What Do You Need To Know About Shoulder Arthroscopy?

What is Shoulder Arthroscopy?

Shoulder Arthroscopy is a minimally invasive procedure performed to inspect and treat shoulder joint abnormalities. This procedure is performed with a help of a small fiber-optic video camera called an arthroscope, which projects the structures inside of the joint on a big video monitor screen which assists in the use of small surgical instruments inside the shoulder to correct and manage any abnormalities. This procedure is more beneficial than open surgery as it results in less pain, less joint stiffness, and shorter recovery time.

Is Shoulder Arthroscopy procedure an elective or an emergency procedure?

Shoulder Arthroscopy is an elective procedure.

Indications of Shoulder Arthroscopy

This procedure is recommended when non-surgical treatment fails to relieve shoulder pain. The following shoulder disorders are treated

• Rotator cuff repair
• Removal or repair of the labrum
• Repair of ligaments
• Removal of inflamed soft tissues or loose cartilage
• Repair of shoulder dislocations
• Never release
• Shoulder bone fracture repair
• Excision of cyst in the shoulder joint

All the above-mentioned shoulder joint deformities can be caused due to the following reasons:

• Infection or inflammation of shoulder joint that causes shoulder pain, swelling, and stiffness
• Overuse of the shoulder
• Age-related wear and tear
• Injury or trauma to the shoulder

Contraindications and Risk Factors

Conditions under which this procudure is not performed include:

• Presence of active local soft-tissue infection in the shoulder
• Presence of severe arthritis

Investigations before the procedure

Investigations that are done before the procedure include:

• Complete blood count
• Electrocardiogram (EKG)
• Chest x-ray

Preoperative Advice 

Preoperatively before undergoing a shoulder arthroscopic surgery:

• Risks, benefits, and alternative methods of procedure are discussed with the patient and the family members
• Any medications that the patient is on are reviewed by the physician
• Certain medications like aspirin or ibuprofen are to be discontinued a few weeks before the procedure
• Oral intake is avoided at least 8 to 12 hours before the procedure

Intraoperative Details

Anaesthesia: Regional nerve block anaesthesia is administrated to numb the shoulder and arms. Anaesthesia is injected at the base of the neck or high on the shoulder.

Duration: Length of shoulder arthroscopic procedure depends upon the repair that is required to be performed.

Description of the procedure

The patient is placed in either a beach chair position or lateral decubitus position or depending on the type of surgery that needs to be performed the patient is placed in the appropriate position. The surgical site is prepped and draped in a sterile fashion. A fluid is injected into the shoulder to inflate the joint. This helps to view all the structures of the shoulder more clearly. A small incision of the size of a buttonhole is made on the shoulder for inserting the arthroscope. Fluid flows through the arthroscope to keep the view clear and control any bleeding.

The arthroscope allows viewing the inside of the joint on a monitor screen. Once the deformity is identified, small surgical instruments are passed through the other incision ports to correct the deformity. With the help of special instruments, shaving, cutting, grasping, suture passing, or knot tying, etc are performed to repair the shoulder joint. After the procedure, the surgical site is irrigated with saline water. The arthroscope and all the instruments are gently withdrawn. The incision site is closed with sterile sutures and the wound site is closed with a bandage.

Postoperative Details

Postoperatively after the procedure, the patient is kept under observation. After stabilization, the patient is discharged home.

Following discharge, the following instructions are to be followed:

• Pain medications are provided for 2 to 3 weeks after the surgery. In some cases, pain medications are given only for a week after the surgery
• Ice packs can be used to reduce swelling and minimize pain
• Dressings over the incision site should be changed regularly
• The incision site is to be observed for any signs of infection. Immediate medication consultation is recommended if there is rapidly increasing pain, swelling around the surgical area, redness around the incision site, or drainage from the surgical wound site
• Fever greater than 101 degrees Fahrenheit should be reported to the physician
• Follow up as scheduled by the physician

Role of Diet/ Exercise/ Lifestyle changes

Recovery from an arthroscopic procedure can be fast, but the shoulder joint would take several weeks or months to recover completely. The recovery pace is different for each individual. Some may recover within 2 weeks and resume normal activities whereas some take four to six weeks to heal and do so.

Other lifestyle changes that need to be followed after the surgery include:

• A sling or special immobilizer is used to protect the shoulder
• Try to remove the sling and bend the arm, straighten the elbow, and move fingers several times a day to avoid stiffness
• Avoid lifting, pushing, or pulling with the operated shoulder during the first six weeks after surgery
• Avoid reaching behind the back with the operated arm
• The shower should be avoided until the incision site is clean and dry
• Avoid getting into a tub or pool for six weeks after the surgery
• Physical therapy after Shoulder Arthroscopy is very important to improve strength and resume normal functioning of the shoulder. Some individuals may have minimal swelling with physical therapy, however, it gradually resolves.
• Avoid lifting heavyweights on the operated arm for a few months until directed by the physician
• Avoid any strenuous physical activities or sports until the shoulder is completely resolved
• Diet can be taken as tolerated
• Avoid wearing t-shirts until the shoulder regains normal strength and flexibility

Complications

Complications that are associated with this procedure are:

• Excessive bleeding during the procedure
• Infection at the surgical site or infection inside the joint
• Bleeding inside the shoulder joint after the procedure
• Formation of any blood clots
• Shoulder joint stiffness
• Injury or damage to the surrounding cartilages, ligaments, blood vessels, and nerves during the procedure.
• Side effects from anaesthesia such as breathing difficulties. Other allergic reactions to anaesthesia or other medications used during the procedure.

Prognosis

The overall prognosis of Shoulder Arthroscopy is good. Although the incisions are small in arthroscopy, this procedure helps to repair more extensive damage within the joint. Even though the full recovery takes several months and the healing process is slow, the outcomes of the surgery are successful.

Indications for hospitalization if required

Shoulder Arthroscopy is performed in a hospital setting. Depending on the extent of the repair, the individual might be discharged on the same day or may have to stay overnight in the hospital while under observation.

Suggested clinical specialist/ Department to consult for the procedure

Orthopedics