ARTHROSCOPIC SHOULDER SURGERY
What is arthroscopic shoulder surgery?
Shoulder arthroscopy is a minimally invasive surgical technique for repairing different structures in and around the shoulder joint. As with other types of minimally invasive surgery, shoulder arthroscopy uses highly specialized instruments inserted through small incisions. By contrast, traditional open surgery uses one or two large incisions. Both surgeries achieve the same goals, but arthroscopy does it with much less trauma to the normal structures around the shoulder. Typical arthroscopic surgical times range from 1 hour for simple procedures to 4 hours for complicated surgeries.
What are the advantages of arthroscopic shoulder surgery?
Traditional, open shoulder surgery involves making large incisions in the skin, moving aside or cutting a muscle or tendon that is overlying the shoulder joint, performing the surgical repair of the damaged structure, and then repairing the cut muscle or tendon prior to closing the skin incision. This type of surgery has proven effective and generally yields good results, but has problems. Patients will have increased pain after open surgery, and, occasionally, the previously normal muscle or tendons that have to be cut to get into the shoulder don’t heal well, causing further problems. For a small number of patients, such as those needing shoulder joint replacement and surgery for a fracture, open shoulder surgery is still the method of choice.
The vast majority of shoulder problems can now be treated with arthroscopic techniques. Arthroscopic surgery has been shown to avoid many of the complications of open surgery, significantly decrease post-operative pain, reduce stiffness, and eliminate the need for a post-operative hospital stay.
Who should have arthroscopic shoulder surgery?
All patients with shoulder problems should first try non-operative treatment methods. If these fail to solve the problem, arthroscopic surgery may be recommended. Shoulder arthroscopy is commonly performed for the following problems:
- Shoulder instability, including dislocations.
- Tears of the rotator cuff (the muscle group that helps move the shoulder)
- Bone spurs or bursitis of the shoulder
- Calcific tendinitis (calcium deposits in the rotator cuff)
- Arthritis of the end of the clavicle (acromioclavicular joint).
- Mild arthritis or damage to the shoulder joint
- A damaged biceps tendon
- Stiffness of the shoulder
What preparations will be needed prior to surgery?
The surgeon may have the patient see a primary care doctor prior to surgery to make sure there are no medical conditions that may cause a problem with the surgery. There will be a pre-op appointment prior to the day of surgery that will include a history and physical examination, possible blood samples, possible EKG, and a visit with a member of anesthesia department. Patients should not eat or drink anything after midnight on the night before surgery.
What type of anesthesia will be required?
Shoulder arthrocopies are done under general anesthesia.
Is there a hospital stay after surgery?
Most shoulder arthroscopies are performed on an outpatient basis. The patient will arrive about 2 hours prior to surgery and often leave approximately 2 hours after the surgery is finished. Patients will need someone to drive them home.
What kind of a recovery can be expected?
Patients typically can start some gentle shoulder and elbow stretches on the first day after surgery. Patients typically can remove the dressing and the pain pump tubing in the evening of the fourth day after surgery and start bathing that night.
The length of recovery depends on what was done. For patients who did not require repair of any major structures, normal activities including driving and work can be resumed as soon as the patient determines that they can be safely performed.
For patients who had repair of major structures such as the rotator cuff or the shoulder ligaments, activities will have to be restricted. Because arthroscopic surgery is less painful, patients often feel tempted to do too much too soon! It is very important for patients to follow the detailed physical therapy protocols exactly, as they are designed not only to help you regain function, but also to protect the delicate structures as they heal. In the case of rotator cuff repair or instability repair, patients must wear a sling, and cannot drive for 4 weeks.