Shoulder arthroscopy

Definition 

Shoulder arthroscopy is a type of surgery to examine or repair the tissues inside or around your shoulder joint. The procedure uses a small camera, called an arthroscope, which is inserted through a small incision. If the doctor is going to repair the joint, small surgical instruments are also used.

Description 

The surgeon makes a small incision, about one-quarter inch (0.25”) long, near the shoulder joint. A small camera 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 patients are asleep during the surgery. Therefore, you will be unable to watch the video monitor. A nerve block may be used to numb the shoulder and arm to help reduce pain after surgery.

Saline (salt solution) 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 evaluate the cartilage, tendons, and ligaments of the shoulder. If damaged tissues need to be repaired, the surgeon will make one to three 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. (This is called 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 completion of the surgery, the fluid is drained from the shoulder, the small incisions are closed, and a dressing is applied. Most surgeons take pictures of the procedure from the video monitor to show the patient 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:

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, remember that the body still needs to heal after arthroscopic surgery, just as if the surgery was done open. Therefore, the overall recovery time may still be lengthy.

Surgery to fix a cartilage tear is usually performed because the shoulder is not stable. Many patients have a full recovery, and the symptoms of instability go away. However, up to 10-20% of patients can have continued instability of the shoulder even after arthroscopic repair.

Using arthroscopy for rotator cuff repairs or Tendonitis usually relieves the pain, but it is less predictable how well your strength will return.

Convalescence 

Recovery can take anywhere from one to six months, depending on the surgery that was performed. Most patients wear a sling for the first week. If a more extensive repair was performed, the sling may be worn longer. Pain medications are often used.

The ability for you to return to work or play sports will depend on the surgery that was performed, ranging from one week to several months.

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

Johns Hopkins patient information

Last revised: December 3, 2012
by Levon Ter-Markosyan, D.M.D.

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