What is shoulder arthroscopy? An arthroscope is a small camera that allows your orthopedic surgeon to inspect and repair a shoulder problem without a large incision. Your surgeon uses the “scope” to look directly into the joint and make needed repairs. The arthroscope is a narrow metal tube about as thick as a pencil. It has a powerful lens and a fiber optic light to magnify and illuminate the inside of the joint. With the “scope,” your surgeon can examine the inside of your shoulder, pinpoint the problem, and make repairs all during the same operation.
The shoulder is designed to give a wide range of arm motion. This mobility however, makes the shoulder vulnerable to injury and other problems. The shoulder is basically a ball (humeral head) and socket (gleniod). The socket is shallow and might be thought of as more of a saucer. A soft tissue lip on the saucer (called the labrum) deepens the saucer to keep the ball centered in the socket. It is the surrounding muscles and ligaments that keep the shoulder in place. The muscles that give the shoulder stability and initiate motion are collectively called the rotator cuff. The top of the shoulder is called the acromion and the ball rotates under the acromion when the arm is in motion.
The shoulder has shock absorbers to allow for smooth motion. Under the acromion is a fluid-filled sac called a bursa. In a healthy shoulder, the bursa acts as a cushion, reducing friction between the ball and the acromion. Cartilage covers the end of the ball and the socket, allowing them to rub together smoothly when in motion.
Many conditions can lead to shoulder pain. Your surgeon can gain helpful information from your medical history and exam: your symptoms, the duration of pain, swelling, tenderness, muscle strength, stability, and range of motion of your shoulder. Special diagnostic tests can be used to determine if arthroscopy may be needed.
- X-RAYS can identify arthritis, a dislocated or separated shoulder, bone spurs, and fractures
- An ARTHROGRAM is an x-ray with dye injected into the shoulder to detect damage to the rotator cuff. If the dye “leaks” out of the shoulder, you may have a rotator cuff tear.
- MRI (magnetic resonance imaging) is a magnetic “picture” of your shoulder with very accurate images of both the bones and soft tissue.
When Is Arthroscopy Needed?
Loose fragments of bone and cartilage – Rough joint surfaces affected by arthritis or calcium deposits can be smoothed and loose pieces of bone and/or cartilage can be removed.
Damage to ligaments or tendons – A small tear in the rotator cuff allows the shoulder to become weak and unstable. These can often be stapled or sutured to help the joint function better. A larger tear may need an open procedure (see ROTATOR CUFF SURGERY).
Shoulder instability – The restraining ligaments and tendons of the shoulder can get stretched out by injury or overuse. This can cause the ball to move out of the socket. To remedy this condition, the ligaments can be tightened with suture or shrunk with a heat probe.
Impingement – Wear and tear or overuse of the shoulder can cause bone build-up under the acromion or on the end of your collar bone (clavicle). This build-up reduces the space in the shoulder causing inflam-
mation and pinching (impinge-
ment) of the rotator cuff. This bone can be removed, thereby restoring the space and relieving the impingement. This is called subacromial decompression.
Preparing for Surgery
After midnight on the night prior to your surgery, you cannot eat or drink anything.
You will be given general anesthesia to sleep during this operation. Your shoulder will be scrubbed and draped with sterile sheets. Your surgeon will make one or more small incisions, through which he will place the “scope” into your shoulder. Sterile water will be pumped into the shoulder to allow better visualization. If repairs are needed, tiny instruments are placed into the shoulder. Depending on the type of problem, these could include shavers, fasteners, sutures, heat probes, or electric cutting tools. When the surgery is finished, the instruments are removed, and the incisions are closed with stitches or surgical tape. The surgery usually lasts 1-2 hours.
An IV will be in our arm to administer antibiotics and fluids. An arm sling will keep your shoulder immobilized. An ice pack will help to relieve discomfort and pain medication will be administered to relieve pain. Most patients can return home the day following surgery.
At home, you will be allowed to more your shoulder as much as tolerated. You will be given a sling for comfort and to support your arm. Swelling is expected for up to 10 days and there may be some drainage from the small incisions. It is recommended that you rest in a reclining chair or with your shoulder supported with pillows. Ice is important to help control swelling (20 minutes on/20 minutes off). If you have also had a rotator cuff repair, your shoulder motion will be limited for two weeks. Make sure that you understand your exercise instructions. Strengthening and range of motion exercises are important to your recovery. Your exercise program is divided into three phases:
- PHASE I (surgery to post-op day 7) On surgery day, only do what you can do comfortably. Elbow circles, swings (with the elbow extended), and forearm rotation can be done 10-25 repetitions each, three times a day, stopping for fatigue or pain.
- PHASE II (post-op days 7-14) Walking the wall and swings holding a yardstick can be added to your exercise program. You can begin to reach your arm above shoulder level. Some soreness with exercise is expected, but NOT sharp pain. If you have sharp pain with a particular exercise, discontinue that exercise.
- PHASE III (post-op day 14-30) You will now be supervised by a therapist for stretching and strengthening exercises. Initially, you will work below shoulder level, and then you will begin exercises above shoulder level. You may be given a THERABAND to exercise with at home. One month after surgery, you may begin work-simulation exercises.
Two weeks: You should be able to lift your arm in front of your body to shoulder level. You should be able to lift your arm to the side of your body to shoulder level.
Four weeks: You should be able to lift your hand above your head and place your hand behind your back or in your back pocket. You should be able to lift your arm in front of your body with 5 lbs. of weight in your hand.
IMPORTANT: If you have any questions about these exercises, contact our office at (540)885-1281. If you feel that you are not progressing appropriately after surgery, contact your physician.
You may remove the bandage 5 days after surgery and cover the small incisions with band-aids. You may shower. No bathing, soaking or swimming until the incisions have completely healed (7-10 days).
You may return to work, walk, drive and do other normal activities to pain tolerance.