Description of Event or Problem · 1
PT HAD EPISODE OF INCREASED PAIN AND SEVERE RESTRICTED RANGE OF MOTION OF SHOULDER. PREOPERATIVE DIAGNOSIS: 1) POSSIBLE ADHESIVE CAPSULITIS, RIGHT SHOULDER. 2) STATUS POST ARTHROSCOPIC BANKART USING BIONIX. POSTOPERATIVE DIAGNOSIS: 1) SYNOVECTOMY OF THE GLENOHUMERAL JOINT, RIGHT SHOULDER. 2) LOOSE BODIES. 3) CHONDROMALACIA OF THE HUMERAL HEAD. PROCEDURE: OPERATIVE ARTHROSCOPY WITH 1) DEBRIDEMENT AND REMOVAL OF BIONIX TACKS, RIGHT SHOULDER. 2) CHONDROPLASTY. 3) CAPSULORRHAPHY USING ORATEC. ANESTHESIA: GENERAL. FINDINGS: THERE WAS A CRUNCHING POP ANTERIORLY WITH EXTERNAL ROTATION. FULL RANGE OF MOTION WAS ACHIEVED WITHOUT DISRUPTING THE CAPSULE. ARTHROSCOPIC FINDINGS: BOTH OF THE HEADS OF THE BIONIX TACKS WERE LOOSE IN THE JOINT WITH FEW MILLIMETERS OF THE STEM ATTACHED TO THE HEADS. THE HEADS WERE FRAGMENTED. ONE OF THE HEADS WAS FRAGMENTED IN TWO PIECES. THERE WAS SYNOVITIS THROUGHOUT THE JOINT. THERE WAS AN AREA OF GRADE II CHONDROMALACIA ON THE ANTERIOR HUMERAL HEAD. THE REST OF THE HUMERAL HEAD LOOKED GOOD. THIS WAS ABOUT A 1 CM AREA ON THE ANTERIOR HUMERAL HEAD. THE ANTERIOR CAPSULE IN THE LABRUM WHICH HAD BEEN TACKED IN WAS HEALED. THERE WAS SOME SLIGHT LAXITY OF THE ANTERIOR CAPSULE, BUT IT APPEARED HEALED WELL IN THE GLENOID LABRUM. OPERATIVE NOTE: THE SHOULDER WAS EXAMINED. THE PT WAS PLACED IN A SUPINE POSITION. EXTERNAL ROTATION GAVE A CRUNCHING ANTERIORLY; IT FELT LIKE POSSIBLY LOOSE BODIES ANTERIORLY IN THE SHOULDER. FULL RANGE OF MOTION WAS ACHIEVED. THE PT WAS THEN PLACED IN A LATERAL DECUBITUS POSITION WITH THE RIGHT ARM IN TRACTION AND ABDUCTION. THE SHOULDER WAS PREPPED AND DRAPED IN A STERILE MANNER. THE ARTHROSCOPE WAS INTRODUCED POSTERIORLY INTO THE GLENOHUMERAL JOINT WITH INFLOW THROUGH THE SCOPE. THE JOINT WAS INSPECTED IN A STANDARD MANNER. IMMEDIATELY ONE OF THE LOOSE BIONIX TACKS WAS NOTED INSIDE THE JOINT. THE TACK WAS LOCATED ANTERIORLY. THERE WAS SOME HYPERTROPHIC SYNOVIUM THROUGHOUT THE JOINT. THE CAPSULE WHERE THE BIONIX TACK HAD BEEN ATTACHED INTO THE GLENOID WAS GOOD. THERE WAS A 1 CM AREA OF GRADE III CHONDROMALACIA ON THE ANTERIOR PORTION OF THE HUMERAL HEAD. THROUGH AN ANTERIOR SUPERIOR PORTAL THE GRASPERS WERE INTRODUCED AND THE FIRST TACK WAS GRASPED AND REMOVED WITH THE GRASPERS. THERE WERE SOME OTHER SLIVERS OF THE BIONIX TACK IN THERE AND THE SHAVER WAS INTRODUCED AND DEBRIDEMENT WAS DONE. SOME OF THE LOOSE PIECES WERE REMOVED WITH THE SHAVER. THE SHAVER WAS USED TO DEBRIDE THE HYPERTROPHIC SYNOVIUM ANTERIORLY AND THE THICKENED CAPSULE ANTERIORLY. THE OTHER BIONIX TACK WAS THEN NOTED AND IT WAS GRASPED WITH THE GRASPERS AND REMOVED. THERE WAS ANOTHER FRAGMENTED PIECE THAT WAS GRASPED WITH THE GRASPERS AND REMOVED. THE SHAVER WAS INTRODUCED AND DEBRIDEMENT WAS DONE. ADEQUATE DEBRIDEMENT WAS DONE THROUGHOUT THE GLENOHUMERAL JOINT. THE ORATEC UNIT WAS THEN PLACED IN AND SOME OF THE ANTERIOR CAPSULE WAS TIGHTENED. THE ORATEC UNIT WAS USED ON THE ANTERIOR REMAINING TISSUE AND ALONG THE SUPERIOR LABRUM. THEN IN THE AREA OF CHONDROMALACIA ON THE ANTERIOR HUMERAL HEAD THE AWLS WERE USED TO MAKE SOME HOLES IN THE HUMERAL HEAD TO BRING IN BLOOD SUPPLY TO THE AREA. THE INSTRUMENTS WERE REMOVED. MARCAINE WITH EPINEPHRINE WAS INJECTED INTO THE JOINT. A STERILE DRESSING WAS APPLIED. THE PT WAS PLACED IN AN IMMOBILIZER. THE PT WENT TO THE RECOVERY ROOM IN GOOD CONDITION.