Arthroscopic Shoulder Debridement

Partial-thickness rotator cuff tear

• Local skin infection or disease
• Systemic infection
• Other medical illness that increases surgical risk
• Full-thickness rotator cuff tear

• Arthroscopy tower and arthroscope
• Arthroscopy set
• Sterile arm traction device
• Full-radius resector
• Sling

Arthroscopic subacromial anatomy

• Biceps tendon used as landmark for orientation
• Lateral decubitus position: with camera in normal upright position, glenoid is horizontal
• Evaluate biceps tendon as far as possible into the rotator interval.
• Directing lens superiorly allows view of rotator cuff and insertion into greater tuberosity.
• Rotator cuff arch, just medial to tendinous insertion
• Small vessels enter inferior to the cuff in a bare area (no articular cartilage covering).
• Subacromial bursa extends at least 2 cm anterior to the anterior edge of the acromion and to the midacromion posteriorly.
• Medially, you can see the acromioclavicular joint and coracoacromial ligament as it ascends under the acromion.
• The subdeltoid bursa is approximately 4 cm from the acromial edge, with the axillary nerve always lateral to the bursa, on average 0.8 cm.

• Use sling until comfort permits removal
• Exercises:
  • Codman pendulum exercises first day
  • Active-assisted range-of-motion and isometric strengthening the first week
  • Resistance exercises with elastic tubing second week
  • Continue strengthening for 3 months.
• Activities of daily living as tolerated
• Return to sports when they have achieved full pain-free range of motion and strength.

• Failure of the procedure and/or persistent symptoms (most common complication)
• Neurologic injury
• Infection
• Subclavian vein thrombosis

Although not as successful as repair of a rotator cuff tear, debridement of partial thickness tears does result in satisfactory subjective scores in the majority of patients.