Case Study: Shoulder Arthroscopy: Rotator Cuff Repair
using smith and nephew in a 43 year-old female

Shoulder repair is being redefined by Smith+Nephew. Surgeons need a means to take the pain out of shoulder repair, from complex cases of rotator cuff repair to the challenges of instability. We can modify their ideas and expectations of shoulder healing by combining Advanced Healing Solutions and Instability Excellence.

A 43 year-old female patient was involved in a car accident in which she hurt both of her shoulders. Her right shoulder hurt more than her left. We performed an MRI, which revealed a rotator cuff tear in the right shoulder. We discussed treatment alternatives, and the patient decided on surgical intervention.

We reviewed risks and benefits such as infection, hemorrhage, nerve and vascular injury, rehabilitation, failure to recover and delayed healing, and the need for revision surgery, among other things.

We also talked about systemic issues, such as cardiac, pulmonary, or neurological complications, which can lead to death. The patient comprehended and signed an informed consent form.

The patient was brought into the operation room and placed on the well-padded operating table. Anesthesia was administered. A preoperative antibiotic was administered. The patient was supported on the left lateral side, with the right shoulder raised.

The bean bag kept her in that posture. All of the bony prominences were adequately cushioned. The right shoulder was prepared and draped aseptically as usual. A timeout was issued. In the soft spot, a posterior entrance hole was created.

The glenohumeral joint was inspected with an arthroscope. Fraying of the anterior and superior labrums was discovered during a glenohumeral joint examination. There was a rotator cuff tearing on the supraspinatus and infraspinatus articular surfaces. Articular cartilages were not damaged.

A spinal needle was used to create an anterosuperior entrance hole. The glenohumeral joint, comprising the labrum and rotator cuff, was debrided. X-rays were obtained and stored. The arthroscope was placed in the subacromial area, and the shaver was inserted through the anterosuperior portal.

The inflammatory bursa was removed via bursectomy. Acromial spur and AC spur acromioplasty were performed using a heat wand followed by a 6.0 bur. The distal clavicular excision was similarly conducted in the same manner as the posteroanterior portal.

The arthroscope was held in place via the lateral portal. The rotator cuff was examined and revealed partial thickness and high-grade ripping of the infraspinatus tendon.

It was decided that the rotator cuff would be repaired using a Regeneten implant. The arthroscope was inserted through the posterior portal, and the implant through the lateral portal. PLA tacks from a superior accessory portal were used to secure the implant.

Final photos of the implant, rotator cuff, acromioplasty, and distal clavicle were taken and stored. The shoulder was irrigated extensively. Closure was accomplished with # 3-0 nylon.

Dressing was done with a 4 x 8, an ABD, and tape. The shoulder was then immobilized. In a stable condition, the patient was extubated and transported to the recovery room. Supraclavicular block was scheduled for the patient’s recovery after surgery.

After two months the patient is seen in the office for her postoperative visit, no x-rays are needed. She denies fever or chills, she only sleeps in the recliner. Initially she was stiff and did not work with PT much, she was just doing home PT also as directed by her mom, but now she was about to start with her PT but is still in pain and not recovering well.

After three months, she is here for her postoperative visit, no x-rays are needed, now she has started PT but is still painful but she seems to be making progress with PT. However, we may consider repeat surgery if still has no progress in the next visit. 

We discussed therapy alternatives such as PT, MRI, injection, and surgery. We agreed to use conservative management for the time being. PT will continue, as will the use of ice and elevation, as well as the use of over-the-counter anti-inflammatory medications and After 4 weeks, there will be another checkup.

After four months the patient is here today for her post operative consultation, she is still in pain but she seems to be making progress with PT. She feels a painful knot in front of left shoulder. We chose to keep her on her present course of treatment, but we reserve the right to repeat surgery if necessary.

We also agreed to have another MRI done at the subsequent session. The patient is still making improvement, albeit slowly, with help of monthly examinations and physical treatment and at home. 

Disclaimer – Patient’s name, age, sex, dates, events have been changed or modified to protect patient privacy.