Pre-operative Diagnosis:
right Biceps tenodesis and impingement
Post-operative Diagnosis:
Same
Procedures Performed:
Manipulation Right shoulder (23700)
Right shoulder arthroscopy with synovectomy (29820)
Arthroscopic acromioplasty (29805)
Open right biceps tenodesis (23430)
Surgeon: MD
Anesthetic: General anesthetic with block
Total IV Fluids: 1500 ml
Estimated Blood Loss: 50 cc
Antibiotic Given: Two grams of Cefazolin were given.
Drains: None
Implants: none
Indications:
Clinical and Mri evidence of shoulder pathology as outlined above.
Intraoperative findings:
Exam under anesthetic findings: Adhesive capsulitis
Arthroscopic findings:
Articular sided partial thickness SST tear and biceps tendinitis
Procedure Details
After the risks, benefits, and indications for the proposed procedure were discussed with the patient, the patient agreed to proceed. Consent form was reviewd, Questions were answered. The correct extremity was identified with permanent one-time use marker in preoperative hold and the patient was brought back to the operating room, where general anesthetic was administered. After I performed an examination under anesthetic of the affected shoulder and manipulated the shoulder with vast improvement of ROM in IR and ABd (findings noted above), we prepped and draped the affected arm. The arthroscope was inserted through a posterior lateral portal. Initial inspection of the joint revealed some tendinitis of the biceps. The joint surfaces were intact. There was some articular surface wear on the supraspinatus tendon at its insertion. Well under 25% thickness. An anterior portal was established. The probe was brought in through the anterior portal and the biceps pulled further into the joint. There was some fraying of the biceps tendon as I pulled it from the groove. The shaver was then introduced and a partial thickness cuff tearing was debrided. A small basket punch was brought in and the biceps tendon was released except for a small strand to keep it in place.
The arthroscope was reinserted into the subacromial bursa. Bursectomy was done. There was some evidence of mild wear from the anterior acromion on the anterior portion supraspinatus tendon. A judicious acromioplasty was done anteriorly and laterally. The arthroscopic ligament was then laid aside.
The anterior incision was made extending the anterior portal into a 3 cm deltopectoral incision. It is carried down through skin subcutaneous tissue to the level of the deltoid which was then split and the deltopectoral groove. A Buxton retractor was placed. The biceps tendon was palpated in the bicipital groove. The bicipital groove retinaculum was incised in the biceps tendon delivered into the incision. The arthroscopic burr was then used to make a groove down to bleeding bone. A #2 fiber wire suture was placed in a Krak?w fashion at the appropriate level. A 4.5 mm ReelX suture anchor was then placed in the upper portion of the prepared bed. The FiberWire sutures were then pulled down into the ReelX suture anchor. This very firmly brought the biceps down against the prepared bed of the bone. Incision is irrigated with sterile saline solution. Deltopectoral interval was LAD fall together again. Subcutaneous sutures were placed. Subcuticular skin closure was then accomplished with #4-0 Vicryl. The arthroscopy portals were closed with interrupted 3-0 nylon.
The sterile dressing was then applied. She was placed into an arm immobilizer. She was awakened from her anesthetic and taken to recovery room in stable condition having tolerated the procedure well. Instrument and needle count were accurate x2.
Complications: None
Condition: Stable
Disposition: Recovery Room, then Same Day Surgery
Post-Operative Plan: The patient will be in a shoulder immobilizer on the right side. Start pendulum exercises tomorrow. RTC 10 days.
right Biceps tenodesis and impingement
Post-operative Diagnosis:
Same
Procedures Performed:
Manipulation Right shoulder (23700)
Right shoulder arthroscopy with synovectomy (29820)
Arthroscopic acromioplasty (29805)
Open right biceps tenodesis (23430)
Surgeon: MD
Anesthetic: General anesthetic with block
Total IV Fluids: 1500 ml
Estimated Blood Loss: 50 cc
Antibiotic Given: Two grams of Cefazolin were given.
Drains: None
Implants: none
Indications:
Clinical and Mri evidence of shoulder pathology as outlined above.
Intraoperative findings:
Exam under anesthetic findings: Adhesive capsulitis
Arthroscopic findings:
Articular sided partial thickness SST tear and biceps tendinitis
Procedure Details
After the risks, benefits, and indications for the proposed procedure were discussed with the patient, the patient agreed to proceed. Consent form was reviewd, Questions were answered. The correct extremity was identified with permanent one-time use marker in preoperative hold and the patient was brought back to the operating room, where general anesthetic was administered. After I performed an examination under anesthetic of the affected shoulder and manipulated the shoulder with vast improvement of ROM in IR and ABd (findings noted above), we prepped and draped the affected arm. The arthroscope was inserted through a posterior lateral portal. Initial inspection of the joint revealed some tendinitis of the biceps. The joint surfaces were intact. There was some articular surface wear on the supraspinatus tendon at its insertion. Well under 25% thickness. An anterior portal was established. The probe was brought in through the anterior portal and the biceps pulled further into the joint. There was some fraying of the biceps tendon as I pulled it from the groove. The shaver was then introduced and a partial thickness cuff tearing was debrided. A small basket punch was brought in and the biceps tendon was released except for a small strand to keep it in place.
The arthroscope was reinserted into the subacromial bursa. Bursectomy was done. There was some evidence of mild wear from the anterior acromion on the anterior portion supraspinatus tendon. A judicious acromioplasty was done anteriorly and laterally. The arthroscopic ligament was then laid aside.
The anterior incision was made extending the anterior portal into a 3 cm deltopectoral incision. It is carried down through skin subcutaneous tissue to the level of the deltoid which was then split and the deltopectoral groove. A Buxton retractor was placed. The biceps tendon was palpated in the bicipital groove. The bicipital groove retinaculum was incised in the biceps tendon delivered into the incision. The arthroscopic burr was then used to make a groove down to bleeding bone. A #2 fiber wire suture was placed in a Krak?w fashion at the appropriate level. A 4.5 mm ReelX suture anchor was then placed in the upper portion of the prepared bed. The FiberWire sutures were then pulled down into the ReelX suture anchor. This very firmly brought the biceps down against the prepared bed of the bone. Incision is irrigated with sterile saline solution. Deltopectoral interval was LAD fall together again. Subcutaneous sutures were placed. Subcuticular skin closure was then accomplished with #4-0 Vicryl. The arthroscopy portals were closed with interrupted 3-0 nylon.
The sterile dressing was then applied. She was placed into an arm immobilizer. She was awakened from her anesthetic and taken to recovery room in stable condition having tolerated the procedure well. Instrument and needle count were accurate x2.
Complications: None
Condition: Stable
Disposition: Recovery Room, then Same Day Surgery
Post-Operative Plan: The patient will be in a shoulder immobilizer on the right side. Start pendulum exercises tomorrow. RTC 10 days.