Shoulder Joint Conditions

Shoulder Arthroscopy

If you have shoulder pain, stiffness, or similar issues, your orthopaedic surgeon may decide to perform a shoulder arthroscopy to help diagnose and repair the problem.

Arthroscopy is a procedure that is used to examine, diagnose, and repair problems inside the joint. It involves inserting a tiny camera – an arthroscope – into the shoulder joint through a small cut or cuts in the skin.

This camera is connected to a digital display and your surgeon uses the images from the camera to guide their miniature surgical instruments.

Arthroscopic shoulder surgery can be significantly less invasive than more traditional forms of surgery, which require opening up more of the shoulder, and tend to have longer recovery times and more associated pain.

The reason for this, is that the arthroscope and the instruments used in the surgery are extremely thin, and require only small cuts in the skin to operate.

As a result, the shoulder arthroscopy recovery timeline is relatively minimal.

The process is the same for a right shoulder arthroscopy or left shoulder arthroscopy; keep in mind that shoulder arthroscopy recovery may be slightly more complicated or difficult if the procedure is being performed on your dominant arm or side – but it still should be fairly simple and much easier to deal with than recuperating after more traditional types of surgery.

What does shoulder arthroscopy surgery entail?

Shoulder arthroscopy surgeries are often recommended after other non-surgical techniques have been tried and failed; e.g. you are still experiencing pain in the affected shoulder.

This non-invasive or keyhole approach to shoulder surgery covers injuries and problems such as:

  • Rotator cuff repair
  • Shoulder impingement syndrome
  • Shoulder instability (shoulder dislocation surgery)
  • Bone spur removal (decompression procedures)
  • Removal or repair of the labrum (stabilisation procedures)
  • Repair of ligaments
  • Removal of inflamed tissue or loose cartilage
  • Repair for recurrent shoulder dislocation
  • Nerve releases
  • Shoulder fractures
  • Cyst decompression or excision

Shoulder arthroscopy and similar surgeries have been performed since the 1970s, and these types of procedures are often the best option for the various injuries or shoulder problems mentioned above.

Surgeons and medical professionals are constantly working to improve arthroscopic techniques and procedures, so be sure to work with an orthopaedic surgeon who is up to date with the latest state of the art arthroscopic technology and instruments.

Why would I need shoulder arthroscopy?

You would need a shoulder arthroscopy surgery if you are suffering from any of the aforementioned conditions and nonsurgical routes such as physiotherapy, rest, and medications or injections to relieve swelling and inflammation, are not working to solve the problem and ease your pain.

Some common reasons why right shoulder arthroscopy or left shoulder arthroscopy is considered a good option include: rotator cuff repair, shoulder impingement syndrome surgery, or shoulder instability surgery.

During shoulder arthroscopy surgery for rotator cuff repair, the edges of the torn tendons in your shoulder are brought together and attached to the bone with sutures and permanent small rivets or suture anchors made of metal or plastic which will dissolve in time.

Surgery for shoulder impingement syndrome involves cleaning out the damaged and inflamed tissue from the areas above and around the shoulder joint.

In addition, the coracoacromial ligament may be released, and the underside of the acromion bone may be shaved, because bone spurs or bony growths on the bottom of the acromion bone is often the cause of shoulder impingement syndrome. These bony growths or bone spurs can cause inflammation and pain in the shoulder joint.

Shoulder instability can also be treated with shoulder arthroscopy surgery.

For instance, if you have torn your labrum – the cartilage that lines the rim of the shoulder joint – an orthopaedic surgeon may repair it with arthroscopic shoulder surgery.

This often includes repairing the ligaments that connect to the labrum area. There are two types of labrum tears; the Bankart lesion or a tear on the labrum in the lower part of the shoulder joint, or a SLAP lesion or tear to the labrum and ligaments on the upper part of the shoulder joint.

Shoulder muscles that may be affected during a shoulder arthroscopy

Your shoulders are perhaps the most complex joints in your entire body. The shoulder joint is a ball and socket joint (like your hips) and it is composed of three different bones – the humerus or upper arm bone, the scapula or shoulder blade bone, and the clavicle or collarbone.

The whole joint is surrounded by ligaments or bands of tissue that hold the joint together, forming the shoulder capsule. Your shoulder capsules are lined by synovium – a thin membrane that produces synovial fluid which lubricates the joint and makes everything move and rotate smoothly.

There are four specific tendons that surround the shoulder capsule and make up the rotator cuff, which keeps your arm centered in your shoulder socket.

These are collectively referred to as the rotator cuff, and covers the head of the humerus or upper arm bone, connecting it to your shoulder blade.

The head of the humerus fits right into the glenoid or the socket, forming your shoulder blade. It is covered by the articular cartilage, a smooth and slippery tissue that covers the surface of the ball and socket that make up your shoulder joint.

This creates a low friction surface that allows the bones of your shoulder to glide and rotate easily.

The labrum is the tough cartilage that rings the glenoid, adding stability and cushioning to the joint.

Finally, there are the bursa sacs, which is a fluid-filled sac located between the rotator cuff and acromion bone on the top of your shoulder joint. It helps the four tendons in your rotator cuff move smoothly when you rotate your arms.

What happens during a shoulder arthroscopy surgery?

Shoulder arthroscopy surgery involves inserting an arthroscope or miniature camera through a small cut in the skin at the back of the shoulder, while images from the arthroscope are projected on a digital display, showing your orthopaedic surgeon the interior of your shoulder joint.

This allows them to assess the damage, identify the problem with your shoulder joint, and fix any issues they can with miniature tools. This system allows the surgeon to assess all the structures within your shoulder.

Fluid runs through the arthroscope camera to keep everything clear, control bleeding, and give your surgeon a good view of the bones, muscles, ligaments, and tendons in your shoulder.

Once your orthopaedic surgeon identifies the damage, they will insert the aforementioned miniature surgical instruments through separate small incisions to repair it; these incisions are usually located around the front or sides of the shoulder.

These specialised miniature instruments are used for procedures like shaving bones, cutting, grasping, suturing, and tying knots.

Often, specialised devices are used to anchor stitches into the bone. The small incisions in the skin are usually closed with stitches or steri-strips (picture a tiny band-aid) and covered with a waterproof dressing after shoulder arthroscopy surgery.

Most arthroscopic shoulder surgeries take about one hour, but that depends on what type of damage your surgeon discovers and what repairs are required.

Shoulder arthroscopy is often performed as an outpatient surgery, meaning you can go home the same day that your surgery is completed.

However, if you have other health problems or complications, your shoulder surgery could be a short in-patient procedure. Always rely on your doctor’s opinion as to what kind of pre-op and post-op care that you need.

Note that both left and right shoulder arthroscopy surgeries are typically performed using regional nerve blocks.

These injections are targeted to the base of the neck or high on the shoulder. This will numb or provide a dull feeling to your shoulder or arm area where the nerves are located.

These nerve blocks will also help control the pain during the time immediately after your surgery; they are often combined with light sedation or general anesthesia since most patients might be uncomfortable being “awake” during the procedure.

Patients are typically put in either a “beach chair position” or a semi-seated position which is similar to laying in a reclining beach lounger, or the lateral decubitus position, which involves laying on your side on the operating table.

What happens after a shoulder arthroscopy surgery?

Recovery time after a right shoulder arthroscopy or a left shoulder arthroscopy surgery varies for everyone depending on the issue or injury that led to the surgery being performed and any other pre-existing health conditions that you may have.

Regardless of the reasons that led to the surgery, physiotherapy, rest, and anti-inflammatory measures like ice and heat treatments, along with over-the-counter pain meds will be recommended.

Minor repairs may or may not require a sling for a short time, and you will likely have a short period of rehabilitation and perhaps some physical therapy.

You will probably be able to return to work, school, and other everyday activities within a few days of the surgery. Intense workouts and other physical activity will need to be curtailed until cleared by your orthopaedic surgeon.

The more complex shoulder arthroscopy surgeries that are needed for extensive repairs to the shoulder joint, naturally require more recovery time, even though the incisions themselves are small, the surgery itself is more invasive.

Recovery from major repairs and surgery to the shoulder joint can take months and involve physical therapy and other rehabilitation treatments.

Always rely on your orthopaedic surgeon’s guidelines and plans for a successful outcome to your shoulder arthroscopy.

Do I need shoulder arthroscopy surgery?

If you have pain or stiffness in your shoulders or have been diagnosed with a shoulder injury, then you should see an orthopaedic surgeon with experience dealing with and operating on the shoulder joint as soon as possible.

This is especially important if non-surgical methods haven’t worked for you, because a non-invasive form of surgery like shoulder arthroscopy can ease your pain and significantly improve your life.

Devinder Garewal

Mr. Devinder Garewal

MBBS, BMedSci, FRACS (Orth), FAOrthA

Devinder completed his medical qualifications from the University of Melbourne and is a Fellow of the Royal Australiasian College of Surgeons and the Australian Orthopaedic Association.

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