Case Study: Left Shoulder Arthroscopy: Rotator Cuff
Debridement and Subacromial Bursectomy
in a 47 year-old patient
Debridement is the process of clearing the area surrounding the shoulder joint of any loose tendon pieces, thickened bursa, and other debris. The doctor can better assess the severity of the injury and decide whether to do additional surgery by removing injured tissue from the shoulder joint area.
Notably painful shoulder injury is frequently a fracture, which is followed by ailments affecting the shoulder joint’s nerves and tissues. By pushing, throwing, lifting, and keeping excellent posture, the shoulders help us do a variety of other things.
A 47-year-old patient visited our office with complaints regarding left shoulder pain due to an MVA. The severity of the pain is 8/10. The quality of the pain is burning and does radiate to her fingers. She has been going to physical therapy 3 times per week which helps a little.
She has not got any injections but is on Gabapentin. She had left shoulder pain in the past due to work for which she was given cortisone injection in left shoulder which helped to resolve all her symptoms.
The patient presented an MRI result that showed partial tear of the bursal surface of the distal supraspinatus tendon with fluid in the perth-humeral bursa. Intact biceps anchor complex. No fractures or acute labral tears. Biceps tendinosis.
We discussed the treatment options for the patient’s diagnosis, which included living with the extremity as it is, organized exercises, medicines, injections, and surgical options. I also discussed the nature and purpose of the treatment options along with the expected risks and benefits. The patient has expressed a desire to proceed with surgery, and I think that is a reasonable option.
I educated the patient regarding the inherent and unavoidable risks which include, but are not limited to infection, stiffness, damage to nerves and blood vessels, blood loss possibly requiring transfusion, blood clots, persistent or worsening pain, loosening or failure of implants, instability, tingling or numbness, anesthesia and systemic complications including cardiac, pulmonary, neurological complications and even death were discussed at length.
I also talked about the possibility of not being able to return to prior activities or employment, the need for future surgery, and complex regional pain syndrome. The patient also understands there is a long rehabilitative process that typically follows the surgical procedure.
I talked about the possibility of not being able to alleviate all the discomfort. Also, I explained there is no guarantee all the function and strength will return. I discussed the type of implants that may be utilized during this surgery. The patient expressed understanding of these risks and has elected to proceed with surgery.
I discussed the patient’s medications and allergies and the possible need for medical and other clearances if needed. I have discussed the surgical procedure as well as the realistic expectations regarding the risks, outcome and post operative protocol.
The patient was taken into the operating room after informed consent and supraclavicular block. She was placed on a well-padded operating table. She was sedated. She was put into a right lateral position with the left shoulder up and placed in a beanbag. All the bony prominences were well padded.
The left shoulder was prepped and draped aseptically in usual fashion and put on traction with 40 degrees of abduction and 30 degrees of flexion on 10-pound traction. A timeout was called. Preoperative antibiotic was given. Anterior portal was made through the posterior soft spot and the arthroscope was inserted into the glenohumeral joint.
Anterosuperior portal was made with the use of spinal needle and cannula was inserted. Examination of the glenohumeral joint showed intact biceps, intact articular side rotator cuff, intact labrum and intact glenohumeral joint with no arthritic changes.
The arthroscope was inserted into the subacromial space where bursitis was present. The shaver was introduced from the anterosuperior portal and the bursa was removed with the use of a shaver. There was an acromial spur with anterior impingement and intact acromion.
Examination of the rotator cuff showed partial bursal-sided tearing, which was cleaned with the use of a shaver. No attempt was made to repair the rotator cuff. The acromial impingement was removed by performing an acromioplasty with the use of coblation wand followed by a burr removing the acromial spur as well as using the coracoacromial ligament. The AC joint did not show any arthritic changes and no excision was done. The final pictures were taken and saved.
Intraoperative Arthroscopy Images
The shoulder was irrigated and drained. Closure was done with the use of nylon. 10 cc of 0.25% Marcaine was injected into the shoulder joint. Dressing was done with the use of Xeroform, 4×4, ABD, and tape. The patient was extubated and moved to Recovery in stable condition. A shoulder sling was applied.
The patient was seen for post operative check up. We have decided to do formal physical therapy as well as a home exercise program for rehabilitation of the shoulder. Patients regularly followed an office visit every 3-4 weeks.
Patient did well after the surgery and continued physical therapy. Patient checked in for a follow up visit after a month and saw significant improvement on her shoulder.
Disclaimer – Patient’s name, age, sex, dates, events have been changed or modified to protect patient privacy.
I am Vedant Vaksha, Fellowship trained Spine, Sports and Arthroscopic Surgeon at Complete Orthopedics. I take care of patients with ailments of the neck, back, shoulder, knee, elbow and ankle. I personally approve this content and have written most of it myself.
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