Playing Doctor

I had my first follow-up appt with the Orthopedic Surgeon this past Thursday and he brought me up to speed on how things had gone. He said that when he got inside my shoulder, he found things to be in worse shape than the MRI’s and X-Rays had indicated. But with a combination of sutures and anchors (drilled into the bone – sweet!), he said everything came together nicely and his prognosis is good.

But the best part of the visit was that he printed out his notes from the surgery for me. Notes from the surgery! Check this sh*t out!...

(And of course I had to add my own little comments from time to time - I colored them in red so you don't think the doc is talking to himself in his notes.)

DATE OF SURGERY: 3/9/2010
DIAGNOSIS: Biceps labral tear, anterior inferior instability, attenuated anterior inferior capsule.
PROCEDURE: Anterior inferior capsuloraphy and biceps labral repair

Following satisfactory induction of general anesthesia, the left shoulder was prepped (that means they shaved the incision spots – too bad they didn’t shave where the bandages were going to be!) and draped in standard fashion for arthroscopy. Through a posterior portal (“portal”? Call it what it is; a hole! You punched a hole into my shoulder so that you could peep in at what was going on!), the arthroscope was introduced. (“Introduced”? What do you mean, “introduced”? You mean it went something like this? “Hello ligaments and shoulder bone, I’d like you to meet Arthur. Arthur Scope.”)

Two anterior portals (there’s that word again. They’re holes!) were created for instrumentation. Through the posterior portal (hole!), the pathologic changes were documented with photography (it’s true, I have the pics at home. Maybe I’ll get a nice frame and mount them over the fireplace).

A 4.0 resector was used to debride the disrupted biceps labrum and to visualize the exposed subchondral bone along the anterior rim of the glenoid from the 11:00 to the 1:00 position. (Now before we continue, I’d like to ask if any of you know what a ‘resector’ is? No? I didn’t either, so I looked it up. And I wish I hadn’t. This thing is basically a saw/grinder combination that fits inside a tiny little tube. They shove it up against anything that’s torn and needs cleaning up, and then they turn it on. And voila! It shreds the loose tissue and sucks it out at the same time. And you’re doing all this inside my shoulder?? I dug up a couple of clips on You Tube that showed this thing in action. Freaky stuff!)

This chronically attenuated (torn!) and detached labrum was freshened (“freshened?” You mean ‘cleaned up by chewing all the loose stuff out’!) broadly with the resector until subchondral bone was microscopically bleeding (“bleeding”? What do you mean “bleeding”? You ground at my bone until it bled??) The anterior rim of the glenoid to the 6:00 position was vigorously debrided (scraped!) while using a liberator to free the attenuated (torn!) labrum. With the capsule and labrum broadly released, the bone and chondral margin were broadly freshened (ground clean!) to stimulate biologic vascularization (again with the bleeding?!?).

With the capsular complex prepared, strategically placed orthocord sutures were used to secure the anterior capsule and attenuated labrum to the 5:30, 4:00 and 2:00 position along the glenoid. (Cool - let's have more of the "fixing things" stuff, and less of the "grinding and bleeding" business.)

The strategically placed push-lock anchors were then used, securing and supporting the capsule to the rim of the glenoid. (Excellent – more repair work!) This was done from the anterior to superior position while maintaining 30 degrees of external rotation at 30 degrees of abduction (“Roger, Roger, What’s our vector, Victor?”). Individually placed anchors and individually tensioned orthocord sutures along the way. With the anterior capsule secure, the most superior suture was used securing the anterior labrum just posterior to the biceps tendon insertion to the labrum. A simple orthocord suture was placed (simple? Nothing about this whole process sounds very simple so far…) corresponding to this position.

A 2.9 push lock anchor was used via predrilling and then inserting the push lock anchor under proper tension to reduce and stabilize the biceps labrum from anterior to posterior. External rotation was maintained throughout and tested at 30 degrees of rotation at 30 degrees of abduction as described above. Copious lavage and irrigation was used throughout. (I know that ‘lavage’ means rinsing, but what’s this about irrigation? You’re planting crops inside my shoulder now?).

An 18-guage needle was inserted and 30 cc of .12% marcain with epinephrine and 4mg of Morphine were instilled (18-guage? That’s not very big. I know for a fact the holes you punched into my shoulder could handle a much bigger needle. And since we’re talking about administering MORPHINE, we should have gone with a bigger needle. Just my opinion.).

The debris (debris??) was vigorously debrided throughout the course freshening the chondral margins and the attenuated labral capsular complex until the joint surfaces and joint cavity were free of debris (What do you mean; “debris”?) along the way.

Bleeders (“We’ve got a bleeder!!!”) were carefully cauterized along the way, as well. The incisions were approximated with 4-0 monocryl and a dry sterile compressive bandage applied (yeah; applied with liberal amounts of super glue).

The patient tolerated the procedure well and left the operating room in satisfactory and stable condition. (I tolerated it well? I was unconscious! It’s hard to complain when you’re out cold. Although…I was curious why my pants were around my ankles when I woke up…).

And there you have it. I still need to wear the sling for another week and a half, and there’s no physical therapy yet - which means no riding yet. I don’t know when I’ll get the green light to hop back onto the bike, but my next ortho appt isn’t for another 5 weeks.

Not sure I can wait that long to put some handlebars into my lap…