Shoulder arthroscopy is a minimally invasive technique that allows orthopedic surgeons to assess – and in some cases, treat – a range of conditions affecting the shoulder joint. During the procedure, the orthopedic surgeon makes small incisions or portals in the affected joint and then inserts a tiny camera and fiber optics to light the interior space. Pictures obtained with the camera are then projected onto a screen in the operating suite.
Early use of arthroscopy focused on the knee; it might come as a surprise that the first arthroscopic evaluation of a knee actually took place in 1918. (This involved the insertion of the scope into a joint, without the benefit of additional lighting.) Additional efforts were made during the following decades, but it was not until surgeons were able to obtain adequate lighting with fiberoptic technology (in the 1970s and 1980s), that arthroscopy became truly useful. Instruments and techniques that yielded good results in the knee were adopted by orthopedic surgeons who specialized in shoulder pain treatment.
We may recommend shoulder arthroscopy if you have conditions such as:
We only recommend shoulder arthroscopy if other forms of treatment aren’t yielding results, or in cases where surgery is the best option.
Shoulder arthroscopy is surgery that uses a tiny camera called an arthroscope to examine or repair the tissues inside or around your shoulder joint. The arthroscope is inserted through a small cut (incision) in your skin.
To prepare for shoulder arthroscopy, you receive either a general anesthetic or local anesthesia in your shoulder, combined with a sedative to keep you relaxed and sleepy. Either way, you won’t feel any pain during the operation.
We make a small incision in your shoulder and insert the arthroscope. We can see the internal tissues of your shoulder via a monitor that receives a feed from the camera on the end of the arthroscope.
The images on the screen enable him to determine where repairs are necessary. We make more small incisions to accommodate specially designed instruments we use to carry out the repairs.
There are a variety of techniques we can use to repair damaged tissues, including:
When the repairs are complete, we close the incisions with stitches and cover them with a dressing to keep the wound clean and protected. After the initial recovery period, we arrange physical therapy to rebuild strength and mobility in the affected shoulder.
Risks of anesthesia and surgery in general are:
Tell your healthcare provider what medicines you are taking. This includes medicines, supplements, or herbs you bought without a prescription.
During the 2 weeks before your surgery:
You may be asked to temporarily stop taking blood thinners. These include aspirin, ibuprofen (Advil, Motrin), naproxen (Naprosyn, Aleve), and other medicines.
Ask your provider which medicines you should still take on the day of your surgery.
If you have diabetes, heart disease, or other medical conditions, your surgeon may ask you to see your doctor who treats you for these conditions.
Tell your surgeon if you have been drinking a lot of alcohol, more than 1 or 2 drinks a day.
If you smoke, try to stop. Smoking can slow wound and bone healing.
Tell your doctor about any cold, flu, fever, herpes breakout, or other illness you may have before your surgery.
On the day of surgery:
Follow any discharge and self-care instructions you are given.
Recovery can take 1 to 6 months. You will probably have to wear a sling for the first week. If you had a lot of repairs done, you may have to wear the sling longer.
You may take medicine to control your pain.
When you can return to work or play sports will depend on what your surgery involves. It can range from 1 week to several months.
Physical therapy may help you regain motion and strength in your shoulder. The length of therapy will depend on what was done during your surgery.
While many people think of the shoulder as a single joint, it is actually made up of two joints: the acromioclavicular joint, where the acromion of the shoulder blade and the collarbone (clavicle) meet, and the glenohumeral joint, where the head of the humerus (the upper bone in the arm) meets the glenoid, the cup-like portion of the scapula.
There is also potential space (the subacromial space) between the acromion and rotator cuff tendon. Injuries to the shoulder may occur in either the joint or in the soft tissues that support and stabilize it.
SLAP (Superior Labrum Anterior-Posterior) lesion which affects the labrum, a rim of cartilage that surrounds the glenoid, was detected in the mid-1980s during arthroscopic evaluations. This painful condition can also be treated arthroscopically. As with diagnostic evaluations, therapeutic applications of arthroscopy can remove the need for large incisions. Early treatment attempts focused on repairs of the labrum. Labral tears are just one injury that contributes to shoulder instability, a condition that can lead to subluxation (partial dislocation) or dislocation of the shoulder.
Arthroscopy often results in less pain and stiffness, fewer complications, a shorter (if any) hospital stay, and faster recovery than open surgery.
If you had a repair, your body needs time to heal, even after arthroscopic surgery, just as you would need time to recover from open surgery. Because of this, your recovery time may still be long.
Surgery to fix a cartilage tear is usually done to make the shoulder more stable. Many people recover fully, and their shoulder stays stable. However some people may still have shoulder instability after arthroscopic repair. Using arthroscopy for rotator cuff repairs or tendinitis usually relieves the pain, but you may not regain all of your strength.