Possible rotator cuff tendonitis, acromioclavicular arthritis, and frozen shoulder, right shoulder.
Frozen shoulder, subacromial bursitis-impingement, and acromioclavicular arthritis, right shoulder.
Arthroscopic subacromial decompression with open distal clavicle resection and manipulation under anesthesia, right shoulder.
INDICATION FOR PROCEDURE: The patient is a 51-year-old male with recalcitrant shoulder pain and a frozen shoulder. He had failed rehabilitative and injection treatments and requested operative intervention.
FINDINGS AT OPERATION: Preop motion was 90 degrees of flexion and 30 degrees of external and internal rotation. There was significant subacromial bursitis with very thickened coracoacromial ligament and a subacromial spur. The intra-articular structures were normal.
DESCRIPTION OF PROCEDURE: The patient was brought to the operative suite and general anesthesia was smoothly induced. The shoulder was examined and the above noted limitation of motion was found. An interscalene block was placed for postop pain control and the patient was placed in the beach chair position. The right shoulder was manipulated with palpable and audible crepitace into 150 degrees of elevation, external rotation was to 80 with the opposite shoulder being 90, and internal rotation was equivalent at 70. Adduction and abduction were equivalent. The shoulder was prepped and draped in a sterile fashion. Through anterolateral, direct lateral, and posterolateral portals, the shoulder was examined and treated arthroscopically. The glenohumeral joint was entered. The glenoid, humeral head, biceps tendon, and labrum were intact. The rotator cuff was intact. The arthroscopic instruments were placed in the subacromial space. The bursa was resected. The coracoacromial ligament was released from the acromion with the cautery. Utilizing a bur and a shaver, the acromion was flattened .
The anterior portion was excised and the rotator cuff was found to have a significant partial-thickness bursal side tear, but no full-thickness tear and the arthroscopic instruments were removed. A small incision was made over the distal clavicle. The deltoidtrapezial raphe was taken down in a subperiosteal fashion off of the distal clavicle and the distal 2.5 cm of clavicle was excised with a saw. Bone wax was placed over the cut end. The deltotrapezial raphe was closed with #1 Nurolon. A small closed suction drain was placed and the wound was closed with 2-0 Vicryl and a Monocryl for the skin. Steri-Strips were applied. The acromioplasty was checked manually before closure. A sterile compressive dressing was applied. The patient was awakened and taken to the recovery room in good condition. There were no complications. Blood loss was minimal. Postoperative plans are to rehabilitate the patient's shoulder.