Shoulder Arthroscopy

What does shoulder arthroscopy involve?

An arthroscopy is a form of keyhole surgery used to diagnose and treat problems of the shoulder joint. An arthroscope (which is an instrument for the examination of the inside of joints consisting of a steel tube arthroscope fibre optic system) is inserted into the cavity of the shoulder via a small incision. The arthroscope is attached to a video camera that allows the surgeon to “see” inside the joint to find out more clearly what needs to be done.

The surgeon then inserts small instruments through a number of additional small incisions. Guided by the image on the TV monitor the shoulder joint is explored and any necessary procedures are carried out (see video).

The operation will be done whilst you sleep under a general anaesthetic. Sometimes a regional interscalene (at the base of the neck) nerve block anaesthetic is used as well, which puts your arm to sleep. This provides additional pain relief and reduces the amount of general anaesthetic required.

Reasons why it is performed:

Diagnosis:

• To confirm a diagnosis that is suggested by your physical problems and any special diagnostic tests that may have been carried out (e.g. x-ray, ultrasound, MRI scan).
• To investigate pain for which there is no apparent cause to try and find a cause. If there is a cause found you might be offered treatment. If no cause is found and no treatment is indicated you may have to continue to live with the discomfort you are experiencing.

Procedures:

Arthroscopic shoulder problems treated arthroscopically may include:

• Shoulder stabilisation: where the joint ligaments may be repaired ad tightened to prevent dislocation.
• Shoulder Decompression (acromioplasty): where some bone is removed to allow more space for the rotator cuff tendons to move your shoulder.
• Tendon repair: often combined with decompression.
• In addition, manipulation of the joint or a surgical release of the tightened ligaments to improve the movements in a stiff shoulder sometimes accompanies arthroscopy.

Are there any risks?

As with the operation, there are risks associated with having a general anaesthetic. However, arthroscopy is generally a safe, reliable operation.

Specific to this operation there is an overall complication rate of about 1%. The most common complications include:

• Failure of the operation to relieve pain, instability or weakness.
• Stiffness of the shoulder sometimes called a ‘frozen shoulder’ (this is often temporary).
• Swelling (this is often temporary) and due to the saltwater pumped into the shoulder during the operation.
• Infection. If this does occur it will be managed with antibiotics. The Hospital of St John & St Elizabeth has extremely low infection rates, maintaining 0% acquired MRSA at the last audit.
• Injury to nerves and blood vessels.
• Bleeding (this is often temporary) and settles as the swelling goes down.

You may wish to discuss these risks with your surgeon prior to surgery.

What improvement am I likely to get after shoulder arthroscopy?

This depends on the underlying problem, but the keyhole allows rapid relief of pain and recovery of function because the incisions are small and no muscles or tendons are divided to gain access to the joint. Depending on the problem, in a small proportion of cases, the may be no improvement.

Is there anything I should do to prepare for the operations?

• If you are a smoker, it would benefit you greatly to stop smoking before you have the operation. This will reduce the risk of chest troubles, as smoking makes your lungs sensitive to anaesthetic. If you stop smoking it improves your chance of a good result. It will also improve wound healing.
• If you find it impossible to stop smoking altogether, try to reduce the number of cigarettes you smoke for at least 48 hours prior to surgery.
• If you are overweight, it will help if you lose any excess weight.
• All infections, including coughs and colds, must be cleared up before you have your operation.
• Let your doctor know the details of all drugs being taken particularly steroids.
• Having a positive outlook before the operation will help you feel better overall and will assist in the speed of your recovery.
• Cooking can be difficult postoperatively, particularly in the days immediately following the operation. Some people benefit from buying ready-made meals or having taken away options available.