PREOPERATIVE DIAGNOSES:
right massive rotator cuff tear, degenerative SLAP tear and impingement,right
shoulder.
POSTOPERATIVE DIAGNOSES:
Same
PROCEDURES:
1. Arthroscopic right massive rotator cuff repair.(29827)
2. Arthroscopic right subacromial decompression.(29826)
3. Arthroscopic limited debridement, right shoulder.(29822)
SURGEON:
.
ANESTHESIA:
General with an interscalene block.
ESTIMATED BLOOD LOSS:
25cc
IV FLUIDS:
1400cc
INDICATIONS FOR PROCEDURE:
is a 57 y.o. right hand dominant male who fell off a ladder in mid January approximately 7 feet onto his right shoulder. He reports global right shoulder pain that is resolved mostly since the fall. He currently reports pain with movement he cannot get his arm overhead he cannot sleep on that side. Of note he had a previous injury to his right shoulder and back in the Army 3 years ago for which he underwent cervical and lumbar fusion in 2010. He had physical therapy of the shoulder was then but otherwise no surgery injections recently. He had a physical exam and MRI consistent with a massive rotator cuff tear and degenerative SLAP 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.
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 into beach chair position with all bony prominences padded, prepped and draped in sterile fashion using ChloraPrep. The limb was elevated and the examination under anesthesia revealed a full range of motion of his
right shoulder and normal stability. Hewas prepped and draped in sterile fashion using ChloraPrep. The arthroscopy was begun using a posterior
portal. We immediately proceeded to the rotator cuff interval, made our
outside-in portal, began the diagnostic arthroscopy with the following
findings. The patient had a torn biceps tendon that had fraying and torn remnants at the glenoid attachment. The anterior, inferior and posterior labrum were otherwise intact. The
subscapularis had some fraying, but it was also attached well to the
lesser tuberosity. Examination of the supraspinatus revealed a massive retracted rotator cuff tear. We debrided
this back to stable rim and later visualized it from the subacromial space.
We used the arthroscopic shaver to debride the subscapularis, labrum, and glenoid back to a stable rim. We entered the
subacromial space and addressed the rotator cuff tear. We did this from the
posterior portal. We noted diffuse bursitis which was resected back to
stable rim using oscillating shaver and ArthroCare wand. There was type 2
acromial morphology anteriorly which was decompressed to type 1 acromial morphology
using a cutting block technique. The distal clavicle was also co-planed to
complete the decompression. We then examined the rotator cuff and again
found a massive retracted rotator cuff tear involving the entire supra and infraspinatus. The cuff was mobilized with a traction stitch elevators and an anterior interval slide technique The cuff was then mobile back to the footprint that was medialized 5mm and the footprint was debrided and prepared in the
standard fashion by removing all soft tissue and lightly decorticating the footprint. We then placed three Arthrex Biocorkscrews along the medial
edge of the footprint and passed each of the FiberWire stitches from those
in a mattress fashion. We put these through 2 lateral SwiveLock anchors for a
double row configuration. This gave us excellent coaptation and reduction
of the rotator cuff into the footprint and moved the unit with good
stability. Once this was accomplished, we removed the arthroscopic tools
from the joint, closed the portals using interrupted 3.0 nylon stitches in
A matress fashion. We put Xeroform over the portals. Dressing, sponges, ABD, foam tape
and an UltraSling were applied. The patient tolerated the procedure well
and was transferred to the recovery room in stable condition.
Postoperatively, the patient will be in an UltraSling for approximately 6 weeks. We
will see the patient back in the clinic in 10-14 days for repeat evaluation and
suture removal. We will start physical therapy on my rotator cuff protocol 4 weeks postoperatively.
right massive rotator cuff tear, degenerative SLAP tear and impingement,right
shoulder.
POSTOPERATIVE DIAGNOSES:
Same
PROCEDURES:
1. Arthroscopic right massive rotator cuff repair.(29827)
2. Arthroscopic right subacromial decompression.(29826)
3. Arthroscopic limited debridement, right shoulder.(29822)
SURGEON:
.
ANESTHESIA:
General with an interscalene block.
ESTIMATED BLOOD LOSS:
25cc
IV FLUIDS:
1400cc
INDICATIONS FOR PROCEDURE:
is a 57 y.o. right hand dominant male who fell off a ladder in mid January approximately 7 feet onto his right shoulder. He reports global right shoulder pain that is resolved mostly since the fall. He currently reports pain with movement he cannot get his arm overhead he cannot sleep on that side. Of note he had a previous injury to his right shoulder and back in the Army 3 years ago for which he underwent cervical and lumbar fusion in 2010. He had physical therapy of the shoulder was then but otherwise no surgery injections recently. He had a physical exam and MRI consistent with a massive rotator cuff tear and degenerative SLAP 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.
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 into beach chair position with all bony prominences padded, prepped and draped in sterile fashion using ChloraPrep. The limb was elevated and the examination under anesthesia revealed a full range of motion of his
right shoulder and normal stability. Hewas prepped and draped in sterile fashion using ChloraPrep. The arthroscopy was begun using a posterior
portal. We immediately proceeded to the rotator cuff interval, made our
outside-in portal, began the diagnostic arthroscopy with the following
findings. The patient had a torn biceps tendon that had fraying and torn remnants at the glenoid attachment. The anterior, inferior and posterior labrum were otherwise intact. The
subscapularis had some fraying, but it was also attached well to the
lesser tuberosity. Examination of the supraspinatus revealed a massive retracted rotator cuff tear. We debrided
this back to stable rim and later visualized it from the subacromial space.
We used the arthroscopic shaver to debride the subscapularis, labrum, and glenoid back to a stable rim. We entered the
subacromial space and addressed the rotator cuff tear. We did this from the
posterior portal. We noted diffuse bursitis which was resected back to
stable rim using oscillating shaver and ArthroCare wand. There was type 2
acromial morphology anteriorly which was decompressed to type 1 acromial morphology
using a cutting block technique. The distal clavicle was also co-planed to
complete the decompression. We then examined the rotator cuff and again
found a massive retracted rotator cuff tear involving the entire supra and infraspinatus. The cuff was mobilized with a traction stitch elevators and an anterior interval slide technique The cuff was then mobile back to the footprint that was medialized 5mm and the footprint was debrided and prepared in the
standard fashion by removing all soft tissue and lightly decorticating the footprint. We then placed three Arthrex Biocorkscrews along the medial
edge of the footprint and passed each of the FiberWire stitches from those
in a mattress fashion. We put these through 2 lateral SwiveLock anchors for a
double row configuration. This gave us excellent coaptation and reduction
of the rotator cuff into the footprint and moved the unit with good
stability. Once this was accomplished, we removed the arthroscopic tools
from the joint, closed the portals using interrupted 3.0 nylon stitches in
A matress fashion. We put Xeroform over the portals. Dressing, sponges, ABD, foam tape
and an UltraSling were applied. The patient tolerated the procedure well
and was transferred to the recovery room in stable condition.
Postoperatively, the patient will be in an UltraSling for approximately 6 weeks. We
will see the patient back in the clinic in 10-14 days for repeat evaluation and
suture removal. We will start physical therapy on my rotator cuff protocol 4 weeks postoperatively.