What is Shoulder Arthroscopy?
Shoulder arthroscopy is a surgical procedure widely used by orthopaedic surgeons to inspect, diagnose and treat ailments inside or around the shoulder joint. The term arthroscopy can be understood more clearly by splitting it into “arthro” and “skopiein” that means joint and to look respectively. In other words, arthroscopy is a surgical procedure that allows the surgeon to look within the joint by a small incision with the help of a camera. In this procedure, small cut usually of 1 centimetre in diameter is made on the skin, and a small camera is introduced through one of these cuts to view the affected part and perform surgery.
Shoulder arthroscopy is recommended when shoulder ailments cause pain and do not improve with the conservative treatment. These ailments are caused by injury, overstrain and age-related degeneration of the shoulder. This procedure assists a lot in the resolution of such ailments with the restoration of normal function and range of motion of the shoulder.
What are the indications for the procedure?
- Diagnostic surgery – persistent pain inspite of normal test/scans
- Impingement syndrome – Subacromial decompression
- Rotator cuff repair
- Removal of loose cartilage, loose piece of bone or inflamed tissue
- Removal of a bone spur
- Labral / SLAP repair
- Pathology of AC joint – Distal clavicle resection
- AC Joint seperation
- Biceps tenotomy/tenodesis
- Release of suprascapular nerve entrapment
- Release of scar tissue or contractures
- Frozen shoulder
What are the benefits?
Shoulder arthroscopy has more advantages than open surgery. Open surgery is a surgical procedure in which your surgeon can approach and treat your affected part directly by using a large incision. Arthroscopy has following benefits over open surgery-
- It is a minimally invasive procedure that means it allows quick access to the affected part with minimum damage to the neighbouring tissues.
- The incision made is also small that promotes quicker healing and less scarring and scar tissue to the shoulder as compared to open surgery.
- The affected arm after surgery can be used more
- This type of surgery doesn’t cause much blood loss it helps in early recovery from the symptoms especially pain.
What are the risks?
Most patients do not feel any complication after this surgery. There are only a few minor risks at the rate of about 1 % that can be treated efficiently. The risks of shoulder arthroscopy are-
- Temporary swelling of the shoulder
- Frozen shoulder
- Hardware problems
- Damage to nerves and blood vessels
- Failure of the operation to resolve symptoms
- Weakness of the shoulder
How should I prepare for the procedure?
- Before surgery, your surgeon will investigate your general condition through certain tests such as blood tests, electrocardiogram or chest X-ray to rule out any health risks. This helps to rule out any possible risks of surgery such as bleeding, heart diseases etc.
- It is advisable to inform your surgeon about any medications or supplements (esp. Blood thinners) you are taking. He may ask you to stop them before the surgery as they may complicate the operation.
- If you are a smoker, you should stop smoking at least 48 hours before the operation. Smoking increases the risk of chest and wound infection. It also affects your recovery process after the surgery by slowing it down. Some patients require help for household activities as many activities that require upper movement of the shoulder and other household activities such as bathing, dressing, laundry and cooking for few weeks nearly six weeks.
- Any infection in the body including common cold or a cough should be cleared up before the operation.
- You should also stop eating or drinking 8 hours before the operation.
- Positive attitude towards the operation and your condition are necessary for the success of the surgery. This will help you for better health benefits and faster recovery.
How is it performed?
- Surgery is performed as a day case after assessment of your general health. You are likely to be discharged on the same day.
- The operation is performed under general anaesthesia or local anaesthesia (Block). In general anaesthesia, the patient does not feel anything and sleeps throughout the operation. In local anaesthesia, the patient remains awake during the operation but he cannot feel whatever is happening in the surgical area. Your anaesthetist can select a combination of both local and general anaesthetic.
Positioning– Beach chair position- in this position, the patient is semi-seated just like sitting in an inclined chair. It has the advantage of decreased bleeding and venous pressure.
- Procedure– first of all, fluid injected into the affected shoulder to inflate the joint. It helps in clear visualization of the structures inside the shoulder. A small incision is made on the skin of the affected area. It is usually a size of a buttonhole and a small camera through a pipe is introduced into this incision to have a clear view. Fluid is continued to flow in the arthroscope (the camera) to distend joint, better visualisation and to control any bleeding. The images obtained from the camera are projected on the screen that reveals all the damage. After the identification of the problem, the surgeon will make some more small incisions and insert small specialized instruments. These instruments are utilized to shave, cut, grasp suture passage and tie a knot. In some cases, specialized devices are used to anchor stitches into the bone. The skin is then closed with absorbable stitches and covered with a large bandage.
- Most shoulder arthroscopic procedures end in less than one hour.
What happens after surgery?
- The anaesthetics wears off in 4-10 hours after the surgery; the patient is encouraged to take painkillers before they can experience pain. This blocks the sensation of pain and discomfort caused by the operation. Thus, most patients report no or little pain.
- A sling is applied on the elbow in order to give rest to the joint and avoid any further injury to the joint and the patient is discharged on the same day.
- You can apply ice to relieve pain and before discharge, you may see a physiotherapist, who will teach you gentle exercises of your shoulder, elbow, fingers and wrist. You may be able to start these gentle exercises on the day of your operation and they are essential to reduce stiffness and pain.
- The bulky bandage could be removed in 24-48 hrs and you will have small dressings covering the key hole wounds.
- You can use your arm to do light activities (writing, using keyboard etc) that don’t cause excessive pain or discomfort. This will be advised by your surgeon and physiotherapists.
- The patient is reviewed in clinic around 2 weeks following the operation for wound check and physiotherapy.
- The wound should be massaged (typically after 2 weeks) using the moisturizing cream by the patient 3 times a day for 3 months once the wound is well healed. This reduces the scar sensitivity and scar-related complications (tenderness; helps scar to mature).
- You could start gentle range of movement (ROM) exercises at 3 weeks and progress to more strenuous activities around six weeks. This will be guided by your surgeon and is based on arthroscopic findings and treatment provided. It is advisable to avoid any injury to the affected area for 3 months. The duration may increase or decrease based on the complexity of primary problem.