j-fowler57
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Below is a OR report and I need help with the "take down of scar tissue rotator interval left shoulder". He has been documenting alot of this lately and just not quite sure what it is. Any help truly appreciated
THANKS
POSTOPERATIVE DIAGNOSES:
1. Anterior impingement of the left shoulder.
2. Chronic fulminous subacromial bursitis of left shoulder.
3. Intact rotator cuff left shoulder.
4. Scarification rotator interval left shoulder glenohumeral joint. OPERATION:
1. Surgical arthroscopy left shoulder.
2. Subacromial decompression left shoulder with subacromial bursectomy.
3. Take down scar tissue rotator interval left shoulder. ANESTHESIA: General inhalation.
BRIEF HISTORY: The above mentioned patient is a 57-year-old gentleman with symptoms referable to the left shoulder characterized as rotator cuff pathology, admitted now for treatment of the same.
FINDINGS AT SURGERY:
1. Intact rotator cuff left shoulder.
2. Intact linear labrum.
3. Scarification of the rotator interval of the left shoulder.
4. Anterior impingement of left shoulder.
DETAILED OPERATIVE PROCEDURE: After induction of satisfactory general inhalation anesthesia and Scalene block anesthesia the patient was placed in the Schlein-type chair position and placed in the appropriate position after which we checked the blood pressure to be sure of stability. The left upper extremity was then prepped and draped in a standard fashion.
The marking pen was used to mark all bony landmarks and a 0.25% Marcaine with Epinephrine was instilled posterior, anterior and lateral to the acromion. The posterior portal was developed. The arthroscope introduced into the glenohumeral joint. Examination of the glenohumeral joint revealed intact glenolabrum with triangulation which appeared to be intact. There was scarification of the rotator interval with inflammation of the superior aspect of the shoulder in the glenohumeral space beneath the rotator cuff and this was taken down very carefully with a smooth shaver. We assessed completely the rotator cuff it was intact in its entirety on the articular side.
I took down the scar tissue of the rotator interval in particular that tissue was from inferior to superior along the anterior aspect of the anterior medial aspect of the shoulder. There was no glenolabrum tear with triangulation. The anterior capsule of the anterior glenoid was intact. Following this debridement the shoulder appeared to be more normal anatomically.
It is important to mention as well, the subcapsular was intact in its entirety. The arthroscope was then introduced into the subacromial space. We developed a subacromial space with debridement of the undersurface of the acromion. Identified a large bone spur across the anterior acromion and this was taken down. It was more thickened medially near the AC joint. The joint did not appear to be involved of any significance and therefore did not require arthroplasty. I completed the removal of the anterior bony ridge which was built up slightly medially at the AC joint under the acromion and took down this area as an anterior decompression and subacromial decompression with good result. The deltoid fascia remained intact. There was significant subacromial bursitis and I did debride this from the rotator cuff on it with a smooth shaver assuring viability of the rotator cuff.
The rotator cuff was debrided with slightly hypermobile, possible slightly redundant but no tears were detached as already identified. Following this the joint was irrigated with antibiotic and Saline solution as was the subacromial space, 0.25% Marcaine instilled into the subcutaneous tissues. The skin reapproximated with interrupted 4-0 nylon.
THANKSPOSTOPERATIVE DIAGNOSES:
1. Anterior impingement of the left shoulder.
2. Chronic fulminous subacromial bursitis of left shoulder.
3. Intact rotator cuff left shoulder.
4. Scarification rotator interval left shoulder glenohumeral joint. OPERATION:
1. Surgical arthroscopy left shoulder.
2. Subacromial decompression left shoulder with subacromial bursectomy.
3. Take down scar tissue rotator interval left shoulder. ANESTHESIA: General inhalation.
BRIEF HISTORY: The above mentioned patient is a 57-year-old gentleman with symptoms referable to the left shoulder characterized as rotator cuff pathology, admitted now for treatment of the same.
FINDINGS AT SURGERY:
1. Intact rotator cuff left shoulder.
2. Intact linear labrum.
3. Scarification of the rotator interval of the left shoulder.
4. Anterior impingement of left shoulder.
DETAILED OPERATIVE PROCEDURE: After induction of satisfactory general inhalation anesthesia and Scalene block anesthesia the patient was placed in the Schlein-type chair position and placed in the appropriate position after which we checked the blood pressure to be sure of stability. The left upper extremity was then prepped and draped in a standard fashion.
The marking pen was used to mark all bony landmarks and a 0.25% Marcaine with Epinephrine was instilled posterior, anterior and lateral to the acromion. The posterior portal was developed. The arthroscope introduced into the glenohumeral joint. Examination of the glenohumeral joint revealed intact glenolabrum with triangulation which appeared to be intact. There was scarification of the rotator interval with inflammation of the superior aspect of the shoulder in the glenohumeral space beneath the rotator cuff and this was taken down very carefully with a smooth shaver. We assessed completely the rotator cuff it was intact in its entirety on the articular side.
I took down the scar tissue of the rotator interval in particular that tissue was from inferior to superior along the anterior aspect of the anterior medial aspect of the shoulder. There was no glenolabrum tear with triangulation. The anterior capsule of the anterior glenoid was intact. Following this debridement the shoulder appeared to be more normal anatomically.
It is important to mention as well, the subcapsular was intact in its entirety. The arthroscope was then introduced into the subacromial space. We developed a subacromial space with debridement of the undersurface of the acromion. Identified a large bone spur across the anterior acromion and this was taken down. It was more thickened medially near the AC joint. The joint did not appear to be involved of any significance and therefore did not require arthroplasty. I completed the removal of the anterior bony ridge which was built up slightly medially at the AC joint under the acromion and took down this area as an anterior decompression and subacromial decompression with good result. The deltoid fascia remained intact. There was significant subacromial bursitis and I did debride this from the rotator cuff on it with a smooth shaver assuring viability of the rotator cuff.
The rotator cuff was debrided with slightly hypermobile, possible slightly redundant but no tears were detached as already identified. Following this the joint was irrigated with antibiotic and Saline solution as was the subacromial space, 0.25% Marcaine instilled into the subcutaneous tissues. The skin reapproximated with interrupted 4-0 nylon.