DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Internal derangement, left shoulder.
POSTOPERATIVE DIAGNOSES:
1. Subacromial bursitis, chronic, and impingement syndrome of the left shoulder.
2. Degenerative arthrosis of the acromioclavicular joint of the left shoulder.
OPERATION PERFORMED:
1. Video arthroscopy of the left shoulder with subacromial decompression.
2. Arthroscopic Mumford procedure.
ANESTHESIA: General endotracheal anesthetic, supplement was scalene block for postop pain management.
CONSENT: Informed consent was signed for video arthroscopy of the left shoulder with subacromial decompression and arthroscopic Mumford procedure.
DESCRIPTION OF OPERATION: The patient was brought from Day Surgery for video arthroscopy of the left shoulder with subacromial decompression and arthroscopic Mumford procedure. Routine intravenous lines were begun. A scalene block was performed to the left upper extremity, and she underwent general endotracheal anesthetic.
She was positioned on a bean bag with her left shoulder upwards. She was secured in place with the bean bag and tape, and appropriate pressure points were padded, including an axillary roll under the right axilla. The left upper extremity was suspended from the shoulder holder with 12 pounds traction.
Routine Betadine prep and drape was performed. It should be noted that prior to the induction of the anesthetic, the anatomic landmarks were outlined with a marking pen. An 18 gauge spinal needle was inserted approximately 1.5 cm inferior and slightly medial to the posterolateral corner of the acromion and directed towards the coracoid process.
The glenohumeral joint was entered, inserted with 20 mL of saline with good backflow. Small stab incision was then made by using a blunt arthroscopic cannula. Using a blunt arthroscopic trocar, the arthroscopic cannula was placed within the glenohumeral joint.
The Arthrotec pump was used to descend the joint. After documenting being within the glenohumeral joint, an anterior portal was then made using a Wissinger rod, staying slightly superior to the subscapularis tendon, with the exit incision lateral to the coracoid process.
A plastic instrument cannula was placed anteriorly. Within the joint itself, there was a mild amount of synovitis present and synovial shaver was inserted anteriorly and synovectomy was performed. The articular surface of the glenoid and humeral head were all intact. The rotator cuff was inspected, and there was a mild amount of synovitis, but there was no evidence of any tear.
The biceps tendon was also inspected. There was no evidence of any degeneration of the biceps tendon or SLAP lesion. The anterior and middle glenohumeral joints were intact as was the labrum, and inferior recess was examined with no evidence of any loose bodies. The arthroscope was then switched to the anterior portal. The entire joint was reexamined from this portal with the instrument portal placed posteriorly and no further pathology was seen.
At this point, the instruments were removed. Using again the blunt arthroscopic trocar through the posterior portal, the arthroscopic cannula was placed within the subacromial space and the anterior instrument portal was also repositioned.
Examination of subacromial space was consistent with a marked amount of bursitis and impingement. Using a combination of motorized shaver, the ArthroCare tissue ablater, probe, and the 5.5 barrel bur, a subacromial decompression was performed resecting the anterolateral two-thirds of the acromion by approximately 6 mm to 7 mm. This was taken posteriorly approximately two-thirds of the way.
The AC joint had evidence of degenerative arthrosis and the bur was used to perform an arthroscopic excision of the distal clavicle. The subacromial space was then debrided with the motorized shaver.
The instruments were removed. The wounds were closed with interrupted 4-0 nylon suture. Betadine-soaked Adaptic compression dressing was applied. The patient was placed in the shoulder immobilizer. She was extubated in the operating room.
The patient tolerated the video arthroscopy of the left shoulder with subacromial decompression and arthroscopic Mumford procedure well. She was transferred to the postanesthetic recovery room where capillary refill was intact to the left upper extremity, but neurologic assessment was not possible due to the effects of the anesthetic.
