Shoulder (shoulder) arthroscopy

Arthroscopy is a surgical procedure used by orthopaedic surgeons to visualize, diagnose and treat joint problems.
The word arthroscopy comes from the Greek words, “Arthro” (joint) and “skopein” (to look). Literally translated it means “to look into the joint”. During shoulder arthroscopy, the surgeon inserts through a small incision in the skin into the shoulder joint a pencil-sized instrument with a miniature video camera at one end, called an arthroscope. The camera displays enlarged images of the joint on a high-definition monitor, and the orthopaedic surgeon can use the images to guide the miniaturized surgical instruments.
Because arthroscopic and surgical instruments are thin, the surgeon makes very small incisions (cuts) compared to the large incisions used in standard open surgery. This results in less pain for the patients, shortens the time needed for recovery and the patient can return to favorite activities more quickly.

Shoulder arthroscopy has been applied since the 70s. Improvements to shoulder arthroscopy are made every year, with new instruments and techniques.

Anatomy

The shoulder is a very complex joint that is capable of more movement than any other joint in the human body. It is made up of three bones: the humerus (humerus), the scapula (scapula) and the clavicle (clavicle).

The glenoid cavity of the scapula is concave, covered by hyaline cartilage and bordered by the glenoid labrum.

The joint capsule is the one that envelops the joint, inserting on the circumference of the glenoid cavity, but also on the external face of the glenoid labrum and on the anatomical neck.
Rotator cuff: above the capsule, a muscular layer surrounds the shoulder joint. It is made up of four short muscles that ensure not only most of the shoulder’s movements, but also its stability.

The subacromial bursa is a very thin membrane containing a small amount of synovial fluid, which is interposed between the clavicle and the acromion, in the upper part and the humerus in the lower part. Its role is to facilitate sliding between the rotator cuff and the upper part of the shoulder.

When shoulder arthroscopy is recommended

Your doctor may recommend shoulder arthroscopy if shoulder motion is painful and does not respond to non-surgical treatment. Non-surgical treatment includes resting the shoulder, physiotherapy, medication or intra-articular injections that can reduce inflammation.
Shoulder injuries, wear and tear, lack of exercise or repeated trauma are the most common causes responsible for most shoulder problems. Shoulder arthroscopy can relieve painful symptoms and restore normal shoulder function.

The most common arthroscopic shoulder operations include:

Repair of rotator cuff injuries
Removal of osteophytes
Excision or suture of labral injuries
Suture of ligaments
Removal of inflamed tissue or cartilage fragments.
Surgical treatment of recurrent shoulder dislocations

Less common procedures such as nerve decompression, fixation of certain fractures and excision of cysts can also be performed using an arthroscope. Some surgical procedures, such as shoulder prostheses, cannot be done arthroscopically, requiring open surgery with larger incisions.

Planning for surgery

Your orthopaedic surgeon may ask you to be seen by your family doctor to make sure you have no other medical problems that need to be addressed before surgery. Blood tests and electrocardiogram may be necessary to safely perform the surgery.
If you have certain health risks, further evaluation may be necessary before surgery. Be sure to properly inform your orthopaedic surgeon of any medications or supplements you are taking. You may need to stop taking some of these before surgery.
The hospital or surgical clinic will contact you in advance to provide specific details about the surgical procedure.
Before surgery, an anesthesiologist will talk with you about your anesthesia options. In shoulder arthroscopy, the most common mode of anesthesia is regional anesthesia that numbs the shoulder and arm. This anesthetic is injected at the base of the neck or upper part of the shoulder. The sensory nerves that control the senses in the shoulder and arm are located in this area. In addition to its use as an anesthetic during surgery, a nerve block will help control pain for several hours after surgery is completed. Many surgeons combine nerve blocks with sedation or general anesthesia, as patients must remain in one position throughout the operation.
Most arthroscopic procedures take less than an hour, however, the length of surgery depends on what the surgeon finds in the shoulder joint.

Surgical procedure

Positioning and preparation

Once you arrive in the operating room, you will be positioned on the operating table so that the doctor can easily maneuver the arthroscope to get a clear view inside the shoulder. The two most common patient positions for shoulder arthroscopy are:

– The “beach chair” position: this is a semi-seated position, similar to sitting in a reclining chair.
– Lateral decubitus position: in this position, the patient lies on the side of the body (left or right) on the operating table.

Once everything is prepared, the surgical team will remove hair from the area of the future incisions, if necessary, and then apply an antiseptic solution to the shoulder to disinfect the skin. They will cover the shoulder and arm with sterile drapes, and will most likely position the forearm in a device to ensure that it remains still throughout the surgery.

Procedure

Your surgeon will first inject a fluid into your shoulder (saline) to enlarge the joint space. This makes it easier to visualize the anatomical elements in your shoulder. Next, your surgeon will make a small incision in your shoulder (about the size of a button) for the arthroscope. A fluid (saline) will flow through the arthroscope to keep the visualization clear and to control any bleeding. The images provided by the arthroscope are projected onto a monitor.

Once the problem is identified, the surgeon will insert other small surgical instruments through separate incisions to repair the damage.

Your surgeon may close the incisions with sutures or sterile tape and cover them with a large, soft bandage.

Postoperative recovery

After the surgery, you will be transported postoperatively for 1-2 hours before returning to your ward.

Although recovery after arthroscopy is often faster than recovery after open surgery, it can be estimated that for the shoulder joint full recovery may take several weeks.

You can expect some pain and discomfort for at least a week after surgery. If you have had more extensive surgery, the pain and discomfort may take several weeks to disappear. Ice will help relieve pain and swelling in your shoulder. Your doctor may prescribe anti-inflammatory medication if necessary.

Although it doesn’t affect how the shoulder heals, bed rest can cause shoulder discomfort. Some patients have slept more comfortably in a reclining chair or sitting up in bed for the first few days after surgery.

A few days after surgery, you should be able to change the large bandage for a simple, small one.

You will most likely need a special shoulder immobilization device to protect your shoulder (sling). The surgeon will discuss with you how long you will need to wear it.

Recover

Recovery plays an important role in your return to everyday activities. An exercise program will help you regain normal shoulder tone and range of motion. Your surgeon will develop a recovery plan based on the surgical procedures used.

If you’ve had more complicated surgery, your surgeon may recommend a physical therapist to oversee your exercise program.
It is important to make a big recovery effort for the operation to be successful.

Complications

Most patients will not suffer complications following shoulder arthroscopy. As with any surgery, however, there are some risks. These are usually minor and treatable. Potential problems after arthroscopy are infections, excessive bleeding, blood clots and damage to blood vessels or nerves.
Your surgeon will discuss possible complications with you before the operation.

Results on term results

Depending on the patients’ state of health, the full recovery time is different for everyone.
If you have had minor surgery, you may return to full capacity after a short recovery period. You may be able to return to work or school within a few days of surgery.

More recovery time is needed after more complicated surgery. Although the incisions are small in arthroscopy, major joint injuries can be repaired by this procedure. Full recovery can take several months. Although it can be a slow process, if you follow the surgeon’s advice and the recovery plan provided by the surgeon, the result will be successful.