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Arthroscopy is a procedure that orthopaedic surgeons use to inspect, diagnose, and treat problems inside a joint. The word arthroscopy comes from two Greek words, “arthro” (joint) and “skopein” (to look). The term literally means “to look within the joint.” During shoulder arthroscopy, we insert a small camera, called an arthroscope, into your shoulder joint. The camera displays pictures on a video monitor, and we use these images to guide miniature surgical instruments.
Because the arthroscope and surgical instruments are thin, we can use very small incisions (cuts), rather than the larger incisions needed for standard, open surgery. This results in less pain for patients and shortens the time it takes to recover and return to favorite activities.
Shoulder arthroscopy has been performed since many years. It has made diagnosis, treatment, and recovery from surgery easier and faster than was once thought possible. Improvements to shoulder arthroscopy occur every year as new instruments and techniques are developed.
Your shoulder is a complex joint that is capable of more motion than any other joint in your body. It is made up of three bones: your upper arm bone (humerus), your shoulder blade (scapula), and your collarbone (clavicle).
This illustration of the shoulder highlights the major components of the joint.
Ball and socket. The head of your upper arm bone fits into a rounded socket in your shoulder blade. This socket is called the glenoid. A slippery tissue called articular cartilage covers the surface of the ball and the socket. It creates a smooth, frictionless surface that helps the bones glide easily across each other.
The glenoid is ringed by strong fibrous cartilage called the labrum. The labrum forms a gasket around the socket, adds stability, and cushions the joint.
Shoulder capsule. The joint is surrounded by bands of tissue called ligaments. They form a capsule that holds the joint together. The undersurface of the capsule is lined by a thin membrane called the synovium. It produces synovial fluid that lubricates the shoulder joint.
Rotator cuff. Four tendons surround the shoulder capsule and help keep your arm bone centered in your shoulder socket. This thick tendon material is called the rotator cuff. The cuff covers the head of the humerus and attaches it to your shoulder blade.
Bursa. There is a lubricating sac called a bursa between the rotator cuff and the bone on top of your shoulder (acromion). The bursa helps the rotator cuff tendons glide smoothly when you move your arm.
We may recommend shoulder arthroscopy if you have a painful condition that does not respond to nonsurgical treatment. Nonsurgical treatment includes rest, physical therapy, and medications or injections that can reduce inflammation and allow injured tissues to heal. Inflammation is one of your body’s normal reactions to injury or disease. In an injured or diseased shoulder joint, inflammation causes swelling, pain, and stiffness.
Injury, overuse, and age-related wear and tear are responsible for most shoulder problems. Shoulder arthroscopy may relieve painful symptoms of many problems that damage the rotator cuff tendons, labrum, articular cartilage, and other soft tissues surrounding the joint.
Less common procedures such as nerve release, fracture repair, and cyst excision can also be performed using an arthroscope. Some surgical procedures, such as shoulder replacement, still require open surgery with more extensive incisions.
These photos taken through an arthroscope show a normal shoulder joint lining (left) and an inflamed joint lining caused by frozen shoulder.
If you have certain health risks, a more extensive evaluation may be necessary before your surgery. Be sure to inform about any medications or supplements that you take. You may need to stop taking some of these prior to surgery.
If you are generally healthy, your arthroscopy will most likely be performed as an outpatient. This means you may not need to stay overnight at the hospital. Make sure to follow the instructions on when to arrive and especially on when to stop eating or drinking prior to your surgery.
Before the operation, a member of the anesthesia staff will talk with you about anesthesia options. Shoulder arthroscopy may be performed using regional nerve blocks which numb your shoulder and arm. This numbing medicine is injected in the base of your neck or high on your shoulder. This is where the nerves that control feeling in your shoulder and arm are located. In addition to its use as an anesthetic during surgery, a nerve block will help control pain for a few hours after the surgery is completed. Many surgeons combine nerve blocks with a light general anesthetic because patients can become uncomfortable staying in one position for the length of time needed to complete the surgery. Most arthroscopic procedures take less than an hour, however, the length of surgery will depend on what type of repairs are required in a particular case.
Once in the operating room, you will be positioned so that surgeon can easily adjust the arthroscope to have a clear view of the inside of your shoulder. Once you are positioned, the surgical team will remove hair, if needed, and then spread an antiseptic solution over your shoulder to clean the skin. We will cover your shoulder and arm with sterile drapes.
We inject fluid into the shoulder to inflate the joint. This makes it easier to see all the structures of your shoulder through the arthroscope. Then we will make a small puncture in your shoulder (about the size of a buttonhole) for the arthroscope. Fluid flows through the arthroscope to keep the view clear and control any bleeding. Images from the arthroscope are projected on the video screen showing us the inside of your shoulder and any damage.
Once the problem is clearly identified, we will insert other small instruments through separate incisions to treat it. Specialized instruments are used for tasks like shaving, cutting, grasping, suture passing, and knot tying. In many cases, special devices are used to anchor stitches into bone. We will close your incisions with stitches and cover them with a large, soft bandage.
After surgery, you will stay in the recovery room for 1 to 2 hours before being discharged home or shifted back in room. Nurses will monitor your responsiveness and provide pain medication, if needed. You will need someone to drive you home or stay with you for the night.
Although recovery from arthroscopy is often faster than recovery from open surgery, it may still take from weeks to months for your shoulder joint to completely recover.
You can expect some pain and discomfort for few weeks after surgery. If you have had a more extensive surgery, it may take longer before your pain subsides. Ice will help relieve pain and swelling. Many types of pain medication are available to help control pain, including opioids, nonsteroidal anti-inflammatory drugs (NSAIDs) and local anesthetics. Treating pain with medications can help you feel more comfortable, which will help your body heal faster and recover from surgery faster.
A few days after surgery, you should be able to replace your large bandage with simple Band-Aids. You may shower once your wounds are dry, but try not to soak or scrub your incisions. You will most likely need a sling or special immobilizer to protect your shoulder. We will discuss with you how long these will be needed.
Rehabilitation plays an important role in getting you back to your daily activities. An exercise program will help you regain shoulder strength and motion. We will develop a rehabilitation plan based on the surgical procedures you required.
If you have had a more complicated surgical repair, we may recommend a physical therapist to supervise your exercise program.
It is important that you make a strong effort at rehabilitation in order for your surgery to succeed.
Most patients do not experience complications from shoulder arthroscopy. As with any surgery, however, there are some risks. These are usually minor and treatable. We will discuss the possible complications with you before your operation.
Long-Term Outcomes
Because patients have varied health conditions, complete recovery time is different for everyone. If you have had a minor repair, you may not need a sling and your strength may return after a short period of rehabilitation. You may be able to return to work within a few days of your procedure.
It takes longer to recover from more complicated procedures. Although the incisions are small in arthroscopy, extensive damage within the joint can be repaired with the procedure. Full recovery may take several months. Although it can be a slow process, following surgeon’s guidelines and rehabilitation plan is vital to a successful outcome.