What is shoulder arthroscopy?
Shoulder arthroscopy, also referred to as "a shoulder scope," is a minimally invasive surgical procedure used by orthopedic surgeons to treat various painful disorders of the shoulder such as rotator cuff tendon tears, cartilage disorders, shoulder instability, torn ligaments and bone spurs. An arthroscope is an instrument thinner than a pencil, containing a system of lenses, a light and a small video camera that allows your surgeon to see the inside of your shoulder joint.
Orthopedic surgeons have been performing arthroscopic surgery on a wide spectrum of painful shoulder problems since the late 1980s. According to the American Academy of Orthopaedic Surgeons (AAOS), shoulder arthroscopy has made diagnosis, treatment and recovery from surgery easier and faster than was once thought possible. Every year, new instruments and techniques are developed that fine-tune the surgery even more.
Why it's done
In the shoulder, uses for arthroscopy include:
- Rotator cuff repair—The rotator cuff is a network of four muscles that comes together as tendons to form a covering around the head of your upper arm bone (humerus). A rotator cuff tear occurs when one or more of the tendons are torn from their insertion into the bone. This can occur from an acute trauma like a fall, or more gradually over time. Shoulder arthroscopy repairs and reattaches the torn tendon(s) of the rotator cuff to normal insertion. This type of injury is one of the most common shoulder complaints; every year, more than 2 million people see their doctors because of a rotator cuff tear, the American Academy of Orthopaedic Surgeons (AAOS) reports.
- Impingement/bone spur removal—A spur is a growth on a bone that can damage and impinge on surrounding bones, ligaments, and tendons such as the rotator cuff. Bone spurs usually form in response to pressure, irritation, inflammation and/or stress on the bone for a long period of time. They also can form because of arthritis. A bone spur is a result of the body trying to repair itself by building extra bone. Using minimally invasive shoulder arthroscopy, your surgeon can go directly to the bone spur and remove it.
- Removal or repair of the labrum—The head of the upper arm bone (humeral head) rests in a shallow socket in the shoulder blade called the glenoid. A soft, fibrous tissue (cartilage) rim called the labrum surrounds the socket and deepens it by up to 50 percent so that the head of the upper arm bone fits more securely. During arthroscopic surgery, your doctor examines the labrum as well as the biceps tendon. Depending on the injury to the labrum, the surgeon may:
- Debride and remove any torn pieces of cartilage
- Repair the labrum if detached, using suture anchors
- Release and/or reattach the biceps tendon if the biceps tendon is your pain source
- Removal of inflamed tissue or loose cartilage—Arthroscopic shoulder surgery can be used to remove any inflamed tissue or damaged lining of the shoulder joint and any loose tissue in the shoulder.
- AC joint resection—Shoulder arthroscopy also can be used for arthritic conditions of the shoulder. A common place to find arthritis is at the acromio-clavicular joint that connects your collar bone (clavicle) to your shoulder. The arthritis can be removed via this minimally invasive technique to relieve your pain.
- Repair for shoulder dislocation—If you have a history of shoulder dislocations or your shoulder just feels “loose,” you may have instability of the shoulder. Shoulder arthroscopy can tighten the structures in your shoulder, create stability and prevent further dislocations.
What to expect
During shoulder arthroscopy, your orthopedic surgeon begins by making small incisions in your shoulder. The arthroscope is inserted into one incision, and very thin surgical tools are inserted through the other small incisions to repair and/or remove damaged structures and harmful debris such as bone or cartilage chips. The camera sends images to a video monitor stationed by the operating table, enabling the surgeon to guide the camera and perform the surgery with the inserted tools. Using the magnified views from the camera, your surgeon can inspect all the tissues of your shoulder including the cartilage, bones, tendons and ligaments. This inside view helps your surgeon identify any problem areas and allows for any repair/treatment needed.
Compared to traditional open shoulder surgery, shoulder arthroscopy allows for the treatment of shoulder problems via a minimally invasive technique and produces comparable, if not better, results. Arthroscopic procedures will decrease the time you spend in the operating room, reduce the amount of anesthesia you receive, decrease postoperative discomfort and speed up your recovery.
Most arthroscopic shoulder surgeries are performed on an outpatient basis and take less than an hour to complete. The length of your surgery will depend on what your diagnosis is, as well as the true extent of your injury and what repairs may be needed.
Icing your shoulder
After this surgery, you will experience discomfort in your shoulder. This is normal and should decrease after the first week. The small entry points may be sore and develop bruising over the next several days. This bruising will eventually disappear and does not require any special care. To minimize swelling and pain, ice your shoulder. This is especially helpful during the first few days after surgery, but can also be done during the next few weeks. Ice can be applied as often as you like but not for longer than 20 minutes at any one time.
Activity and work
Immediately after surgery, stay home, limit your activities and get frequent rest. If you’re feeling fine in the following days, you may leave the house. Do not drive, as one of your upper extremities is temporarily impaired. Plan to take three to four days off from work. You may resume work when you are comfortable, especially if you don’t have a physically strenuous job. If your job requires repetitive use of your shoulder, your return to work will be determined by you and your surgeon.