Shoulder arthroscopy is the process in which the patient's shoulder is arthroscopically performed by orthopedic surgeons to diagnose or treat arthroscopic injuries without major surgery.
Overview of shoulder arthroscopy
It is a surgical procedure that uses a small camera called an arthroscope to examine or repair the ligaments and tissues surrounding the shoulder or those within it. This endoscope is inserted through a small incision with a diameter of 0.5 cm.
Dr. Bircher of New York University in the 1920s was one of the first to examine the shoulder with a special endoscope, but it wasn't until the 1970s that this technique was widely applied.
Currently, shoulder arthroscopy is one of the common orthopedic surgeries, as it is the second most common surgery after knee arthroscopy, with the aim of partially removing the meniscus, and treating many cases such as torn ligaments, frozen shoulder, and osteoarthritis.
in our center We do this process routinely and usually with a remarkable success rate.
Overview of the shoulder joint
The shoulder joint is one of the largest and most complex joints in the human body. It connects the humerus bones and the scapula, and is classified as a ball and socket joint.
The normal joint contains many important bone structures such as the acromion which is a bony process that protrudes from the scapula, the collarbone and the coracoid process which is seen at the tip of the scapula.
Of the non-osseous structures in the shoulder joint we note:
- rotator cuffIt is a group of muscles and ligaments that surround and support the joint.
- bursaA small sac containing a lubricating fluid that protects the rotator cuff tendon.
- Shafa Al-Jawf Labrum: a cartilaginous structure in the form of a basket or small plate embracing the head of the humerus.
All structures of the shoulder joint are held together relatively loosely when compared to other large joints in the body, such as the hip and knee joints. This allows a wide range of motion but exposes it to many risks and injuries.
The most common injuries and diseases affecting the shoulder:
- frozen shoulderSevere inflammation in the joint that lasts for a long time and causes pain and stiffness.
- Osteoarthritis.The risk of infection increases with age, and the shoulder is less common than the joints of the lower extremity such as the knee.
- Shoulder jamA chronic lesion in which the acromial process presses on the rotator cuff when the forearm is raised and causes pain if the tendon is inflamed or damaged.
- Shoulder dislocation and instabilityThe dislocation includes the bones that make up the joint, such as the humerus. A distinctive clicking is heard when it occurs, and it is accompanied by many problems.
When is it recommended to do a shoulder arthroscopy?
A consultant orthopedic surgeon or doctor may suggest an arthroscopy of the shoulder joint when there is a condition that causes pain that does not improve with non-surgical treatment. Non-surgical treatments include rest, physical treatment of the shoulder and pain relief by giving medications and injecting anti-inflammatory drugs into the joint.
Most shoulder problems occur as a result of frequent and excessive use, after direct injury, and as a result of aging without a clear medical reason for the occurrence of disorders.
Shoulder arthroscopy is performed to treat:
- torn cartilage and ligaments
- joint instability
- bony beaks
- Rotator cuff tendon impingement and its repair
- Shoulder Arthritis
- A stiff or frozen shoulder
Advantages of arthroscopic shoulder surgery
Since it is a closed surgery, that is, it is done without causing a large wound, it has an advantage over open surgeries, especially after the operation where a quick and comfortable healing process occurs because the surgical incision is small (sometimes called a keyhole).
Shoulder arthroscopy also allows today to perform complex surgeries on tendons and muscles in a short time with the ability to shoot high-resolution video, which greatly reduces the incidence of errors and complications.
The arthroscopic shoulder surgery in general has the following advantages:
- Rich details and quality information through photography
- Shoulder arthroscopy is a comfortable procedure for the surgeon allowing excellent performance
- Laparoscopic surgery is safer than its open counterpart
- Shoulder arthroscopy is less painful than open surgery
- The endoscopic wound heals faster and leaves an unnoticeable scar
Preparation before arthroscopic shoulder surgery
Often the surgeon or the surgical team will request that some tests be done in a routine way, such as blood analysis, ECG and chest X-ray.
It is checked whether the patient suffers from common diseases such as pressure, diabetes and others. If he is in relatively good health, he can perform the shoulder arthroscopy as an outpatient, meaning there is no need for the patient to stay in the hospital usually after the endoscopy.
It is very important for the specialized surgical team to be able to anesthetize the patient with an effective and appropriate mechanism so as to ensure his relative stability during the surgical work, and this is done by determining the appropriate dose for the situation that may differ in the athlete patient from that in the obese patient, for example.
The majority of arthroscopic shoulder surgeries do not take long and are performed in a hospital or specialized center, usually using modern tools. It is a quick and practical procedure.
Arthroscopic shoulder surgery techniques
The fact that the shoulder arthroscopy is a common operation has allowed it to be performed in more than one way and in several modes by taking different steps when performing it for the purpose of treatment or diagnosis.
The surgery is performed in special modes, including:
- Bench seat position chair positionIt is similar to lying on an ordinary chair, and it is safe and feasible to perform most of the shoulder surgeries.
- Side lying position lateral decubitus position: The patient lies on his side and this position allows to see the shoulder joint clearly, especially when it is needed to immobilize it.
First, the patient is prepared by moving his bed with the help of the surgery team to the operating room, and then checking the possibility of general anesthesia in case the laparoscopic operation changes for open surgery.
After placing the patient in the appropriate position and anaesthesia, the basic parameters that are normally found in most patients are determined, as they may be absent in some of them, especially in cases of fractures and dislocations, and this must be known before starting the shoulder arthroscopy.
The next step involves starting the shoulder arthroscopic surgery, by making small holes or incisions in specific areas of the skin in order to insert the endoscopes through which the operation will be performed.
The first hole is usually 0.5 cm in size in a specific area in the lower part of the scapula in the posterior endoscopy. When using the anterior endoscope, the location of the first hole varies according to the case and its appropriate treatment.
A fluid is injected using special machines inside the joint, which increases the visibility and protects against bleeding and the possibility of complications.
The endoscopes used vary according to their function:
- Some of them work to restore the affected rotator cuff muscles.
- The other is to replace some damaged structures to treat chronic conditions that affect the range of motion.
- In acute laparoscopy, it is possible to cut some ligaments when treating tendon impingement syndrome.
- Bony beaks require a special endoscope to file and remove them.
- Some endoscopes straighten the shoulder in order to return the work in a wide field to what it was before.
- Finally, another endoscope is used to place the electrode and connect it to ensure that the surgical field is free of problems that will affect the outcome of the shoulder arthroscopy operation in the future.
Follow-up after shoulder arthroscopy
The recovery process takes about 1-6 months, and the patient may be advised to wear a bra for at least a week after the shoulder arthroscopy operation, in addition to the possibility of taking medications to relieve pain after the operation.
The possibility of returning to work again and exercising depends on the nature of the laparoscopic operation, and your shoulder may need several weeks to heal.
Some patients are required to undergo physical therapy and rehabilitation depending on the injury and the operation, which may last several months.
Shoulder arthroscopic complications
Complications are rare after the shoulder arthroscopic operation and it is considered one of the best orthopedic operations as a result, however, some patients may face a problem in special cases such as diabetes, pressure and heart disease.
The most common surgical complications include:
- Shoulder joint fibrosis and stiffness
- Persistent pain after the operation
- Joint instability after arthroscopic surgery
- Injury to the cartilage or surrounding tissues
- Feeling of numbness, numbness and nerve damage
- Damage to blood vessels and the occurrence of bleeding
The percentage of these complications in total does not exceed 8%, with stiffness being the most common at 2%.
If you have any questions or inquiries, you can contact with us and seek medical advice.
The average cost of the operation is 2-8 thousand dollars, and in Turkey the minimum cost is 1500 dollars.
The process takes about an hour, and sometimes it takes two hours.
It reaches about 90%.
Pain and failure of treatment after the operation may lead to the patient's need to re-intervene the affected joint.