CPT® Code 23450

The CPT® Code 23450 refers to a surgical procedure known as capsulorrhaphy, specifically an anterior repair of the shoulder capsule. This procedure is primarily indicated for treating instability of the glenohumeral joint, which is the ball-and-socket joint of the shoulder, and for addressing recurrent anterior dislocation of the shoulder. The procedure encompasses two specific techniques: the Putti-Platt procedure and the Magnuson type operation. In the Putti-Platt procedure, the subscapularis tendon, which is a key muscle in the shoulder, is shortened to effectively bring the head of the humerus, the bone of the upper arm, closer to the shoulder blade, thereby stabilizing the joint. The subscapularis muscle originates from the subscapular fossa of the scapula and inserts onto the anterior aspect of the humerus at the lesser tubercle. This tendon plays a crucial role in forming the shoulder joint capsule by fusing with other tendons. During the procedure, an incision is made over the anterior aspect of the shoulder joint, allowing for dissection of the soft tissue and opening of the joint capsule. The insertion point of the subscapularis tendon on the lesser tubercle is then exposed, allowing for detachment and longitudinal division of the tendon. The lateral free end is subsequently attached to the anterior rim of the glenoid, while the medial free end is sutured over the lateral end, effectively shortening and tightening the tendon. The Magnuson procedure follows a similar approach but involves detaching the subscapularis from the lesser tuberosity and reattaching it just lateral to the bicipital groove, creating a tendon sling that aids in maintaining the humeral head's position within the glenohumeral joint.