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Mini Lateral Shoulder Approach (MLSA) (Second Sayed Issa's Approach)

Authors:
  • Independent Researcher

Abstract and Figures

Introduction: The incision is very useful and easy for the direct lateral shoulder joint exposure, open shoulder release, open subacromial decompression, Impingement syndrome in the absence of rotator cuff tear, and Hill-Sachs lesion repair [1-3]. Methods: Clinical experience with this technique consists of 28 cases over a period of two years, this study were from January 17, 2019 to February 4, 2021. All cases were done as outpatient and under general anesthesia. Results: The mean duration of the operation was 35 minutes, and the minimum duration was 25 minutes. Conclusion: moderate experienced hand surgeons can use it. This technique is simple, safe, cosmetically and satisfactory.
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Case Report | Issa AS. J Orthop Study Sports Med 2021, 1(1)-03.
Journal of Orthopaedics Study and Sports
Medicine
Genesis-JOSSM-1(1)-03
Volume 1 | Issue 1
Open Access
Mini Lateral Shoulder Approach (MLSA)
(Second Sayed Issa's Approach)
Abdulhamid Sayed Issa*
Orthopedic Surgeon, Professor, Adults Nursing Department and Traumatic and Orthopedic Nursing Faculty, School of
Nursing and Midwifery of Aleppo, Syria
*Corresponding author: Abdulhamid Sayed Issa, Orthopedic Surgeon, Professor, Adults Nursing Department and
Traumatic and Orthopedic Nursing Faculty, School of Nursing and Midwifery of Aleppo, Syria
Citation: Issa AS. (2021) Mini Lateral Shoulder
Approach (MLSA). J Orthop Study Sports Med. 1(1):1-
5.
Received: December 14, 2021 | Published: December
30, 2021
Copyright© 2021 by Issa AS. All rights reserved. This
is an open access article distributed under the terms
of the Creative Commons Attribution License, which
permits unrestricted use, distribution, and
reproduction in any medium, provided the original
author and source are credited.
Abstract
Introduction: The incision is very useful and easy for the direct lateral shoulder joint exposure, open shoulder
release, open subacromial decompression, Impingement syndrome in the absence of rotator cuff tear
, and Hill-Sachs
lesion repair [1-3].
Methods: Clinical experience with this technique consists of 28 cases over a period of two years, this study were
from January 17, 2019 to February 4, 2021. All cases were done as outpatient and under general anesthesia.
Results: The mean duration of the operation was 35 minutes, and the minimum duration was 25 minutes.
Conclusion: moderate experienced hand surgeons can use it. This technique is simple, safe, cosmetically and
satisfactory.
Keywords
Shoulder; Shoulder approach; Lateral shoulder approach; Shoulder impingement syndrome; Rotator cuff
tendinopathy; Adhesive capsulitis; Frozen shoulder syndrome; Shoulder impingement syndrome Shoulder injuries;
Tendinopathy; Bursitis pathologic processes; Muscular diseases, Musculoskeletal; Diseases; Tendon injuries; Wounds
and injuries; Joint diseases
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Case Report | Issa AS. J Orthop Study Sports Med 2021, 1(1)-03.
Introduction
Condition or disease
Shoulder Impingement Syndrome, Rotator Cuff Tendinopathy, Adhesive Capsulitis and
Frozen Shoulder Syndrome [4-7].
Detailed description
The length of the incision is about four centimeter made by the lateral acromial edge (Figure 1).
Figure 1: Length of the incision is about four centimeter made by the lateral acromial edge.
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Case Report | Issa AS. J Orthop Study Sports Med 2021, 1(1)-03.
Figure 2: The dissection takes place slightly over the acromial edge proximally and over the origin of the acromial
deltoid part (the middle part of deltoid origin) distally.
After clearly revealing the region of the medial deltoid origin on the acromion, the acromionic deltoid
origin is skinned only; of the edge of the acromion, and that may be achieved by electric knife pen or
periosteal elevator, without exposure the clavicular deltoid origin (front deltoid) in the front and the
deltoid origin on the spine of scapula (posterior deltoid) in the back, the origin of the medial acromial
deltoid is distanced laterally and distally, where the lateral edge, the lower surface of the acromion,
under acromial bursa and the rotator cuff can be reached easily. Throw this approach can be made
acromioplasty (Figure 3), and rotator cuff tears repair especially upper part of rotator cuff tear very
easily (Figure 4).
Figure 3: Acromioplasty.
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Case Report | Issa AS. J Orthop Study Sports Med 2021, 1(1)-03.
Figure 4: For wound closure, the acromionic deltoid origin is reattached to the acromial edge by long period
synthetic absorbable sutures as PDS or PDO, or non-absorbable sutures as Polyester suture, under skin and skin
sutures are made.
Results and Outcome Measures
1.This procedure takes about 35 minutes, that depends of rotator cuff tear if exist or not.
2. Less rehabilitation time than traditional approaches, for 6 - 8 weeks.
3. Passive physiotherapy immediately, on the next day of surgery.
4. Active physiotherapy without rotator cuff tear, after two weeks of surgery.
5. Mini cosmetic incision to the shoulder, about 4-5 cm.
6.Active physiotherapy with rotator cuff tear, after three weeks of surgery.
8. Very good patient’s satisfaction, after 8 weeks.
9. Restore deltoid muscle strength, about 3 months after surgery.
Eligibility Criteria
Ages Eligible for this approach is from 16 to 73 years old, for both sexes.
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Case Report | Issa AS. J Orthop Study Sports Med 2021, 1(1)-03.
Inclusion criteria
Patients presented with Shoulder Impingement Syndrome refractory to conservative.
Treatment and local steroid injection.
Patients presented with Adhesive Capsulitis and Frozen Shoulder Syndrome refractory to conservative
treatment and local steroid injection.
Patients without femur head immigration on X-ray.
Patients with injury for one month to six months maximum.
Exclusion criteria
Patients with femur head immigration on X-ray.
Patients with injury for more than six months.
Uncontrolled diabetes mellitus type one and two.
Patients with non controlled vascular hypertension.
Patients with history of Carpal Tunnel release surgery failure.
References
1. https://clinicaltrials.gov/ct2/show/NCT04766905
2. Eid A. (2012) Miniopen coracohumeral ligament release and manipulation for idiopathic frozen shoulder.
Into J Shoulder Surg. 6(3):90-6.
3. Lin KC. (2010) Rotator cuff: 1. Impingement lesions in adult and adolescent athletes. In JC DeLee et al.,
eds., DeLee and Drez's Orthopaedic Sports Medicine, Principles and Practice, 3rd ed., vol. 1, pp. 986
1015. Philadelphia: Saunders Elsevier.
4. Khan M, Alolabi B, Horner N, Bedi A, Ayeni OA, et al. CMAJ Open. 7(1):E149-158.
5. Mehta S, Gimbel JA, Soslowsky LJ. (2003) Etiologic and pathogenetic factors for rotator cuff tendinopathy.
Clin Sports Med. 22:791.
6. https://online.boneandjoint.org.uk/loi/bjj
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Article
In the management of idiopathic frozen shoulder, manipulation under anaesthesia is known to have serious potential complications including fractures and intra-articular injuries. Arthroscopy is a safer treatment modality but requires special instruments, experience, and involves added cost. The aim of this work was to study the use of miniopen Coracohumeral ligament release and manipulation of the shoulder as a safe and simple method of treating idiopathic frozen shoulder that could be performed as a quick procedure under short duration anaesthesia obtaining a significant improvement of shoulder function while avoiding complications that are feared to occur with the use of manipulation under anaesthesia. Miniopen Coracohumeral ligament release is performed through a 3-cm incision. The Coracohumeral ligament is divided, and then the shoulder is manipulated without undue force. A case series including fifteen patients (19 shoulders) with idiopathic frozen shoulder operated by this technique is described. Miniopen Coracohumeral ligament release and manipulation is a quick procedure that may be performed under short duration anaesthesia obtaining a significant improvement of shoulder function meanwhile avoiding complications that are feared to occur with the use of manipulation under anaesthesia.
Article
Etiologic and pathogenetic factors for rotator cuff tendinopathy, although often compartmentalized to intrinsic or extrinsic causes, have multifactorial roots. The development of animal models for the study of rotator cuff disease has increased the fund of knowledge regarding this disease and has paved the way for future studies. Further multidisciplinary studies at molecular, biomechanical, and clinical levels should be undertaken to enhance the understanding of this common disorder. Ultimately, the goals of improved care, increased comprehension, and prevention of rotator cuff tendinopathy are attainable.
Rotator cuff: 1. Impingement lesions in adult and adolescent athletes
  • K C Lin
Lin KC. (2010) Rotator cuff: 1. Impingement lesions in adult and adolescent athletes. In JC DeLee et al., eds., DeLee and Drez's Orthopaedic Sports Medicine, Principles and Practice, 3rd ed., vol. 1, pp. 986-1015. Philadelphia: Saunders Elsevier.