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Shoulder arthroscopy

Definition

Shoulder arthroscopy is a type of surgery that uses a small camera (arthroscope) inserted through a small incision to examine or repair the tissues inside or around your shoulder joint.

Description

The surgeon makes a small incision, about one-quarter inch (0.25") long, near the shoulder joint. A small camera (arthroscope) is then inserted into the joint. The camera is attached to a video monitor to allow the surgeon to see inside the joint.

Unlike knee arthroscopy, most people are asleep during the surgery. Therefore, you will be unable to watch the video monitor. A nerve block may be used to numb your shoulder and arm to help reduce pain after surgery.

A salt solution (saline) is pumped into the shoulder to expand the joint. This helps the surgeon see the joint and helps control any bleeding.

The surgeon will look around the entire joint to check the cartilage, tendons, and ligaments of the shoulder. If damaged tissues need to be repaired, the surgeon will make 1 to 3 additional small incisions to insert other instruments. These may include a blunt hook to pull on tissues, a shaver to remove damaged or unwanted tissues, and a burr to remove bone.

In addition to working on the shoulder joint, the surgeon often places the camera in the space above the rotator cuff tendons (the subacromial space). The surgeon can evaluate the area above the rotator cuff, clean out inflamed or damaged tissue, remove a bone spur, and fix a rotator cuff tear.

At the end of the surgery, the fluid is drained from the shoulder, the small incisions are closed, and a dressing is applied. Your surgeon will probably take pictures of the procedure from the video monitor to show you what was found and what was done.

Indications

Arthroscopy may be recommended for shoulder problems, such as:

• A torn or damaged cartilage ring (labrum) or ligaments (in cases of shoulder instability)
• A torn or damaged biceps tendon
• A torn rotator cuff
• A bone spur or inflammation around the rotator cuff
• Stiffness of the shoulder
• Inflammation or damaged lining of the joint
• Arthritis of the end of the clavicle (acromioclavicular joint)

Risks

The risks for any anesthesia are:

• Allergic reactions to medications
• Problems breathing

The risks for any surgery are:

• Bleeding
• Infection
• Nerve damage

Additional risks include:

• Stiffness of the shoulder
• Failure of the surgery to relieve symptoms
• Failure of the repair to heal
• Weakness of the shoulder

Expectations after surgery

Arthroscopy is an alternative to "open" surgery that completely exposes the shoulder joint. Arthroscopy results in less pain and stiffness, fewer complications, shorter (if any) hospital stays, and possibly faster recovery time.

The expectations vary depending on the purpose of the surgery. In cases where repair is needed, the body still has to heal after arthroscopic surgery, just as if the surgery were open. Therefore, the overall recovery time may still be long.

Surgery to fix a cartilage tear is usually performed because the shoulder is not stable. Many people recover fully, and the symptoms of instability go away. However, some people can still have instability of the shoulder after arthroscopic repair.

Using arthroscopy for rotator cuff repairs or tendonitis usually relieves the pain, but you may or may not regain all of your strength.

Convalescence

Recovery can take anywhere from 1 to 6 months, depending on the surgery that was performed. You will probably have to wear a sling for the first week. If you had a more extensive repair, you may have to wear the sling for a longer period. You may take medications to control your pain.

When you can return to work or play sports will depend on the surgery that was performed, but it can range from 1 week to several months.

For many procedures, especially if a repair is performed, physical therapy may help you regain the motion and strength of your shoulder. The length of therapy will depend on the repair that was done.

Review Date:5/3/2007
Reviewed By:Robert A. Cowles, MD, Assistant Professor of Surgery, Columbia University College of Physicians and Surgeons, New York, NY. Review provided by VeriMed Healthcare Network.

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