This has become a routine procedure, which is most commonly performed as a day case.
A thin fibre-optic telescope (Arthroscope) is passed into the shoulder joint to visualise the inside of the shoulder. Intra- articular damage can be diagnosed, assessed and treated.
Many shoulder conditions including bursectomy, acromioplasty, resection of the AC-joint , repair of labral tears , repair of SLAP tears, treatment of cartilage damage , removal of loose fragments, removal of inflamed joint membranes or release of a contract capsule in case of frozen shoulder or severe Arthritis can be treated arthroscopically. Rotator cuff tears are also assessed or repaired with the help of an Arthroscope.
The Procedure
Shoulder Arthroscopy is usually performed under general anaesthetic.
Two, three or more very small incision on the outside of the shoulder are used to allow the insertion of the arthroscope and instruments into the joint. For safet,y Jens usually uses a small suture to close the portals after surgery. These very small puncture holes (portals) usually heal within 1 week .
Cartilage Damage and Osteoarthritis of the Shoulder Joint
Loose floating cartilage fragments can cause sharp pain and locking of the joint.
Damage to the surface of the shoulder can cause increased friction , swelling and pain. Generalised cartilage wear can lead to painful arthitis.
Mainly in cases where the arthritis leads to impingement, arthroscopic debridement with capsular release, removal of osteophytes, bursectomy and acromioplasty can help significantly to reduce pain and improve range of motion .
Surgical Treatment of Impingement Syndrome
If there is a thickened acromion or acromial bone spur causing impingement, it can be removed with a burr using arthroscopy. If there is painful arthritis of the AC joint, this will be resected at the same time. The procedure is performed in hospital under a general anaesthetic, and at the same time, any minor damage and fraying to the rotator cuff tendon and scarred bursal tissue can be removed. Often this will completely cure the impingement and prevent progressive rotator cuff injury. After impingement surgery, your shoulder will be protected in a sling for the first 24 hours only.
Treatment of Rotator Cuff Tears
A torn tendon cannot heal without the intervention of surgery. The choice of surgery does depend on the severity of the symptoms, the health of the patient, and the functional requirements for that shoulder. In young working individuals, repair of the tendon is most often suggested. In some older individuals who do not require significant overhead lifting ability, surgical repair may not be as important. If chronic pain and disability are present at any age, consideration for repair of the rotator cuff should be given. After shoulder cuff repair surgery, your shoulder will be protected in a sling for 4-6 weeks.
Treatment of Shoulder Disclocation/Labral Tears
The advantage of arthoscopic surgery compared to open surgery is that anterior, posterior , inferior and superior labral tears can all be repaired at the same time.
The aim of surgery is to repair all the torn tissue (labrum) and reduce it back into its normal anatomical position. This is achieved with small suture anchors which are placed at the glenoid rim . It is also possible to tighten a loose capsule with arthroscopically placed sutures. After shoulder stabilization surgery, your shoulder will be protected in a sling for the first 6 weeks.
Risks
- Shoulder Arthroscopy is safe and effective , but as with all surgery there are risks.
- Infection : Rare < 0,3%, If it occurs it can be a serious complication requiring antibiotic treatment and further surgery with wash out of the shoulder.
- Some bruising is common and will subside.
- Blood Clots in a deep vein including life threatening clots have been reported in the literature, but are very rare.
- Numbness near the incisions is common, but usually disappears over time.
- Injury to blood vessels and nerves are extremely uncommon.
- Synovial fistulas are usually avoided by using a suture for the small skin incisions.
- In general the risk of major problems is below 1%
General Protocol for Rehabilitation and Physiotherapy
In Hospital
- Exercises as per physiotherapist
- Waterproof dressings are usually applied before discharge
At Home
- Keep the wounds dry
- Leave the waterproof dressing on unless you notice wound ooze or if water gets underneath . In this case, replace the dressing
Follow-up review
- Usually 5-10 days post Op
- Stitches will be removed