The patient was seen in the preoperative holding area, signed consent was verified, and surgical site was signed. The patient was given preoperative antibiotics. The patient was then taken to the operating room, after administration of a neural scalene block.

The patient was then placed supine on the operating room table and a general anesthetic smoothly induced without complication. The patient was then placed in the left lateral decubitus position, and the right shoulder was sterilely prepped and draped in the usual fashion. The standard arthroscopic portals were established posteriorly and anteriorly. The glenohumeral joint was then evaluated. The articular surface of the glenoid and corresponding humeral head were found to be unremarkable. Significant tendinitis and fraying of the biceps tendon was noted, and a partial tear of the superior labral attachment was also noted. This necessitated doing a biceps tenotomy at that point for later biceps tenodesis. The biceps tendon was then cut at the root of its attachment to the superior labrum, and using the electrocautery wand, the labrum and corresponding synovitis was cleaned up. The subscapularis tendon was then evaluated and found to be intact. For the most part, the superior aspect of the subscapularis tendon was mildly frayed, but not torn, and this was débrided as well.

In the superior aspect of the shoulder, at the rotator cuff reflection, it was noted that the rotator cuff had a complete tear. This was débrided from the intraarticular aspect as well for visualization, and the tear was evident approximately 1.5 to 2 cm in width, and about 1 cm retracted.

The subacromial space was then entered. A bursectomy was completed to remove the bursa for visualization. A rather prominent CL ligament was then cut and removed from the inferior aspect of the acromion and anterior aspect of the acromion, exposing a very large subacromial spur. This was subsequently planed off using a barrel burr, back to the AC joint. The AC joint was then uncovered, and a significantly arthritic denuded of cartilage distal clavicle was noted. This was subsequently planed off through the anterior portal using the burr instrument as well. Approximately 8 to 9 mm of distal clavicle was resected.

The decompression was felt to be adequate at that point. The rotator cuff was then evaluated, and complete tear through the rotator cuff could be identified and probed. Again, its dimensions were similar to what was previously thought, which was about 1.5 cm x 1 cm retraction.

Through the lateral incision area this was extended to the anterolateral aspect of the acromion and carried down through the deltoid tissue, and a self-retaining retractor was placed, exposing the subdeltoid and subacromial space, and the rotator cuff tear. At that point, the arm was externally rotated, and the bicipital groove was palpable. A small incision was made overlying the proximal aspect of the bicipital groove, and the biceps tendon was retrieved out of this small incision distally for later tenodesis.

Attention was then directed to the rotator cuff margin, where a trough was made in the greater tuberosity area the width of the tear. The edge of the tear was very mobile. Two suture anchors with fiber tape were then passed into the edge of the tear, and then brought out the superior aspect of the tendon into the lateral distal row into the humerus. A total of four anchors were utilized to repair the tendon, which was felt to be watertight, and completely repaired.

Attention was then directed to the biceps tendon. At that point, a suture anchor was placed into the bicipital groove, after debridement of that area, and this suture was then woven into the tendon, and then sunk into the predrilled hole with the suture anchor. The tendon was then oversewn with fiber wire and Vicryl.

The wound was copiously irrigated at that point, the deltoid tissue reapproximated, the subcu layer reapproximated, and a subcuticular stitch of 4-0 Monocryl was used in all incisions, which were then covered with benzoin, and Steri-Strips. 0.25% Marcaine with epinephrine was injected into and around the incision area using 30 cc. The patient was taken in a shoulder immobilizer to the recovery area, and tolerated the procedure well. There were no intraoperative complications.

this is a medicare patient

I need some help with this shoulders are not my specialty can someone please help teach??