DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Chronic pain, right shoulder.
POSTOPERATIVE DIAGNOSES:
1. Labral degeneration type 1, right shoulder.
2. Chronic synovitis, right shoulder.
3. Biceps tendinosis, right shoulder.
4. A 3 cm rotator cuff tear, right shoulder.
5. Acromioclavicular arthritis, right shoulder.
OPERATION PERFORMED:
1. Arthroscopy of right shoulder with extensive debridement of labral degeneration, biceps tendinosis, and synovitis.
2. Acromioplasty.
3. Acromioclavicular joint resection arthroplasty.
4. Repair of 3 cm rotator cuff tear, right shoulder.
5. Insertion of catheter for postoperative pain management.
SURGEON: John Doe, MD
ANESTHESIA: General.
FLUIDS: Crystalloids.
ESTIMATED BLOOD LOSS: Minimal.
DRAINS: None.
SPECIMEN: None.
INDICATIONS FOR OPERATION: The patient is a (XX)-year-old female with chronic pain in the right shoulder. Exam, x-rays, and MRI consistent with rotator cuff tear, and she has failed to respond to conservative treatment and presents at this time for arthroscopy.
DESCRIPTION OF OPERATION: The patient was brought to the operating room and placed in the supine position. After adequate anesthesia was obtained using a general anesthetic, the right shoulder was examined with no signs of adhesions. She was turned to a left lateral decubitus position. The right arm was suspended in 15 pounds of traction with it in 20 degrees of flexion and 40 degrees of abduction. The right shoulder was then prepared and draped in the usual sterile manner. The right shoulder was then marked on the skin with the bony prominences of the clavicle, the AC joint, the acromion and coracoid process. We injected Marcaine with epinephrine.
We started with the posterolateral portal where an incision was made in the skin. The sheath and semisharp trocar were used to introduce the 4.0 Stryker scope in the joint. We did an immediate inside-out technique for introduction of an anterior cannula where a shaver was used for drainage and debridement.
On initial inspection, the patient had labral degeneration type 1. This was very carefully smoothed and saucerized back to a healthy stable rim. She had significant synovitis, which was cleaned and then we identified that there was moderate biceps tendinosis. The tendon, however, had good substance and we used the VAPR and the shaver to smooth it down so that there were no large nodules. We found that there was rotator cuff tear of approximately 3 cm in size, and we used the shaver and the VAPR to clean the bed and to create a nice bleeding surface of bone.
We then inspected the joint, which showed chondromalacia grade 2/4. After flushing and cleaning the joint, we went to the subacromial space where, after an extensive bursectomy, we identified the tendon tear and then cleaned the bed again from the bursal side. We used the shaver and the bur to resect the anterior process of the acromion, tapering it posteriorly in a smooth fashion. We used the shaver and the bur to resect the distal end of the clavicle, taking 1 cm of the distal clavicle and a parallel resection of the medial border of the acromion. We then used the shaver to remove any fragments that escaped during the burring process and now went to an open procedure.
We extended our lateral portal for a distance of approximately 4 cm and dissected down through subcutaneous tissue to the deltoid, where we did a deltoid-splitting incision into the subacromial space. We identified the rotator cuff tendon tear and placed one Panalok RC double suture anchor. We used the medial side to use a modified Kessler stitch to reapproximate the medial edge and then at the lateral, we used a grasping inverting stitch to help attach laterally. We did reinforce the line of the tear using a #2 Polydek in a figure-of-eight stitch. We then irrigated out copiously. We then placed in a catheter from the Accufuser. We closed the deltoid with a 2-0 Vicryl in a running simple stitch, and 4-0 Monocryl was used to perform a subcuticular closure. Dermabond was applied, and she was placed in a compressive dressing and a sling and taken to the recovery room in good condition.
