What Is Arthroscopy?
Arthroscopy is a minimally invasive surgical technique used by experienced orthopedic surgeons to treat mechanical injuries of the joint. Usually two or three incisions are made into the area around the injured joint. The incisions, also known as portals, are only about six millimeters long (about a quarter of an inch). That may seem small but they only need to be big enough for small instruments to fit through during surgery.
An instrument called an arthroscope (which, in Greek, means “to look at joints”) is inserted into one of those incisions. The arthroscope is a really interesting device. No longer than three to four millimeters in diameter (about an eighth of an inch), it has a very small fiber-optic camera bundled with a light, which provides video observation from inside of the joint. The video is displayed upon a computer screen in the operating room, and the orthopedic surgeon uses this video feed to see inside the joint and perform surgery without having direct open visualization of the joint. Thanks to the arthroscope, orthopedic surgeons can visualize the inner workings of patients’ joints in ways never before imagined.
Small instruments (scissors, punchers, grabbers, etc.) are inserted at various times into the other incision(s). They are also very small. These instruments perform the actual trimming and repair work required to complete the surgery.
The following joints are most likely to receive arthroscopic surgery when injured:
What You Need to Know About Shoulder Arthroscopy
The shoulder arthroscopy procedure typically takes about one hour and involves using a small camera, which is known as an arthroscope, to look at the shoulder joint and surrounding tissues. The arthroscope allows the Phoenix orthopedic surgeon to be able to see inside the body, without making a large opening or incision. The scope is inserted through a tiny incision that is made in the skin. This surgery requires either regional anesthesia or general anesthesia, so the patient will not feel any pain during the procedure.
The anesthesia will numb you starting at the base of the neck to high up on your shoulder. Most commonly, the doctor will insert in nerve blocks to completely numb your arm and shoulder area. This numbing also helps to control the pain following the surgery, so that the patient has time to get the pain medication they will need.
The Arthroscopic Procedure
Arthroscopy originated in the 1970’s and has enabled the diagnosing, treating, and patient recovery time to be much more efficient than ever before. Instead of performing open surgery, arthroscopy uses thin instruments, so that the Scottsdale orthopedic surgeon does not cause as much pain, there is less damage, and it an easier process for the patient.
The procedure requires inserting the scope into the shoulder and streaming the video onto a screen in the room. The doctor can then inspect the tissues around the shoulder joint, which include the tendons, ligaments, bones, and cartilage. Once the doctor has examined the area, he will then make further incisions so he is able to shave or remove damaged tissues, or repair tears in the cartilage, muscle, or tendon.
The procedures that are commonly performed using the arthroscopic method include treatment for conditions that are painful and do not respond to other surgeries, such as repair of shoulder instability, impingement syndrome, and tears to the rotator cuff. In order to repair instability in the shoulder, the labrum often needs to be repaired along with the attached ligaments.
There are also two other issues which result in the instability of the shoulder, which include a tear on the shoulder joint’s lower part (known as the Bankart lesion) as well as damage on the shoulder joint’s upper part (known as a SLAP lesion).
Arthroscopy for Shoulder Impingement Syndrome
Shoulder impingement syndrome is caused by tissue that becomes damaged or inflamed from the bone (acromion) rubbing against the soft tissues over the rotator cuff musculature. It requires the soft tissue under the bone being cleaned up with a procedure known as a debridement. The surgery also sometimes requires the shaving of the under part of the bone known as the acromion.
Also, when the rotator cuff is repaired using this surgery, the surgeon will go in and bring the edges of the muscles together. They will use anchors to connect the bone to the tendon. These anchors are commonly made out of plastic or metal and can remain after the surgery.
In some cases, supplements and medications should be stopped before the arthroscopic surgery. Because this surgery does require anesthesia, you will be given instructions ahead of time including when you should halt any eating or drinking.
During the two weeks before the surgery, you should stop taking drugs that interfere with blood clotting, such as aspirin and non-steroidal anti-inflammatory agents. If you have medical conditions, discuss these with the doctor. Also, smoking delays bone and wound healing, so you should avoid this habit.
Arthroscopic Shoulder Surgery
Arthroscopic shoulder surgery is performed through tiny incisions made on the shoulder region. The orthopedic surgeon inserts a small camera into the joint and shoulder area to visualize damage and make repairs.
Tiny instruments are used during the procedure through the same incisions. The advantages of arthroscopic surgery over open traditional surgery include smaller incisions, less tissue damage, less surgery time, and quicker recovery.
Candidates for Shoulder Arthroscopy
When a person has a shoulder injury, and it doesn’t respond to nonsurgical treatments, the orthopedic surgeon may recommend shoulder arthroscopy. This procedure is often done when there is shoulder inflammation that doesn’t go away.
Inflammation is the body’s reaction to disease or injury, and this can lead to shoulder stiffness, swelling, and pain. Injury, age-associated wear-and-tear, and overuse of the shoulder are other reasons for shoulder arthroscopy. Also, shoulder arthroscopy is often done to relieve the discomfort associated with damaged rotator cuff tendons, articular cartilage, labrum, and other soft joint tissues.
Common Arthroscopic Shoulder Procedures
- Repair of ligaments – Arthroscopic surgery is done to repair ligaments that are torn in the shoulder area.
- Bone spur removal – For some patients, bone spurs of the shoulder are quite painful. This procedure is a minimally invasive means of bone spur removal.
- Rotator cuff repair – Treatment of rotator cuff tears is usually successful when the tear is partial rather than complete.
- Removal of inflamed tissue – With shoulder bursitis and biceps tendonitis, there are inflamed and irritated structures. The arthroscopic procedure removes the inflamed bursa, bone, or tendon, and more space is made for the remaining structures. This allows inflammation to subside.
- Removal of loose cartilage – With loose or worn cartilage, as in acromioclavicular (AC) joint arthritis, the ends of the collarbone (clavicle) is removed, and this relieves the pain and stiffness.
- Repair shoulder instability – When there is a labral or Bankart tear, the shoulder is considered not to be stable.
- Repair of frozen shoulder – A frozen shoulder occurs from trauma. The arthroscopic technique can be used to make necessary repairs to the shoulder and increase mobility and function.
Recovery and Rehabilitation
The recovery process following arthroscopic shoulder surgery varies in length, depending on the severity of the injury, the type of procedure, and the patient’s overall health and shoulder function. This could be anywhere from 1 to 6 months. You will be given medications for pain and to prevent infection, and your arm will be placed in a sling. A physical therapist will work with you to teach range of motion exercises to improve strength, flexibility, and mobility.
As with other types of surgery, arthroscopic shoulder surgery does carry certain risks and complications. Infection is a possibility, but rates of this are very low. Stiffness following the procedure is the most common complication, but rehabilitation and physical therapy helps prevent this. Also, some patients develop chondrolysis, a rare complication. Other risks include:
- Weakness of the shoulder
- Blood clots
- Injury to a nerve or blood vessel
- Failure to repair or heal
- Failure to relieve symptoms
When the surgery has been completed, the arthroscope will be removed and the entry place will be closed up with stitches. It will then need to be covered with a bandage. This method of surgery can be used as long as the damage is not too extensive.
In that case, a large incision may be required during open shoulder surgery, so the surgeon can work on the bones and tissues directly. However, with arthroscopic surgery, there is no lengthy hospitalization, it doesn’t take long for patients to recover, and it spares damage to the bones, structures, and soft tissue.