Pneumothorax after shoulder arthroscopy: a case report and literature review

摘要

Arthroscopic surgery can effectively improve the pathologic changes and pain of the shoulder joint and shorten the recovery period after the operation.13Mall N.A. Chahal J. Heard W.M. Bach Jr., B.R. Bush-Joseph C.A. Romeo A.A. et al.Outcomes of arthroscopic and open surgical repair of isolated subscapularis tendon tears.Arthroscopy. 2012; 28: 1306-1314https://doi.org/10.1016/j.arthro.2012.02.018Abstract Full Text Full Text PDF PubMed Scopus (56) Google Scholar,16Schmidt C.C. Jarrett C.D. Brown B.T. Management of rotator cuff tears.J Hand Surg Am. 2015; 40: 399-408https://doi.org/10.1016/j.jhsa.2014.06.122Abstract Full Text Full Text PDF PubMed Scopus (41) Google Scholar It has greatly improved the surgical skills of surgeons, and now, it is becoming more and more widely accepted.6Iyengar J.J. Samagh S.P. Schairer W. Singh G. Valone 3rd, F.H. Feeley B.T. Current trends in rotator cuff repair: surgical technique, setting, and cost.Arthroscopy. 2014; 30: 284-288https://doi.org/10.1016/j.arthro.2013.11.018Abstract Full Text Full Text PDF PubMed Scopus (84) Google Scholar The incidence of complications after arthroscopic shoulder surgery is relatively rare, such as axillary nerve injury, infection, thrombosis, compartment syndrome, pulmonary edema, cerebral infarction, pneumothorax, and so on.18Shin J.J. Popchak A.J. Musahl V. Irrgang J.J. Lin A. Complications after arthroscopic shoulder surgery: a review of the American Board of Orthopaedic Surgery database.J Am Acad Orthop Surg Glob Res Rev. 2018; 2: e093https://doi.org/10.5435/JAAOSGlobal-D-18-00093Crossref PubMed Google Scholar Pneumothorax after shoulder arthroscopy is a dangerous potential complication.4Dietzel D.P. Ciullo J.V. Spontaneous pneumothorax after shoulder arthroscopy: a report of four cases.Arthroscopy. 1996; 12: 99-102Abstract Full Text PDF PubMed Scopus (23) Google Scholar Patients with pneumothorax often present with shortness of breath, dyspnea, respiratory distress, hypoxemia, reduced ipsilateral air entry, and percussion hyperresonance.5Huang T.J. Ahmed A. D'Souza D. Awad H. Delayed diagnosis of contralateral tension pneumothorax during robotic lung wedge resection.J Clin Anesth. 2018; 45: 30-31https://doi.org/10.1016/j.jclinane.2017.11.023Crossref PubMed Scopus (1) Google Scholar,14Noppen M. De Keukeleire T. Pneumothorax.Respiration. 2008; 76: 121-127https://doi.org/10.1159/000135932Crossref PubMed Scopus (164) Google Scholar Cardiac arrest may occur if it is not diagnosed and treated in time.15Roberts D.J. Leigh-Smith S. Faris P.D. Blackmore C. Ball C.G. Robertson H.L. et al.Clinical presentation of patients with tension pneumothorax: a systematic review.Ann Surg. 2015; 261: 1068-1078https://doi.org/10.1097/SLA.0000000000001073Crossref PubMed Scopus (57) Google Scholar We reviewed 1140 cases of shoulder arthroscopic surgeries in our hospital from January 2015 to December 2019. We found 2 cases of postoperative pneumothorax in which timely diagnosis was made and effective treatment was adopted to avoid catastrophic consequences. Herein, we reported our experiences that successfully rescued patients from spontaneous or tension pneumothorax after arthroscopic shoulder surgery. Before reporting the case, we had obtained the patients’ consent. A 24-year-old man was admitted to our department. He complained of anterior pain and apprehension of the right shoulder after initial shoulder dislocation 6 years ago. He had approximately 10 instability episodes after his initial dislocation. The physical examination showed anterior tenderness of the shoulder and a positive anterior apprehension test. The AP shoulder radiograph was normal. Magnetic resonance imaging showed an anteroinferior labral lesion (Fig. 1, A). Computerized tomography scan showed no obvious bone loss of the glenoid and humeral head. He had no history of surgery but a smoking history of more than 7 years (1 pack/day). To distinguish whether there was lung disease or not,4Dietzel D.P. Ciullo J.V. Spo