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Shoulder Arthroscopy

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.

Disease Overview

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:

Shoulder Impingement: this occurs when the shoulder blade applies pressure on the underlying soft tissues when the arm is lifted
Rotator cuff tear
Frozen shoulder or stiffness of the shoulder joint
Shoulder Instability this occurs when the head of the upper arm bone slips out of the socket of the shoulder blade’s glenoid cavity either due to injury or overuse
Biceps rupture occurs when the tendons attaching the bicep muscle to the shoulder or elbow tears
Damaged cartilage or ligaments
Bone spurs or bony projections
Arthritis of the collarbone

Procedure

Your surgeon performs shoulder arthroscopy under general or regional anaesthesia. 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.

Summary

Shoulder arthroscopy is a minimally invasive surgical procedure used to view the shoulder joint and repair any damage to the bones, muscles, tendons or ligaments found on observation. It is normally performed on an outpatient basis and is considered more reliable than other diagnostic methods such as X-rays.