Ultrasound‐Guided Deflation and Arthroscopic Removal of a Migrated Subacromial Balloon Spacer

Figures

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  Fig 1. External view of a right shoulder 5 days after arthroscopic partial cuff repair and subacromial balloon insertion. These photos show the location of a painful anterior prominent bulge (black arrow) seen on the (A) lateral view and (B) frontal view.

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  Fig 2. Ultrasound image of the right shoulder of the same patient. The transducer is oriented in the sagittal plane with anterior to the left and posterior to the right. Ultrasonic imaging of the symptomatic bulge reveals an anechoic mass in the subdeltoid space consistent with a fully inflated displaced balloon (arrow).

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  Fig 3. (A) Ultrasound image of the right shoulder. The transducer is oriented in the sagittal plane and an 18-g needle has been placed in plane from anterior under the transducer and is visualized (needle) in the center of the balloon. The inferior wall of the balloon is seen as labeled. (B) External view of the patient’s right shoulder while in the semi-upright position with the transducer aligned in the sagittal plane. “A” is anterior and “L” represents the lateral aspect of the shoulder. A total of 17 cc of saline is aspirated from the balloon.

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  Fig 4. External view of right shoulder. After balloon deflation, the patient continues to complain of significant anterior shoulder pain. The deflated balloon remains palpable and is visible anteriorly as seen on the (A) lateral and (B) frontal views.

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  Fig 5. External view of the right shoulder with the patient placed in a beach chair position in the operating room. (A) The previous posterior portal (P) is initially used to visualize the prior cuff repair site which was intact (cuff). (B) The arthroscope is then placed in the posterolateral portal (PL), which allows visualization of the anteriorly displaced balloon (balloon).

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  Fig 6. Arthroscopic view of the right shoulder from the posterolateral portal revealing the anteriorly displaced balloon superior to the capsule. The locking grasper is brought in from an anterolateral portal to secure and remove the balloon.

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  Fig 7. Outside view of the right shoulder with the intact deflated balloon outside the anterolateral portal after removal with the arthroscopic grasper.