--------------------------------------------------------------------------------
posterolateral arthroscopy portal. I was able to enter the shoulder joint with a blunt cannula and trocar. I used the anterior superior viewing portal made with the 18-gauge needle to confirm the trajectory, and then with a small stab incision in the skin. This allowed me to gain access with the small cannula using the ArthroWand and shaver. Immediately, I noticed a large superior labral tear with attachment of the superior labrum and the peel back mechanism noted, and detachment of the biceps anchor. The labral tear extended anteriorly down to about the 3 o'clock position, with complete detachment. I was able to use the shaver to help delineate the remaining viable anatomy. I did trim this all down to stable peripheral rim of the labral tissue, including the superior aspect and the posterior superior portion, which was torn to about the 11 o'clock position. I obtained pictures of the inferior labrum, showing how there was really a hypoplastic labral tissue noted on the inferior aspect of the labrum, and that her shoulder was easily mobilizable and subluxable inferiorly.
The biceps tendon was tenotomized at this point to help to trim back the labral tissue to a stable peripheral rim. I was able to use a combination of biters and shavers to help to trim this back to a stable rim. I then visualized the rotator cuff, which was noted to be intact, even through internal and external rotation of the arm.
At this point, we suctioned the shoulder completely dry. I was able to advance with the cannula and trocar up into the subacromial space, where I was able to visualize purulent bursal material. I used the direct lateral portal to help me to remove this bursal tissue and visualize the rotator cuff. I did use a sweeping fashion with the shaver to help me to get the bursal tissue off of the rotator cuff around in the subdeltoid region, especially in the anterior and posterior aspect, and back to the musculotendinous junction. I viewed the inferior aspect of the AC joint and noted there was no evidence of prominent spurs or hyperplastic tissue in this area.
29823 is really all I see, am I missing something?
__________________
posterolateral arthroscopy portal. I was able to enter the shoulder joint with a blunt cannula and trocar. I used the anterior superior viewing portal made with the 18-gauge needle to confirm the trajectory, and then with a small stab incision in the skin. This allowed me to gain access with the small cannula using the ArthroWand and shaver. Immediately, I noticed a large superior labral tear with attachment of the superior labrum and the peel back mechanism noted, and detachment of the biceps anchor. The labral tear extended anteriorly down to about the 3 o'clock position, with complete detachment. I was able to use the shaver to help delineate the remaining viable anatomy. I did trim this all down to stable peripheral rim of the labral tissue, including the superior aspect and the posterior superior portion, which was torn to about the 11 o'clock position. I obtained pictures of the inferior labrum, showing how there was really a hypoplastic labral tissue noted on the inferior aspect of the labrum, and that her shoulder was easily mobilizable and subluxable inferiorly.
The biceps tendon was tenotomized at this point to help to trim back the labral tissue to a stable peripheral rim. I was able to use a combination of biters and shavers to help to trim this back to a stable rim. I then visualized the rotator cuff, which was noted to be intact, even through internal and external rotation of the arm.
At this point, we suctioned the shoulder completely dry. I was able to advance with the cannula and trocar up into the subacromial space, where I was able to visualize purulent bursal material. I used the direct lateral portal to help me to remove this bursal tissue and visualize the rotator cuff. I did use a sweeping fashion with the shaver to help me to get the bursal tissue off of the rotator cuff around in the subdeltoid region, especially in the anterior and posterior aspect, and back to the musculotendinous junction. I viewed the inferior aspect of the AC joint and noted there was no evidence of prominent spurs or hyperplastic tissue in this area.
29823 is really all I see, am I missing something?
__________________
