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Vol 2 Issue 4 Pg. no. 13
©2023 Abdulhamid Sayed Issa. This is an open access article distributed under the terms of the
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Journal of Clinical Case Reports and Images
Sayed Issa Abdulhamid1,*
Abstract
Introduction
The idea of HLSSM2 is to get the least easy surgical intervention, as arthroscopic
surgery begins with examining the shoulder joint, and the location and size of the
lesion are determined, then open over the lesion with an open surgical approach
that is very limited for surgical repair; not using arthroscopic instruments but con-
ventional surgical instruments in the second step. (Figure 1)
Methods
Clinical experience with this technique consists of 44 cases over a period of thir-
ty-one months, this study was from September 2020 to May 2023. All cases were
done as outpatients and under general anesthesia.
Results
The mean duration of the operation was 35 minutes, and the minimum duration
was 25 minutes. There was no major nerve or vascular injury in all cases. This
technique is simple, safe, and good cosmetically satisfactory for all patients after
full recovery about three months after the procedure, and it is cost-effective. One
43-year-old female patient suffered pain and stiffness during the first six months
after surgery and was not very satisfied, she did not stop visiting us till now, she
was not happy because of shoulder pain and tenderness.
Conclusion
It can be used by experienced hand surgeons in shoulder arthroscopy and in Mini
Lateral Shoulder Approach (MLSA)3, especially in countries where shoulder ar-
throscopic release and repair with suture anchors are expensive4 or not available.
This technique is not very simple but is available, safe, cosmetically satisfactory,
and cost-effective.
Introduction
HLSSM (Sayed Issa's Hybrid Shoulder Arthroscopic-Open Surgical Management)
can be used by experienced hand surgeons in shoulder arthroscopy and in Mini
Lateral Shoulder Approach (MLSA), especially in countries where arthroscopic
release is expensive and not available.
1Professor, Adults Nursing Department and Traumatic and Orthopedic Nursing Faculty, School of Nursing and Midwifery of
Aleppo, Syria.
Hybrid Limited Shoulder Surgical Management (HLSSM)
Sayed Issa's Hybrid Shoulder Arthroscopic-Open Surgical
Management
Clinical T ri al s
Open Ac cess &
Peer -Re vi ew ed Ar ti cle
Doi: 1 0.14302/issn.2641 -5518 .jcci-23-
4646
Corresponding author:
Sayed Issa Abdulhamid, Dr. Abdulhamid
Sayed Issa’s clinic, Modern Consulting
Hospital, Aleppo, Syria.
Keywords:
mini-incision release, safety, cosmetic,
rehabilitation, complications, Shoulder,
Shoulder injuries, Tendinopathy, Bursitis
pathologic processes, Rotator Cuff Tear,
Shoulder approach, Lateral Shoulder
approach, Shoulder impingement syndrome,
Rotator cuff tendinopathy, Adhesive
capsulitis, Frozen shoulder syndrome,
HLSSM, HSSM, Approach, Second Sayed
Issa's , Hill-Sachs lesion, tendon injuries,
wounds and injuries.
Received: June 23, 2023
Accepted: August 11, 2023
Published: August 31, 2023
Academic Editor:
Mona Hassan. Department of Human Anato-
my and Embryology, Faculty of Medicine,
Suez Canal University, Ismailia, Egypt.
Citation:
Abdulhamid Sayed Issa, Hybrid Limited
Shoulder Surgical Management (HLSSM)
Sayed Issa's Hybrid Shoulder Arthroscopic-
Open Surgical Management, Journal of
Clinical Case Reports and Images 2(4):13-
18. https://doi.org/10.14302/issn.2641-
5518.jcci-23-4646.
Vol 2 Issue 4 Pg. no. 15
©2023 Abdulhamid Sayed Issa. This is an open access article distributed under the terms of the
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Journal of Clinical Case Reports and Images
Figure 2
Figure 3
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©2023 Abdulhamid Sayed Issa. This is an open access article distributed under the terms of the
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Journal of Clinical Case Reports and Images
HLSSM is Hybrid Limited Shoulder Surgical Management. (Figure 2)
There is one arthroscopic incision on the posterior lateral edge of the acromion for the arthroscope
entrance, the second entrance is for the probe, arthroscopic incisions approach is about 0.5cm. (Figure
3).
Figure 4
After identifying the full characteristics of the lesion; which are its size, shape, and topographic
location5; we go for Mini Lateral Shoulder Approach (MLSA), as known as Second Sayed Issa's
Approach. (Figure 4).
HLSSM acquires good rehabilitation achievements in a shorter time, more rapid return to work and daily
activities, a short healing period, less surgical traumatic incision, fewer tissues dissection, and less scar
tenderness, than in typical open shoulder release, it causes gentle scar and good cosmetic skin healing,
the procedure takes about 35 to 45 minutes.
The disadvantages of shoulder arthroscopy with repairing the identifying lesions include the costly full
equipment required, costly surgery, and prolonged procedure time (more than 45 minutes). Most
importantly, there have been many reported complications in association with the procedure, including
neuropraxia.
Results
The mean duration of the operation is less than typical shoulder arthroscopy. No single major
complication, wound or neurovascular, was recorded in any of the patients. Minor complications were
Vol 2 Issue 4 Pg. no. 17
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Journal of Clinical Case Reports and Images
observed including two superficial wound infections, no wound hematomas, and no paresthesia in upper
limb nerve distribution.
Fibrous adhesion is effective between subcutaneous tissue from one side and the acromion edge on the
other side at the skin incision zone.
After a six months follow-up evaluation, all patients were satisfied with their cosmetic results.
(Figure 5).
The postoperative cosmetic appearance of the shoulder is an important issue related to skin incisions.
Our results showed clearly that the HLSSM we used is moderately satisfactory and comparable to
typical open approaches. The overall patient satisfaction with the procedure was also good at the final
follow-up visit after eight months. A longer follow-up period is needed to assess the long-term results of
this approach regarding the possibility of recurrence of the disease, which was not done in our study.
Discussion
An open repair requires several centimeter-long incisions. This procedure is performed when there is a
large or complex tear or when tendon stitching is needed.
During the open procedure, the shoulder surgeon split the shoulder muscles to access the torn tendon6.
Typically, this procedure also involves the removal of the bone spurs.
The all-arthroscopic rotator cuff repair procedure is performed with the help of an arthroscope – a small,
thin, flexible tube with a camera on one end. During all-arthroscopic repair, only key-hole size incisions
are made to send the arthroscope and surgical
instruments .The surgeon views the torn tendon on a video monitor and re-attaches it with small surgical
instruments.
Figure 5
Vol 2 Issue 4 Pg. no. 18
©2023 Abdulhamid Sayed Issa. This is an open access article distributed under the terms of the
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Journal of Clinical Case Reports and Images
Mini-Open Rotator cuff repair7
Compared to open repair, mini-open repair techniques involve making a smaller incision. Like
all-arthroscopic repair, this technique avoids the need to split shoulder muscles to access the torn
tendons.
Like open repair, this procedure involves viewing the torn tendon directly rather than via a monitor. with
no complications in 44 cases, our study has good advantages with a good plain presentation.
We found no differences between the two techniques and ours by scar length, complications, and
rehabilitation.
Our results show that a large improvement in symptoms and function occurred in the first three weeks
after surgery, and further improvement continued up to two months postoperatively. These improvements
are comparable with those after open shoulder release and after endoscopic ones.
The Average operating time in our series was 35 minutes (range 25-45 minutes). It is almost similar to
the operating times reported by other authors who used the comparable small incision technique. The
reduced scar, pillar pain, and tenderness of arthroscopic techniques were better than the ones.
The postoperative cosmetic appearance of the shoulder is an important issue related to skin incisions.
Our results showed clearly that the HLSSM we used is good satisfactory and comparable to endoscopic
and open approaches. The overall patient satisfaction with the procedure was also good at the final
follow-up visit.
Conflict of interest
The author declares there is no conflict of interest in publishing the article.
References
1. https://ichgcp.net/clinical-trials-registry/NCT05897866
2. Search Results | Beta ClinicalTrials.gov
3. https://www.genesispub.org/mini-lateral-shoulder-approach-mlsa-second-sayed-issas-approach
4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5298472/
5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6551420/
6. https://orthoinfo.aaos.org/en/treatment/rotator-cuff-tears-surgical-treatment-options/
7. https://link.springer.com/referenceworkentry/10.1007/978-3-319-34109-5_15