Shoulder arthroscopy is a minimally invasive surgical technique used to diagnose and repair issues within the shoulder joint. This procedure is often referred to as keyhole surgery because it requires only small incisions, unlike traditional open surgery. Surgeons utilize a thin, fiber-optic instrument called an arthroscope, which contains a miniature camera and light source, to visualize the joint’s internal structures on a video monitor. The development of this technique allows for precise treatment of many shoulder problems while minimizing trauma to the surrounding muscles and skin.
How the Procedure is Performed
The surgery begins after the patient is positioned, typically in a semi-seated or side-lying position, and a regional nerve block is often administered to numb the entire arm and shoulder. The surgeon first injects a sterile saline solution into the joint space, which gently expands the area to provide a clearer view of the anatomy. This fluid flow also helps to manage any minor bleeding and flush out debris during the operation.
The surgeon then creates a few small punctures, often referred to as “portals,” around the shoulder joint. The arthroscope is inserted through one of these portals, transmitting high-definition video images of the tendons, ligaments, and cartilage to a screen in the operating room. Through the other portals, specialized miniature surgical instruments are carefully inserted to perform the necessary repairs.
These instruments are designed for specific tasks like shaving, cutting, grasping, and securing tissue. Once the repair is complete, the instruments and arthroscope are removed, and the small incisions are closed, usually with a single stitch or sterile adhesive strips.
Conditions Treated with Arthroscopy
Shoulder arthroscopy is commonly used to address a variety of painful conditions that have not responded to non-surgical treatments. One frequent indication is the repair of rotator cuff tears, where the procedure allows the surgeon to reattach the torn tendons to the humerus bone. The technique is also effective for addressing partial tears and removing inflamed tissue in cases of shoulder impingement syndrome.
Tears in the labrum, the ring of cartilage surrounding the shoulder socket, are frequently treated arthroscopically. This includes Bankart lesions, often associated with shoulder instability, and SLAP (Superior Labrum Anterior to Posterior) tears.
The minimally invasive approach is also used to treat:
- Chronic shoulder instability, by tightening the joint capsule or repairing damaged ligaments.
- Loose fragments of cartilage or bone floating within the joint.
- Frozen shoulder, by addressing inflamed tissue that causes joint stiffness.
Preparing for Surgery and Immediate Aftercare
Preparation for shoulder arthroscopy involves specific instructions to ensure patient safety. Patients are typically required to stop eating and drinking for eight to twelve hours before the surgery to prevent complications related to anesthesia. The surgical team will also review all medications, as some, particularly blood thinners, may need to be adjusted or stopped several days beforehand.
Anesthesia for the procedure typically involves a regional nerve block, which provides several hours of post-operative pain relief, combined with either general anesthesia or conscious sedation. Following the surgery, the patient is moved to a recovery area for monitoring until they meet discharge criteria, which often occurs on the same day.
Immediate post-operative care focuses on managing discomfort and protecting the repair. Pain management protocols involve using prescribed oral medications before the nerve block wears off. The shoulder will be placed in a sling or brace immediately after the procedure, which must be worn consistently to immobilize and protect the joint. Patients are also instructed on initial wound care, which involves keeping the small incision sites clean and dry for the first few days.
The Recovery and Rehabilitation Process
The long-term recovery following shoulder arthroscopy is a structured process centered on restoring full motion and strength, with the total timeline often taking several months. The initial phase of rehabilitation focuses on protection, requiring the patient to wear the sling for a period that can range from a few days to six weeks, depending on the complexity of the repair. During this time, activities are highly restricted, often limiting movement to gentle exercises for the elbow, wrist, and hand.
Physical therapy (PT) usually begins shortly after surgery and is divided into progressive phases.
Passive Range of Motion
The first phase involves passive range of motion exercises, where the therapist moves the arm without the patient engaging the shoulder muscles. This is especially important after a tendon or labral repair. The goal during this period is to prevent stiffness and scar tissue formation without stressing the healing tissue.
Active Range of Motion
Once adequate protection is achieved, typically after four to six weeks, the patient progresses to the active range of motion phase. Here, the patient begins to move the arm independently, gradually regaining control and flexibility.
Strengthening
The final, and often longest, phase of rehabilitation is dedicated to strengthening, introducing resistance exercises to rebuild the endurance and power of the shoulder muscles.
Returning to daily activities occurs in stages. Driving is often restricted for four to six weeks. Patients with desk jobs may return to work within a week, but those whose work involves heavy lifting or strenuous activity may require two to six months or more before resuming full duties. Consistency with the physical therapy program is paramount, as adherence directly influences the ultimate success of the surgery.