The shoulder is a complex ball-and-socket joint, providing the human body with its widest range of motion, but this mobility also makes it susceptible to injury and wear. When non-surgical treatments like rest, physical therapy, and medication fail to resolve pain and dysfunction, surgery may be necessary to restore function. Shoulder arthroscopy is a modern, less invasive approach to diagnosing and treating problems within the joint. This common outpatient surgery allows surgeons to address internal damage with high precision and less disruption to surrounding healthy tissues.
Defining Arthroscopy: The Minimally Invasive Approach
The term arthroscopy translates from Greek to “to look within the joint.” This procedure uses specialized instruments to view and work inside the shoulder joint through small incisions. The primary tool is the arthroscope, a thin camera about the size of a pencil, which is inserted into the joint. This camera transmits real-time images of the internal anatomy onto a video monitor, providing the surgeon with a magnified view of the cartilage, ligaments, and tendons.
The surgeon creates several small incisions, often called “portals,” around the shoulder joint, typically only a few millimeters in length. One portal is used for the arthroscope, while others allow for the insertion of miniature surgical instruments designed for tasks like cutting, grasping, shaving, and securing sutures. This “keyhole” method differs from traditional “open” surgery, which requires a much larger incision to expose the joint. Arthroscopy results in less trauma to muscle and soft tissues and potentially a quicker recovery.
Conditions Treated by Shoulder Arthroscopy
Shoulder arthroscopy is a versatile procedure used to address numerous anatomical problems that cause pain and instability after conservative methods have been exhausted. A frequent indication is the repair of a torn rotator cuff, where the surgeon uses sutures and small devices called suture anchors to reattach the damaged tendon back to the upper arm bone. This is effective for tears caused by injury, overuse, or age-related degeneration.
Another common application is the repair of labral tears, which affect the ring of fibrous cartilage surrounding the shoulder socket (the glenoid). These tears often lead to shoulder instability or recurrent dislocation. Specific types include Bankart lesions, associated with dislocation, and Superior Labrum Anterior to Posterior (SLAP) tears, which involve the biceps tendon anchor. The surgeon reattaches the torn labrum to the socket bone using anchors and specialized sutures.
The procedure also treats shoulder impingement syndrome, a condition where the rotator cuff tendons are irritated as they pass through a narrow space beneath the acromion (shoulder blade). The surgeon may perform a subacromial decompression, which involves arthroscopically shaving away bone spurs or a portion of the acromion to create more space for the tendons. Arthroscopy is also used to treat several other conditions:
- Remove loose bodies of cartilage or bone fragments.
- Excise inflamed joint lining tissue (synovectomy).
- Release thickened tissue in cases of frozen shoulder (adhesive capsulitis).
The Surgical Process
On the day of the procedure, the patient undergoes preparation, including a discussion with the anesthesia team about pain management. Anesthesia typically involves a combination of a regional nerve block and light general sedation or general anesthesia. The regional nerve block is a local anesthetic injected near the neck or shoulder to numb the arm, providing pain relief that can last for many hours post-surgery.
Once the anesthesia takes effect, the patient is positioned to give the surgeon optimal access to the joint, usually in a semi-seated “beach chair” position or lying on their side (lateral decubitus). The surgical area is cleaned with an antiseptic solution. The arm may be placed in a traction device to gently pull the joint open, making internal structures easier to visualize. The surgeon then injects sterile fluid into the joint space, which inflates the shoulder capsule, improving visibility and creating a working area.
The surgeon makes the first small incision to insert the arthroscope, and subsequent portals are created as needed for specialized instruments. Using the monitor images as a guide, the internal joint structures—including the rotator cuff, labrum, and cartilage—are inspected, and necessary repairs are performed. After the surgical work is completed, the instruments are removed, the fluid is drained, and the small incisions are closed with sutures or sterile adhesive strips. The procedure often takes less than two hours.
Recovery and Post-Operative Care
Immediately following shoulder arthroscopy, the patient is monitored in a recovery area before being discharged, as it is usually performed as an outpatient procedure. Pain control is a primary focus in the initial post-operative period, aided by the regional nerve block. Patients are prescribed oral pain medication once the block wears off, and the application of ice or a cold therapy unit is encouraged to reduce swelling and pain.
The operated arm is typically placed in a sling, worn for a period determined by the type of repair performed. For example, a rotator cuff repair requires longer immobilization to protect the healing tendon. While the shoulder is immobilized, patients are instructed to perform gentle exercises for the elbow, wrist, and hand to prevent stiffness. The small incisions must be kept clean and dry according to instructions. Showering is usually permitted after a few days, but submerging the shoulder in baths or pools is restricted until the wounds are fully healed.
Physical therapy (PT) is a necessary element of the recovery process. It begins with passive range-of-motion exercises, where the arm is moved without using the shoulder muscles. Progression to active-assisted motion and then strengthening exercises is phased over several weeks or months to allow tissues time to heal securely. Full recovery and return to vigorous activities can take three to six months, depending on the extent of the injury and the complexity of the repair. Complications are uncommon but can include:
- Temporary nerve irritation from the nerve block.
- Stiffness (arthrofibrosis).
- Infection.
- Failure of the repair.
Adherence to the prescribed rehabilitation protocol is extremely important.