Biceps tendon rupture is a condition requiring open surgery.

Cerclage fixation under shoulder arthroscopy is a technique that requires extremely high operating skills. The number of such patients is not particularly large in the Second Xiangya Hospital. This is because such patients have been discovered before surgery, and

For the sake of safety, most of them are sutured open.

Although Chang Weilong and Zhu Lihong were the referees, no one thought there was anything wrong with them quitting for surgery midway.

Just kidding, although this is a surgical assessment, this is real clinical practice after all. The first principle as a doctor in clinical practice is the principle of non-harm. Ask Lu Cheng to force such an operation, not to mention whether Lu Cheng dares or not.

Even if they dare, they don't have such courage.

Even such a rare patient with a rupture of the long head of the biceps tendon that cannot be seen on MRI has aroused the curiosity of Hu Xuanyi, Dong Zuolin and others.

When Huang You explained the specific situation to Xiang Xuewen, Hu Xuanyi said: "This patient is also very interesting. How about we also take a look at this patient's MRI?"

"Okay! It just so happens that Professor Hu can also explain it to us." Dong Zuolin said jokingly.

Although Hu Xuanyi's skills and level may be higher than mine, but it is still a bit too exaggerated to say that he is really high enough to be his teacher.

Hu Xuan glared at Dong Zuolin and murmured in detail: "You are so old and you are still learning the yin and yang. Do you really think that old people can stop practicing martial arts?"

"Let's go study together."

Immediately afterwards, Tian Jin, Guang Qing and An Xueliang also echoed: "Professor Hu is too polite, I still want you and Professor Dong to give you some advice. Such patients are still very rare. I have encountered them once before.

, just turn it around and cut it."

If the biceps tendon is ruptured far away from its insertion point, it is naturally not too difficult to suture it open, but it is not that simple to cerclage and suture it under arthroscopy!

Several people walked to the MRI and took it out one by one. After reading it, they frowned hard!

Sure enough, the long head of the biceps tendon seen on the MRI is very smooth, without any loss of continuity. It is almost impossible to diagnose such a patient through auxiliary examinations!

It’s almost like whoever meets someone is unlucky.

After Lu Cheng saw the rupture of the long head of the biceps tendon, he was not particularly panicked and did not deal with it immediately. Instead, he continued to observe other structures.

Arthroscopically examine the anterior part of the inferior glenohumeral ligament and the middle glenohumeral ligament further downward.

Under normal circumstances, the anterior bundle of the inferior glenohumeral ligament is attached to the glenoid neck between two and four o'clock. The anterior joint capsule contains three independent ligaments with different attachment points. The attachment of these ligaments is normal, and only

A small amount of synovial attachment.

Immediately after, Lu Cheng controlled the arthroscope to enter the inferior recess, and rotated the arthroscope toward the top of the glenoid to inspect the glenohumeral ligament and labrum. The integrity of the glenohumeral ligament and labrum was still acceptable.

At this moment, Lu Cheng did not rush to open the next hole, but gently externally rotated the upper limb. If the arthroscope easily moves forward in the joint, this phenomenon is called "Warren's passing sign" and indicates the existence of extensive ligament laxity.

.

Fortunately, this situation does not exist. Although the reviewers are not watching at the moment, Lu Cheng, as the chief surgeon, also has to pay attention to all the details that should be paid attention to.

But even so, Lu Cheng still frowned deeply.

Because after this circle of exploration, the patient's blood strips and diseases were also revealed.

Shoulder impingement syndrome: long head of biceps tendon rupture, rotator cuff injury: supraspinatus tear (huge rotator cuff) lv51 (mutated monster!).

HP:514585/514585!

Level 51 monster!

This is not scientific, this is absolutely unscientific, this is definitely not the MRI of the patient we just saw on the MRI, because even though the biceps tendon rupture cannot be seen, such an obvious huge tear in the supraspinatus is not visible on the MRI.

It's easy to see.

Since there is a tear of the supraspinatus tendon, it is difficult to see it from the glenohumeral space.

Immediately afterwards, Lu Cheng took the arthroscope out slightly from the glenohumeral joint, inserted the lever, and entered the subacromial space diagonally upward!

The arthroscope is entered again through the arthroscopic sleeve, and then the subacromial space is observed again.

The space under the acromion has become a mess.

There was a large amount of synovial hyperplasia inside, and the specific structure could not be seen at all. Moreover, when the arthroscope entered, it punctured the synovium. There was a lot of bleeding and the scope was red.

"Lumbar puncture needle!" Lu Cheng shouted to the handwashing nurse.

Lin Hui raised his eyebrows when he saw that Lu Cheng was still continuing to operate, but he immediately understood what Lu Cheng meant!

Then he immediately inserted the lumbar puncture needle from the front entrance into the subacromial space to drain the water. Lu Cheng immediately put in the flushing fluid before flushing the blood cleanly and restoring the field of view of the arthroscope. Then Lu Cheng took the lumbar puncture needle

After the needle moves up and down.

The needle of the lumbar puncture needle was found in the field of view.

"sharp knife!"

After Lu Cheng took the sharp knife, he made another incision along the lumbar puncture needle. After using straight pliers to expand it, he immediately started cauterizing with the plasma electric knife. The joint cavity was cleaned. When only a small part was cleaned, it could be roughly

After seeing the shoulder joint capsule clearly, Lu Cheng called the handwashing nurse to bring over the probe hook.

At this time, Chang Weilong and Zhu Lihong also washed their hands and walked in, got dressed and came to the stage.

Then he found that Lu Cheng suddenly ran into the gap under the shoulder. He frowned and asked, "Xiao Lu, what are you doing?"

"Teacher Chang, I suspect that this patient also has a rotator cuff injury. Under normal circumstances, if the type 3 acromion wears out the biceps tendon, the supraspinatus muscle closest to the acromion will definitely not be particularly good.

"

"However, this patient's situation is a bit special."

"He doesn't have a Type III acromion." Lu Cheng calmly told Chang Weilong what he saw, and moved the arthroscope to a position where he could just see the acromion.

Chang Weilong immediately looked at Lin Hui: "Does this patient have a history of trauma?"

"Yes! It was the fifth day after the trauma when I was admitted to the hospital. I came to the outpatient clinic because of unbearable pain, and then was admitted to the hospital. The patient is currently 52 years old. An MRI was taken in the outpatient clinic, which showed acromion impingement syndrome. The patient is also suitable for his age.

, and took it in."

"But, Wei Ge, I just saw that the injury to this patient's biceps tendon is fresh, not old. And during the physical examination, no muscle atrophy was seen!"

"And the patient's MRI showed no edema in the tendon. Therefore, the patient is most likely to have an MRI problem."

Chang Weilong quickly took over the patient's shoulder joint capsule, and after briefly exploring the shape of the supraspinatus muscle, he suddenly saw the contracted supraspinatus muscle.

Chang Weilong's expression tightened at that time. He only hesitated for three seconds, then turned around and said, "On patrol, call the MRI room and ask them to check this patient's MRI and explain that there are special circumstances."

Chang Weilong's voice was very loud, and Huang You and others also came closer.

Min Hong also gathered around and asked, "What's going on?"

"Xiao Lu suspects that this patient's MRI may have been wrong. It's another patient's MRI!"

"I just looked at the patient's supraspinatus. It's a huge rotator cuff, and the retraction must be more than 5cm. This patient may eventually need biceps tendon transposition surgery!"

When Min Hong heard this, he scolded his mother in his heart: "I'm going to look at the medical records. Who is in charge of this patient?"

"It's me, Master." Ji Mo said immediately.

"This patient has instability in the shoulder joint, drawer test (+). There is a history of trauma, but his current MRI results are also consistent with the current diagnosis. In the case of acromial impingement syndrome, Hawkins sign (+), Neer

Sign (+), there is also a decrease in muscle strength.”

"With the support of imaging evidence, rotator cuff injury was not considered, but during the conversation before the operation, I told the patient about the possibility of rotator cuff suture surgery."

Min Hong closed his eyes.

I also recalled what happened during the ward rounds. I have talked about it at the end of these seasons, but it is indeed the case. Who would suspect that the MRI would be wrong? Moreover, the two diseases are so similar during the physical examination, just because of the drawer

If the test is positive, it would be a waste for the patient to do the test again.

The operating room called the MRI room and received a response quickly.

The other party immediately said: "Hey, is this Professor Chang? We have checked the imaging data record of this patient, and currently our hospital does not have relevant MRI. Can you please check if this film was taken by our hospital?"

"Don't look at it, this MRI was taken in the county hospital." Dong Zuolin, who was holding the film, replied after listening.

"Just hang up." Min Hong said to the traveling nurse.

What else can be done? The MRI was not taken here, and there is a problem with the MRI. This is not an excuse not to continue the operation now. It is just that in this way, there will be no assistance from imaging data, making the operation more difficult.

Moreover, the current health system clearly stipulates that all MRIs in tertiary hospitals must recognize each other. Even if they do not recognize the imaging results, there will generally be no problems with MRIs. You can just read the images yourself.

This kind of thing, appearing in such a situation, is not only a test, but also an opportunity to prove one's strength.

"Let's explore the whole joint under arthroscopy. Chang Weilong, you will be the chief surgeon, Lu Cheng, you will be the first assistant! Lin Hui, you will be the third assistant and make way for Zhu Lihong." After Min Hong finished speaking, he looked at Huang You again.

.

"Professor Huang, how about this surgery?"

Huang You's professional title and qualifications are higher than Min Hong's. When Min Hong was still the chief physician, he worked with Professor Huang You for a while, so he respected him very much.

Huang You said: "Chang Weilong and Zhu Lihong have grown up, so I won't join in the fun. This is not the first time they have done the biceps tendon transfer surgery. I can just watch from the side."

"

"Even if I am not skilled enough, Professor Hu Xuanyi, Professor Dong Zuolin and Professor Tian are still there."

Huang You said half-jokingly.

In fact, when something like this happens now, it has both advantages and disadvantages. The current leader of sports medicine is Hu Xuanyi, but it is more likely that Zhu Lihong will take the lead next time.

Zhu Lihong will soon be a deputy senior. Although Chang Weilong has already been a senior, he heard that he intends to develop into a teaching position, and in terms of clinical talent, he may be a little bit worse than Zhu Lihong.
To be continued...