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Shoulder Arthroscopy
Dr Kau Chung Yuan (许医生)
MBBS (S’PORE)
MRCS (Ireland)
MMed (Ortho)
FRCSEd (Ortho)
What is Shoulder Arthroscopy?
Shoulder arthroscopy is a surgical procedure used to diagnose and treat problems inside the shoulder joint.
This minimally invasive technique involves making small incisions through which a tiny camera, known as an arthroscope, and specialised instruments are inserted. The arthroscope transmits images from inside the shoulder to a video monitor, allowing the surgeon to guide miniature surgical instruments to address the specific issue within the joint.
When is Shoulder Arthroscopy Needed?
Shoulder arthroscopy is typically considered when a patient has a condition within the shoulder joint that has not responded to non-surgical treatment methods. Common conditions that may warrant shoulder arthroscopy include:
- Rotator Cuff Tears
These involve tears in the muscles or tendons surrounding the shoulder joint, often causing pain and weakness. - Impingement Syndrome
This condition occurs when the shoulder blade (scapula) puts pressure on the underlying soft tissues when the arm is lifted. - Frozen Shoulder
Also known as adhesive capsulitis, it is characterised by stiffness and pain in the shoulder joint. - Shoulder Instability
This happens when the shoulder joint is too loose and can move or slide around too much in the socket. In some cases, it may lead to dislocation. - Labral Tears or SLAP Lesions
Injuries to the ring of cartilage (labrum) surrounding the shoulder socket, often as a result of repetitive overhead actions. - Bursitis
Inflammation of the bursa, a small fluid-filled sac that reduces friction between joint tissues. - Arthritis
Particularly osteoarthritis, which involves the degeneration of joint cartilage and the underlying bone.
Benefits and Risks of Shoulder Arthroscopy
Benefits
- Less Invasive: With smaller incisions, arthroscopy is less invasive, leading to reduced muscle and tissue trauma.
- Reduced Pain and Swelling: Patients generally experience less postoperative pain and swelling compared to open surgery.
- Faster Recovery: Recovery time is typically shorter, allowing patients to return to daily activities more quickly.
- Improved Accuracy: The use of a camera provides orthopaedic surgeons with a clear view of the shoulder joint, potentially increasing the precision of the procedure.
- Diagnostic Capability: Arthroscopy can be used for both diagnostic and treatment purposes, often in the same procedure.
Risks
- Infection: A risk present in any surgery, though minimally invasive procedures like arthroscopy have a lower risk.
- Blood Clots: Although rare, there is a risk of developing blood clots in the veins, particularly in the legs.
- Nerve or Blood Vessel Damage: There is a small risk of damage to nerves or blood vessels surrounding the shoulder.
- Anaesthesia Complications: Reactions to anaesthesia, while uncommon, can occur.
- Persistent Pain or Stiffness: In some cases, patients may continue to experience pain or stiffness in the shoulder after surgery.
Preparing for Shoulder Arthroscopy
Preparation for shoulder arthroscopy involves several steps to ensure the safety and effectiveness of the procedure:
- Medical Evaluation
Patients may undergo a thorough medical examination to assess their overall health. This evaluation can include blood tests, an electrocardiogram (EKG), and chest X-rays. - Medications Review
Informing the orthopaedic surgeon about any medications, including over-the-counter drugs and supplements, is crucial. Certain medications, especially those that affect blood clotting like aspirin or blood thinners, may need to be stopped before surgery. - Preoperative Instructions
The orthopaedic surgeon will provide specific instructions regarding bathing, eating, and medication adjustments before the surgery. - Shoulder Imaging
Additional imaging studies, such as an MRI or CT scan, might be requested to provide the surgeon with the most recent and detailed view of the shoulder’s condition. - Anesthesia Discussion
A meeting with the anesthesiologist before the procedure is important to discuss the type of anaesthesia to be used. Shoulder arthroscopy can be performed under general anaesthesia, where the patient is asleep, or regional anaesthesia, where only the shoulder area is numbed.
What Can You Expect During a Shoulder Arthroscopy Procedure?
The shoulder arthroscopy procedure is typically performed in a hospital or outpatient surgical centre.
- Anesthesia Administration: Depending on the decision made during the preoperative phase, either general or regional anaesthesia will be administered to ensure the patient is comfortable and pain-free during the procedure.
- Positioning: The patient is positioned in a way that provides the orthopaedic surgeon with optimal access to the shoulder joint. This positioning is typically either sitting up (beach chair position) or lying on the side (lateral decubitus position).
- Incision and Access: Small incisions, usually about a half-inch long, are made around the shoulder. The arthroscope is inserted through one of these incisions. Sterile fluid is also pumped into the joint to expand the space and provide a clearer view.
- Diagnosis and Treatment: The surgeon uses the arthroscope to examine the shoulder joint, diagnose the issue, and guide other small instruments for treatment. This can involve repairing torn tissues, removing loose bodies, or other corrective actions depending on the specific condition.
- Closure and Bandaging: Once the procedure is complete, the incisions are closed with stitches or small bandages. In some cases, a temporary drainage tube may be inserted to prevent fluid accumulation.
Postoperative Care and Recovery
The recovery period following shoulder arthroscopy can vary depending on the specific procedures performed and the individual’s overall health. Key aspects of postoperative care and recovery include:
Pain Management
Patients typically experience some pain and discomfort after the procedure. Pain management may include prescribed medications or over-the-counter pain relievers. Ice packs can also help reduce swelling and pain.
Immobilisation
The shoulder may need to be immobilised with a sling for a period of time post-surgery. The duration of immobilisation depends on the type of surgery performed.
Physical Therapy
Rehabilitation plays a critical role in recovery. A physical therapist will typically guide the patient through exercises to improve shoulder strength and flexibility. The rehabilitation program is tailored to the patient’s specific surgical procedure and overall goals.
Wound Care
Keeping the surgical area clean and dry is important. Patients will receive instructions on how to care for their surgical wounds, which may include changing dressings and identifying signs of infection.
Follow-Up Appointments
Regular follow-up appointments with the orthopaedic surgeon are necessary to monitor the progress of recovery. These appointments are also opportunities to adjust pain management and rehabilitation plans as needed.
Activity Modification
Gradual resumption of daily activities is recommended. Patients are usually advised to avoid strenuous activities or heavy lifting for a period of time.
Monitoring for Complications
While complications are rare, it is important to be vigilant for signs such as excessive pain, redness, swelling, or fever, which could indicate infection or other issues.
Patient Feedback
Dr. Kau Chung Yuan
MBBS (S’pore)
MRCS (Ireland)
MMed (Ortho)
FRCSEd (Ortho)
Dr Kau (许医生) is a Fellowship trained Orthopaedic Surgeon with a subspecialty interest in Hip and Knee surgery and has been in practice for more than 15 years.
He is experienced in trauma and fracture management, sports injuries, and joint replacement surgery.
- Fellow of the Royal College of Surgeons Edinburgh, Orthopaedics (FRCS, Edin) 2014
- Master of Medicine (Orthopaedics), Singapore (MMed) 2013
- Member of the Royal College of Surgeons Ireland (MRCS, Ire) 2009
- Bachelor of Medicine and Surgery (MBBS, Singapore) 2004
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Frequently Asked Questions (FAQs)
How Long Does It Take to Recover from Shoulder Arthroscopy?
Recovery times can vary depending on the specific procedures performed and individual factors. Typically, patients may start to resume light activities within 2 to 4 weeks post-surgery.
However, full recovery, especially for more extensive procedures, can take anywhere from 4 to 6 months. Adherence to the orthopaedic surgeon’s postoperative instructions and active participation in physical therapy are crucial for a successful recovery.
Is Shoulder Arthroscopy Painful?
Some pain and discomfort are expected after the surgery, but it is typically less severe than with open shoulder surgery. Pain management strategies, including medications and ice, are used to control discomfort during the recovery period.
When Can I Return to Work After Shoulder Arthroscopy?
The timeline for returning to work depends on the nature of the job and the extent of the surgery. For sedentary jobs, some people may return within a few days to a week, while physically demanding jobs may require a longer recovery period.
How Successful Is Shoulder Arthroscopy?
The success of shoulder arthroscopy depends on the specific condition being treated, the skill of the orthopaedic surgeon, and the patient’s adherence to postoperative care and physical therapy. In general, it has a high success rate, particularly for conditions such as rotator cuff repairs and removal of loose bodies.
How Long Does The Actual Shoulder Arthroscopy Procedure Take?
The duration of the shoulder arthroscopy procedure typically depends on the complexity of the specific condition being treated. For simpler procedures, such as a diagnostic arthroscopy or minor repairs, the surgery may last approximately 30 to 45 minutes.
More complex procedures, like extensive rotator cuff repairs, can take up to 2 to 3 hours. The exact time also varies based on individual patient factors and the orthopaedic surgeon’s technique.