Successful Arthroscopic SLAP Repair, Bursectomy & Capsular Release for Grade 3 SLAP Tear with Bursitis in a 40 Y.O. Male
PACE Hospitals
PACE Hospitals’ expert Orthopaedic team successfully performed a
Diagnostic Arthroscopy, Subacromial Bursectomy, Capsular Release, and SLAP Repair (Superior Labrum Anterior to Posterior tear repair)
of the right shoulder on a 40-year-old male patient diagnosed with SLAP Tear Grade 3, Subacromial Bursitis, and Periarthritis. The aim of the procedure was to relieve pain, remove inflamed and damaged tissue, repair the torn labrum, restore joint mobility, and improve overall shoulder function, enabling the patient to return to normal daily activities.
Chief Complaints
A 40-year-old male patient with a
body mass index (BMI) of 22 presented to the Orthopaedic Department at
PACE Hospitals, Hitech City, Hyderabad, with complaints of right shoulder pain and difficulty performing overhead activities for the past few months. He also reported difficulty in carrying out daily activities due to pain. The patient had previously undergone conservative management with physiotherapy but experienced no significant relief in symptoms.
Past Medical History
The patient had no significant past medical or surgical history. There was no history of chronic illnesses such as
diabetes or
hypertension, and no previous hospitalizations or surgeries were reported. He was otherwise healthy prior to the current condition, with no known comorbidities.
On Examination
On examination, the patient was conscious, coherent, and oriented. His vital signs were stable at the time of assessment. General examination revealed no evidence of pallor, icterus, lymphadenopathy, clubbing, or cyanosis. Local examination of the right shoulder showed mild swelling with restriction of movements. Internal rotation was reduced, and abduction as well as external rotation were painful. Clinical tests for SLAP tear were positive. No neurovascular deficit was noted in the affected limb.
Diagnosis
Following the clinical evaluation, the Orthopaedics team at PACE Hospitals conducted a detailed assessment focusing on the patient’s complaints of right shoulder pain associated with difficulty in performing overhead activities and routine daily activities for the past few months.
A comprehensive clinical and systemic examination was carried out to determine the severity of the condition. Examination of the right shoulder revealed mild swelling with restriction of movements, including reduced internal rotation and painful abduction and external rotation. Special clinical tests for SLAP tear were positive, indicating labral involvement. There was no neurovascular deficit in the affected limb. Radiological evaluation (MRI shoulder) confirmed the presence of SLAP Tear Grade 3, Subacromial Bursitis (inflammation of the subacromial bursa), and Periarthritis (adhesive capsulitis/frozen shoulder changes) of the right shoulder.
Based on these findings, the patient was advised to undergo SLAP Tear Grade 3 with
Subacromial Bursitis and Periarthritis of the right shoulder Treatment in Hyderabad, India, under the care of the Orthopaedic Department, to relieve pain, restore shoulder joint mobility, improve overall functional outcome and quality of life.
Medical Decision-Making (MDM)
After a detailed consultation with Dr. Raghuram, Consultant Orthopaedic Surgeon, a comprehensive evaluation was performed to determine the most appropriate diagnostic and therapeutic approach. Considering the patient’s history of right shoulder pain, difficulty in performing overhead activities, and associated restriction in daily functional movements, along with clinical findings of mild swelling, reduced internal rotation, and painful abduction and external rotation, a focused local examination and radiological assessment were undertaken to formulate an optimal treatment strategy. Clinical tests for SLAP tear were positive, and MRI findings confirmed SLAP Tear Grade 3, Subacromial Bursitis, and Periarthritis of the right shoulder.
Based on the clinical findings and imaging, which confirmed SLAP Tear Grade 3 with Subacromial Bursitis and Periarthritis of the right shoulder, it was determined that Diagnostic Arthroscopy, Subacromial Bursectomy, Capsular Release, and SLAP Repair of the right shoulder was identified as the most suitable intervention to relieve pain, remove inflamed tissue, release the tight joint capsule, repair the torn superior labrum using suture anchors, restore shoulder function, and improve range of motion, as conservative treatment had failed to provide adequate relief.
The patient and his family members were thoroughly counselled regarding the diagnosis, need for surgery, procedure details, risks, and recovery process. Informed consent was obtained, ensuring their understanding and involvement in the treatment plan.
Surgical Procedure
Following the diagnosis, the patient was scheduled to undergo Diagnostic Arthroscopy, Subacromial Bursectomy, Capsular Release, and SLAP Repair surgery in Hyderabad at PACE Hospitals, under the supervision of the expert Orthopaedic Department.
The surgical procedure involved the following steps:
- Patient Positioning and Anaesthesia: The patient was positioned in the beach chair position and the procedure was performed under general anaesthesia (GA). The right shoulder was prepared and draped in a sterile manner.
- Diagnostic Arthroscopy: A small camera (arthroscope) was introduced into the shoulder joint to assess internal structures. Biceps tendon degeneration was seen, and the damaged tissue was shaved and cleaned.
- Subacromial Bursectomy: The inflamed subacromial bursa was identified and removed to reduce pain and inflammation and improve shoulder movement.
- Capsular Release: The shoulder joint capsule was found to be tight with rotator interval synovitis. A capsular release was performed to improve range of motion and reduce stiffness.
- SLAP Repair and Closure: A SLAP tear was identified and repaired using one suture anchor (Synovix). The repair was stable, and the procedure was completed with Ethilon 2-0 sutures and sterile dressing.
Postoperative Care
Postoperatively, the patient had an uneventful recovery period. The patient was mobilized appropriately during the hospital stay with guided shoulder movements as tolerated. Medications were administered to prevent infection, control pain, reduce inflammation, protect the stomach lining, and support overall recovery and healing. Regular wound dressings were performed and the surgical site was found to be clean with no signs of infection or discharge. The patient’s condition remained stable throughout the hospital stay and at the time of discharge.
Discharge Medications
Upon discharge, the patient was prescribed medications for prevention of postoperative infection, reduction of pain and inflammation, and support of wound healing and recovery following shoulder arthroscopy. Additional medications were advised to protect the stomach from acidity related to postoperative treatment and to support tissue repair and enhance overall recovery through nutritional supplementation. The patient was instructed to continue the prescribed regimen as directed to ensure optimal healing and to prevent postoperative complications.
Advice on Discharge
The patient was advised to continue a normal diet as tolerated. The patient was instructed to adhere to physiotherapy focusing on shoulder range of motion (ROM) exercises as advised to improve joint mobility and prevent stiffness. The use of an arm sling was also recommended to support and protect the operated shoulder during the recovery period.
Emergency Care
The patient was informed to contact the emergency ward at PACE Hospitals in case of any emergency or development of symptoms such as fever, increasing shoulder pain, swelling, redness, discharge from the surgical site, or difficulty in shoulder movement.
Review and Follow-Up Notes
The patient was advised to return for a follow-up visit with the Orthopaedic Doctor in Hyderabad at PACE Hospitals after 1 week for wound dressing.
Conclusion
This case highlights SLAP Tear Grade 3 with Subacromial Bursitis and Periarthritis of the shoulder, causing pain and restricted movements not relieved by conservative treatment. The condition was effectively managed with Diagnostic Arthroscopy, Subacromial Bursectomy, Capsular Release, and SLAP Repair. The postoperative course was uneventful with stable recovery at discharge.
Integrated Arthroscopic Treatment for Complex Shoulder Conditions
Multiple shoulder problems can occur together and lead to ongoing pain, stiffness, and difficulty with daily activities. When non-surgical treatments do not provide relief, a combined arthroscopic procedure allows accurate diagnosis and treatment at the same time. An orthopaedic doctor/orthopaedic surgeon, can address labral tears, inflammation, and joint tightness in a single setting to improve shoulder stability and movement. The minimally invasive nature of arthroscopy reduces tissue damage and supports faster recovery. Early physiotherapy is essential to regain strength and flexibility. A well-planned, patient-specific approach improves overall outcomes. Timely intervention can help achieve better pain relief and functional recovery.
Frequently Asked Questions (FAQs)
When is arthroscopic surgery recommended for a SLAP tear?
Arthroscopic surgery is usually suggested when shoulder pain does not improve with rest, medications, or physiotherapy. It is considered when there is difficulty in lifting the arm, doing overhead activities, or performing daily tasks. If the tear affects shoulder stability or causes persistent discomfort, surgery helps repair the damage. It allows better healing and restores function.
Can multiple shoulder conditions be treated in a single arthroscopic procedure?
Yes, different shoulder problems can be treated together using arthroscopy. Conditions like labral tears (Cartilage injury), inflammation, and stiffness are often managed in one procedure. This reduces the need for multiple surgeries and helps in faster overall recovery. It also improves the final outcome by addressing all underlying issues at once.
How long does recovery take after SLAP repair and capsular release?
Recovery varies from person to person but usually takes a few weeks to a few months. Initial healing happens within a few weeks, but full recovery may take around 3 to 6 months. Regular physiotherapy is important during this period. Gradual improvement in strength and movement can be expected over time.
Will shoulder movement improve after capsular release surgery?
Capsular release is done to reduce stiffness in the shoulder joint. After the procedure, most patients notice better movement and less tightness. Improvement depends on proper rehabilitation and exercises. With consistent physiotherapy, flexibility and range of motion usually improve significantly.
Is physiotherapy necessary after shoulder arthroscopy?
Physiotherapy plays a key role in recovery following shoulder arthroscopy. It helps in improving the range of motion (ROM), restoring strength, and reducing stiffness of the shoulder joint. Regular adherence to the advised exercise program is essential, as a lack of physiotherapy may delay or limit complete recovery. Following the prescribed rehabilitation plan supports optimal healing and facilitates a smoother return to normal daily activities.
Can shoulder pain return after SLAP repair surgery?
In most cases, surgery provides lasting relief from pain. However, pain can return if the shoulder is strained (stressed) too early or if rehabilitation is not followed properly. Re-injury or overuse may also cause symptoms again. Taking proper precautions and completing physiotherapy reduces this risk.
What precautions should be followed after shoulder arthroscopy?
After surgery, the shoulder needs proper rest and support to heal well. An arm sling is usually used, and heavy lifting or sudden movements should be avoided. Following the doctor’s advice and doing physiotherapy regularly is important for recovery. Slowly returning to normal daily activities helps in better healing and prevents problems.
When can normal daily activities be resumed after shoulder surgery?
Simple daily activities are usually possible within a few weeks after surgery. Tasks that involve lifting weights or raising the arm above the head may need more time. Recovery varies from person to person and improves with regular physiotherapy. It is best to return to normal activity only after the doctor confirms it is safe.
Is arthroscopic shoulder surgery safe for long-term outcomes?
Arthroscopic surgery is generally safe and widely performed. It uses small incisions, that decreases the risk of complications. Most patients experience good long-term results with improved function and less pain. Proper post-operative care and exercises are important for lasting benefits.
What are the benefits of arthroscopic shoulder surgery compared to open surgery?
Arthroscopic surgery is minimally invasive, meaning smaller cuts and less damage to surrounding tissues. This usually results in less pain, quicker recovery, and shorter hospital stay. It also allows better visualization of the joint for precise treatment. Overall, it helps patients return to normal life faster.
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