Shoulder Arthroscopy : An Overview
Shoulder arthroscopy is a surgical technique that has revolutionised the diagnosis and treatment of shoulder conditions. This minimally invasive procedure involves the use of a small camera called an arthroscope, which is inserted into the shoulder joint through minimally invasive surgery ( 1 cm) incisions. This blog post will outline what shoulder arthroscopy involves, its use scenarios, and the benefits it brings to patients.
Dr Gavin Nimon is a specialist Orthopaedic Surgeon, and has over 20 years of experience in Shoulder Arthroscopies.
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?
- 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.
Benefits of Shoulder Arthroscopy
Studies have demonstrated benefits for
- Reduced Pain and Swelling: The minimally invasive nature of the surgery often means less pain and swelling post-operatively compared to open surgery.
- Shorter Recovery Time: Patients often recover more quickly and can return to their daily activities, including sports, sooner.
- Less Scarring: Smaller incisions result in minimal scarring.
What to Expect During Your Consultation
During your consultation at Glenelg Orthopaedics, we will discuss the options of treatment, which may include the option of surgery. Dr Gavin Nimon believes that in most cases, a non-operative approach should always be attempted, and in those cases that do not improve with this, surgery options will then be considered.
FAQs About Shoulder Arthroscopy
In this section, we address common questions about Shoulder Arthroscopic procedures, providing you with reliable information to understand and manage your recovery.
Q1: Is it painful after surgery and how do I deal with it?
A: Patients vary on how easily they recover from surgery, and whilst most have difficulty sleeping for the first week, many recover fairly easily. The following Post op shoulder pain outlines how best to manage symptoms that arise from surgery.
Q2: What treatment do I require after Shoulder Arthroscopy?
A: All patients require post-operative physiotherapy, but the extent of time this is required for varies depending upon what is done at the procedure. Also on occasions a sling is required to protect the surgery.
The following blog article on post-op shoulder recovery goes into this in more detail.
Q3: What is the difference between a shoulder reconstruction and a shoulder replacement?
A: A shoulder replacement is a replacement of the shoulder joint with an artificial implant and is often done for arthritis, breaks or irrepairable rotator cuff tears. A shoulder arthroscopy involves debriding ( cleaning out) or repairing the natural structures and is considered a reconstruction.
The following blog article (reconstruction vs replacement) outlines this in more detail.
Q4: Can I drive after shoulder surgery?
A: In all cases after shoulder surgery, a patient should not drive until well over the anaesthetic and the pain is such that it does not hinder control of the vehicle. However in those cases that require a sling, it is important not to drive until no longer required.
Driving after shoulder surgery is discussed in more detail, in this blog article.
Contact us for a Consultation
At Glenelg Orthopaedics, we are highly trained and skilled in treating patients and performing Shoulder arthroscopic procedures. Dr Gavin Nimon is committed to providing Affordable and Quality Care and he will support you every step of the way.