Extreme Slip to Extreme Slap

(Injury, Surgery, and a BASS Guitar / Guitar Instructor's Segue to Recovery.)

Injury, Treatment, and Recovery

Patient Name:
Gregory Bruce Campbell

Occupation:
Professional Private BASS guitar, Guitar and Ukulele Teacher

The Fall: Initial Incident and Injury:
On the evening of November 22, 2024, Campbell, an otherwise healthy and active individual, experienced a traumatic fall due to icy conditions underfoot combined with a 100' extension cord on the ground. Losing balance, Campbell fell sideways, landing directly on the coiled up extension cord striking his outstretched left arm and shoulder with significant force.

Immediate Symptoms and Impact:

• Pain: Excruciating pain radiated from the midshaft of the left humerus to the shoulder. The pain was sharp and stabbing, worsening with any attempt to move the arm actively.
• Mobility: Complete inability to lift or actively move the left arm, although passive motion was still achievable, albeit painful.
• Other Symptoms:
  • No loss of consciousness or head impact.
  • No shortness of breath, chest pain, or systemic symptoms like fever or chills.

Emergency Department Evaluation:
Campbell presented to the Emergency Department approximately an hour after the incident. He appeared in significant distress but remained alert and cooperative.

Clinical Examination:

• Observation:
  • The left arm was cradled close to the body, and the shoulder displayed no visible deformity or swelling.
  • No bruising or external wounds were initially noted, though deep tenderness was evident along the posterior deltoid region.
• Range of Motion:
  • Passive external rotation and forward flexion elicited pain but were nearly full.
  • Active movement was entirely restricted due to severe pain.
• Neurological and Vascular Exam:
  • Sensation intact across radial, ulnar, median, and axillary nerve distributions.
  • Normal radial pulses bilaterally and good capillary refill.

Imaging:

• X-rays of the Left Humerus and Shoulder:
  • No fractures or dislocations were identified.

Initial Management and Plan:

• Prescribed NSAIDs (ibuprofen) for inflammation and pain relief.
• Immobilized with a sling to provide support and protection.
• Advised to begin gentle passive range-of-motion exercises within 48 hours to minimize stiffness.
• Referral for orthopedic follow-up if symptoms persisted.

Orthopedic Consultation and Diagnosis:
By December 2, 2024, Campbell reported persistent pain and stiffness despite initial conservative management. He attended an appointment at Broadway Clinic Orthopedics for further evaluation.

Orthopedic Findings:

• Symptoms:
  • Pain localized to the posterior shoulder and lateral upper arm, particularly during lifting or overhead activities.
  • Difficulty performing occupational tasks, such as teaching guitar, with complaints of stiffness and reduced arm mobility.
• Examination:
  • Tenderness noted over the posterolateral shoulder, with diffuse pain on palpation of the rotator cuff muscles.
  • Limited active range of motion in flexion, abduction, and external rotation (<90 degrees).
  • Positive Hawkins Test, indicative of rotator cuff impingement.

MRI Results (December 2, 2024): An MRI confirmed significant structural injuries:

1. Rotator Cuff Tears:
   • Partial tears with full-thickness components in both the supraspinatus and subscapularis tendons.
2. Labral Tear:
   • Superior glenoid labrum showed significant detachment and fraying.
   • Tear extended to involve the biceps tendon insertion.
3. Additional Findings:
   • Subacromial impingement caused by a prominent bone spur.
   • Subdeltoid bursal fluid.
   • Early osteoarthritis in the AC joint.

Expedited Surgical Plan:
Given the extent of injuries and failure of conservative management, arthroscopic surgical intervention was scheduled within two weeks of the MRI to prevent further deterioration and expedite recovery.

Surgical Intervention Date:
December 19, 2024

Surgeon:
Jeffrey S. Dickson, DO

Procedure:
Arthroscopic subacromial decompression, rotator cuff repair, labral repair, and open subpectoral biceps tenodesis.

Preoperative Preparation:
Campbell was brought into the operating room under general anesthesia. The left shoulder was sterilized, draped, and padded for protection. A "time-out" was performed to confirm the surgical plan, including patient identity, procedure, and laterality.

Step-by-Step Surgical Procedure

1. Diagnostic Arthroscopy:
   • Posterior and anterior portals were created for arthroscopic access.
   • A diagnostic examination revealed:
     • Partial-thickness tears in the supraspinatus and subscapularis tendons.
     • A superior labral tear with associated biceps instability.
     • Hypertrophic synovium and subacromial impingement.
2. Rotator Cuff Repair:
   • Torn edges of the supraspinatus and subscapularis tendons were debrided and prepared for repair.
   • Fiber tape sutures were passed through the tendon tissue using a scorpion suture passer and anchored securely to the bone using two 4.75 mm Arthrex swivel-lock anchors.
3. Biceps Tenodesis:
   • The biceps tendon was released from its origin and whipstitched for stabilization.
   • A unicortical drill hole was created in the humerus, and the tendon was secured using a biceps tenodesis button, ensuring proper tension.
4. Subacromial Decompression:
   • The hypertrophic subacromial bursa and a large bone spur were removed with a shaver and ablator.
   • This created a smooth, impingement-free surface.
5. Labral Repair:
   • Fiber tape sutures were passed through the labrum and anchored to restore stability to the glenoid.
6. Closure and Postoperative Care:
   • All portals were closed with Prolene sutures, and the anterior incision was closed with Vicryl and dermabond.
   • A sterile dressing was applied, and the arm was immobilized in a sling with an abduction pillow.

Postoperative Recovery Immediate Postoperative Period:

• Minimal blood loss and no complications during surgery.
• Pain managed with oxycodone and NSAIDs.
• Sling immobilization for 4-6 weeks, with early passive pendulum exercises.

Current Status and Prognosis:
As of January 3, 2025, Campbell had his 2-week follow-up visit, during which the incisions were healing well, and pain was controlled. He had started physical therapy and was working on regaining mobility and strength.

Prognosis:
With continued adherence to therapy, a FULL return to pre-injury function is anticipated.