To understand Shoulder Arthroscopy, we need to first understand what is Arthroscopy. The word Arthroscopy comes from Greek words árthro’ meaning ‘joint’ and ‘skopein’ meaning ‘to look’. Thus, Arthroscopy is a surgical procedure used by orthopaedic surgeons to view the joint (without making large incisions), diagnose and treat the problem.
In this procedure, very small incisions are made in the patient’s skin from where pencil sized instruments are inserted which contains magnifying lens, tiny television camera and lighting systems. This helps the surgeons to view the inside of the joint on television screens.
In Shoulder Arthroscopy, the surgeon will make one or more incisions in the shoulder and insert the arthroscope through it. This will help the surgeon inspect the tissues in the joint, cartilages, bones, tendons and ligaments. More than once incisions are made to insert other surgical instruments which are used to repair the damaged tissues.
Advantages of Arthroscopy
Arthroscopy or Minimal invasive surgery and Joint Replacement Surgery has been two of the most important technological innovations in orthopaedic surgery in last 100 years. The first report of shoulder arthroscopy was by Burman (1931) on cadavers. Arthroscopy has lot of advantages over open surgical methods. These minimal invasive surgeries result in less post-operative complications, faster recovery time, less pain, minimal scar. With arthroscopy, the number of morbidities have significantly reduced. Arthroscopy helps the surgeons visualize the joints thoroughly and hence the understanding of shoulder problems and their treatment has improved significantly post the introduction of arthroscopic surgery.
Types of problems that require Shoulder Arthroscopy
Injury, overuse and age-related wear and tear causes most of the shoulder problems. Injury or disease in a shoulder causes inflammation which causes pain and stiffness. Your doctor may recommend shoulder arthroscopy if you have a painful condition that does not respond to non-surgical treatments like rest, medications or physiotherapy. All shoulder problems cannot be corrected using an arthroscopy. The most common disorders where shoulder arthroscopy is used is as follows:
- Rotator Cuff Tear
- Shoulder Instability
- SLAP Tear
- Collarbone and Shoulder Arthritis
- Cartilage defects
- Biceps Tendon Tear
- Shoulder Impingement Syndrome
- Frozen Shoulder
- Calcific Tendinitis
Preparation for Arthroscopy
There are certain preparations that are required before an arthroscopic procedure. Your surgeon will first review your entire medical and surgical history. He might advise you to stop certain medications. You will be required to fast before the procedure, wear loose and comfortable clothing and make arrangements beforehand for a smooth and comfortable post-operative recovery period.
Arthroscopy is done under anesthesia. Most patients are put under general anesthesia however for some patients depending on the condition, only regional anesthesia is used. One or more tiny cuts (incisions) are made around the shoulder joint and arthroscope is introduced. Thorough assessment is made by the surgeon by visualizing the images on the television screen. Based on the analysis, the problem is diagnosed. In most arthroscopies, the problem is rectified then and there. After this, the incision is closed using stitches. The procedure takes approximately 2 to 2.5 hours. However, the pre-operative preparation and post-operative care adds to the overall time.
Surgeon might advise you to wear a sling for the couple of weeks after the procedure. Depending on the extent of the damage, the surgeon will prescribe a period of rest along with physiotherapy sessions. Only after assessment and confirmation by the surgeon can the patient return to active sports or other physical activities.
There are no complications for most of the patients after an arthroscopy. As with any surgery, there might be some risks which includes excessive bleeding, blood clots, infection, damage to blood vessels or nerves.