ortho1991
Guru
Hi All
I hope someone can help.
Dr dictates open casular release, open decompression.
status post hemiarthroplasty done 3 years ago.
A previous deltopectoral incision was made over the anterior aspect of the shoulder. We used that same incision, extended it slightly about 2-3 cm. Exam under anesthesia demonstrated and essentially locked frozen shoulder. Careful dissectin was taken down through the deltopectoral interval, down to the conjoined tendon. I then stayed lateral to the conjoined tendon, carefully resected down to over the coracoid process and then laterally over top of the subscapularis. Once I was able to identify this and carefully peel the deltoid away from the rotator cuff, the rotator cuff anteriorly was completely intact where I had done a previous osteotomy and repair. As I went slowly internally rotatin ghe arm, I was able to peel the entire supra and infraspinatus and all the way around the back of the shoulder, there were extensive adhesions noted between these layers totally capturing the patient's motion. However once I did this, the rotator cuff specially superior and posterior, was completely intact and healthy looking then motion was able to be achieved in the arm. I was able to externally rotate the arm out to about 60-70 degrees. I did open up the rotator interval to excise some of this tissue to further gain external rotation, but this also allowed me to place a retractor in the rotator interval and reach inside the subscapularis and release the anterior capsular with the Mets with direct visualization along the labrum. I was able to dissect down to the edge of the resurfacing head. I did remove andy inflamed synovities over the glenoid itself, released further labrum. Because I was able to achieve significant return, almost 80 % of pt range of motion
Please any suggestions will be greatly appreciated
Thank you
I hope someone can help.
Dr dictates open casular release, open decompression.
status post hemiarthroplasty done 3 years ago.
A previous deltopectoral incision was made over the anterior aspect of the shoulder. We used that same incision, extended it slightly about 2-3 cm. Exam under anesthesia demonstrated and essentially locked frozen shoulder. Careful dissectin was taken down through the deltopectoral interval, down to the conjoined tendon. I then stayed lateral to the conjoined tendon, carefully resected down to over the coracoid process and then laterally over top of the subscapularis. Once I was able to identify this and carefully peel the deltoid away from the rotator cuff, the rotator cuff anteriorly was completely intact where I had done a previous osteotomy and repair. As I went slowly internally rotatin ghe arm, I was able to peel the entire supra and infraspinatus and all the way around the back of the shoulder, there were extensive adhesions noted between these layers totally capturing the patient's motion. However once I did this, the rotator cuff specially superior and posterior, was completely intact and healthy looking then motion was able to be achieved in the arm. I was able to externally rotate the arm out to about 60-70 degrees. I did open up the rotator interval to excise some of this tissue to further gain external rotation, but this also allowed me to place a retractor in the rotator interval and reach inside the subscapularis and release the anterior capsular with the Mets with direct visualization along the labrum. I was able to dissect down to the edge of the resurfacing head. I did remove andy inflamed synovities over the glenoid itself, released further labrum. Because I was able to achieve significant return, almost 80 % of pt range of motion
Please any suggestions will be greatly appreciated
Thank you