The OR Times

Week of 1/12/2020

During shoulder arthroscopy, it’s extremely common to find some form of a bone spur on the acromion that is impinging the rotator cuff, typically supraspinatus, that is causing pain on patients. This pathology can appear when using radiology pre-op, and make it easier to find rotator cuff tears when in the sub-acromial space. However, occasionally an x-ray that shows a bone spur can be very misleading.

I was with a surgeon that was operating on a 46 year old male suffering from textbook acromioclavicular joint impingement symptoms, as well as a possible rotator cuff tear. Interestingly enough, the pre-op radiology report saw a slightly odd bone spur on medial side of the acromion, so the surgeon thought that it was going to be a simple distal clavicle excision and SAD. What we found through the microscope was a previous acromial fracture from when the patient was a child that had healed, but had also calcified over, so it was impinging on the shoulder in a major way and the main source of his pain.

Common Sub-Acromial Decompression with a bone spur.

This discovery did not necessarily affect the surgery in any way, outside of taking longer than expected, but left the surgeon upset because he had sent the students observing him for the day home. Acromial fractures are uncommon, personally I have seen thousands of shoulder cases and this was the first fracture of its kind I have seen in my career, so the teaching moment was lost. The simple solution that Med Dimensions could have assisted with is a pre-op model of the surrounding osteology of the glenohumeral joint, so this surgeon could have seen this odd x-ray in 3D and been prepared to teach his students in the moment, rather than just having to tell them about the unique case he had just completed.

Please leave a comment if you have any questions, and reach out to me at fred@m3dimensions.com if there is anything you’d like me to cover!

-Fred

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