- Discussion:
- see
arthroscopic rotator cuff repair
- basic science:
-
Vascular
endothelial growth factor 121 and 165 in subacromial bursa are involved in
shoulder joint
contracture in type II diabetics with RC disease.
-
The molecular pathophysiology of subacromial bursitis in rotator cuff disease.
-
Proinflammatory cytokines and metalloproteases are expressed in the subacromial
bursa in patients
with rotator cuff disease.
-
Stromal cell-derived factor 1 (SDF-1, CXCL12) is increased in subacromial
bursitis and downregulated
by steroid and NSAIDS.
-
Increased IL-1beta expression and myofibroblast recruitment in subacromial bursa
is associated with
rotator cuff lesions with shoulder stiffness.
-
Interleukin-1-induced glenohumeral synovitis and shoulder pain in rotator cuff
diseases.
- Surgical Considerations:
- note that the
subacromial bursa
is an anterior structure;
- it is located from the anterior one half to one third of the acromion to
just medial to A-C joint to 1 to 2 cm
anterior to acromion and 2.5 cm laterally;
- posterior busrsal wall is thick posteriorly (called posterior bursal
curtain))
- this posterior bursal curtain frequently “closes” as the scope
is backed posteriorly to get a larger field;
- it may be necessary to resect a portion of this structure to
visualize the entire arch;
- technical considerations (see
acromioplasty)
- when introducing instruments into the subacromial bursa, use the blunt
trochar sheath is lyse adhesions
from the undersurface of the
acromion and
the lateral part of
the deltoid;
- OR descriptions bursal proliferation and inflammation, hemorrhaging in
CA ligament,
hypertrophy and fraying of CA
ligament, acromial spur formation;
- bursa is sometimes debrided after the acromioplasty, since it tends to
bleed more (disrupting the case);
- take special when debriding around the AC joint since bleeding
is especially troublesome;
- rotate the arm internally and externally to expose different parts of the
bursa;
- downward traction generally increases the working space available
for the subacromial space.
- use of a radiofrequency
device before a motorized shaver is used for bursectomy can help to minimize
bleeding;