Case Study: Shoulder Arthroscopy with
Rotator Cuff Repair in a 42 year-old guy
Shoulder arthroscopy is a minimally invasive surgery used to detect and treat issues with the shoulder. Arthroscopy may be required if you have rotator cuff injuries or shoulder impingement. Minimally invasive surgery necessitates smaller incisions than regular surgery. Every incision is roughly the size of a keyhole.
Small incisions are made in the shoulder, and an arthroscope, a small tube fitted with a camera, is guided to the site of the tear. The rotator cuff is then repaired using specifically specialized devices that cause little stress to the surrounding muscles and tissues.
The patient is a 42-year-old guy who presented in the office with complaints of right shoulder pain following a car accident. He tried nonsurgical treatment such as physical therapy and anti-inflammatory drugs, but these were ineffective. He had an MRI, which revealed a partial-thickness tear of the rotator cuff tendon, AC arthritis, rotator cuff impingement, and an acromial spur.
We discussed treatment alternatives with him, and he chose surgical management. We examined the dangers and problems, which included infection, hemorrhage, nerve and artery injury, stiffness, the need for rehabilitation, and the necessity for repeat surgery, among other things.
We talked about systemic concerns such as blood clots, cardiac, pulmonary, and neurological issues. The informed consent was understood and signed by the patient.
The patient was transferred to the surgery room. In the holding area, a supraclavicular block was administered. The patient was placed on a comfortable operation table. Anesthesia was administered. The patient was positioned in the left lateral position, with the right shoulder raised.
He was restrained in a bean bag with axillary rolls and padding on all bony prominences. The right shoulder was prepared and draped aseptically as usual. A timeout was issued. A preoperative antibiotic was administered. A lateral entrance hole was created posteriorly through the soft spot.
The arthroscope was introduced. The cannula was inserted through an anterosuperior entrance hole created with the help of a spinal needle. The probe was inserted through the anterosuperior cannula. The examination revealed undamaged biceps, cartilage, and subscapularis. There was no rotator cuff rupture on the articular side. There was no evidence of a HAGL lesion.
The glenoid labrum was fraying at the anterior, superior, and posterior aspects. A shaver was developed, as well as Shaver debridement of the glenoid labrum was performed. Photographs were taken and preserved.
The arthroscope was then placed into the subacromial area, and the shaver was inserted from the anterior superior border. There was subacromial synovitis, which was removed with a shaver. Impingement occurred over the acromion as well as the AC joint with type II acromion. Acromioplasty was performed with a Coblation wand and a 6.0 bur.
The CA ligament was also loosened using a Coblation wand. The distal clavicle excision was likewise conducted with the Coblation wand, followed by the removal of around 1 cm of the distal clavicle with a bur. Photographs were taken and preserved.
The rotator cuff examination revealed partial-thickness tearing into the supraspinatus and infraspinatus regions of the rotator cuff. There was no complete tear. The choice was made to repair it using the REGENETEN patch.
The patch was inserted through the lateral portal and placed flat across the rotator cuff in the area of the tear. Following the insertion of the cannula, an accessory superior portal was created, followed by PNA tacks. PNA tacks x7 were inserted to secure the patch to the rotator cuff.
Final photographs were taken and saved. The shoulder was carefully irrigated and drained. The closure was made of 3-0 nylon. The patch was inserted through the lateral portal and placed flat over the torn rotator cuff.
Following cannula insertion, an accessory superior portal was created, followed by PNA tacks. PNA tacks x7 were used to secure the patch to the rotator cuff. The final photographs were shot and preserved.
Dressing was done with the use of Adaptic, 4×4, ABD, and tape. Shoulder immobilizer was applied. The patient was extubated and moved to recovery in stable condition.
The patient came today for his postoperative visit. He denies fever, chills and his pain is well controlled. We chose to proceed with official physical therapy as well as a home exercise regimen for shoulder rehabilitation after examining treatment choices.
During today’s visit, we removed the stitches. We will continue to use ice and elevate the shoulder to reduce swelling and pain. We will gradually wean them off any narcotic medications and transition them to anti-inflammatories and Tylenol as long as there are no contraindications.
During today’s appointment, we also addressed the risks, advantages, and common adverse effects of taking these medications. I’ll meet them again in three weeks to assess their improvement.
The patient was seen in the office for his postoperative visit, after one month. He denies fever or chills and his pain is well controlled; he is working now with his PT at Mount Joy PT.
The patient’s progress and development have been undeniable with continued physical treatment and regular attendance at his follow-up checkups.
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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