Shoulder Arthroscopy
What is it?
Arthroscopy is a procedure that orthopaedic surgeons use to inspect, diagnose, and treat problems inside the joint. During shoulder arthroscopy, the surgeon inserts a small camera, called an arthroscope, into the joint. The camera displays pictures on a video monitor, which the surgeon uses to guide miniature surgical instruments. Because the arthroscope and surgical instruments are tiny, they allow the surgeon to use very small incisions, rather than the larger ones needed for standard, open surgery. This results in less pain for patients and shortens the time needed for recovery.
When is this procedure indicated?
The procedure is indicated when an orthopedic evalution and diagnostic exams, such as MRI and ecography, point out shoulder pathologies in the patient such as: chronic subacromial conflict; rotator cuff injuries; recurrent shoulder dislocation; chronic shoulder instability; biceps tendinitis; calcific tendinitis; acromion-clavicular ostheoarthrosis and lesions; labrum tears; adhesive capsulitis.
How is it performed?
Shoulder arthroscopy may be performed in local anesthesia using regional nerve blocks which numb the shoulder and arm, or, according to the patient's desire and/or anesthesiologist's indication, under total anesthesia.
Step 1
The surgeon injects fluid into the shoulder to inflate the joint. This makes it easier to see all shoulder structures through the arthroscope.
Step 2
Fluid flows through the arthroscope to keep the view clear and control any bleeding. Images from the arthroscope are projected on the video screen showing the surgeon the affected site and damage.
Step 3
Once the problem is clearly identified, the surgeon will insert other small instruments through separate incisions to treat it. Special instruments are used for tasks like: shaving, cutting, grasping, suture passing, and knot tying. In many cases, special devices are used to anchor stitches into bone.
Step 4
Finally the surgeon closes the incisions with stitches or steri-strips (small Band-Aids) and cover them with a large, soft bandage.
Recovery
Although recovery from arthroscopy is often faster than recovery from open surgery, it may still take from weeks to months for your shoulder joint to completely recover. Recovery duration depends on which type of pathology was treated. In fact simpler procedures, such as biceps tenotomy, will have faster recovery times than more complex procedures. For example for reconstructive surgeries, such as the ones needed for rotator cuff tears or chronic shoulder instability, recovery time is much longer since it is also influenced by the tissue healing rate. So in this kind of surgeries a full recovery may need up to 4-6 months. Ice will help relieve pain and swelling. The doctor may prescribe pain medicine, if needed. A sling or special immobilizer is indicated to protect the treated shoulder. Active rehabilitation plays an important role in getting back to daily activities. An exercise program will help the patient to regain shoulder strength and motion. The surgeon may indicate a rehabilitation plan based on the surgical procedures that were performed. In case of complicated surgical repair, the surgeon may recommend a physical therapist to supervise the patient's exercise program. It is important that the patient will make a strong effort at rehabilitation in order for the surgery complete success.
Short-term complications
Most patients do not experience complications from shoulder arthroscopy. As with any surgery, however, there are some risks. Potential problems with arthroscopy include infection (0.04% -0.23% incidence), excessive bleeding, blood clots, and damage to blood vessels or nerves.
Long-term complications
One of the most common problems after shoulder surgery is stiffness of the shoulder joint. For some surgical procedures, a period of time of immobilization is necessary to allow for adequate healing. However, immobilization of the joint can also cause patients to develop a condition called a frozen shoulder (incidence in the population inferior to 2%) . Patients who develop a frozen shoulder have excessive scar tissue form in the shoulder joint capsule, the tissue that surrounds the ball-and-socket shoulder joint. Frozen shoulder is generally treated with aggressive therapy and sometimes a cortisone injection. Many cases of frozen shoulder take months or longer to resolve. Risk of recurrence for rotator cuff tear, with a 10%-30% incidence depending on quality of the tendon and the severity of its leasion . Risk of recurrence for chronic shoulder instability, with a 3%-15% incidence according to the intensity of physical activity and/or type of sport practiced.
Where do we treat it?
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