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    2017
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Shoulder Arthroscopy

Shoulder Arthroscopy

Shoulder Arthroscopy

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.

Shoulder_Arthroscopy

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
    • Tendonitis
    • 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.

The Procedure

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.

Post Surgery

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.

Complications

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.

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Q&As on Reverse Shoulder Arthroplasty

1. What is reverse shoulder arthroplasty?

Reverse shoulder arthroplasty is a type of orthopedic surgical procedure in which the damaged bone of your shoulder joint is replaced with a prosthesis. It utilizes the convex glenoid hemispheric ball and a hollow humerus articulating cup for the reconstruction of the glenohumeral joint. This inventive method offers substantial relief from shoulder pain and enhances the range of mobility in your shoulder. It is most commonly done for the treatment of conditions such as rotator cuff tear arthroplasty, fractures caused by displacement of the proximal humerus, and failure of shoulder arthroplasty.

2. For which conditions is reverse shoulder arthroplasty used as treatment?

Reverse shoulder arthroplasty is effective for the treatment of the following conditions:

  • Rotator cuff arthroplasty, a degenerative shoulder disease caused by a massive rotator cuff tear, leading to arthritis glenohumeral joint alterations and migration of the proximal humerus
  • Pseudo paralysis of the shoulder caused by irreversible massive rotator cuff tear
  • Fractures such as acute multiple parts proximal humerus
  • Glenohumeral arthritis caused after trauma
  • Chronic irreversible shoulder dislocation
  • Repeat surgery for failure of proximal humerus hemiarthroplasty
  • Inflammation of joints, such as rheumatoid arthritis.
  • Tumours in the shoulder joint

Reverse shoulder arthroplasty becomes an option when pain and weakness start affecting day-to-day activities. If conservative treatments such as medicines, physical therapies, and injections fail, surgery is the only option. Rehabilitation and precautionary measures after surgery must be properly followed. These primarily include home exercise routines, prevention of sudden body movements, especially of the arms, proper rest, good diet including many others.

3. What care should be taken after reverse shoulder arthroplasty?

After surgery, intravenous antibiotics and some pain medications are given. Most patients can start taking solid food and moving the day post surgery. Discharge from the hospital is allowed on the second or third day post operation based on the patient’s comfort level. Rehabilitation and precautionary measures after surgery must be properly followed. These primarily include home exercise routines; prevention of sudden body movements, especially those of arms; and avoiding excessive rehabilitation exercises and heavy lifting. Any movements that put pressure on your shoulder joint must be avoided.

4. What you should expect from reverse shoulder arthroplasty?

Reverse shoulder arthroplasty surgery takes about 3 to 5 hours for completion. As the bones require time for healing near the implants, movement of the shoulder is limited for several days to weeks after the procedure. Like all surgeries, there are certain risks associated with this orthopedic procedure, such as:

  • Infections
  • Clotting of blood
  • Dislocation
  • Damage of nerve

Regarding the effectiveness of the procedure, even if it does not reestablish the complete range of motion in the patient, it is effective in offering relief from pain and enhancing the range of motion to some extent. It will take around 4 to 5 months for complete recovery. And new implants last for about 15 years before they require any fixing or replacement with repeat surgery.

5. What are the benefits of reverse shoulder arthroplasty surgery?

There are numerous advantages of reverse shoulder arthroplasty, such as:

  • The center of rotation progresses inferiorly and is medialized.
  • This surgical procedure facilitates the deltoid muscles to work on a long fulcrum and possesses more mechanical benefits for substituting the scarce rotator cuff muscles for offering abduction of the shoulder.
  • It does not substantially assist shoulder rotation, either internal or external.
  • It can be mixed with latissimus dorsi transfer to help with rotation.
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