What is Shoulder Arthroscopy?
Shoulder Arthroscopy is a minimally invasive surgical technique used to treat a large number of shoulder conditions. Shoulder arthroscopy has a faster recovery time compared to open surgery. The arthroscope allows for a better view of all the anatomy inside the shoulder joint as well as the surrounding area compared to open surgery.
An arthroscope is a tiny medical camera about the size of a pencil. It is inserted into the shoulder through a small incision called a portal. The view from the scope is shown on a monitor above the patient. Miniature surgical instruments are inserted through other portals to perform the shoulder repair. Arthroscopy has become the standard of care for treating most shoulder surgical conditions, such that less and less open surgery is required. Arthroscopic techniques and innovations continue to develop and improve over time. Dr. Cunningham is a shoulder surgeon at Vail Summit Orthopedics and Neurosurgery. He is an expert at diagnosing and treating shoulder conditions for patients in Vail, Summit County, Aspen, and Denver, CO.
What is Shoulder Arthroscopy Used For?
Shoulder arthroscopy is used for diagnosing and treating of a range of shoulder conditions. These conditions include injuries to the:
- Rotator cuff: The rotator cuff is made up of 4 muscles and their attached tendons that act to move the shoulder. The tendons cover the front, top and back of the shoulder joint as one continuous cuff of tissue. One or more of these tendons can tear away from their bone attachment on the head of the humerus, resulting in a rotator cuff tear. These tears usually occur as a result of “wear and tear” over time. Rotator cuff tears are painful and cause shoulder weakness. Rotator cuff tears can be repaired using shoulder arthroscopy. Bone spurs impinging on the rotator cuff tendon on the top of the shoulder are commonly removed at the same time using shoulder arthroscopy.
- Shoulder capsule and labrum: The shoulder capsule is the sac of tissue that spans from the ball to the socket and completely encapsulates the shoulder joint. The capsule attaches to the labrum, which is a ring of rubbery tissue surrounding the socket like the orange rubber gasket on the top of a mason jar. Patients who dislocate or partially dislocate (subluxate) their shoulder can tear the labrum away from the edge of the glenoid, stretch out the capsule, and have unstable shoulders as a result. These injuries can be repaired with shoulder arthroscopy.
- Glenohumeral Joint: The shoulder is a ball and socket joint formed by the top of the humerus (ball) and the glenoid (socket). The glenoid is part of the shoulder blade. There is cartilage coating on both the ball and the socket. Osteoarthritis is a wearing down and roughening of this coating cartilage layer. With shoulder arthroscopy, this worn cartilage can be smoothed and any floating fragments of bone or cartilage removed.
Although most shoulder conditions can be repaired using shoulder arthroscopy, there is still a need for using open surgery methods to do certain shoulder procedures such as fixing fractures or to do shoulder replacement surgery.
When is Arthroscopic Shoulder Surgery Necessary?
Arthroscopic shoulder surgery may be necessary when non-surgical treatments do not provide improvement or for certain diagnoses that are known to do better when treated surgically. The most frequent conditions for which arthroscopic shoulder surgery is utilized are:
- Chronic shoulder dislocations
- Rotator cuff repair
- Labrum repair or trimming
- Shoulder capsular tightening or shoulder ligament repair
- Bone spur removal
- Removing loose fragments of cartilage or bone
- Smoothing arthritic areas in the shoulder joint
- Removing the outer edge of the collarbone for painful bone on bone AC joint arthritis
How is Shoulder Arthroscopy Performed?
Shoulder arthroscopy is an outpatient surgical procedure. The procedure typically takes 1-2 hours depending on the severity of the condition. The anesthesiologist may place a peripheral nerve block prior to surgery which acts to numb your entire shoulder and arm, such that when you awake from surgery, you are in minimal pain. A light general anesthestic is also given so that you remain totally still during surgery and are not experiencing any pain. Patients are often positioned in the “beach chair” position, in which you are reclined on a special shoulder table. The shoulder area is thoroughly scrubbed with antibiotic solution and sterile drapes are placed around the shoulder to keep the entire area sterile. A small portal is made in the back of the shoulder and the arthroscope is inserted into the shoulder joint and corresponding view of the shoulder is displayed on a monitor. A pressurized salt water solution is runs from the arthroscope into the shoulder joint, and this fluid acts to distend the joint, allowing for good visualization. Several other portals are made. Small plastic tubes called cannulas are placed into each portal so that pressurized fluid does not run out of the shoulder and so that instruments can be easily inserted and removed from the shoulder. A variety of fine instruments are introduced into the shoulder joint and used to repair the problem. These instruments allow the surgeon to do many things including cut, shave, grasp, and pass sutures through torn tissues as well as burr bone spurs away or place suture anchors into bone. Following surgery, stitches or steri-strips will be used to close the incision. A shoulder sling is applied and you are transferred from the operating room to the recovery room.
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Dr. Cunningham utilizes innovative treatment techniques to get patient’s back on the road quicker.
What is the Recovery Like After a Shoulder Scope?
Although the initial post-surgical recovery is quicker than open surgery recovery, the recovery timeframe depends on what procedure was done. If surgery consists of removing bone spurs and smoothing arthritic areas, then the recovery is quick with patients being out of their sling within a week and being fully recovered in 6 weeks. If surgery consists of a large rotator cuff repair, then one is in a sling for up to 8 weeks and is very restricted in how they are allowed to move the shoulder so as not to disrupt the repair. A rehabilitation program will help patients achieve an optimal outcome. With a high level of compliance to the rehabilitation program, most patient having a shoulder arthroscopy can expect a very good outcome, with the ability to return to all your activities. Dr. Cunningham is a shoulder surgeon at Vail Summit Orthopedics and Neurosurgery. He is an expert at diagnosing and treating shoulder injuries for patients in Vail, Summit County, Aspen, and Denver, CO.
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Dr. Cunningham specializes in the treatment of knee, shoulder, and sports injuries.