Shoulder Arthroscopy

What is Shoulder Arthroscopy?  

Shoulder arthroscopy is a minimally invasive (keyhole) surgical procedure commonly employed by orthopaedic surgeons to examine, diagnose, and treat conditions affecting the shoulder joint. Typically, between 2 to 7 small incisions of around 1 centimetre in diameter are made through the skin, allowing the insertion of a camera to visualize the affected area and perform necessary surgical interventions. 

This procedure is recommended when conservative treatments fail to alleviate persistent shoulder pain caused by injuries, overuse, or age-related degeneration. Shoulder arthroscopy facilitates the resolution of such conditions by restoring normal shoulder function and range of motion. 

Indications for shoulder arthroscopy include: 

  • Diagnostic surgery for persistent pain despite normal test results 
  • Impingement syndrome with subacromial decompression 
  • Rotator cuff repair 
  • Removal of loose cartilage, bone fragments, or inflamed tissue 
  • Labral or SLAP repair 
  • Treatment of Acromioclavicular joint arthritis with distal clavicle excision 
  • AC joint separation 
  • Biceps tenotomy/tenodesis 
  • Release of shoulder lining for Frozen shoulder 

Benefits of shoulder arthroscopy over traditional open surgery include: 

  1. Minimally invasive approach, minimizing damage to surrounding tissues. 
  1. Smaller incisions lead to faster healing and reduced scarring. 
  1. Quicker postoperative recovery, allowing for earlier resumption of shoulder function. 
  1. Reduced blood loss during surgery, resulting in less postoperative pain and faster recovery. 

Even though the vast majority of patients do not have any complications following a shoulder arthroscopy, there are some potential risks associated with surgery, although they are very uncommon. The success rate of surgery in relieving pain and other symptoms is usually in the region of 90-95%. 

  • Infection  
  • Damage to nerves  
  • Temporary swelling or stiffness of the shoulder 
  • Formation of adhesions leading to frozen shoulder 
  • Bleeding or hematoma formation 
  • Hardware-related issues 
  • Failure of the procedure to resolve symptoms 
  • Risks associated with anaesthetic  

The procedure itself is typically performed as a day case under general anaesthesia with a local anaesthetic block. Almost all patients will be discharged on the same day. During the procedure, the patient is positioned in the beach chair position to reduce bleeding and venous pressure. Fluid is continuously infiltrated into the shoulder joint to provide better visualization, and specialized instruments are used to address the identified issues. The surgery usually lasts around an hour. 

After surgery, patients are encouraged to take painkillers as needed to facilitate exercise and physiotherapy. A sling is provided to support the arm and prevent further injury. The sling is prescribed for anything between one day to six weeks depending on the procedure performed. Physiotherapy is initiated early to promote shoulder mobility and reduce stiffness. Follow-up appointments are scheduled for wound checks and further rehabilitation. 

Patients are advised to avoid strenuous activities and protect the shoulder from injury during the recovery period, which typically spans several weeks to several months depending on the complexity of the initial problem. Massaging the wound with moisturizing cream helps reduce scar sensitivity and promotes healing. Gradual return to normal activities is guided by the surgeon and physiotherapist based on individual progress and surgical outcomes.