Shoulder Arthroscopy

What is arthroscopic shoulder surgery?

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Arthroscopic surgery is performed through small incisions using a camera to see the inside of a joint. Through several small incisions (about 1 centimeter each) your surgeon will insert a camera into one incision, and small instruments through the other incisions. The exact number of incisions made depends on the specific surgery that needs to be performed.

Arthroscopic vs. Open Surgery

There is often a debate among patients and surgeons about which is better, arthroscopic or 'open' surgery.

Open surgery, a procedure using larger incisions and enabling the surgeon to look inside the joint, may be better for certain procedures under certain circumstances. Arthroscopic surgery has some advantages--smaller incisions, less tissue damage--but these are usually not helpful if the overall procedure cannot be performed as well. Other surgeons feel that directly looking at the area of damage can allow for a better and stronger repair of damaged structures. The truth is that it depends on exactly what needs to be done, the patient's specific condition, and the surgeon's experience. Depending on the combination of these factors, one surgery may be best for your particular situation. You need to discuss with your surgeon if a particular procedure can be done arthroscopically.

There are debates among orthopedic surgeons about how to best perform different types of surgery. For example, many shoulder surgeons disagree about whether or not rotator cuff repairs can be performed as well arthroscopically as they can open.

Unfortunately, there are pros and cons to both, and no one knows for sure that one or the other is better.

Arthroscopic Shoulder Surgeries

  • Shoulder Instability - Labral Tears
    Labral tears, such as Bankart tears and SLAP tears, are commonly treated with arthroscopy. It is very important that patients who have arthroscopic surgery for these procedures follow their post-operative rehab protocol very closely. Patients are often tempted to do too much too soon!
  • Shoulder Bursitis
    Patients with shoulder bursitis, also called impingement syndrome, that is not cured with simple treatments may consider a procedure called an arthroscopic subacromial decompression. This procedure removes the inflamed bursa and some bone from the irritated area around the rotator cuff tendons. By removing this tissue, more space is created for the tendons and the inflammation often subsides.
  • Biceps Tendonitis
    The biceps tendon can become irritated and inflamed as an isolated problem or in association with problems such as impingement syndrome and rotator cuff tears. When the biceps tendon is damaged and causing pain, a procedure called a biceps tenodesis can be performed. This procedure usually causes no functional difference, but often relieves symptoms.
  • Frozen Shoulder
    Frozen shoulder seldom requires operative treatment, and treatment for many months or years is often necessary before considering operative treatment. When frozen shoulder must be treated surgically, it is of utmost importance to begin aggressive physical therapy immediately following surgery. Without this, it is likely the problem will return.
  • AC Joint Arthritis
    The AC joint, or acromioclavicular joint, is occasionally affected by arthritis. When arthritis of the AC joint is severe, the end of the clavicle (collarbone) can be removed. By removing the damaged joint, the symptoms of AC arthritis are often relieved.

Shoulder Arthroscopy Rehab

The recovery depends on what type of surgery is performed. One of the problems with shoulder arthroscopy is that the procedure hurts much less than open shoulder surgery, and therefore patients may tend to do too much, too soon. It is very important that you only perform activities that your surgeon recommends following a shoulder arthroscopy. Even though your shoulder may feel fine, you need to allow time for repaired tissues to adequately heal. This is especially important for patients who have rotator cuff repairs and labral repairs. For these surgeical procedures to be successful, soft-tissues must heal before stress is placed on the repaired structures. Too much activity, too quickly, can lead to a recurrence of the problem that your surgeon was trying to address.

Surgical Complications

Complications of shoulder arthroscopy are uncommon, but do occur. Infection rates tend to be very low. The most common complication of surgery on the shoulder is stiffness after surgery, and prolonged rehabilitation. This can usually be managed with physical therapy. Occasionally, shoulder arthroscopy can lead to a frozen shoulder that can make rehab challenging. One rare complication of shoulder arthroscopy is called chondrolysis. This is a very usual, but particularly serious complication seen after arthroscopic shoulder surgery.

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