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The diagnostic shoulder arthroscopy offers the orthopedist the ability to immediately review, diagnose and surgically treat a variety of traumatic and non-traumatic articular pathologies.
During the procedure, the surgeon inserts through a small incision a small camera (called an arthroscope) into the shoulder joint.
This special camera displays these images on a television screen, and the surgeon uses these images to guide special arthroscopic tools inside the joint. These tools are thinner and smaller than the classic tools of open surgery and, thus, very small incisions are needed.
As a result, patients experience less postoperative pain and a faster return to their daily activities.
The arthroscopic approach to the shoulder joint has been in use since the 1970s and has dramatically facilitated the diagnosis, treatment and recovery of patients.
However, as with any surgical technique, continuous improvements are achieved each year.
Anatomy
The shoulder is a complex joint, capable of the widest range of motion in the human body.
It consists of three bones:
- The humerus
- The scapula
- The clavicle
The head of the humerus rests on the glenoid cavity of the scapula. The surface of the bones in contact with each other is coated with articular cartilage, reducing frictional forces.
In addition, the glenoid cavity is strengthened in its periphery by a fibrous ring that increases the surface and the curvature of the articular surface, the labrum cartilage.
The joint is surrounded by the articular capsule which is supported by a number of ligaments that stabilize the shoulder. The articular capsule is responsible for the production of the synovial fluid that lubricates the articular surfaces. Around the capsule is the rotator cuff, four tendons intended to hold the head of the humerus in place and to move in all possible directions. The rotator cuff normally covers the head of the humerus.
Diagnostic shoulder arthroscopy – When is shoulder arthroscopy indicated?
In cases where a shoulder condition does not respond to conservative treatment, the orthopedist may recommend arthroscopic treatment.
Conservative treatment includes:
- Rest
- Physical therapy
- NSAIDs medication
- Joint Injections
in an attempt to alleviate the inflammation it causes:
- Edema
- Pain
- Stiffness
Responsible for most shoulder diseases are:
- Injuries
- Sports injuries
- Degenerative lesions related to the patient’s age
The arthroscopic treatment of shoulder diseases can alleviate the painful symptoms caused by the tears of the rotator cuff, the labrum, the articular cartilage and the soft tissues surrounding the joint.
Arthroscopic shoulder surgery includes:
Staple of the rotor pedal tendons
Osteophyte removal
- Restoration of the rotator cuff tears
- Removal of osteophytes
- Restoration of the labrum cartilage injuries
- Restoration of ligaments
- Removal of free pieces
- More rarely, fracture treatment, cyst resection and nerve release
Finally, some procedures, such as total shoulder arthroplasty, are still performed using the open method, with more extensive incisions.
Surgery
Before surgery, the anesthesiologist visits the patient and discusses the options for anesthesia. Shoulder arthroscopy can be performed by blocking the peripheral nerves to numb the shoulder and the upper extremity of the patient. In addition to the use of nerve blocking, surgeons often combine the use of general anesthesia or sedation, as immobility during the procedure can be uncomfortable for the patient.
Most arthroscopic surgeries do not last more than an hour, however each case is different and the surgical time may be longer.
Patient’s Position and Preparation
In the operating room, the patient is positioned in such a way that the surgeon may have immediate access to the shoulder joint and adjust the arthroscope accordingly.
The two most common patient positions are:
- Beach chair position
- Lateral decubitus position
Each position offers some advantages, but the surgeon’s decision is based on the type of injury that is dealt with each time and his experience. After the patient is placed, the shoulder is sterilized with antiseptics.
Surgical Procedure
Initially, sterile serum is injected into the shoulder joint to extend it.
This makes it easier to review shoulder structures.
Then the surgeon makes a small incision on the back of the shoulder and inserts the arthroscope.
Throughout the procedure, there is a constant flow of sterile serum into the joint that dilates the articular capsule and prevents any bleeding.
Images from the arthroscope are projected on a television screen for the surgeon to assess the damage to the joint.
After the first assessment, specialized arthroscopic tools are introduced through an even smaller incision.
With the use of these tools, the surgeon is able to scrape, cut and place sutures with special methods, repairing the lesions.
Finally, after rinsing the joint and removing the arthroscope, the small incisions are stitched with one suture each.
Recovery
After surgery, the patient remains in the recovery room for about one to two hours, and is discharged from the hospital on the same day with instructions and medications for pain relief, as appropriate. It is recommended that the patient is accompanied by a familiar person during the first 24 hours. After a few days, the patient returns to the surgery to change the wound dressing. In most cases, and depending on the condition, the patient uses a simple suspension with or without shoulder abduction.
Diagnostic Shoulder Arthroscopy – Results
The prognosis is different for each patient, based on their medical history and the condition they are treated for.
For minor interventions, it is very likely that no immobilization is required, and complete recovery is achieved within a few days. Most of the time, the patient returns to work within the first few days.
More complex procedures may take several days for complete recovery.
Although the incisions are small, restoration, e.g. by suturing the rotator cuff tendons, may take several weeks, during which the patient should have upper extremity immobilized.
However, after the first few days a physiotherapy program is launched that aims to completely restore the patient’s condition.
