and superior labral complex.
3.Biceps partial tear/tendinitis.
4.Impingement syndrome.
Procedure Performed:
1.Arthroscopic surgery of the right shoulder with debridement of the rotator cuff and anterior, posterior, and superior labral complex.
2.Biceps tenodesis arthroscopically.
3.Subacromial decompression with release of the CA ligament.
4.Application of Breg SlingShot sling.
Description of Procedure: The patient was brought to the operating room. A time-out procedure was performed as per our protocol. Antibiotics were infused as per our protocol. The right shoulder was prepped and draped in the usual sterile fashion. All bony prominences had been well padded and the neck was placed in neutral position. The eyes were protected and sealed very nicely. It should be noted that an interscalene block had been performed by the department of anesthesia for postoperative pain control at my request. Portals were pre-injected with 2 mL of Marcaine each. Posterior portal was made. A 15-point inspection was performed. Type 1 labral tearing anterior, posterior, and superior labral complexes were debrided through a 7-mm Arthrex cannula with a 3.5 straight shaver until there were no loose edges or transition zones. At this point, the glenohumeral joint was assessed. There was no significant degenerative changes in the glenohumeral joint. There were no loose pieces. The rotator cuff was intact from the articular standpoint. The biceps tendon showed considerable fraying and inflammation. A Loop 'N' Tack was selected from Arthrex and the FiberWire was placed and looped up with the piercing device from Arthrex through the 7-mm Arthrex cannula. The loop was placed securely in the biceps tendon itself. Secure fixation was obtained with a FiberWire and using an ArthroCare type wand, the biceps was released. A shaver was used to debride the stump of the biceps until it was very smooth. At this point, our attention turned to a small incision made percutaneously. A longitudinal split in the rotator cuff was very small and this was over the bicipital groove. A 4.75 SwiveLock was inserted and the biceps was tenodesed nicely into this bicipital groove arthroscopically. Excellent secure fixation was obtained on the biceps itself. At this point, our attention turned to subacromial space where a thick bursitis was noted. A rather large anterolateral spur was noted as well. A subacromial decompression was performed removing all of the bursitis, removing the spur using a cutting block type technique. The CA ligament was released with an ArthroCare type wand. All loose pieces were removed. The rotator cuff showed minimal fraying from a bursal standpoint. This was debrided with a 3.5 straight shaver until there were no loose edges or transition zones. This was done without difficulty. At this point, a copious amount of irrigation was utilized. Hemostasis was maintained throughout the case with an ArthroCare type wand. At this point, 10 mL of 0.25% Marcaine was injected intra-articularly. The portals were closed with 4-0 nylon in simple interrupted fashion, followed by sterile dressings, followed by shoulder tape, followed by a Breg SlingShot sling. At this point, the patient was transferred to the recovery room in stable and satisfactory condition having tolerated the procedure well. There were no complications.