Name:
How to Proper Identify and Treat Subscapularis Upper Third Partial Tears
Description:
How to Proper Identify and Treat Subscapularis Upper Third Partial Tears
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Duration:
T00H10M04S
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Upload Date:
2024-05-31T00:00:00.0000000
Transcript:
Language: EN.
Segment:0 .
Hello, my friends, how are you? This is me, Dr. Sergio Rowinski from Shoulder Planet here, from Sao Paolo, Brazil, and in this video, I'm presenting to you a nice way of identifying and fixing upper third partial subscapularis. We all know that upper third partial subscap tears they are not uncommon.
They do exist, and many times we can understand them clinically, and we know that many times we simply can't feel them. We can understand them clinically, but we cannot see them in the MRI because of a lot of limitations of the MRI in seeing such lesions. In this sense, it's extremely important to know how to identify them and properly fix them. And this is what this video is about, so I hope you'll like it.
I hope you enjoy it. Please don't forget to subscribe and let us see the video. So this is the arthroscopy. This is a right shoulder. We are establishing the your portal with a spinal needle and entering with a straight artery forceps. It's very important to do a wide and good opening of the capsule. We starting removing the anterior capsule and the rotator interval with a radiofrequency device.
Then we will come with a shaver, a soft tissue shaver. What is important for us to understand is that it's extremely important to remove all of the anterior capsule. And all of the rotator interval in order for us to do a proper assessment, a diagnostic assessment of the subscap and hence fixation if needed, as it was in this case. So now we are removing the anterior interval the rotator interval with a shaver.
And finally, we started to see the scabs. So what we have seen here is a very important image, and it's very important for all of us to understand the anatomy in order for the orthopedic surgeon to know how to triangulate in the articular space of the shoulder.
So what we are seeing here below is the humeral head. It's very easy to see, and it always has a broad, ample surface and circular surface two on the right side of the screen. What we are seeing is the long head of the biceps as we are, of course, in our right shoulder. What we are seeing inferiorly is the subscap, and seeing the subscap is absolutely fundamental for us to evaluate if there is a tear and if a positive force to fix it.
And on the left side of the screen, we are seeing the anterior labrum in this case, what was much probably a cord like made a cord like mid renal humeral ligament with absolutely no pathological value. So now we are below the long head of the biceps, the patient seems to have a mid-cord, glenohumeral ligament with no pathological value, and then finally, we started to see the subscap.
It's very important to do a dynamic analysis of this subscap with internal and external rotation. We are doing it now and see, once we do internal and external rotation, it became very easy for us to see that the patient indeed had a significant partial.
So this is a very, very evident image in which we can see a clear partial tear, partial but important tear of the subscap and as I have said, without a full removal of the rotator interval and the anterior capsule is basically impossible for the surgeon to properly identify such a tear. So, as I have said, full removal of the anterior capsule above the rotator interval and with dynamic evaluation of the cap with internal and external rotation, we can come to see such a clear image with a cap insertion now tear.
So what we are seeing here in this image is the healthy part of the tendon, which is the medial part and the articular part. But it's very easy for us to understand, of course, that the vast majority of the tendon was in good shape. Nevertheless, there is a tear here with a lot of fraying and that this insertion of the upper third of the cap from the letter to velocity. And obviously, that would be a tear that definitely would have not only to be diagnosed, but also to be fixed.
Tear of the subscap that would definitely need to be fixed. So I always like to put an anchor just above the insertion of the cap and medial to the long head of the biceps. We are seeing the long head of the biceps now, which was quite healthy and quite innocent, so we did nothing with it. And I always like to put my anchor very medial and a little bit straight upon the insertion of the subscap, so we don't need to use the burr just with a soft tissue shaver, we can gently remove the articular cartilage in that part of the lesser porosity until we see a bony bed bleeding base that it's beautifully seen now.
And once that bony bed was created and then we would have to put an anchor in the proper way. It's very important to protect the face of the patient when we are doing this. And you can use a metallic anchor and absorbable anchor. It doesn't matter. It must be, of course, double loaded. This one was in case and absorbable double loaded anchor.
We are just preparing the hole and then we are finally entering with the anchor. So this is, as I have said, they've all loaded, absorbable anchor as soon as the anchor is put. We can just test it, as we are doing now. So now we are just testing the purchase of the implant, which was very nice. And in this sense, then I just have to put one of these sutures in front of this subscap and with a very simple instrument in case a bird beak, we can pass a big health bite on the subscap and in a retrograde fashion, we can tie the knot.
So in this case, which is quite easy to understand with only one suture, we can do as we are seeing now a very, very nice and easy fixation of the subscap in these situations. One suture is, as a rule, absolutely enough. And now we are seeing the final fixation of the subscap with a very good, healthy tendon touching the bone.
So here we can see in a very easy way the native aspect of the subscap upper tear partial tear. Immediately after we identified it on the left side of the image and then the final aspect of the repair on the right side. Partial subscap tears are indeed not rare, and it's very important for any shoulder surgeon to know not only how to identify them, but still how to properly treat them to any way with adequate intraoperative measures, which includes a broad and ample and wide removal of the anterior capsule upon the rotator interval and the dynamic evaluation of the tear with internal and external rotation of the arm.
These lesions can be adequately identified and hence treated whenever needed. So I hope you like it. The video a nice demonstration of how to see and how to fix upper third partial subscap tears please don't forget. Subscribe give us your comment and leave you like and see you in the next video. And as Doctor Sergio loves to say, never stop flying.
Thank you very much.
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