Procedure Name:
1) Left shoulder examination under anesthesia
2) Left shoulder diagnostic arthroscopy
3) Left shoulder arthroscopic biceps tenotomy
4) Left shoulder debridement degenerative SLAP tear
5) Left shoulder arthroscopic subacromial decompression
6) Left shoulder arthroscopic distal clavicle resection
7) Left shoulder open subpectoral biceps tenodesis
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Findings: type II degenerative SLAP tear, biceps inflammation, subacromial bursitis. Degenerative AC joint.
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Implants:
Implant Name Type Inv. Item Serial No. Manufacturer Lot No. LRB No. Used
KT SUT FIBERLOOP DRL PIN NDL – SAR-2290 – LOG505948 Other Implant KT SUT FIBERLOOP DRL PIN NDL AR-2290 Arthrex 10155719 Left 1
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Arthroscopic findings: Biceps tendon: proximal tenosynovitis superior labrum: type 2 degenerative tear anterior labrum: intact subscapularis: intact axillary pouch: no loose bodies teres minor: intact infraspinatus: intact supraspinatus: intact articular surface the glenoid: pristine articular surface the humeral head: pristine Bursa: bursitis and synovitis bursal surface of the rotator cuff: intact. AC joint: advanced DJD.
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DESCRIPTION OF PROCEDURE:
The patient was identified in the preop hold area and the surgical site was marked. The history and physical was updated. The patient was transported to the operating room and placed supine on the OR table. General endotracheal anesthesia was administered without difficulty. An exam under anesthesia was performed and there was no instability and full range of motion. Prophylactic antibiotics were administered. The patient was placed in the beach chair position, the head was well supported in the head holder. The intermittent compression stockings were on the lower extremities. The shoulder and arm were prepped with ChloroPrep, in the usual fashion, dry time allowed and draped free into a sterile field. The arm holder was used to place the arm in traction and well supported.
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The bony landmarks were identified and marked. A spinal needle was used to enter the posterior glenohumeral joint and insufflated with 25 mL of sterile saline. The standard posterior arthroscopy portal was made and the scope was inserted into the posterior glenohumeral joint. The biceps tendon showed tenosynovitis . The biceps anchor was type II degenerative tear. An arthroscopic debridement of the degenerative slap tear was performed and biceps was tenotomized with arthroscopic scissors. The subscapularis was intact. The inferior pouch was intact. The undersurface of the teres minor was intact, the undersurface of the infraspinatus was intact. The undersurface of the supraspinatus was intact. The articular surface of the humeral head and glenoid revealed pristine..
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The scope was repositioned the subacromial space. The bursa was inflamed and synovitic. The rotator cuff was intact. The CA ligament showed an impingement lesion. There was a type 3 acromion. Subacromial decompression was performed with burr and cautery.
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AC joint was visualized arthroscopically. The skin was incised in the posterior A-C joint portal and a blunt trocar was inserted. The shaver was brought in and the soft tissue was debrided, to better visualize the A-C joint itself. The distal clavicle had almost no normal cartilage on it. There was a small amount of synovitis in the A-C joint space. Hemostasis was maintained with the wand. The distal clavicle resection was performed alternating the scope and the burr between the anterior and posterior portals. The resection was started inferiorly, working superiorly. Once it was felt that the resection was uniformed from anterior to posterior and from inferior to superior. The space was measured. A needle was dropped down on either side of the space and measured at the anterior and posterior aspect of the A-C joint at approximately 7 mm.
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A small incision was made at the medial arm just below the palpable lower border of the pectoralis tendon. The tendon was identified and retracted superior. Underneath the biceps was palpated and identified. A right angle clamp was used to pull the tendon out of the incision. A #2 Fiberloop was placed in the tendon. An button was used for fixation. The hole was drilled at the inferior aspect of the bicipital groove and the tendon inserted around the anchor which was inserted in the usual fashion. This was then pulled through the button. The suture ends were tied through the tenodn. Care was taken that the elbow was in full extension to avoid overtightening the biceps. The incision was copiously irrigated. The subcutaneous tissue was closed with 2-0 Vicryl and the skin with a running 3-0 PDS subcuticular running suture.
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The arthroscopic instruments were removed. The portals were closed with 3-0 nylon figure-of-eight sutures. A sterile dressing was applied consisting of Adaptic, 4 x 4’s, and ABD covered with foam tape. The arm was placed in a sling. The patient was repositioned supine and extubated without difficulty. The patient was transported to the recovery room in stable condition. This procedure was tolerated quite well.
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