Shoulder Arthroscopy

Procedure Overview

Why the procedure is performed

Arthroscopy may be recommended for these shoulder problems:

• A torn or damaged cartilage ring or ligaments
• Shoulder instability
• A torn or damaged biceps tendon
• A torn rotator cuff
• A bone spur or inflammation around the rotator cuff
• Inflammation or damaged lining of the joint
• Arthritis of the end of the clavicle
• Loose tissue need to be removed
• Shoulder impingement syndrome

Description of Procedure

The rotator cuff is a group of muscles and tendons that cover your shoulder join. These muscles and tendons hold your arm in your ball and socket shoulder joint. They also can help you move your shoulder in various directions. The tendons in the rotator cuff can tear when they are injured or overused.

A majority of patients receive general anesthesia before this procedure. You may also receive regional anesthesia, which means your arm and shoulder area will be numbed and you will be unable to feel pain in this area. If you’re given regional anesthesia, you will also given a sedative to make you relaxed and also very sleepy during the operation.

Your surgeon will examine your shoulder with the arthroscope and then insert it into your shoulder through a small incision. The arthroscope is connected to a video monitor in the operating room. The surgeon will then inspect all of the tissues of your shoulder joint as well as the area above the joint – cartilage, bones, tendons, and ligaments. After this, any damaged tissue will be repaired. To do this, your surgeon will make 1 to 3 more small cuts and insert other instrumentation through them. A tear in a muscle, tendon, or cartilage will be fixed. Damaged tissue may need to be extracted.

One or more of the following procedures may be used during your surgery:

• Rotator cuff repair: The edges of the muscles are brought together. The tendon is attached to the bone with sutures. Small anchors are often used to help attach the tendon to the bone. The anchors can be made of metal or plastic. They do not need to be removed after surgery.
• Surgery for impingement syndrome: Damaged or inflamed tissue is cleaned out in the area above the shoulder joint itself. Your surgeon may also cut a specific ligament, called the coracoacromial ligament, and shave off the under part of a bone. This under part of the bone is called the acromion. The spur can be a cause of inflammation and pain in your shoulder.
• Surgery for shoulder instability: If you have a torn labrum, the rim of the shoulder joint that is made out of cartilage, your surgeon will repair it. Ligaments that attach to this area will also be repaired. The Bankart lesion is a tear on the labrum in the lower part of the shoulder joint. A SLAP lesion involves the labrum and the ligament on the top part of the shoulder joint.

At the end of surgery, your incisions will be closed with stitches and covered with a bandage. Several surgeons opt to take photos of the surgery from the video monitor so that you can see what was repaired and/or what was type of damage was found.

Your surgeon may need to do open surgery if there is a lot of damage. Open surgery means you will have a large incision so that the surgeon can get directly to your bones and tissues. Open surgery is a more complicated surgery.

Before Surgery

Before the procedure

During the 2 weeks before your surgery

• You may be asked to stop taking drugs that make it harder for your blood to clot. These include aspirin, ibuprofen (Advil, Motrin), naproxen (Naprosyn, Aleve), and other drugs.
• Always tell your health care provider what drugs you are taking, even drugs, supplements, or herbs you bought without a prescription
• Ask your health care provider what drugs you should still take on the day of your surgery
• If you have diabetes, heart disease, or other medical conditions, your surgeon will ask you to see your doctor who treats you for these conditions
• Tell your health care provider if you have been drinking alcohol excessively, more than 1 or 2 drinks per day
• If you smoke, try to quit. Ask your health care provider or nurse for help. Smoking can slow down wound and bone healing.
• Always let your doctor know about any cold, flu, fever, herpes breakout, or other illness you may have before your surgery

On the day of your surgery

• Do not drink or eat anything for 6 to 12 hours prior to the procedure.
• Take the drugs your health care provider advised you to take with a small sip of water.
• Your health care provider will tell you when to arrive at the hospital.

After Surgery

After the procedure

Recovery can take 1 to 6 months. You will most likely have to wear a sling for the first week. If you had a considerable amount of repair done, you may have to wear the sling longer. It may range anywhere from 1 week to several months before you can return to work or play sports. Recovery time will depend on what your surgery entailed.

You may take medication to minimize your pain.

For many procedures, particularly those that required repairs, physical therapy may help you regain motion and strength in your shoulder. The length of therapy will depend on the repair that was needed.

Benefits of Arthroscopy

• Less pain and stiffness
• Fewer complications
• Shorter (if any) hospital stays
• Faster recovery times

Surgery to fix a cartilage tear is usually done to make the shoulder more stable. Many people recover fully, and their shoulder stays stable. However, some people may still experience shoulder instability after arthroscopic repair.

Arthroscopy for rotator cuff repairs or tendonitis typically relieves the pain, but you may not recover all of your strength.

Risks

• Shoulder stiffness
• Failure of the surgery to relieve symptoms
• Failure of the repair to heal
• Weakness of the shoulder
• Injury to a blood vessel or nerve