DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Chronic tendonitis of the rotator cuff with possible tear of the cuff.
2. Degenerative arthritis of the acromioclavicular joint.
POSTOPERATIVE DIAGNOSES:
1. Chronic tendonitis of the rotator cuff with impingement.
2. Synovial cyst, acromioclavicular joint, right.
OPERATION PERFORMED:
1. Arthroscopy of the right shoulder with debridement and lavage.
2. Bursoscopy, right shoulder.
3. Subacromial decompression.
4. Acromioplasty, partial excision of the lateral end of the clavicle.
5. Excision of large synovial cyst, right shoulder.
SURGEON: Jane Doe, MD
ANESTHESIA: General.
DESCRIPTION OF OPERATION: Under general anesthesia, following endotracheal intubation, the patient was placed in a beach chair position. The right shoulder was then isolated with isolation drape and then prepped and draped in a routine manner for arthroscopy. Posterior portal was used to enter the joint from posterior aspect through a small incision. Joints were checked out. There were degenerative changes in the joint but no major damage noted. There was some fibrillation at the attachment of the biceps tendon. The second portal was created anteriorly and a plastic cannula inserted into the joint for continuous irrigation of the joint. The labrum was noted to be intact, although some fibrillation was noted. The rotator cuff did not appear torn checking from underneath. Debridement of the fibrillated areas was done and then this procedure was terminated and we decided to go to the next phase of the operation, which was a bursoscopy.
Arthroscope was withdrawn from the joint and into the subacromial bursa. A lateral portal was created and then a 4 mm aggressive meniscal cutter was introduced into the subacromial space. The cobweb of synovial tissues was excised as much as necessary to get a clear visualization of the subacromial area. The rotator cuff was found to be intact. There was hypertrophy at the end of the clavicle that was noted after the posterior capsule was debrided and removed. The soft tissue underneath the anterior acromion was denuded with the 4 mm meniscus cutter and then a 5 mm bur was introduced and undersurface of the acromion was shaved and smoothed out. Next, the outer end of the clavicle was partially excised using the bur. ArthroCare instrument was also introduced to coagulate any bleeding points. After thorough irrigation and after the subacromial decompression was satisfactorily completed, instruments were withdrawn and then we went to the next phase of the procedure.
The last phase of the procedure was to excise the cystic lesion that was discovered at the top of the AC joint. Initially, we introduced the needle and mucinous thick fluid came out proving the point that there was in fact a big synovial cyst. Incision was made over the cyst. Incision was slightly curved. It was about 2 inches long. The incision was taken down through the skin, subcutaneous tissue, fascia down to the synovial tissue, which was dissected. It was quite tense, and we decided to go ahead and open the cyst, which we did and evacuated all the contents. We identified the wall of the cyst, and it was in close association with the superior part of the acromioclavicular joint. The capsule and the ligaments were all found to be intact. We just simply removed the wall of the cyst in piecemeal. Thorough irrigation was done and then the closure was completed. We are leaving a Penrose drain in place. The deep tissues were approximated with interrupted 2-0 Vicryl sutures. The subcutaneous tissues were approximated with 2-0 Vicryl sutures and skin closed with skin clips. Dressing was applied. The patient went through the procedure without complication and was taken to recovery.
