With the growing awareness of being fit, more and more people are getting involved in heavy exercise and recreational sports leading to various shoulder injuries. A relatively simple and safe procedure, called shoulder arthroscopy, is performed to diagnose and treat many shoulder injuries and diseases. Shoulder Arthroscopy is done using a small camera, called an arthroscope, which helps in examining and performing surgery on the bones and soft tissues in and around the shoulder. Most surgeons prefer arthroscopy instead of open shoulder surgery because there is less chance of infection and the shoulder heals more quickly.
Anatomy of the Shoulder
The shoulder is a ball-and-socket joint where the arm joins the upper part of the body. The ends of the two bones, the humerus (upper arm bone) and the scapula (shoulder blade) are covered by articular cartilage. The smooth surface of the articular cartilage makes movement of the joint easy and pain free. The shoulder joint (acromioclavicular joint) is held together by a group of muscles and tendons called the rotator cuff. A healthy rotator cuff keeps the ball of the humerus in the socket (glenoid) of the scapula and aids in the movement of the shoulder in many directions. Injury or disease of the rotator cuff from overuse, injury or trauma can cause pain and instability in the shoulder.
See Anatomy of the Shoulder for more details.
Shoulder Problems Diagnosed or Treated With Arthroscopy
Shoulder arthroscopy may be done to diagnose or treat the following:
Rotator Cuff Tear or Injury
Rotator cuff repair: The edges of the muscles are brought together. The tendon is attached to the bone with sutures. Small rivets (called suture anchors) are often used to help attach the tendon to the bone. The anchors can be made of metal or plastic. They do not need to be removed after surgery.
Instability is when bony segments cannot maintain alignment due to torn or lax ligaments and weak muscles. Shoulder Instability is when the shoulder joint becomes loose and the joint dislocates—the ball slips out of the socket.
Surgery for shoulder instability: If you have a torn labrum, the rim of the shoulder joint that is made out of cartilage, your surgeon can repair it.
Labral or Ligament Tears
Shoulder arthroscopy is a commonly used for tears of a labrum, like a Bankart lesion or SLAP lesion, as well as ligament tears. Rehab after the arthroscopy for these problems play an important role in getting back to normal.
Shoulder Impingement Syndrome
Impingement syndrome is a condition where the rotator cuff tendons become inflamed at the subacromial space causing pain, weakness and loss of movement of the shoulder. Arthroscopic subacromial decompression (cleaning out the space under the acromion) removes the bursa (the fluid-filled sac near the shoulder joint) and other bony projections (bone spurs) that may be causing the irritation creating space for the tendons and helping reduce inflammation. Decompression is done when other conservative treatments don’t work.
Surgery for impingement syndrome: Damaged or inflamed tissue is cleaned out in the area above the shoulder joint itself. Your surgeon may also cut a specific ligament, called the coracoacromial ligament, and shave off the under part of a the acromion.
A frozen shoulder, called adhesive capsulitis, is a condition where the connective tissues surrounding the shoulder joint become inflamed causing pain and restricting the movement of the shoulder. Similar to impingement syndrome, arthroscopy for frozen shoulder is done only after conservative therapy doesn’t work. An arthroscopic procedure for a frozen shoulder should be immediately followed by physical therapy to reduce chances of the problem coming back.
Arthritis or inflammation of the joint, an arthroscopic procedure is performed to remove the damaged bone to regain normal movement of the shoulder joint. Shoulder arthroscopy may also be done to relieve the arm from problems related to arthritis like cartilage inflammation or tear, ligament rupture, or even when the joint surfaces become rough due to constant rubbing against each other.
Torn or Damaged Biceps Tendon
The biceps tendon becomes inflamed from impingement syndrome or rotator cuff tears. It can also become inflamed on its own. In order to relieve the symptoms of biceps tendonitis, an arthroscopic procedure called the biceps tenodesis is performed to anchor the tendons and prevent further problems.
Preparing for Shoulder Arthroscopy
Be sure to tell your surgeon about all prescription and non-prescription medicines you are taking, including alcohol, supplements, cigarettes, or herbs. Include the name, the amount and how often you take them. Ask your surgeon which medications you should take on the day of your surgery.
Two Weeks Before Surgery
To prepare shoulder arthroscopy you may need to get an urinalysis and blood tests. If you are over 50, you may also need an EKG, chest x-rays to make sure you’re OK for anesthesia. If you have other illnesses like diabetes, heart or lung disease, you will need clearance for the surgery from your regular doctor. If you take medications that cause thinning of the blood—like ibuprofen, aspirin, naproxen—you should stop taking these medicines about two weeks before your surgery.
If you are suffering from an illness like a cold, flu, fever, herpes or infection within a week of your surgery, tell your surgeon—your surgery many need to be postponed to prevent complications.
If you smoke or use tobacco products, stop them before surgery. Nicotine slows down the healing process for tissues and bone. Ask your ways to help you stop. Do not use nicotine patches to help you stop since you will still be getting nicotine. If you drink more than one or 2 drinks a day, be sure to tell your surgeon.
The Day of Surgery
Don’t eat or drink anything after midnight of the day of your surgery. Take the daily medicines with just a sip of water that your surgeon said it’s OK to take. Arrive at the hospital or surgical center on time.
You will probably go home the day of surgery, so wear clothes that are easy to get on and off. Your shoulder will be in a sling so zippers and ties will be all but impossible with one hand. Buttons are OK, snaps are better. You can’t raise your arm to put on a sweatshirt or T-shirt. A big shirt or jacket that buttons or snaps up the front will work well. Wear pants that you can slip on and have an elastic waistband, like sweat pants or exercise shorts. Wear shoes, without stockings or socks, that slip on like flip flops, clogs, loafers, or sandals.
Anesthesia for Shoulder Arthroscopy
Usually a combination of both regional anesthesia and general anesthesia is used. The regional anesthesia makes the arm and shoulder numb so you don’t feel any pain during surgery. General anesthesia puts you to sleep and is used to make you comfortable during surgery.
Shoulder arthroscopy begins with a few small incisions made at the shoulder area. The arthroscope, which is connected with a video monitor, is inserted through one of these incisions. The other incisions are for inserting equipment needed for the repair, reconstruction, etc. The arthroscope helps the surgeon to get a clear view of the shoulder joint and adjoining cartilage, ligaments and tendons to diagnose the exact problem.
At the end of the procedure, all the incisions are taped, the area is bandaged you’ll be taken to the recovery room.
Risks and Complications of Shoulder Arthroscopy
Shoulder arthroscopy is a safe procedure and the chances of complications are low. However, it’s important to know the risks and complications so that it’s easier to identify if it actually happens.
• Bleeding, infection, or blood clots.
• Infection, vomiting, nausea, urinary retention, sore throat, headache from the anesthesia. Some serious effects of anesthesia include strokes, heart attacks and pneumonia.
• Shoulder stiffness or weakness and/or loss of some or all sensation.
• The repair doesn’t heal.
• The repair does not relieve symptoms.
• Blood vessel or nerve damage in or near the shoulder.
After Shoulder Arthroscopy
The patient is generally allowed to go home on the same day of the surgery, but with the arm in a sling, which needs to be in place for about one week or a little more depending on the intensity of the surgery. Medications are given to control the post procedure pain. Most of these procedures should be followed by physical or occupational therapy for regaining motion and strength of the shoulder and a speedy recovery. However, recovery can range anywhere from one to six months, again depending on the type of surgery, post surgery care and rehabilitation, and physical therapy.
Care Following Shoulder Arthroscopy
When you are ready to go home, your will be given a list of things to do to speed your recovery including the following.
• How long you have to wear the sling will depend on the type of shoulder repair you had. For labral repairs it’s typically worn for 4 weeks. Your surgeon will tell you if it is OK to take it off for physical therapy or grooming.
• Apply ice to the area as per surgeon’s instructions either by using an ice machine or putting ice over the bandaged area. Do not apply ice directly to the skin, put a cloth between your skin and the ice. Do not apply heat to the area. (How to make an ice bag.)
• In most cases sutures for closing the incision sites are used with absorbable sutures and does not need to be removed, otherwise, the suture removal is done within seven to ten days after surgery.
• Start eating clear liquids and soups until you see if you are nauseated. Then slowly return to your regularly diet if you’re not nauseated. Sometimes the digestive system is slow to respond after anesthesia or while taking narcotic pain medicine. If you get constipated, use a mild over-the-counter laxative.
• Strong pain pills (narcotics) may be prescribed for the first few days. Pain medicine should be taken exactly as your surgeon prescribes and as needed, but not more often than every 4 hours. Don’t wait to take your pain medicine until you are in a lot of pain; pain medicine works best if you stay ahead of the pain. Do not drink alcohol or take Tylenol while you’re taking pain medicine. You can take anti-inflammatory medicines along with the pain medicine. Take pain medicine with food to prevent an upset stomach. Call your surgeon if you have pain that is not controlled with your pain medicine.
• The bandage around the shoulder area is usually removed in about three days, however, the instructions of the physician should always be followed in this regard. Because so much fluid is used during the procedure, you may notice some bloody drainage on the dressing. If the drainage is excessive, call your surgeon. Do not touch the incisions or put anything on the incision.
• You can take a shower after the bandage is removed in about 3 days. Do not take bath until the wound has healed completely in about 10-12 days.
• Though physical therapy is usually started after one to two weeks after the surgery, some simple exercises are given to the patients to do at home just after the surgery as this helps to keep the shoulder joint mobilized.
• Do not drive until your surgeon say it’s OK; do not drive if you are taking narcotics or muscle relaxants as they can affect your ability to drive.
• If the patient’s job does not involve the affected arm, then returning to work can be within three to five days. However, if it involves the affected arm, it will take a little longer.
When to Call Your Surgeon
• If you have difficulty breathing.
• If you have increased swelling in your thigh or calf.
• If you have pain in your thigh or calf.
• If your affected arm changes color or temperature.
• If you have progressive numbness in the affected arm.
• If the pain in the affected arm gets worse even with proper use of pain medication; or if you cannot control the pain with the pain medicine.
* If you have a fever higher than 101.5°F.
• If you have excessive nausea and/or vomiting from the pain medication.
• If you have continuous draining or bleeding from the incisions.
What You Can Expect After Shoulder Arthroscopy
Shoulder arthroscopy is a better alternative to open surgery because arthroscopy is less invasive, requires a shorter hospital stay, has fewer complications and a faster recovery. Even so, the affected arm should not be exerted too much, but rather activities should be done only as tolerated.
Complete recovery can take as long as 6 months to a year depending on what type repair was done. Your return to normal depends a lot on your commitment to physical therapy and your overall health.
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