Shoulder Arthroscopy

Arthroscopy is a minimally invasive surgical technique that involves making several small incisions and inserting a fiber-optic device (arthroscope) and tiny surgical instruments to diagnose or treat certain conditions. Connected to a camera that displays images of the internal structure of the shoulder on a computer screen, the arthroscope allows the surgeon to precisely identify and target joint abnormalities. Orthopedic surgeons may perform a shoulder arthroscopy to diagnose and treat several different conditions of the shoulder. With this type of procedure, patients benefit from less tissue damage, shorter recovery times, less scarring and less post-operative pain than traditional open procedures. The use of this technique also avoids cutting any muscles or tendons in order to gain access to the affected area. Arthroscopy is an ideal treatment option for many patients suffering from shoulder conditions.

Candidates for Shoulder Arthroscopy

Shoulder arthroscopy, also known as shoulder scope, is often performed to treat an injury to the structures within a joint, such as the shoulder, knee, hip, elbow, wrist, and, ankle.

Arthroscopy may be used to treat conditions that affect the shoulder joint which may include:

Rotator cuff tears
Labral tears
Impingement syndrome
Tendonitis
Bursitis
Joint arthritis

Arthroscopy provides many benefits over traditional open shoulder surgery, including smaller incisions, less trauma and shorter recovery times.

The Shoulder Arthroscopy Procedure

The shoulder arthroscopy procedure is performed while the patient is sedated under general anesthesia, and is usually performed on an outpatient basis. During the procedure, the surgeon will insert the arthroscope into a tiny incision in order to thoroughly examine the cartilage, bones, tendons and ligaments within the joint. Any damaged areas may be repaired during the same procedure by making several other small incisions through which surgical instruments are inserted. The type of repair performed will depend on the patient’s individual condition, but may include removing inflamed tissue, reattaching torn tissue or replacing damaged cartilage. Once the repair is completed, the incisions will be closed with stitches and a dressing will be applied to the area.

Risks of Shoulder Arthroscopy

While arthroscopy is considered safer and less invasive than traditional surgery, there are risks associated with this procedure which may include:

Bleeding
Blood clots
Shoulder stiffness
Shoulder weakness

Nerve damage and infection are also possible complications associated with the shoulder arthroscopy procedure.

Recovery from Shoulder Arthroscopy

After surgery, patients can usually return home the same day, although an overnight hospital stay may be required in some cases. Patients are encouraged to ice the shoulder and keep it immobilized in a sling until seen by the surgeon, around day 5. Time to full recovery will depend upon the extent of the surgical procedure performed. Full recovery from the shoulder arthroscopy procedure may take anywhere from 2 to 12 months, depending on each patient’s individual condition. A physical rehabilitation program helps patients restore function to the joint and ensure that it heals properly.

Once the shoulder has fully healed, most patients experience restored function, pain relief, improved range of motion and improved stability of the shoulder.

Rotator Cuff Injuries

Four muscles in the shoulder that when injured or damaged can lead to sleepless nights, pain, and weakness.

The most common ways of injury to the rotator cuff are trauma, such as a fall on the outstretched hand, repetitive overload to the tendon by activity, or bone spurs cutting into the tendon.

Symptoms commonly begin with pain over the upper arm that is worse with reaching overhead, lying on your side, reaching behind your back, and weakness.

The rotator cuff has a very limited capacity to heal on its own and therefore treatment is often required to improve symptoms. This usually begins with a short period of rest, followed by a rehabilitation program focused on mobility, and strength to improve function. Steroid injection can be used if significant inflammation is present and interferes with the ability to engage in the exercise program. Two thirds of patients will improve with these modalities alone, and thus this is the first phase of treatment.

If symptoms persist, MRI is utilized to evaluate the rotator cuff for tears. Most commonly injured is the supraspinatus tendon. This is the muscle that allows you to put on a jacket, reach into the kitchen cabinet and get out the dishes, put a gallon of milk in the refrigerator, or pour a pot of coffee. Because the tendon is spring loaded, full tears commonly separate or retract. The more the retraction, the more serious the tear. If these tears are not addressed, atrophy will ensue and the tears will frequently get larger over time.

Surgical repair is performed arthroscopically and consists of stretching the tendon back out to it’s attachment point and repairing it back to the humerus greater tuberosity that it pulled off from. Traditionally, the shoulder was immobilized in a sling for up to 6 weeks before starting physical therapy to protect the repair. The downside of this approach was a high rate of postop stiffness, called frozen shoulder. We pioneered an accelerated rehab program for rotator cuff 25 years ago that reduced this immobilization down to just 5 days and actually lowered to postop stiffness rate.

Quality of the rotator cuff tissue has been a major determinant of success of the surgery, as well as the recurrent tear rate. The larger the tear and degree of separation, the higher the recurrent tear rate – that can approach 50 percent!

Innovation in rotator cuff surgery revolves around the use of biologics to reduce the risk of recurrent tears. CuffMend is an acellular, dermal allograft that is placed upon the repair to effectively double the thickness of an atrophic tendon and reduce the risk of recurrent tears. We have been effectively utilizing this technology over the past 2 years with great success to enhance patient outcomes for the most serious tears.

We remain committed to utilizing the best technology to remain innovators in rotator cuff surgery.