Shoulder Arthroscopy

Introduction

Arthroscopy is a minimally invasive diagnostic and surgical procedure performed for joint problems. Shoulder arthroscopy is performed using a pencil-sized instrument called an Arthroscope. The arthroscope consists of a light system and camera to project images to a computer screen for your surgeon to view the surgical site. Arthroscopy is used to treat disease conditions and injuries involving the bones, cartilage, tendons, ligaments, and muscles of the shoulder joint.

The shoulder joint is made up of a ball and socket joint, where the head of the humerus (upper arm bone) articulates with the socket of the scapula (shoulder blade) called the glenoid. The two articulating surfaces of the bones are covered with cartilage, which prevents friction between the moving bones enabling smooth movement. Tendons and ligaments around the shoulder joint provide strength and stability to the joint. Injury and disease to the bones or soft tissues of the shoulder joint can make it instable, and lead to pain, inflammation and reduced mobility.

Indications

Shoulder arthroscopy is indicated to treat the following shoulder conditions when conservative treatment such as medication and therapy fails to relieve pain and disability:

  • Rotator cuff tears
  • Tears of the labrum, SLAPtears
  • Bone spurs or bony projections
  • Arthritis of the collar bone
  • Dislocations and instability
  • Frozen shoulder or fitness of the shoulder joint
  • Repair of Bankart lesions
  • Humeral Avulsion of the Glenohumeral Ligament (HAGL) lesions
  • Posterior labral tears
  • Superior Labrum Anterior and Posterior (SLAP) tears
  • Subscapularis tears
  • Shoulder impingement
  • Distal clavicle arthrosis
  • Loose bodies
  • Biceps instability and tears

Procedure

Your surgeon performs shoulder arthroscopy under general or regional anesthesia. You may be positioned lying down on your side with your arm propped up or sitting in a semi-seated position. Sterile fluid is injected into the shoulder joint to expand the surgical area so your surgeon has a clear view of the damage and room to work. A button-sized hole is made in the shoulder and the arthroscope is inserted. Your surgeon can view images captured by the camera in the arthroscope on a large monitor. Surgical instruments are introduced into the joint through separate small holes to remove and repair the damage to the joint. After surgery, the instruments are removed and the incisions are closed with stitches or small sterile bandage strips.

Post-operative Care

After the surgery, the small surgical wounds take a few days to heal and the surgical dressing is replaced by simple Band-Aids. The recovery time depends on the type and extent of problem for which the procedure was performed. Pain medications are prescribed to keep you comfortable. The arm of the affected shoulder is placed in a sling for a short period as recommended by your doctor. Physical therapy is advised to improve shoulder mobility and strength after the surgery.

Advantages

The advantages of arthroscopy compared to open surgery with a large incision include

  • Less pain
  • Fewer complications
  • Shorter hospital stay
  • Faster recovery

Risks and complications

Complications of shoulder arthroscopy include infection, bleeding, damage to nearby nerves or blood vessels, or delayed healing after the surgery. In certain cases, stiffness of the shoulder joint may occur after the surgery.  It is important to participate actively in your physical therapy to prevent this from occurring.

Arthroscopic Versus Open Surgery

Arthroscopic Surgery

Arthroscopy is a minimally invasive diagnostic and surgical procedure performed for joint problems.

Shoulder Arthroscopy is indicated for

  • Repair of Bankart lesions
  • Humeral Avulsion of the Glenohumeral Ligament (HAGL) lesions
  • Posterior labral tears
  • Superior Labrum Anterior and Posterior (SLAP) tears
  • Rotator cuff tears
  • Subscapularis tears
  • Shoulder impingement
  • Distal clavicle arthrosis
  • Loose bodies
  • Biceps instability and tears

Advantages

  • Less pain
  • Fewer complications
  • Shorter hospital stay
  • Faster recovery

Open Surgery

An open surgery requires a single, large incision. The choice of treatment approach depends on the severity of the conditions and diseases.

Procedures performed through Open Shoulder surgery includes

  • Glenoid reconstruction for shoulder bone loss and instability (Latarjet procedure)
  • Superior capsular reconstruction
  • AC joint reconstruction
  • Open biceps tenodesis
  • Open pectoralis major tendon rupture repairs
  • Biological resurfacing of the glenoid
  • Shoulder replacement
  • Reverse total shoulder replacement

Drawbacks

A larger incision

An increased risk of infection

Admitted to the hospital for 1 or 2 nights for post-surgical recovery

  • American Academy of Orthopaedic Surgeons
  • International Society For Hip Arthroscopy
  • RYC Orthopaedics
  • American Orthopaedic Society for Sports Medicine
  • Arthroscopy Association of North America
  • Pro Medical New York,PLLC