Shoulder arthroscopy, often called a shoulder scope, is a minimally invasive surgical procedure to diagnose and treat various problems within the shoulder joint. It uses specialized instruments and a small camera to visualize and address conditions causing pain or limited mobility.
Understanding Shoulder Arthroscopy
Shoulder arthroscopy involves tiny incisions, about the size of a buttonhole, rather than the larger cuts of traditional open surgery. Through these small openings, a surgeon inserts a thin tube with a camera, called an arthroscope, into the shoulder joint. The arthroscope transmits real-time images to a video monitor, providing a detailed view of the joint’s interior.
Compared to traditional open surgery, arthroscopic procedures lead to less post-operative pain, smaller scars, and a reduced risk of infection due to less tissue disruption. Patients often experience a quicker return to daily activities and may begin physical therapy sooner due to minimal trauma to surrounding muscles and tissues.
Common Conditions Addressed
Shoulder arthroscopy addresses common conditions causing pain or dysfunction that haven’t responded to non-surgical treatments. One issue is rotator cuff tears, damage to the group of four muscles and their tendons that stabilize the shoulder and enable arm movement. Shoulder instability, where the upper arm bone repeatedly moves partially or completely out of the shoulder socket, is also treated. This can stem from stretched or torn ligaments and often presents as the shoulder “giving way.”
Impingement syndrome occurs when rotator cuff tendons or the bursa become pinched beneath the acromion, the top outer edge of the shoulder blade. This pinching causes inflammation, pain, and limited movement, especially when lifting the arm overhead. Labral tears, damage to the rim of cartilage surrounding the shoulder socket that helps deepen it and improve stability, are also managed arthroscopically. These tears, such as SLAP (Superior Labrum Anterior to Posterior) tears, can lead to instability or pain.
Loose bodies, small fragments of bone or cartilage floating within the joint, can cause catching, locking, pain, and restricted motion. Arthroscopy can remove these fragments. Conditions like frozen shoulder (adhesive capsulitis), where the joint capsule tightens, and certain types of shoulder arthritis can be treated using arthroscopic techniques to release scar tissue or remove frayed cartilage.
The Arthroscopic Procedure
Preparation for shoulder arthroscopy begins with a discussion of anesthesia options; most procedures use general anesthesia, often combined with a regional nerve block for post-operative pain control. Before surgery, medical history is reviewed, and patients may need to stop certain medications. The surgical area is cleaned, and the arm may be secured in a holding device.
During the procedure, the surgeon makes small incisions, known as portals, around the shoulder. Fluid, such as sterile saline, is injected into the joint to inflate it, creating more space and improving visibility. The arthroscope is then inserted through one incision, projecting images onto a video screen to guide the operation.
Additional small incisions are made for specialized miniature surgical instruments. These instruments allow the surgeon to perform various tasks, including shaving, cutting, grasping, or repairing damaged tissues. For instance, suture anchors may be used to reattach torn tendons or ligaments to bone. Once the repair is complete, instruments and the arthroscope are removed, and incisions are closed with stitches or adhesive strips. The entire procedure often takes less than an hour and is commonly performed as outpatient surgery, allowing patients to return home the same day.
Life After Shoulder Arthroscopy
Following shoulder arthroscopy, patients experience some pain and swelling for several weeks, managed with prescribed pain medication and cold compresses. A sling is often provided to support the arm and protect the healing shoulder, with duration of use depending on the specific procedure. While some immediate rest is necessary, gentle movements of the hand and elbow are encouraged to prevent stiffness.
Physical therapy plays a role in recovery, often beginning within weeks of surgery. The rehabilitation plan is tailored to the individual and the extent of repair, focusing on gradually restoring range of motion, flexibility, and strength. Patients will progress through phases, from initial pain management and gentle exercises to more active strengthening activities.
Recovery timelines vary based on surgery complexity and individual factors, but it can take weeks to several months for the shoulder joint to fully heal. Light activities, such as desk work, may be resumed within a few days to weeks, while more strenuous activities or sports can take several months. Adherence to the physical therapy program and post-operative instructions is important for achieving the best outcome and returning to normal function.