Shoulder arthroscopy is a minimally invasive technique that allows orthopaedic surgeons to assess and treat a range of conditions and illnesses affecting the shoulder joint, in the various structures that make up this complex joint. The technique is applied through two or three small incisions of less than one centimeter in the skin.
Benefits of intervention
This technique, which has become the standard treatment of shoulder pathology and is in constant development, allows the access to deep and hard to reach structures in the shoulder, with a complete view of the inside. The technique makes possible the treatment of problems in the shoulder that usually appear in patients who suffer pain around the shoulder or with limited mobility therein, which have failed to improve after medical treatment and physiotherapy. These conditions have required, until now, a more complex surgery and lengthy recovery periods
Medical-technical description
Shoulder arthroscopy is indicated for 4 types of conditions:
- Impingement syndrome: a partial removal of the subacromial bursa and acromioplasty is performed, which involves the removal of a bone spicule at the bottom of the acromion and impingement which is responsible for what happens in these patients with tendons rotator cuff (primarily the supraspinatus)
- Rotator cuff tear: When there is a break in any of the tendons of the rotator cuff, a repair can be performed arthroscopically, and its reintegration to the bone in the humeral head, with a number of special harpoons. This is achieved by restoring the function of these tendons, a technique that improves the patient's symptoms
- Shoulder instability and recurrent dislocation of the shoulder in patients who have undergone several episodes of dislocation of the humeral head. It allows the repair of injuries, in order to avoid new episodes of dislocation of the shoulder
- Traumatic injuries: fractures of the greater tuberosity joint and proximal humerus, glenoid fractures, dislocated acromio-clavicular and acute lesions of the soft tissues.
Depending on the pathology, the orthopaedic surgeon makes from 2 to 5 small incisions, of about 1/4 of an inch, in the affected joint surrounding the shoulder, through which gain access to the injured area and then inserts a camera and instruments specific to each type of injury. The soft tissue repair is carried out by different types of sutures and next generation suture anchors of resorbable coated osteoinductive material or titanium, depending on the case.
The Procedure
Shoulder arthroscopy is performed in the operating theatre, in a semi-sitting position or sideways, with a traction device, clamping the arm to be intervened. The anesthesiologist performs a wide regional anesthesia of the brachial plexus (nerves to numb the arm) and sedation, thereby achieving a more comfortable postoperative period with less pain than conventional surgery of the shoulder. The surgery takes approximately 30 to 90 minutes depending on the problem being treated. The patient spends a night in the hospital, and is discharged the next day. Then the patient receives a discharge report with recommendations, treatment and recall appointments to follow.
Preoperative Measures
- Prior assessment in consultation, deciding and stating the specific aspects of the intervention and giving the informed consent
- You must provide a comprehensive list of medicines you take regularly (including herbal medicines) at the time of the operation
- Conduct comprehensive preoperative laboratory tests, consisting of blood count, biochemistry, coagulation, ECG and X-ray studies
- Wash the previous night and morning of surgery, with antiseptic soap, the area to undergo surgery.
- Do not eat or drink 8 hours before surgery
- Do not wear any metal object during operation (rings, bracelets, earrings, piercing, etc.)
Postoperative care
- You may feel some discomfort or swelling after surgery and during the following days, that will disappear with the medication as directed by your surgeon
- You must wear a sling for immobilizing the shoulder for 2 to 4 weeks depending on the injury and surgical findings. Every hour you must release the sling and perform elbow flexion-extension and mobilize the fingers
- Do not wet the incisions until the removal of the stitches, in 5-10 days
- After the stitches are removed, you can start a treatment by a physiotherapist, which can last from 4 to 8 weeks
- Normally, after the start of physiotherapy, you will be able to drive or perform a light activity. Resume sporting activity within 2-4 months
- After discharge, you must contact us if you have chest pain and shortness of breath, pain, swelling or redness in the arm, sudden pain in the operated shoulder; untreatable by the usual means at the surgical site or fever and chills processes
You can also download the Informed Consent from the official website of the SECOT, the Sociedad Española de Cirugía Ortopédica y Traumatología
