Introduction
Shoulder Arthroscopy is a ‘keyhole’ surgical procedure where a camera (arthroscope) and instruments are inserted into the shoulder joint through a number of small incisions (3-4mm). A number of shoulder conditions can be diagnosed and treated this way.
Because small incisions are used, this surgery is less invasive and potentially less painful with quicker recovery.
The shoulder is comprised of the ball and socket joint involving the humerus and glenoid. The glenoid is lined by labrum which stabilizes the joint. The rotator cuff tendons stabilize and move the joint. The bursa (lubricating sac) that lines the shoulder joint and undersurface of the clavicle (collar bone) can also be visualised and treated with shoulder arthroscopy.
Indications
A number of conditions can be diagnosed and treated with shoulder arthroscopy.
Rotator Cuff Tears
Tears of the rotator cuff tendons are common. The tears can be seen and repaired with shoulder arthroscopy utilizing the camera and specialized instruments.
Shoulder Dislocations
Shoulder dislocation and recurrent instability involve tears of the labrum. The labrum tear can be identified and repaired.
Shoulder Arthritis
Arthritis of the shoulder joint or acromioclavicular joint can be visualised. Excess bone formed in arthritis can be debrided.
Frozen Shoulder (Adhesive Capsulitis)
This condition causes thickening and tightening of the shoulder capsule. The tight capsule and ligaments can be released in shoulder arthroscopy to free up the shoulder joint.
View Frozen Shoulder (Adhesive Capsulitis)
Infection
Infection / Pus build up in joint can be washed out.
Stiffness
Soft tissue scarring and fibrosis within the joint can be resected to improve movement.
Fractures
Fractures involving the humerus or glenoid can be visualised and lined up for fixation.
Procedure
This procedure can be day only or may require one-night stay in hospital. The procedure is performed under general anaesthesia and may be accompanied by an anaesthetic block. The procedure takes 30-90minutes depending on case complexity.
The proposed incisions are marked out on the skin to minimize risk of damage.
The incisions are approximately 3-4mm. Usually two to four small incisions are made. The incisions may be at the back, side or front of shoulder joint.
Fluid is used to distend the joint and aid vision. A camera is inserted through one incision. This is connected to a monitor where the images from the camera are seen. The different structures of the shoulder are visualised, and the problem is identified. The instruments (e.g. grasper/shaver) are inserted through another incision and the procedure is carried out.
At the end of the procedure, the skin is closed with dissolvable sutures and dressed. The arm will be placed in a sling at the end of the case.
Recovery
- The arm will be in a sling after the surgery.
- Discharge from hospital on painkillers.
- Regular finger and elbow movement exercise will also help with stiffness and swelling.
- Physiotherapy may be required after surgery depending on the condition.
- Return to driving / work / sport depends on the type of procedure.
Risks and complications
Shoulder arthroscopy is generally very safe with few risks. They include:
- Infection.
- Stiffness.
- Bleeding.
- Nerve Injury.