Case Study: Subacromial Decompression and Acromioplasty,
Rotator Cuff Repair in right shoulder, and Subpectoral Mini
Open Biceps Tenodesis in a 49 year-old patient

Acromioplasty, also known as shoulder subacromial decompression, is a surgical treatment used to treat shoulder impingement, a common problem that results in discomfort and weakness in the shoulder when you lift your arm over your head.

A ruptured tendon in the shoulder can be repaired surgically with rotator cuff repair. Shoulder arthroscopy, which employs smaller incisions, or a big (open) incision might be used for the operation. Several muscles and tendons come together to create a cuff around the shoulder, called the rotator cuff.

Common treatment for tendinopathy of the long head of the biceps brachii (LHB) is biceps tenodesis. Partial-thickness LHB tears, tendon subluxation with or without subscapularis tears, and unsuccessful conservative therapy of bicipital tenosynovitis are examples of indications.

If you experience any of the following signs of shoulder discomfort or are unable to move your shoulder normally, you should get in touch with an orthopedic surgeon. You may experience shoulder dislocation. There is obviously something wrong with your shoulder joint.

A 49-year-old patient was in our office with complaints regarding his shoulder pain following an accident. We injected the left shoulder but had no relief. We discussed treatment options and the patient opted for surgical management.

We discussed risks and benefits including infection, bleeding, injury to adjacent nerves and vessels, possibility of repeat injection, possibility of shoulder pain and need for cortisone injections among others. The patient understood and signed an informed consent.

The patient was taken to the operating room where he was placed on a well-padded operating room table. General anesthesia was induced. He was turned in the right lateral position so that the shoulder was up. The left shoulder was prepped and draped aseptically in the usual fashion.

The left shoulder was put into 40 degree of abduction and 10 degrees of flexion with the use of called. Perioperative antibiotics given. Anterior portal was made posteriorly through a soft shoulder sport. The Glenohumeral joint was reached and entry into the anterior portal was made using a spinal needle.

The glenohumeral joint was examined. Subscapularis, suprascapularis, intrascapular, and biceps tendon were intact. There was no arthritic change in the glenohumeral joint. There was fraying of the glenoid labrum, which was cleaned using a shaver. There was no articular side rotator cuff tear.

The scope was entered into the subacromial region. Bursitis was present. The shaver was used to clean off the bursitis. There was some subacromial spurring which was cleaned by using bur and doing subacromial acromioplasty. The rotator cuff was examined, and this was found to be intact.

There was arthritis in the AC Joint. The decision for distal clavicular excision was taken. The distal clavicular excision was performed using the bur from the posterior portal as well as the anterior portal.

A centimeter of distal clavicle was excised. Dressing was done using Xeroform, 4 x 4, ABD, and tapes. The patient was put in a shoulder sling. The patient was extubated and moved to recover in a stable condition.

The patient visited our office again with complaints regarding pain in both of his shoulders for months. He had undergone arthroscopic surgery on the left shoulder a few weeks ago. He has no pain in the left shoulder.

He came into our office with recurrent right shoulder recurrent pain which has not been getting better. The patient was weak in his rotator cuff muscles. The patient presented an MRI result and showed that it was normal but there was a high suspicion of rotator cuff tear.

MRI-3T Right Shoulder non-contrast

MRI-3T Right Shoulder non-contrast

We discussed treatment options and the patient opted for surgical management. We discussed infection, bleeding, nonhealing, need for repeat surgery or repair, injury to adjacent nerves and vessels, systemic complications among others. The patient understood and signed informed consent.

The patient was taken to the operating room where general anesthesia was induced. A supraclavicular block was given in the holding area. The patient was put in the left lateral position with the right shoulder up. An axillary roll was applied. All bony prominences were well-padded.

He was held in place with a bean bag. Preop antibiotics were given. The right upper extremity was prepped and draped aseptically in the usual fashion. A posterior entry portal was made through a soft spot. The Glenohumeral joint was reached. Debridement was done with a shaver.

There was a partial articular sided rotator cuff tear. The decision was made to repair the rotator cuff. Debridement of the rotator cuff edges was done. Bony attachment was decorticated and prepped using a burr. The path for the SwiveLock was checked using a spinal needle followed by an incision.

The SwiveLock was inserted after punch insertion. Once the anchor was in place, one limb of the satire was retrieved using a bird beak through the medial rotator cuff the scope was entered into the subacromial space.

The sutures were visualized. The suture was knotted. A good repair was achieved. There was no subacromial bursitis or fraying. The AC joint looked good. Final pictures were taken and saved.

Intraoperative Arthroscopic Images

Intraoperative Arthroscopic Images

The shoulder was thoroughly irrigated and drained. Closure was done using 3-0 nylon. shoulder immobilizer. in stable condition. Dressing was done. The patient was put in a shoulder immobilizer. The patient was extubated and moved to recovery.

The patient came back to our office. He underwent right shoulder rotator cuff repair with me four months ago. He started having pain in his right shoulder, especially in the anterior part. The patient did physical therapy, but the pain did not relieve.

An MRI result was presented which showed biceps tenodesis and possible tear in the rotator cuff. Evidence of prior rotator cuff repair with suture anchor in the greater tuberosity. However, findings compatible with a recurrent tear of the supraspinatus at least moderate severity.

Low-grade partial thickness tear of the subscapularis tendon. Biceps tendinosis and tenosynovitis without tears. Findings suggesting adhesive capsulitis. Small tear at the base of the anterior labrum. Mild bursitis.

MRI-3T Right Shoulder non-contrast

MRI-3T Right Shoulder non-contrast

We discussed treatment options and the patient opted for surgical management. We discussed risks and benefits including infection, bleeding, nonhealing, repeat surgery, rehabilitation, and stiffness, among others. The patient understands and signed informed consent.

The patient was taken to the operating room where general anesthesia was induced. The right upper extremity was prepped and draped aseptically in a usual fashion. Preop antibiotic was given. Incision was given for the posterior entry portal and arthroscope entered.

There was some fraying of the labrum, which was debrided. No rotator cuff tear could be seen on the surgical site. The Glenohumeral examination also showed inflammation of the biceps tendon with fraying. Biceps tenotomy was performed on the joint with a plan for doing a subpectoral biceps tenodesis. The scope was entered into the subacromial space.

Examination of subacromial space showed bursitis and thickened bursa, which was removed. Satisfactory acromioplasty was already there. The AC joint was intact and no inflammation was seen and so no intervention was done there.

There was superficial fraying, then 50% deep tear of the supraspinatus was seen. A decision was made to use a regeneten patch. Tear was debrided and Patch was inserted through the lateral entry portal and placed over the frayed area.

It was tacked to the rotator cuff using PLA staples x 5. The lateral part of the patch was tacked to the greater tuberosity using PEEK staples x 2. It was found to be in a stable condition. Final pictures were taken and saved.

Intraoperative Arthroscopic Images

Intraoperative Arthroscopic Images

The scope was removed, and the arm was removed from traction. A 3 cm anterior axillary Fold incision was given for subpectoral fascia was brought in the line of biceps tenodesis incision. Subpectoral dissection led to the tendon of the long head of the biceps. The biceps tendon was delivered.

The suture of the tendon using fibrecinch was performed. From the myotendinous junction proximally, a drill hole was made for the button insertion. The tendon sutures were put on the Endo button and the button was inserted through the drill hole and tightened.

The suture was passed to the tendon again and tied onto itself. The unicortical PEEK screw was not used as it was not stable.

The wound was thoroughly washed and closed in layers using #0 Vicryl, #3-0 Vicryl followed by #4-0 Monocryl. The incisions are closed using nylon #3-0. The wound was infiltrated with 0.5% lidocaine x10 cc.

The wounds were dressed using 4×8 followed by ABD and dressing was performed. Sterile dressing was applied. The patient was extubated and was moved to recover in stable condition.

We have decided to proceed with formal physical therapy as well as a home exercise program for rehabilitation of the shoulder. The patient did well after the surgery and continued physical therapy. The patient checked in for a follow up visit after a month and saw significant improvement in his shoulder.

Disclaimer – Patient’s name, age, sex, dates, events have been changed or modified to protect patient privacy.

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Based on 116 reviews
I had an extremely friendly and personalized medical consult with Dr Karkare. Dr Karkare was very knowledgeable and very professional. His communication skills was extremely good and explained my medical condition in very simple words. The office visit was very helpful in understanding my medical condition. Thank you Dr Karkare
Padmanabhan Nagaraj
20:49 25 Sep 23
Dr. Karlkare and his staff were excellent. Dr. Karkare explained everything clearly and took his time getting to know my Dad.
Anna Acker
22:46 07 Sep 23
Dr Vedant Vaksha had done emergency surgery in 2020 after a traumatic injury.His office at Complete Orthopedics handled the continued care thereafter.Dr V and his staff had been Professional and friendly throughout the process, taking the time to explain all the questions on how to proceed and what to expect.Whenever I needed to speak with Dr V or the office they were a phone call away, without waiting or calling several numbers like in so many other medical offices.The office was accommodating to scheduling to my needs at all times. Dr Vedant Vaksha earned the following5 out of 5 stars, highly recommended.
John Kuey
20:58 05 Sep 23
Dr. Vaksha helped me recover from an injury. I am very thankful that he took the time to explain the best treatment for my injury. Also thankful for the wonderful office staff!
Joseph Castelli
22:30 02 Aug 23
The office is wonderful!… Dr Paresh was very helpful and attentive and made my sister in laws recovery so much better.. Thank you for everything
Jazz Lorenzo
17:48 14 Jul 23
The ladies are very welcoming, the service is great, the doctor is very professional and caring and the building is super clean. I really like to come here, the atmosphere is very friendly... Come and you will love it too.
Joan Carasco
14:41 30 Jun 23
Dr. Nakul Karkare is awesome! And patriotic! Thank you, Dr. Karkare for displaying the American Flag in your waiting room, honoring and mourning our military personnel, this Memorial Day, who died while serving in the United States Armed Forces.
00:52 30 May 23
Excellent and skilled orthopedic practice specializing in joint replacements. Dr Karkare was trained at the Hospital for Special Surgery and has excellent results, as do his associates!! Would gladly refer family members to the practice!!
00:24 30 May 23
I had such a wonderful experience with Complete Orthopedics in Stony Brook. Not only did Dr. Kuo fix my broken wrist with such kindness and care, but the office staff, including Billing, Reception and the X-Ray Technician, was always so helpful, going out of their way to ensure that each patient felt welcome, answering any questions with a smile, and ensuring any issues with insurance/billing were handled with the utmost professionalism. I highly recommend their practice!
Victoria DeMatteo
19:49 10 May 23
I'm very happy St. Catherine's sent me to this office for treatment after I broke my collar bone! Unfortunately the break was too severe to repair on its own and I had to have it rebuilt a week after the injury. Dr. Vaksha did a great job fixing it. I'm three months out, and I have full use of the arm and shoulder. The whole office staff is very professional, accommodating, and welcoming. I hope to not need orthopedic services again, but Dr. Vaksha will be my number one choice if I or anyone in family suffers such am injury.
Tina Rivera
20:42 08 May 23
No one likes going to the doctor. But these people make it painless. I go for knees, hips and shoulders. At almost 70 Complete Orthopedics keeps my active life style running smoothly. Whether chasing my Grandson and even surfing again, I highly recommend them!!
Thomas Slavin
15:02 02 Mar 23
Dr. Kuo knowledgeable and competent surgeon- very good experience and more importantly great result.
Joseph McCoy
21:23 25 Feb 23
Dr Vaksha was so kind and helpful. He took extra time with us and explained things so thoroughly. Highly recommend. Office very clean.
Susan Bosinius
20:20 19 Feb 23
Dr Vaksha, is a great doctor very professional knows what he talking about. Treat patient with upmost respect. Thank You
Troy Spencer
16:46 19 Jan 23
Dr. Karkare is an amazing doctor, very caring and attentive, the girl at the front desk is very kind and helpful. .elizabeth .thank you so much .
blanca ventura
21:32 26 Oct 22
Been going to this place before my accident and after I had my knee surgery. So happy how I been treated and how well I am getting. Thank you all and specially Dr. VAKSHA for everything and getting back on track.
Ita Opico
19:01 25 Oct 22
Love this place From the minute I called I was treated kindly. When I arrived The Dr saw me right away he was compassionate and ordered the appropriate tests for me. I came back in for my follow up and had the same great experience.
Christine Rostock
21:28 23 May 22
Dr Vaksha and Dr karkare are 2 of the best orthopedic doctors around my wife Susan had a very serious broken ankle in March of 2019 she didn't think she was going to walk again Dr vaksha did an excellent surgery on her ankle he said it was his toughest he ever did he put a lot of hardware in her ankle and told her she would be alright she made remarkable recovery thanks to his surgery as of now she regained 100 percent use of her ankle she would highly recommend him to anyone. My own experience with Dr karkare has been wonderful he takes his time with you listens to what you have to say and prescribes various treatments and is very caring I would highly recommend him to anyone I would give both doctors a 10 plus rating we are very happy with them the best.
Harry Jones
23:31 19 May 22
Complete orthopedics is a wonderful place to go when you hurt or injured a great staff and wonderful doctors very knowledgeable and helpful I would recommend this place to all of my family and friends that is in me of orthopedic care I give them 10 thumbs up
Wayne Pemberton
17:39 18 May 22
The staff is very professional and helpful. Dr. Vaksha is excellent. He takes time to listen and offer suggestions to help you get better. I’m very thankful and happy to be a patient here at Complete Orthopedics.
Phoenix Rising
19:54 16 May 22
Dr.Karkare is the best. He listens to everything and explains everything I recommend him to everyone. I am so happy he is my doctor.
Myrna James
00:48 13 May 22
Dr.Kuo is amazing very attentive,caring,and passionate and staff is awsome too.Thank you for everything Dr.kuo.
Erick Murillo
23:17 12 May 22
I was in a car accident November 1 I was referred to Dr. Vaksha For shoulder surgery . I he was amazing he made me feel very comfortable and explained everything that was going to happen from surgery all the way through my physical therapy highly recommend Dr. Vaksha
Yolanda Ojeda
19:37 09 May 22
My appointment with Dr. Vaksha was amazing. Dr. Vaksha was very thorough and kind. I would refer this office to anyone who needs a great orthopedic doctor.
John Senechal
19:54 05 May 22
Scheduling my appointment was quick and easy. The staff was super friendly and down to earth. I was seen on time. The appropriate test, “x-rays” were taken before the conversation with doctor, something I really liked, test for analysis and conversation was done upfront. Dr. V had a great personality and was no BS, straight forward diagnosis and a play on next steps. I am happy I found them and would refer them to friends and family.
00:46 03 May 22
I have seen Dr. Kuo two times already and he's awesome along with his staff. Very friendly office and I'm glad to be a patient here.
Camaris A
20:01 28 Apr 22
Amazing team!! Very caring, profesional, and friendly!! Dr. Kevin Kuo, you are the best, very passionate, caring, and helping thank you for getting me better and being so kind to me! Elizabeth you the best thank you for you help always and you big smile and positive actitud❤️🙏🏼
breidy valerio
19:01 22 Apr 22
The staff is truly exceptional, they make you feel comfortable and welcomed. The doctors are amazing,always professional, compassionate and great listeners.
Elizabeth Collado
03:25 09 Apr 22
What a great place! The place is clean and organized.The staff is wonderful. Setting up physical therapy is right there as well.I'm so glad I found this place.
Donna Anne
22:45 05 Apr 22
This was my 1st time breaking something in my 27 years on this planet. I was recommended here by a friend Dr. Vashka helped me from day 1 and still continues to check in on me and my healing ankle. Would highly recommend
tyron davis
16:06 01 Apr 22
Brand new office, same great doctors! Rooms are clean, plenty of parking, physical therapy attached, Dr. Karkare and his staff are awesome. Thank you!
Emily B
02:49 24 Mar 22
Dr.VAksha is the best, I love the way he treats me as his patient, he is caring,understanding and very attentive to my needs
Mirna Caballero
14:53 03 Mar 22
Great staff. Dr. Vaksha is awesome and takes the time to listen to his patients. He is very compassionate. I would highly recommend this office.
Bebe Doyle
01:24 23 Feb 22
After suffering from a severe ankle injury Dr. V was able to help me heal and return back to work completely to a job where I stand for 12 hours a day. The office is very clean and I appreciated the reminders of my appointments via phone call and through text. The patient portal made it easy for me to access all my documents including work notes. The office staff is wonderful and Rebecca was able to schedule me with a busy schedule and awesome at answering all of my questions including referring me to a great physical therapy office. I highly recommend this office to anyone who’s looking for knowledgeable and kind orthopedic office.
Elizabeth Birchwell
21:31 28 Jan 21
The staff here are great, I was seen at the time of my appointment and was well taken care of!
Shaun Berry
18:14 07 Jan 21
They are an excellent practice. The front and back office people are amazing and so helpful. Rebecca is such a kind and understanding person. I had an issue with paperwork and she cleared it right up. Dr. Karkare is very knowledgeable, helpful, and caring.
Matt S.
19:31 18 Nov 20
Rebecca K. - What a true burst of sunshine. Very friendly and definitely an asset to the practice!
Laura Aston
18:17 17 Nov 20
Great experience, the Doctor is nice but the staff is incredible. I worked with Linda, who was profession and assisted me beyond what any person has done at other practices. Complete Ortho should be complimented for having such a person on their staff.I highly recommend this place!!!
Joe Allen
17:26 17 Nov 20
Linda and Becca they are so good ever time I come they are very nice I would tell everyone I no to come to this office..
Barbara Victor
16:45 17 Nov 20
I was rear ended in an auto accident , Dr Vashka was recommended by a friend of mine .I was experiencing Back , neck , and shoulder pain . After a thorough examination and given exercises to do at home , I am feeling much better , and I ended up avoiding surgery . The staff at Complete Ortho is extremely attentive and show great care when making an appointment and are very friendly and i never waited more than 5 minutes for my appointment . So I would strongly recommend Complete Orthopedics for any aches and pains that one might be experiencing.....
Bill Becht
04:44 17 Nov 20
It was the afternoon of Friday Sept. 24. We were in Pt. Jefferson and my wife, Mary Ann, broke her hip. We went to Mather Hospital and it was determined that she would have to have an operation to have it repaired. This would be her third time under the knife in the past year. It just so happened that we were very fortunate enough to have Dr. Karkare, who was on standby, perform the surgery. He put in a rod and two screws in her hip. She spent a few days in the hospital and then went to Gurwin rehabilitee for another few weeks.It has now been almost six weeks and we both worked the election the other day. If it wasn’t for Dr. Karkare’s expertise she never would have been able to work. She is able to walk with a walker and is doing physical therapy three times a week.We can not thank the doctor enough for the compassion and dedication that he puts into his work. It allows Mary Ann do the things that she likes to do, even on a limited basis for a while. I know that with her will, perseverance and the great work that the surgeon performed she will be back on her feet in no time.Sincerely:John V. PlumpEast Northport, NY 11731
Jack Harris
14:36 06 Nov 20
In the year of 2018 I was referred to Dr. Karkare because I was experiencing severe knee joint pain. After exhausting physical therapy and trying to labor through the pain, I had to make a quality of life decision. Total knee replacement was the only viable option. Dr. Karkare made my decision easy as he walked me through the whole process from surgery to recovery.On 12/13/19 ( Friday the 13th) I enter Lenox Hill Hospital in great hands. From the time I entered Dr. Karkare’s office for the first time until now, his staff has been amazing. Andrea the medical coordinator walked me through all the paper work and necessary preparations for the surgery. Courtesy and kind would be an understatement. Dr. Karkare went over and beyond from the wellness checks and phone calls all to assure me that I was important to him. This was the right decision no pain and no limp. Complete Orthopedics should be your choice!
Kenneth Randolph
22:18 25 Sep 20
Dr. Vadshka has a great bedside manner. He really takes his time and explains treatment options.
T Lee
12:33 09 Sep 20
I suffered with pain in both knees for years. My orthopedic doctor kept recommending knee replacement . I fought it for years, as I was just afraid. When I had no choice and could barely walk , it was recommended I see Dr. Karkare. We set up a consultation and my wife and I left his office feeling totally confident and comfortable with moving ahead with the surgery. He explained everything to us, and the office staff set everything up for us and made the process easy. So about one month after our initial meeting I had the first knee done. I was up walking mere hours after the surgery, and on the workout machines the next morning. I went home two days after the surgery, and yes walked my daughter down the aisle at her wedding only one week after the surgery without even a cane! Three months later I had the other knee done and went home the very next day. Dr. Karkare put my fears to rest . I would highly recommend him. His expertise gave me my life back. Thank you Dr. Karkare.SincerelyVito Congro
Ethel Congo
23:58 12 Aug 20
Dr Rhodin really cares for his patients. When I see him he makes sure to review my progress in detail.
Micki Cahill
15:03 08 Feb 20
My mom had a total hip replacement by dr karkare. He is the BEST orthopedic doctor.Her incision is almost invisable.She is going back for her other hip next week. The office staff is the best, love Andrea.You wont find a better doctor.
21:06 13 Jul 18
There is no better Orthopedic doctor you will find. Broke my ankle three places on a Saturday. Called Dr. Karkare. He had is team ready at the hospital and operated on me within 6 hours after my injury. Now After 3 months of great care by him and his staff, I am walking to normalcy.
Spacecom Tel
04:13 23 Mar 18

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.

Please take a look at my profile page and don't hesitate to come in and talk.