When is shoulder arthroscopy recommended?

Your doctor may recommend shoulder arthroscopy in cases where you have a painful shoulder condition that does not respond to nonsurgical treatment. Non-surgical treatments include rest, physical therapy, taking and injecting drugs that reduce inflammation and heal the damaged tissue. Inflammation is one of your body's natural reactions to illness or injury. In an injured or sick shoulder, inflammation causes swelling, shoulder pain and dryness. Injury, overuse, and the wear and tear process associated with aging are the cause of most shoulder problems. Arthroscopy may relieve the painful symptoms of many injuries to the rotator cuff tendons, labrum, articular cartilage, and other soft tissues around the joint. Common arthroscopic procedures include:

• Rotating cap repair
• Labrum repair or removal
• Ligament repair
• Removal of inflamed tissue or loose cartilage
• Repair of frequent shoulder dislocation

Less common procedures such as nerve release, fracture repair, and cyst removal can be performed with an arthroscope. Some surgeries, such as shoulder replacements, still require open surgery with larger incisions.These images taken with an arthroscope show a normal shoulder joint lining (left) and an inflamed shoulder lining due to frozen shoulder.

Planning for arthroscopic shoulder surgery

The orthopedic surgeon may want to see your family doctor to make sure you don't have any other medical conditions that need to be treated before surgery. Blood tests, ECG and chest X-ray may be required for the safety of your surgery. If you have a specific medical condition, a more detailed evaluation may be needed before surgery. Be sure to tell your orthopedist about the medications and supplements you are taking. You may need to stop taking certain medications before surgery. If you are generally healthy, arthroscopy will most likely be done on an outpatient basis. The hospital or surgery center will give you details about the procedure. Make sure you follow these instructions, especially when you shouldn't eat or drink anything before the procedure. Before the procedure, a member of the anesthesia team will discuss anesthesia options with you. Shoulder arthroscopy may be performed under a nerve block that numbs your arm and shoulder. This anesthetic drug is injected in the lower neck or upper shoulder. This is where the nerve that controls sensation in the arm and shoulder is located. In addition to its use as an anesthetic, a nerve block also helps control pain for several hours after surgery. Many surgeons combine a nerve block with a light general anesthesia because it can be difficult for the patient to stay in one position for the long time required for surgery. Most arthroscopic procedures will take less than an hour, but the duration of the procedure depends on what the surgeon sees and what repairs are needed. This is where the nerve that controls sensation in the arm and shoulder is located. In addition to its use as an anesthetic, a nerve block also helps control pain for several hours after surgery. Many surgeons combine a nerve block with a light general anesthesia because it can be difficult for the patient to stay in one position for the long time required for surgery. Most arthroscopic procedures will take less than an hour, but the duration of the procedure depends on what the surgeon sees and what repairs are needed. This is where the nerve that controls sensation in the arm and shoulder is located. In addition to its use as an anesthetic, a nerve block also helps control pain for several hours after surgery. Many surgeons combine a nerve block with a light general anesthesia because it can be difficult for the patient to stay in one position for the long time required for surgery. Most arthroscopic procedures will take less than an hour, but the duration of the procedure depends on what the surgeon sees and what repairs are needed.

Arthroscopic shoulder surgery

Body condition and preparation

In the operating room, you will be placed in a position where the surgeon can easily adjust the arthroscope to get a clear picture of the inside of the shoulder. The two most common conditions for which most patients undergo shoulder arthroscopy are:

• Seaside chair position: This position is a semi-sitting position similar to reclining on a chair.
• External decubitus position: In this position, the patient lies on the bed and on his shoulder.

Each situation has advantages. Surgeons choose the position based on the procedure to be performed and based on their skill. Once you are in the right position, the surgical team will shave the hair of the area if needed and apply a special antiseptic solution to the skin to clean the skin completely. They will cover your shoulder and arm with sterile drapes and will most likely immobilize your forearm with a device to make sure your hand doesn't move.

Surgical procedure

Your doctor may inject fluid into the shoulder to inflate the joint. This makes it easier to see the shoulder structures through the arthroscope. The surgeon then makes a hole (the size of a buttonhole) in the shoulder for the arthroscope. Fluid moves through the arthroscope to keep the image clear and control bleeding. Arthroscope images on the screen show the surgeon inside the joint and any damage.The image and photo show the arthroscope and the arthroscopic device that are inserted into the shoulder joint through a port. Once the problem is clearly identified, the surgeon inserts the arthroscopic device through a separate hole and port for treatment. Special arthroscopic instruments are used to perform tasks such as shaving, cutting, grasping, suturing and tying. In many cases, special devices are used to secure the suture to the bone.(Left) Torn rotating cap. (Right) The rotator cuff tendon is attached to the head of the humerus using sutures. Your doctor may close the incision with stitches or special bandages and cover it with a large, soft dressing.