Shoulder Arthroscopy

Information

The head of the humerus sits in the socket of the scapula. This socket is called the glenoid. Articular cartilage, an elastic tissue, covers the surface of the humeral head and the glenoid socket. It creates a smooth surface with minimal friction, which helps the bones glide easily against one another.

The periphery of the glenoid socket consists of a ring of fibrous cartilage called the labrum. The labrum plays a key role in the stability of the shoulder joint, and the tendons surrounding the shoulder also play an important role in this stability.

The shoulder joint is surrounded by a joint capsule, the inner surface of which is a thin membrane called the synovium. This synovium produces the synovial fluid, which lubricates the shoulder joint and helps nourish the articular cartilage.

Another important structure of the shoulder joint is the rotator cuff, which is formed by four tendons that attach to and cover the head of the humerus. The rotator cuff stabilizes the head of the humerus in the glenoid socket and is a primary internal and external rotator.

Between the rotator cuff and the acromion is a lubricating sac called the bursa. This bursa helps the tendons of the rotator cuff glide smoothly when you move your arm.

When is shoulder arthroscopy recommended?

Shoulder arthroscopy is recommended when there is a painful condition that does not respond to conservative treatment. Conservative treatment includes rest, physical therapy and medications or injections that can reduce inflammation. Inflammation is one of the body's normal responses to injury or disease. In an injured or diseased shoulder joint, inflammation can lead to swelling, pain and stiffness.

Injuries, repetitive microtrauma and age-related wear of the joint are responsible for most shoulder problems. Shoulder arthroscopy leads to relief of the painful symptoms of many conditions that cause damage to the rotator cuff tendons, the labrum, the articular cartilage and other soft tissues around the joint.

Common arthroscopic procedures include

• Rotator cuff repair
• Removal of osteophytes (bone spurs)
• Removal or repair of the labrum
• Tendon repair
• Removal of inflamed tissue or cartilage
• Prevention of recurrent shoulder dislocation

Less common procedures, such as nerve release, fracture treatment, and cyst excision, can also be performed using an arthroscope. Some surgical procedures, such as joint replacement, still require open surgery with larger incisions.

Preparing for shoulder arthroscopy

If you smoke, you will be asked to stop, as smoking increases the risk of infection, which can slow recovery.

The surgery is usually performed as a day procedure, which means you will not need to stay in the hospital overnight.

The surgery may be performed under general anesthesia, but it may be combined with a local anesthetic to relieve pain after the surgery. General anesthesia means you will be asleep during the operation. The local anesthetic completely blocks pain in the shoulder area. Sometimes the entire operation can be performed under local anesthesia, which means you will remain awake during the surgery.

Typically, no food or drinks are consumed for about six hours before the procedure.

Surgical procedure

Once you enter the operating room, you will be positioned so that your surgeon can easily adjust the arthroscope for a clear view inside the shoulder. The two most common patient positions for shoulder arthroscopic surgery are:

• "Beach chair" position - a semi-seated position
• Lateral position - in this position, the patient lies on one side on the operating table

Once positioned, the surgical team will clean the skin with an antiseptic solution. The shoulder and arm will be wrapped in sterile drapes, and the forearm will most likely be placed in a special device to ensure that the arm remains still.

Fluid is injected into the joint to distend the joint cavity. This makes it easier to see all the intra-articular structures through the arthroscope. A small puncture (about the size of a buttonhole) is then made for the arthroscope. Fluid flows through the arthroscope, with the function of keeping the image clear and controlling bleeding. The images from the arthroscope are projected onto a monitor, showing the inside of the shoulder and any damage.

Once the problem has been identified, other small instruments are inserted through separate incisions. Specialized instruments are used for activities such as cutting, grasping, suturing, etc. In many cases, special implants are used to anchor the tendons, joint capsule and labrum to the bone.

The incisions are closed with stitches or steri-strips and bandaged.

Most arthroscopic procedures take less than an hour, but in some cases involving more severe injuries and necessary reconstructions, they can last up to two hours.

Possible complications

In most cases (over 95%), there are no postoperative complications. However, as with any surgery, potential problems are possible, such as: infection, excessive bleeding, thrombosis and damage to blood vessels and nerves. Most often, these complications are mild, temporary and resolve within a few days.

Recovery process

Although recovery after arthroscopy is often faster than after open surgery, it may still take weeks for the shoulder joint to fully recover.

You can expect some pain and discomfort for at least a week after the surgery. If you have had a more complex operation, however, it may take several weeks for the pain to subside. Ice will help relieve pain and swelling. A painkiller will also be prescribed if needed.

Although it does not affect healing, lying on your back after the surgery may cause discomfort. Some patients find it more comfortable to sleep in a reclining chair or propped up in bed during the first few days after the surgery.

You will most likely need a soft-tissue bandage or a special immobilizer to protect the shoulder for a certain period after the surgery (15-30 days).

Rehabilitation

Rehabilitation plays an important role in returning to daily activities. The exercise program will help you regain strength and movement in the shoulder.

If you have had a more complex surgical correction, your surgeon may recommend a visit to a physical therapist to supervise your exercise program.

Advantages of shoulder arthroscopy

Arthroscopy is an alternative to open surgery, in which the joint is opened with an incision. The results of arthroscopy include less pain and stiffness, fewer complications, a shorter hospital stay (if any) and faster recovery.

Shoulder arthroscopy has been performed since the 1970s. It has made diagnosis, treatment and recovery after surgery easier and faster than ever. Improvements in shoulder arthroscopy are made every year, with new instruments and techniques continuously being developed.