Shoulder arthroscopy is a minimally invasive surgical procedure that uses a tiny camera called an arthroscope to examine or repair the tissues inside or around your shoulder. The arthroscope is inserted through a small incision in your skin. This camera projects pictures of your shoulder joint to a video screen. Your surgeon looks at the images to find the source of your injury. One or two further small incisions are made to insert instruments in order to address/repair the pathology inside your shoulder. Each incision is about the size of a keyhole (4mm). You might have arthroscopy for rotator cuff tears, shoulder impingement or shoulder instability (dislocated shoulder). Minimally invasive procedures require smaller incisions than traditional surgery. They allow the surgeon to address more accurately any pathology encountered. They allow for faster healing, shorter hospital stay and less postoperative pain.
Shoulder arthroscopy can treat problems such as:
• Rotator cuff tears
• Tendonitis/impingement syndrome
• Frozen shoulder (adhesive capsulitis)
• Shoulder instability/dislocated shoulder (labral tears)
• Biceps tendon problems
• Osteoarthritis
• Bone spurs
• Acromioclavicular joint injuries
Before shoulder arthroscopy, you will typically undergo preoperative assessment. You will be asked about your health history in detail. You will be asked to bring along a full list of your medications. You may need to stop taking some of your medications a few days before surgery (especially blood thinners). Before the procedure, you may also need blood tests, a chest x-ray or an ECG (electrocardiogram), to make sure it’s safe to proceed with surgery. The anaesthetist will give you specific preoperative instructions, including how long before surgery to stop eating and drinking.
Shoulder arthroscopy may last from 20 minutes to 2 hours, depending on the complexity of the case. During shoulder arthroscopy:
• You may be in a semi-seated position (beach-chair position) or lying on your side (lateral position).
• Your skin will be cleaned with an antiseptic solution.
• The surgeon will make a small incision (4mm) in the back of your shoulder and insert a small camera, called arthroscope, which will project images of your shoulder in a video screen.
• The arthroscope is essentially a slim telescope (4.5mm or 2.9mm) with a high-definition camera, surrounded by a fiber-optic tube that functions as a light source.
• In order to see inside the joint and to undertake any procedures, the joint needs to be ‘opened’ up. This is done by distending the joint with normal saline fluid.
• A specialized pump is used to control the pressure and rate of fluid going into the joint, to optimize visualization.
• The surgeon will make small incisions in the front and side of your shoulder to insert tiny instruments in order to address all pathology found.
• Multiple arthroscopic instruments may be used during the procedure. These include probes, graspers, punches, rasps, elevators and suture cutters. Power instruments, such as shaver and burrs, or radiofrequency probes may also be used.
• Small implants may be used during the procedure. Suture-anchors are the most common implant used during arthroscopic shoulder surgery. A suture-anchor is essentially a small screw made usually out of biocomposite material, loaded with sutures through a small eyelet. The anchor is placed flash with the bone and the suture is threaded through the tissue to repair. This allows the damaged tissue to be repaired to its anatomical position.
• Once surgery is finished, all incisions will be closed, and a bandage will be placed on top.
• Your arm will be placed in a sling after surgery.
Almost all of the arthroscopic procedures that Dr. Panagopoulos performs are done under general anesthesia +/- regional nerve block on an outpatient basis. Since muscles and tendons are not cut during a shoulder scope, there is less postoperative pain, and the patient is able to recover faster. You may opt to go home the same day or stay overnight in the hospital, if you wish. You will have a small dressing on top of your shoulder for a few days. Your arm will be in a sling for a period of time that will depend on the underlying problem.
What are the advantages of shoulder arthroscopy over the more traditional open surgery?
The advantages of arthroscopy over a traditional open procedure are:
• smaller incisions
• initial recovery is quicker and postoperative pain is less, as the surrounding tissues have not been disturbed
• the actual procedure can be undertaken more accurately (under magnification and with more accurate instruments)
• Complications are much less common than with open surgery (infection, bleeding, etc.).
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