POSTOPERATIVE DIAGNOSES: Subchondral collapse of the bone with complete
deformity of the articular surface of the humeral head, biceps tendinosis, no
visible labrum gross or adhesive capsulitis with posterior subluxation of the
humeral head.
PROCEDURE PERFORMED: Diagnostic arthroscopy with arthroscopic capsular
release and arthroscopic biceps tenotomy with mini open retrieval of loose
cartilage fragments from the joint essentially performing an arthroscopic and
mini open resectional arthroplasty of the shoulder along with the capsular
release essentially creating space for her to externally and internally rotate
the shoulder. We also performed a coracoid plasty resection of portion of the
coracoid because it was very sharp and protuberant and hurting her in the
front of the shoulder.
INDICATIONS FOR PROCEDURE: This is a 24 yr old female with severe
deformities related to neurofibromatosis and severely abnormal anatomy. We
were hopeful that we could perform some sort of a capsular shift or
stabilization procedure, but the articular surface as we found was just
completely unsupported by subchondral bone and therefore fragmented,
anatomically unstable and unsound, so we counseled with her and her parents
about the risks, benefits and alternatives to surgical versus nonsurgical
treatment and her and her mother knowing that there were no guarantees in this
essentially they requested to proceed with diagnostic arthroscopy and
manipulation under anesthesia and any indicated procedures.
NARRATIVE OF PROCEDURE: The patient was identified and the proper extremity
was identified and signed in the holding area. Prior to being brought to the
operating theater where she was placed in supine position, general
endotracheal anesthesia was initiated and prepped and draped the left shoulder
in the usual fashion. We performed diagnostic arthroscopy, the findings are
stated in the postoperative diagnosis section. Essentially, she did not have
a shoulder, her anatomy was so distorted and her articular surface on the
humeral side was so distorted that her shoulder joint was essentially
posterior subluxed and really unsupported by subchondral bone. Nevertheless,
we were able to perform an arthroscopic biceps tenotomy from the supraglenoid
region ____ and we were able to ultimately convert to a mini approach and
remove many of the loose fragments of the articular surface and essentially
perform what was a resectional arthroplasty of the joint in anticipation of
what may need to be done in the future, which is either a fusion. Really a
fusion is probably her only other option other than the resectional
arthroplasty, so that would be done ____ but we certainly freed and performed
the capsular resection, freed up her shoulder from being stuck in internal
rotation and now freely rotate which should help her pain. We performed a
biceps tenotomy, we performed coracoid plasty and essentially a resectional
arthroplasty, but her shoulders far from normal. She is not a candidate for
any sort of shoulder replacement because her glenoid is again weak and
unsound, the version of both the humeral head and the glenoid is not anatomic,
so we concluded the procedure by irrigating and obtaining final hemostasis and
closing in layers.