Shoulder Arthroscopy : An Overview

Introduction to Shoulder Arthroscopy

Definition and Brief History:

Shoulder arthroscopy is a keyhole surgery method used to visualise, diagnose, and treat problems inside the shoulder joint and in the space surrounding the rotator cuff. This technique was developed to minimise recovery time and reduce the risk of complications that are often associated with traditional open surgery.

What Shoulder Arthroscopy Involves

Preparation and Procedure:

Patients are typically given general anaesthesia, and often an interscalene block is performed. This involves the anaesthetist inserting long acting ( 12 hours usually) local anaesthetic around the nerves to the shoulder in the neck.

This has the advantage of less pain initially, and therefore less pain killers ( analgesia ) afterwards. Consequently there is often less nausea because of this. It does however often lead to a temporarily completely numb and paralysed arm, which can feel unusual.

The patient is positioned on their side, and the surgeon makes small incisions (usually about 1 cm) around the shoulder and inserts the arthroscope to view the shoulder joint on a video monitor. Using specialised instruments, the surgeon can then repair or remove damaged tissues.

Techniques and Instruments Used:

The procedure utilises advanced instruments, such as coblation devices to expose bone, high speed burrs, to shave bone away and suture passing equipment to repair soft tissues. These are utilised to perform various tasks like removing loose fragments of bone , repairing torn ligaments or tendons, and releasing tight ligaments.

What is Shoulder Arthroscopy used for?

Use Scenarios

• Diagnosis: Arthroscopy can be used to diagnose a variety of shoulder problems when non-invasive methods like MRI scans or X-rays are inconclusive.
• Rotator Cuff Repairs: This is a common reason for shoulder arthroscopy, addressing tears in the muscles or tendons around the shoulder joint.
• Impingement Syndrome: The procedure can relieve pressure on the rotator cuff from a bony spur 
• Shoulder Instability: Arthroscopy can be used to repair ligaments that are torn or stretched to restore stability to the shoulder.
• Removal of Loose Bodies: Small pieces of bone or cartilage that become loose and float within the joint can be removed arthroscopically.
• Labral Tears or Injuries: Repairing tears in the labrum, the ring of cartilage that surrounds the shoulder socket.
• Excision of the outer most  aspect of the clavicle ( lateral clavicle) for an arthritic acromio-clavicular joint.

Risks of Shoulder Arthroscopy

Shoulder arthroscopy is a minimally invasive surgical procedure, but there are still risks associated with the procedure. Potential risks of shoulder arthroscopy include:

• Infection: Although rare due to the minimally invasive nature of the procedure, there’s still a risk of infection at the site of the incisions or within the joint itself.
• Bleeding : Many patients experience bruising which can radiate down the arm or onto the chest wall
• Anaesthetic Complications: Complications related to anesthesia can occur, including allergic reactions, nausea or chest infections, albeit rare.
• Shoulder Stiffness and Pain: Post-operative stiffness and pain are common, though they usually improve with physical therapy.
• Incomplete resolution of symptoms: There’s always a risk that the surgery might not fully correct the problem, or that the repaired tissues do not heal properly, leading to the need for additional surgery.