Shoulder arthroscopy (keyhole surgery)

Dealing with persistent shoulder pain or limited movement can significantly impact your daily life, from simple tasks like reaching for an item on a high shelf to enjoying your favorite sports and hobbies. If conservative treatments haven’t provided the relief you need, your doctor might recommend shoulder arthroscopy (keyhole surgery). This advanced, minimally invasive surgical procedure has revolutionized how surgeons diagnose and treat a wide array of shoulder problems, offering patients a path to reduced pain and improved function with generally quicker recovery times than traditional open surgery.

This article will guide you through what shoulder arthroscopy entails, the conditions it can address, what to expect during the procedure and recovery, and its benefits and potential risks.

What is Shoulder Arthroscopy (Keyhole Surgery)?

Shoulder arthroscopy is a type of keyhole surgery that allows an orthopaedic surgeon to visualize, diagnose, and repair problems inside and around your shoulder joint through very small incisions. The name “arthroscopy” comes from two Greek words: “arthro” (joint) and “skopein” (to look).

Here’s how it works:

  • An arthroscope, a thin instrument about the width of a pencil, is inserted into your shoulder through a small cut. This device contains a tiny camera and a light source.
  • The camera transmits high-definition images from inside your shoulder to a video monitor in the operating room. This gives your surgeon a clear, magnified view of the bones, cartilage, tendons, and ligaments.
  • Once the problem is clearly identified, specialized, thin surgical instruments are inserted through other small incisions (portals) to perform the necessary repairs. These instruments can be used to shave, cut, grasp, suture, or anchor tissues as needed.

The minimally invasive nature of shoulder arthroscopy means less trauma to surrounding muscles and tissues compared to traditional open surgery, which often requires larger incisions.

When is Shoulder Arthroscopy Recommended?

Your orthopaedic surgeon may recommend shoulder arthroscopy if you have a painful shoulder condition that doesn’t respond to non-surgical treatments like rest, physical therapy, medication, or injections. It’s a versatile procedure used to treat a variety of common shoulder conditions, including:

  • Rotator Cuff Tears: This is one of the most common reasons for shoulder arthroscopy. The procedure allows surgeons to perform a rotator cuff repair by reattaching the torn tendon(s) to the upper arm bone (humerus). Keywords like torn rotator cuff and rotator cuff surgery are central here.
  • Shoulder Impingement Syndrome: Also known as subacromial impingement, this occurs when the space between the acromion (outer part of the shoulder blade) and the rotator cuff narrows, causing irritation. Arthroscopy can be used for subacromial decompression (also called acromioplasty), where a small amount of bone or tissue is removed to create more space.
  • Labral Tears: The labrum is a ring of cartilage that lines the shoulder socket (glenoid). Tears in the labrum, such as SLAP lesions (Superior Labrum Anterior to Posterior) or Bankart lesions (often associated with dislocations), can be repaired arthroscopically. Keywords: torn labrum, Bankart repair, SLAP lesion repair.
  • Shoulder Instability / Recurrent Dislocations: If your shoulder joint is loose and prone to dislocating or subluxating (partially dislocating), arthroscopy can be used to tighten and repair the stretched or torn ligaments and joint capsule. This is often referred to as shoulder stabilization surgery.
  • Biceps Tendon Issues: Problems with the long head of the biceps tendon, such as tears or inflammation (tendinitis), can often be addressed arthroscopically, sometimes involving a tenotomy (releasing the tendon) or tenodesis (reattaching the tendon to a new location).
  • Removal of Loose Bodies: Fragments of bone or cartilage can break off and float within the joint, causing pain and catching. These can be removed arthroscopically.
  • Frozen Shoulder (Adhesive Capsulitis): In persistent cases of frozen shoulder where other treatments fail, an arthroscopic capsular release can be performed to cut the thickened, tight joint capsule, improving range of motion.
  • Acromioclavicular (AC) Joint Arthritis: The AC joint, where the collarbone (clavicle) meets the acromion, can develop arthritis. Arthroscopy can be used to remove the inflamed tissue and a small portion of the end of the collarbone (distal clavicle excision).

The decision to proceed with shoulder arthroscopy is made after a thorough evaluation by your surgeon, including a physical examination and often imaging studies like X-rays or an MRI.

The Shoulder Arthroscopy Procedure: What to Expect

Understanding the process can help alleviate anxiety and prepare you for your shoulder arthroscopy procedure.

Before the Surgery

  • Medical Evaluation: You’ll undergo a pre-operative assessment to ensure you’re fit for surgery. This may include blood tests, an ECG, and a review of your medical history and medications.
  • Imaging: Your surgeon will review your X-rays and MRI scans to plan the surgery.
  • Medication Review: You might need to stop certain medications, like blood thinners, for a period before surgery.
  • Fasting: You’ll be instructed not to eat or drink for a certain number of hours before the procedure, as it’s typically done under general anesthesia.
  • Arrange for Help: Since shoulder arthroscopy is usually an outpatient surgery (meaning you go home the same day), you’ll need to arrange for someone to drive you home and assist you for the first few days.

During the Surgery

  • Anesthesia: Most shoulder arthroscopy procedures are performed under general anesthesia (you’ll be asleep). Your anesthesiologist may also administer a regional nerve block. This involves injecting local anesthetic around the nerves in your shoulder or neck, which can provide excellent pain relief for several hours after the surgery.
  • Positioning: You will be positioned either on your side (lateral decubitus) or in a semi-seated (beach chair) position, depending on the surgeon’s preference and the specific procedure.
  • The Procedure:
    1. Your surgeon will make a few small incisions (portals), typically less than half an inch long, around your shoulder.
    2. The arthroscope is inserted through one portal, and sterile fluid is pumped into the joint to expand it, making it easier for the surgeon to see and work.
    3. The images from the arthroscope are displayed on a monitor.
    4. Specialized surgical instruments are inserted through the other portals to perform the necessary repairs or removals.
    5. Once the surgery is complete, the instruments are removed, the fluid is drained, and the small incisions are closed with sutures or surgical tape and covered with a dressing.
  • Duration: The surgery itself usually takes between 30 minutes to a couple of hours, depending on the complexity of the problem being addressed.

After the Surgery

  • Recovery Room: You’ll be monitored in a recovery area as you wake up from anesthesia.
  • Pain Management: You will receive pain medication to manage discomfort. The nerve block, if administered, will also help significantly during the initial hours.
  • Sling: Your arm will likely be placed in a sling to protect the shoulder and provide comfort. You’ll receive instructions on how long to wear it.
  • Discharge: Once you are stable and comfortable, you’ll be discharged home with detailed instructions on wound care, pain management, activity restrictions, and follow-up appointments.

Keywords like what to expect after shoulder arthroscopy and post-operative care are crucial for patient understanding.

Recovery and Rehabilitation After Shoulder Arthroscopy

A successful outcome from shoulder arthroscopy depends heavily on your commitment to the rehabilitation process. The shoulder arthroscopy recovery time can vary widely depending on the type of surgery performed, the severity of your condition, your age, and your overall health.

Initial Recovery (First Few Weeks)

  • Pain and Swelling: Expect some pain and swelling for the first few days to weeks. Applying ice packs and taking prescribed pain medication will help.
  • Sling Use: You will likely need to wear a sling for a period, which could range from a few days to several weeks, to immobilize and protect the shoulder as it heals. Your surgeon will provide specific instructions.
  • Wound Care: Keep the incision sites clean and dry. Follow your surgeon’s instructions regarding showering and changing dressings.
  • Early Movement: You may be encouraged to do gentle hand, wrist, and elbow exercises soon after surgery to prevent stiffness in these joints.

Physical Therapy

Physical therapy is a cornerstone of recovery after shoulder arthroscopy.

  • Starting Therapy: You’ll typically begin physical therapy within a few days or weeks after surgery, as recommended by your surgeon.
  • Goals: The goals of physical therapy are to:
    • Reduce pain and swelling.
    • Restore your shoulder’s range of motion.
    • Regain strength in the shoulder muscles.
    • Improve overall shoulder function.
    • Help you safely return to activities of daily living, work, and sports.
  • Exercises: Your physical therapist will guide you through a progressive rehabilitation protocol that includes:
    • Passive range-of-motion exercises: Where the therapist moves your arm for you.
    • Active-assisted range-of-motion exercises: Where you use your other arm or a device to help move the surgical arm.
    • Active range-of-motion exercises: Where you move your arm on your own.
    • Strengthening exercises: Gradually introduced as healing progresses, often starting with isometric exercises (muscle contractions without movement) and progressing to resistance exercises.
  • Duration: The full rehabilitation process can take several months. Patience and consistent effort with your shoulder exercises are key.

Timeline for Return to Activities

  • Daily Activities: You may be able to resume light daily activities within a few days to weeks, but you’ll need to avoid heavy lifting or strenuous use of your shoulder.
  • Driving: This usually takes several weeks, once you are out of the sling, have regained sufficient control of your arm, and are no longer taking strong pain medication.
  • Work: Return to work depends on the nature of your job. Desk jobs may be possible within a week or two, while jobs requiring physical labor or overhead arm use will take longer, potentially several months.
  • Sports: Return to sport varies greatly depending on the sport and the specific surgery. It can range from a few months for low-impact activities to six months or more for overhead or contact sports.

Always follow your surgeon’s and therapist’s specific guidance regarding activity progression.

Benefits and Potential Risks of Shoulder Arthroscopy

Like any surgical procedure, shoulder arthroscopy has both significant benefits and potential risks.

Benefits

  • Minimally Invasive: This is a primary advantage. Smaller incisions mean less damage to surrounding tissues.
  • Less Post-Operative Pain: Patients often experience less pain compared to open shoulder surgery.
  • Reduced Scarring: The small portal incisions result in minimal scarring.
  • Quicker Recovery: In many cases, recovery and return to activities may be faster than with open procedures.
  • Outpatient Procedure: Most shoulder arthroscopies are performed on an outpatient basis.
  • Diagnostic Accuracy: Allows for direct visualization of the joint, leading to accurate diagnosis and targeted treatment.
  • High Success Rates: For many common shoulder conditions like rotator cuff tears and shoulder impingement, arthroscopic surgery has high success rates in relieving pain and restoring function.

Risks and Complications

While shoulder arthroscopy is generally safe, potential risks of shoulder arthroscopy and complications can occur, although they are uncommon. These include:

  • Infection: Any surgery carries a risk of infection at the incision sites or within the joint.
  • Bleeding: Excessive bleeding is rare.
  • Blood Clots (Deep Vein Thrombosis or Pulmonary Embolism): Though less common with shoulder surgery than lower limb surgery, this is still a potential risk.
  • Nerve or Blood Vessel Damage: The nerves and blood vessels around the shoulder could be inadvertently injured during surgery. This is rare, and surgeons take great care to avoid it. Symptoms might include numbness, weakness, or altered sensation.
  • Stiffness (Frozen Shoulder): The shoulder can sometimes become stiff after surgery. Adhering to the physical therapy program is crucial to prevent this.
  • Continued Pain or Symptoms: In some cases, the surgery may not fully alleviate all symptoms, or pain may persist.
  • Failure of Repair: A repaired tendon (like a rotator cuff) or ligament may not heal properly or could re-tear.
  • Anesthesia Complications: Risks associated with general anesthesia.
  • Hardware Problems: If anchors or other fixation devices are used, they can occasionally cause irritation or other issues, though this is rare with modern implants.

It’s important to discuss these potential risks and benefits thoroughly with your orthopaedic surgeon before deciding to proceed with surgery. They can provide you with information specific to your condition and overall health.

Key Takeaways and Next Steps

Shoulder arthroscopy (keyhole surgery) is a highly effective and widely used minimally invasive procedure for diagnosing and treating a multitude of painful shoulder conditions. Its benefits often include less pain, smaller scars, and a quicker return to an active lifestyle compared to traditional open surgery.

Successful recovery relies on a collaborative effort between you, your surgeon, and your physical therapist. Diligently following your post-operative instructions and rehabilitation plan is essential for achieving the best possible outcome.

If you are experiencing persistent shoulder pain or dysfunction, and conservative treatments have not been successful, shoulder arthroscopy might be an option for you.

To explore your treatment options and see if shoulder arthroscopy is right for you, we encourage you to schedule a consultation.
You can book an appointment with Mr. David Shields via this link: https://www.circlehealthgroup.co.uk/consultants/david-shields
Alternatively, you can contact us for an appointment at: info@theupperlimbclinic.co.uk

Don’t let shoulder pain hold you back. Take the first step towards recovery today.