Shoulder arthroscopy is a minimally invasive surgical technique used to address issues within and around the shoulder joint. This procedure allows orthopedic surgeons to diagnose and treat a variety of painful conditions without the need for a large incision. It involves the use of an arthroscope, which is a small camera connected to a light source. The camera is inserted through a small puncture in the skin and transmits a magnified image of the interior joint structures to a high-resolution video monitor. The surgeon uses this detailed visual guide to perform the necessary repairs with specialized miniature surgical instruments.
Conditions Treated by Arthroscopy
Shoulder arthroscopy is commonly recommended when non-surgical treatments like rest, medication, or physical therapy have not relieved persistent pain or restored function. One of the most frequent indications for this surgery is the repair of a torn rotator cuff, where the damaged tendons are reattached to the bone.
Another frequent use is the repair of labral tears, which involve the ring of cartilage that surrounds the shoulder socket. These include a Bankart lesion, often associated with shoulder dislocation, and a Superior Labrum Anterior-Posterior (SLAP) tear, which affects the biceps tendon anchor. Both types are often stabilized by reattaching the torn tissue to the bone using suture anchors.
The technique is also used to treat shoulder instability, a condition where the joint dislocates repeatedly. This often involves tightening the stretched ligaments or repairing the capsule to prevent future episodes. Arthroscopy can address shoulder impingement syndrome by performing an acromioplasty, which involves shaving a portion of the acromion bone to create more space for the rotator cuff tendons to glide freely. It can also be used to remove inflamed synovial tissue, loose fragments of bone or cartilage, and to release contractures in cases of frozen shoulder.
The Arthroscopic Procedure
Preparation for an arthroscopic procedure begins with the administration of anesthesia, which is often a combination of general anesthesia and a regional nerve block. The nerve block provides effective pain control that can last for many hours after the surgery is complete. The patient is then positioned either in a semi-seated “beach chair” position or lying on their side, depending on the surgeon’s preference and the type of repair needed.
The surgeon starts by making a few small puncture wounds, known as portals, in the shoulder joint. A sterile fluid, usually saline solution, is continuously pumped into the joint space through one of these portals. This fluid gently inflates the joint capsule, which helps to separate the structures and allows the surgeon a clear view of the joint anatomy on the monitor.
The arthroscope is inserted through the initial portal, and subsequent portals are created for the specialized surgical tools. These instruments include miniature graspers, shavers, and motorized burrs for removing tissue or smoothing bone. For repairs, such as reattaching a torn tendon or labrum, the surgeon uses sutures and small devices called suture anchors.
These anchors are secured into the bone, and the attached sutures are then used to tie the torn soft tissue back down to its proper anatomical position. Once the repair is complete and the joint is thoroughly inspected, the fluid is drained, and the small incisions are closed with a stitch or sterile tape strips. The entire procedure is generally completed as an outpatient surgery, allowing the patient to return home the same day.
Recovery and Rehabilitation
Immediately following the procedure, the patient’s arm is typically placed in a specialized sling to protect the surgical repair. Pain management is a significant focus in the initial days and is managed through prescription medication. It is common for the patient to experience swelling and discomfort for the first few weeks.
The progression of recovery depends on the specific procedure performed, with simple debridement requiring a shorter immobilization period than a major tendon repair. Physical therapy (PT) is a key component of the recovery process, often beginning within the first week or two. Early phases of PT focus on passive range of motion, where the therapist moves the arm without the patient engaging the repaired muscles.
Later phases of rehabilitation transition to active range of motion and strengthening exercises to rebuild the muscle power around the joint. Patients with light, sedentary jobs may be able to return to work within a few days to a week, but those with physically demanding jobs may require three to six months. Driving is often permitted once the sling is discontinued and the patient is no longer taking narcotic pain medication, typically ranging from one to three weeks post-surgery. Full recovery and a return to sports or heavy manual labor can take anywhere from four to six months.