Shoulder Arthroscopy

Overview

Shoulder arthroscopy, often referred to as shoulder keyhole surgery, is an innovative alternative to traditional open surgical procedures. This method involves inserting a small camera, or arthroscope, through minor incisions, allowing surgeons to have a clear view of the shoulder joint. This minimally invasive approach reduces tissue disruption, leading to less post-operative pain and quicker recovery times. 

Anatomy of the Shoulder

shoulder anatomy image showing major bones and structures

Fig 1. Shoulder Anatomy

The shoulder is a complex joint made up of several key structures, including:

  • Humerus: The upper arm bone that fits into the shoulder socket.
  • Scapula: Also known as the shoulder blade, it provides the socket for the humerus.
  • Clavicle: The collarbone that connects the arm to the body.
  • Rotator Cuff: A group of muscles and tendons that stabilize the shoulder and allow for a wide range of motion.
  • Labrum: A fibrocartilaginous structure that deepens the shoulder socket and provides stability.
  • Bursa: Small fluid-filled sacs that reduce friction between moving parts.

Shoulder arthroscopy allows surgeons to access and repair these structures with minimal disruption to surrounding tissues.

What is Shoulder Arthroscopy?

Shoulder arthroscopy is a minimally invasive surgical procedure designed to diagnose and treat various shoulder conditions. By using a small camera, surgeons can visualise the inside of the joint and perform necessary repairs without the need for large incisions. This technique can be used to perform a wide range of procedures, including:

  • Rotator Cuff Repair: Restoring torn rotator cuff tendons to their normal position.
  • Rotator Cuff Repair with Patch Augmentation: Reinforcing repairs with graft material.
  • Superior Capsule Reconstruction: Repairing the superior capsule to enhance stability.
  • Labral or SLAP Repair: Fixing labral tears to improve stability and reduce pain.
  • Shoulder Stabilisation: Addressing recurrent dislocations.
  • Capsular Release for Adhesive Capsulitis (Frozen Shoulder): Improving range of motion by releasing tight capsules.
  • AC Joint Stabilisation: Repairing injuries to the acromioclavicular joint.
  • Subacromial Decompression or Bursectomy: Reducing impingement by removing inflamed tissue.
procedure left image

Benefits and Risks

Shoulder arthroscopy provides several significant benefits. The smaller incisions used in this procedure result in less tissue damage, which leads to reduced post-operative pain. Patients typically experience faster recovery times, allowing them to return to their daily activities sooner. Additionally, the small incisions mean that scarring is minimal compared to traditional open surgery. Many patients can also go home on the same day as their surgery, enhancing convenience and comfort.

However, like all surgical procedures, shoulder arthroscopy carries certain risks, including:

  • Infection: There is a risk of infection at the incision sites.
  • Nerve Damage: Though rare, nerve injury can occur during surgery.
  • Stiffness or Pain: Some patients may experience persistent stiffness or pain post-operatively.
  • Conversion to open surgery: In some cases, it may not be possible to adequately perform the surgery through the keyhole technique.

Patients should be aware of warning signs that could indicate complications, including:

  • Increased Swelling: Swelling that worsens rather than improves over time.
  • Severe Pain: Pain that is not relieved by prescribed medications or worsens significantly.
  • Fever: A high temperature that could suggest infection.
  • Numbness or Tingling: Unusual sensations in the arm or hand, indicating possible nerve issues.

What Should I Expect?

Before the Procedure

Before undergoing shoulder arthroscopy, patients will have a comprehensive consultation with Mr. Chua. This includes a physical examination and imaging studies to confirm the diagnosis and surgical plan. Prior to the surgery, Mr. Chua, along with your anaesthetist, will ensure the selection of an optimal anaesthetic. This typically involves a light general anaesthetic complemented by a regional nerve block to numb the specific area involved. This combination not only facilitates a restful post-operative experience but also ensures effective pain control in the initial hours after the procedure.

During the Procedure

On the day of surgery, small incisions (usually about 0.5 to 1 cm) are made around the shoulder. The arthroscope and other surgical instruments are inserted through these incisions, allowing the surgeon to visualise the shoulder joint and perform necessary repairs. The procedure typically lasts between 30 minutes to 2 hours, depending on the complexity of the surgery.

After the Procedure

Post-surgery, patients may either return home the same day or stay overnight in the hospital, depending on the complexity of the procedure. A supportive sling is applied, and waterproof dressings allow patients to shower immediately after surgery. Pain medications will be prescribed to manage discomfort effectively.

Recovery times can vary based on the extent and type of repairs performed. For minor surgeries, patients can often resume regular activities within a few weeks, while more extensive repairs may require several months for full recovery.

Before leaving the hospital, a physiotherapist will consult with patients to initiate a personalised post-operative exercise regimen. Adhering strictly to post-surgery guidance is crucial for achieving optimal outcomes.

Frequently Asked Questions

  1. Is shoulder arthroscopy painful?
    Patients generally experience less pain compared to open surgery due to the minimally invasive nature of the procedure. Pain management strategies will be implemented post-operatively.
  2. Can I drive after shoulder arthroscopy?
    Driving may be restricted for a period following surgery, especially if your dominant arm was operated on. It is best to consult with your surgeon before resuming driving.
  3. Are there any long-term limitations after shoulder arthroscopy? While many patients experience significant improvement in shoulder function, some may have limitations in certain activities, especially those involving overhead motions. Mr. Chua will provide guidance on activity modifications based on individual recovery progress.

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