Arthroscopy of the Shoulder

Introduction

Shoulder arthroscopy is a surgical technique in which an arthroscope is inserted into the shoulder joint.  An arthroscope is a small fibre-optic viewing instrument made up of a tiny lens, light source which is connected to a video camera. This camera displays images on a television screen. By using the arthroscope, the surgeon is able to visualise the shoulder joint – cartilage, ligaments and rotator cuff.  Using this portal, fluid is introduced into the joint to expand the joint and allow adequate vision and access. Another portal is used to introduce small instruments to enable repair of the damaged shoulder. The advantage of arthroscopy is that it uses small incisions and is much less traumatic to the muscles, ligaments and tissues and so allowing for quicker recovery. It is a day procedure and the patient is able to return home on the same day as surgery.

Indications for shoulder arthroscopy

  • Rotator cuff tear.
  • Sub-acromial decompression (shoulder impingement surgery).
  • Damaged cartilage.
  • Shoulder stiffness.
  • Removal of loose bodies.
  • Washout and debridement of shoulder infection.
  • Labral tears.
  • Biceps tendinopathy.
  • Treatment for frozen shoulder.

Peri-operative patient education

The patient’s condition is evaluated by clinical history and physical examination. Shoulder X-ray, ultrasound and MRI scans help to support clinical diagnosis. If shoulder arthroscopy is recommended, Dr Lane will give his patients a comprehensive explanation of the procedure, expected recovery and surgical risks. Educational leaflets supplied by the Australian Orthopaedic Association are also supplied for patient information.

Pre-operative Instructions

Non-steroidal anti-inflammatory drugs such as Feldene, Naprosyn and Celebrex should be stopped 5 days before surgery. These drugs increase the risk of bleeding. Aspirin or other blood thinning drug use prior to surgery should be discussed with Dr Lane as it would depend on the patient's underlying medical condition. The shoulder to be operated on should be free of cuts, scratches or sores as this can increase the risk of post-operative infections. If there is damage to the skin, surgery will be postponed until healed.

Shoulder arthroscopy is performed as a day procedure. The reception staff will give clear instructions about your admission location and time. Do not eat or drink 6 hours before your surgery.

Bring to Hospital:

  • List of medications.
  • Relevant X-rays or MRI scans.
  • Medicare, DVA or Private Health Care Cards.

Once your details have been taken in the admissions area:

  • The duty nurse will take your clinical details and baseline observations.
  • Theatre gown is given to wear.
  • The shoulder to be operated on will be inspected by the nursing staff, washed with anti-septic solutions and covered with sterile drape.
  • TED stocking will be given to wear to reduce the risk of deep venous leg thrombosis after surgery.

You will be taken to the theatre complex by the nursing staff and then into the anaesthetic bay where you will meet Dr Lane and your anaesthetist.

Shoulder arthroscopies are performed under a general anaesthetic. The anaesthetist may also give you a regional nerve block when you are asleep to help with post-operative pain.

Procedure

When asleep, the patient will be positioned onto their side and weighted traction applied to the arm to hold it upwards, thus allowing access into the shoulder joint.The skin of shoulder, arm and upper chest is prepped with anti-septic solution and then the patient covered with sterile drapes with a window for the arthroscopic site. Dr Lane makes a small incision around back of the shoulder to introduce the arthroscope and further 1 -2 incisions to enable small probes and instruments to perform the surgery.

Once surgery is complete, the incisions are usually closed with steri-stripes and occasionally sutures. The wound is covered with sterile primapore and dressings. The patient is put in a sling for comfort. Shoulder arthroscopy usually takes about an hour.

The patient is then taken to recovery. When adequately awake, observations stable and able to eat and drink, the patient is discharged home. A script for pain relief medication is given to the patient. It is important that someone takes the patient home.

Post-operative Instructions

The outer dressings can be removed after 3 days and primapore left intact and dry until seen at the follow-up visit. There may be slight swelling of the shoulder after surgery which is normal. You can resume with normal activities when you feel comfortable. Please schedule an appointment with Dr Lane 10–14 days following surgery. At this visit, he can monitor your progress and discuss the operative findings again, as well as providing you with photos of the procedure.

Risks

General risks associated with Anaesthetic (rare)

  • Death.
  • Myocardial Infarction (heart attack).
  • Stroke.
  • Pneumonia.
  • Deep Venous Thrombosis.

Local risks (Uncommon)

  • Bleeding.
  • Nerve damage.
  • Shoulder stiffness.
  • Infection 

Patients with diabetes, obesity, pre-existing multiple medical conditions and smokers will have an increased risk of adverse complications.