M.L., a 56-year-old business executive and former college football player, was referred to an orthopedic surgeon for recurrent shoulder pain. M.L. was unable to abduct his right arm without pain even after 6 months of physical therapy and NSAIDs. In addition, he had taken supplements of glucosamine, chondroitin, and S-adenosylmethionine for several months in an effort to protect the flexibility of his shoulder joint. M.L. recalled a shoulder dislocation resulting from a football injury 35 years earlier. The surgeon recommended the Bankart procedure for M.L.'s complete tear to restore his joint stability, alleviate his pain, and permit him to return to his former normal activities, including golf.
After anesthesia induction and positioning in a semisitting (beach chair) position, the surgeon made an anterosuperior deltoid incision (the standard deltopectoral approach) and divided the coracoacromial ligament at the acromial attachment. The rotator cuff was identified after the deltoid was retracted and the clavipectoral fascia was incised. The subscapularis tendon was incised proximal to its insertion. After incision of the capsule, inspection showed a large pouch inferiorly in the capsule, consistent with laxity (instability). The torn edges of the capsule were anchored to the rim of the glenoid fossa with heavy nonabsorbable sutures. A flap from the subscapularis tendon was transposed and sutured to the supraspinatus and infraspinatus muscles to bridge the gap. An intraoperative ROM examination showed that the external rotation could be performed past neutral and that the shoulder did not dislocate. The wound was closed, and a shoulder immobilizer sling was applied. M.L. was referred to PT to begin therapy in 3 weeks and was assured he would be able to play golf in 6 months.
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