The patient is positioned side-lying with arm suspended using a weight and a pulley system. An anesthetic is administered. Two to four small poke hole incisions are made around the shoulder joint to allow access to all areas of the shoulder joint. A solution is pumped through one of these incisions and into the joint to expand the joint for better visualization and to cleanse the joint. The arthroscope is inserted through a hole allowing the physician to perform a diagnostic arthroscopic exam by visualizing the shoulder joint. The corticoid process is identified and the tendon of the biceps (short head) is at times incised distal to corticoid for exposure. The anterior capsule is visualized through a small transverse incision of the subscapularis tendon which is tagged for identification and removed from its attachment on the capsule. The quality and laxity of the capsule are assessed and the joint is explored for damage to the labrum or glenoid. The joint is irrigated to remove any loose bodies. If there is no other abnormal laxity, the capsule is advance superiorly and attached to the labrum with sutures. An appropriate amount of slack is taken up to provide stability within the joint. Once the capsule is reattached, the subscapularis tendon is reapproximated but not tightened and repaired. A long acting local anesthetic may be injected into the joint to help with post-operative pain. The joint is irrigated and suture or Steri-strip closes the incisions. The area is covered with a dressing and a sling or shoulder immobilizer is applied.
SLAP lesions are injuries to the labrum that extend from anterior to the biceps tendon to posterior to the biceps tendon. For a SLAP lesion repair, the physician makes three incisions: one for the arthroscope, a second for the suture hook, and a third for a cannula. The surgeon prepares the bony bed with a small ball burr and drills or punches a hole at the cartilage bone junction of the superior labrum. A hook is passed through the anterior superior portal and the inside limb is grasped with a suture retrieval forceps. The physician sets an anchor into the drill hole by mounting the suture anchor on the inserter and sliding it down the suture. The physician closes the loop with a slipknot that is tied and tightened outside the cannula. A knot pusher secures the knot under arthroscopic control. A long acting local anesthetic may be injected into the joint to help with post-operative pain. The joint is irrigated and suture or Steri-strip closes the incisions. The area is covered with a dressing and a sling or shoulder immobilizer is applied.
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