PREOPERATIVE DIAGNOSIS: Right shoulder AC joint arthritis with rotator cuff tear.
POSTOPERATIVE DIAGNOSIS: Right shoulder AC joint arthritis with rotator cuff tear.
PROCEDURE: Right shoulder distal clavicle excision with rotator cuff repair.
INDICATIONS: This is a 57-year-old male who injured his right shoulder at work about 3 years ago and thereafter had some loss of motion. He reinjured his shoulder about 5 or 6 months ago. His x-rays at that time showed some AC joint arthritis and an arthrogram showed leakage of dye through the rotator cuff interval. He was PARd reference his options and accepted the above procedure.
DESCRIPTION OF PROCEDURE: Under general anesthesia with a bump under the right scapula the right shoulder was prepped and draped using normal sterile technique. The patient's shoulder was approached through the standard anterolateral oblique incision. This was centered over the body of the acromion. The soft tissues were elevated off the distal clavicle and the lateral 1 to 1.5 cm of clavicle were excised with an oscillating saw. The articular surface appeared fitted. The distal clavicle was excised after releasing the soft tissues.
Next, the shoulder joint was approached through the standard anterior lateral approach. The anterior lateral raphe was incised and the shoulder joint was entered with the following findings. The long head of the biceps was intact. A portion of the rotator cuff was intact on the posterior half of the greater tuberosity. Roughly one-third was intact. Exploration within the shoulder joint after acromioplasty of the anterior inferior corner of the acromion showed that the torn portion of the rotator cuff had retracted posteriorly. It was possible to elevate in advance a portion of the torn rotator cuff into the greater tuberosity.
Following advancement of the rotator cuff, roughly two-thirds to three-fourths of the humeral head was covered with rotator cuff tendon. It was not possible to cover the entire humeral head with the rotator cuff tendon. It should be noted that this rotator cuff tendon had the appearance of a chronic rotator cuff tendon tear commensurate with his injury of 3 years ago. A slot was cut in the greater tuberosity. A screw was placed into the humeral head and the rotator cuff was repaired into the slot using the sutures from the screw. An attempt was made to cover the anterior one-fourth of the humeral head, but this was not possible because of the chronic retraction of the rotator cuff.
The wounds were irrigated. The deltoid was repaired to itself over the greater tuberosity and rotator cuff tendon. The soft tissues were repaired over the lateral clavicle. The skin was closed with absorbable sutures and staples. A light dressing was applied followed by a sling. He was awakened from the anesthetic and taken to recovery in stable condition having tolerated the procedure well.
PLAN: He was given a prescription for 30 Vicodin and 30 Vistaril for postoperative pain control. He will return to see me in my office in a week for dressing removal and removal of some of his staples. A week later we can remove the remainder of his staples.