Introduction to Shoulder Arthroscopy
Nearly six million people a year go to the doctor’s office for a shoulder sprain, strain, dislocation or other shoulder problem. The shoulder joint is prone to injury since it is very mobile. Frequent overhead movements and sudden trauma can damage the tissues inside the shoulder. This can cause pain, tenderness, weakness, instability, and limitation of movement in the shoulder joint. Although symptoms, physical examination, and different types of X-rays and related studies can tell us a great deal about the nature of the problem, we often need to use shoulder arthroscopy to determine more precisely what is wrong.
The types of disorders that can be diagnosed with arthroscopy include tears, swelling, abnormal formations, detachments, loose fragments (loose bodies), and arthritis. However, arthroscopy cannot diagnose all conditions, therefore, after a proper examination; we will be able to determine if arthroscopy is right for you.
How the surgery is performed?
At first, the surgon will inject a fluid into the shoulder joint to inflate it. Inflating the joint makes it easier to see the shoulder structures through the arthroscope. To insert the arthroscope inside, the surgoen will first make a small incision in the shoulder. The arthroscope inside will be connected to a monitor outside which will give a clear view of the inside of the joint. Through this, the doctor will be able to identify the damage inside. Once the doctor clarifies the damage, he/she will insert the surgical instruments through the incision. Specialised small instrments are used to repair the damage inside the joint. It may vary according to the different kinds of damages inside the joint. After completing the procedure, the doctor will close the incision swith sutures.
What about the recovery and rehabilitation?
One of the main advantages of this procedure is that, the surgery does not require a hospital stay as the traditional surgery. The patient will be discharged from hospital in 1 or two hours after surgery. Unlike an open surgery, an arthroscopic shoulder repair offers faster recovery. The patient may experience ome discomforts and pain for a few weeks after the surgery. However, the type of surgery done is also a factor that determine the recovery period. To get back to daily activities faster, a good rehabilitation plan is necessary. The doctor will suggest Physical therapy and special exercise program according to the patientâ€™s condition.
What are the complications of arthroscopic shoulder repair?
An arthroscopic procedure contains less risks and complications. However, there can be certain minor complications and risks as with any surgery. These minor issues can be treated with simple steps. Some of the potential risks and complications of the procedure may include:
- Damage to blood vessels
- Damage to the nerves
- Excessive bleeding
- Blood clots
When is arthroscopic shoulder surgery performed?
The procedure is usually recommended when the patient finds it difficult to get through their painful shoulder condition with nonsurgical treatments. Most shoulder problems are caused due to injury, age-related wear and tear and overuse. Such issues cause pain, swelling and stiffness of the joint in patients. Shoulder arthroscopy can be used to solve various issues that affect various structures of the shoulder. Some of the issues where shoulder arthroscopy can be useful may include:
- Repair of ligaments
- Repair or removal of the labrum
- Rotator cuff repair
- Recurrent shoulder dislocation repair
- Bone spur removal
- Loose cartilage or inflammed tissue removal
There are certain procedures such as fracture repair, cyst excision, nerve release etc, can also be performed through shoulder arthroscopy. However, all the patients with these issues cannot be a good candidate for shoulder arthroscopy surgery.
Rotator Cuff Tears
Treatment of rotator cuff tears with shoulder arthroscopy is controversial. Some orthopedic surgeons treat all rotator cuff tears arthroscopically, some choose particular tears, and others treat them all open. There is no consensus which one is better.
Labral tears, such as Bankart tears and SLAP tears are commonly treated with arthroscopy. It is very important that patients who have arthroscopic surgery for these procedures follow their post-operative rehab protocol very closely. Patients are often tempted to do too much too soon.
Patients with shoulder bursitis, also called impingement syndrome, that is not cured with simple treatments may consider a procedure called an arthroscopic subacromial decompression. This procedure removes the inflamed bursa and some bone from the irritated area around the rotator cuff tendons. By removing this tissue, more space is created for the tendons and the inflammation often subsides.
The biceps tendon can become irritated and inflamed as an isolated problem or in association with problems such as impingement syndrome and rotator cuff tears. When the biceps tendon is damaged and causing pain, a procedure called a biceps tenodesis can be performed. This procedure usually causes no functional difference, but often relieves symptoms.
Frozen shoulder seldom requires operative treatment, and treatment for many months or years is often necessary before considering operative treatment. When frozen shoulder must be treated surgically, it is of utmost importance to begin aggressive physical therapy immediately following surgery. Without this, it is likely the problem will return.
AC Joint Arthritis
The AC joint, or acromioclavicular joint, is occasionally affected by arthritis. When arthritis of the AC joint is severe, the end of the clavicle (collarbone) can be removed. By removing the damaged joint, the symptoms of AC arthritis are often relieved.
What are the possible complications in Shoulder Arthroscopy?
Complications of shoulder arthroscopy are uncommon, but do occur. Infection rates tend to be very low. The most common complication of surgery on the shoulder is stiffness after surgery, and prolonged rehabilitation. This can usually be managed with physical therapy. Occasionally, shoulder arthroscopy can lead to a frozen shoulder that can make rehab challenging. One rare complication of shoulder arthroscopy is called chondrolysis. This is a very usual, but particularly serious complication seen after arthroscopic shoulder surgery.
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