Arthroscopic Repair

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Shoulder arthroscopy involves a tiny camera called an arthroscope to examine or repair the tissues inside or around the shoulder joint. The arthroscope is inserted through a small incision (cut) in the skin.

The word arthroscopy is derived from two Greek words, “arthro” (joint) and skopein" (to look). Therefore, the term literally means "to look within the joint." During the procedure, the surgeon inserts a small camera, called an arthroscope, into the shoulder joint. The camera displays pictures on a television screen, and the surgeon uses these images to guide miniature surgical instruments.

Due to the thin structure of the arthroscope and surgical instruments, the surgeon uses very small incisions, rather than the larger incision needed for standard, open surgery. This results in less pain for patients, and shortens the recovery time.

Causes

Injury, overuse, and age-related wear and tear are common reasons behind most shoulder problems. Arthroscopic shoulder surgery may relieve painful symptoms of many problems that damage the rotator cuff tendons, labrum, articular cartilage, and other soft tissues surrounding the joint.

Common arthroscopic procedures include:

  • Rotator cuff surgery
  • Bone spur removal
  • Removal or repair of the labrum
  • Repair of ligaments
  • Removal of inflamed tissue or loose cartilage
  • Repair for recurrent shoulder dislocation

Less common procedures such as nerve release, fracture repair, and cyst excision can also be performed using an arthroscope.

The procedure

Shoulder arthroscopy is most commonly performed using regional nerve blocks which numb the shoulder and arm. This numbing medicine is injected in the base of the neck or high on the shoulder. This is where the nerves that control feeling in the shoulder and arm are located. In addition to its use as an anesthetic during surgery, a nerve block will help control pain for a few hours after the surgery is completed. Many surgeons combine nerve blocks with sedation or a light general anesthetic because patients can become uncomfortable staying in one position for the length of time needed to complete the surgery.

Most arthroscopic procedures take less than an hour; however, the length of the surgery depends on what repairs are required.

During the surgery, the surgeon will first inject fluid into the shoulder to inflate the joint. This makes it easier to see all the structures of the shoulder through the arthroscope. The surgeon then proceeds to make a small puncture in the shoulder (about the size of a buttonhole) for the arthroscope. Fluid flows through the arthroscope to keep the view clear and control any bleeding. Images from

The surgeon may close the incisions with stitches or steri-strips (small Band-Aids) and cover them with a large, soft bandage.

Recovery

Although recovery from arthroscopy is often faster than recovery from open surgery, it may still take weeks for the shoulder joint to completely recover.

Some pain and discomfort can be expected for at least a week after surgery. In cases involving extensive surgery, it may take several weeks before the pain subsides. Ice and painkillers aid in the treatment for shoulder pain that follows the surgery.

Also, rehabilitation plays an important role in the recovery process. An exercise program helps regain shoulder strength and motion.