Shoulder Arthroscopy

What Is Shoulder Arthroscopy?

Shoulder arthroscopy is a minimally invasive surgical procedure that is used to inspect, diagnose, and treat a variety of shoulder conditions. The procedure involves inserting a tiny fiber-optic camera into the shoulder joint via a small incision. This camera allows the inside of the shoulder joint to be visualized by the surgeon on a monitor in the operating room. All of the tissues, including the bones, cartilage, tendons, and ligaments within the shoulder joint are inspected. If repairs are needed, additional incisions are made that allow for insertion of surgical instruments. If there are tears in the muscles, tendons, or cartilage, they are fixed and damaged tissue is removed.

There are benefits associated with having shoulder arthroscopy as opposed to open surgery. These include:

• Less pain and stiffness
• Fewer surgical complications
• Shorter hospital stays
• Less scarring
• Quicker recovery times

However, even though arthroscopic surgery is minimally invasive, it is vital that patients allow adequate time for full healing to occur in order to prevent complications and future injury.

The risks associated with arthroscopic surgery are rare, but they do exist and include:

• Infection
• Bleeding and possible blood clots
• Stiffness of the shoulder
• Weakness of the shoulder
• Damage to the deltoid muscle or tendon
• Blood vessel or nerve injury
• Failure to relieve pain
• Impaired healing

Additionally, there are risks associated with the anesthetic medication used to perform this procedure. These risks include breathing problems and allergic reactions to the medication.

How Is Shoulder Arthroscopy Performed?

There are a variety of arthroscopic techniques for shoulder injuries, including arthroscopic rotator cuff repair, arthroscopic anterior shoulder stabilization (Bankart repair), arthroscopic posterior labral repair, SLAP repair, and biceps tenodesis.

Complete rotator cuff tears require surgical intervention as they will not heal on their own. During a rotator cuff repair, the surgeon will usually remove any loose fragments of tendon, bursa, and other debris from the shoulder joint region. This will make more room for the rotator cuff tendon. Additionally, if any bone spurs are found, they will also be removed. Once the area is cleared, the torn tendon will be sutured back to its original attachment on the humerus.

A SLAP repair is an arthroscopic shoulder surgery that is used to repair a SLAP (superior labrum, anterior to posterior) lesion. This procedure uses sutures to reattach the torn labrum back to the bone of the shoulder socket. Normal functioning is restored after a SLAP repair because the labrum is reattached to its normal position.

An arthroscopic posterior labral repair is performed for patients suffering from a posterior labral tear. The area of the tear is confirmed and the attachment site is cleared of scar tissue and anchors are placed into the glenoid fossa. Sutures are then looped around the labrum and capsule. Knots are then tied that allow the labrum to reattach to the bony edge of the socket.

To repair Bankart lesions, and for individuals suffering from recurrent anterior shoulder dislocations, arthroscopic anterior shoulder stabilization can be performed. This procedure involves reattaching and tightening the torn labrum and ligaments of the shoulder (capsulorrhaphy). Research has suggested that arthroscopic stabilization of traumatic, first-time anterior shoulder dislocations is a safe and effective treatment option. Furthermore, it significantly reduces the recurrence rate of shoulder dislocation in young athletes compared to traditional, non-surgical treatment.

In older individuals, a procedure called biceps tenodesis is often performed as opposed to a SLAP repair. Biceps tenodesis is usually performed on patients who have excessive biceps tendon symptoms or those who have evidence of biceps tendon inflammation visualized on arthroscopy. During this procedure, the attachment of the biceps tendon is cut from the labrum and is reattached to a new position on the humerus. Normal functioning is not always restored with this procedure because the original attachment is not used.

Conditions Related To Shoulder Arthroscopy

Various shoulder conditions can be repaired using arthroscopic techniques. Shoulder arthroscopy may be recommended for individuals who have the following shoulder conditions:

• Labral tears (SLAP tears, Bankart tears, posterior labral tears)
• Shoulder instability (acute and recurrent shoulder dislocations)
• Rotator cuff tears
• Biceps tendon irritation, inflammation, or damage
• Bone spurs
• Inflammation or damage to the lining of the joint
• Arthritis affecting the bones of the shoulder
• Loose tissue fragments
• Shoulder impingement syndrome

Conclusion

Shoulder pain is a common complaint of many patients. Fortunately, many shoulder conditions can be treated arthroscopically. Shoulder arthroscopy is a minimally invasive surgical technique that can often relieve the pain associated with shoulder problems, including labral tears, recurrent or acute shoulder dislocations, rotator cuff tears, biceps tendon issues, bone spurs, inflammation, and arthritis. Risks associated with shoulder arthroscopy are rare but should be thoroughly discussed prior to surgery. Following surgery, ample time should be given to allow for complete healing. Patients are encouraged to discuss their shoulder symptoms with their physician to determine if shoulder arthroscopy is suitable for their condition.

References

1. Bottoni CR, Wilckens JH, DeBerardino TM, D’Alleyrand J-CG, et al. A prospective, randomized evaluation of arthroscopic stabilization versus nonoperative treatment in patients with acute, traumatic, first-time shoulder dislocations. Am J Sports Med. 2002;30(4):576-580.
2. Bottoni CR, Smith EL, Berkowitz MJ, Towie RB, et al. Arthroscopic versus open shoulder stabilization for recurrent anterior instability. A prospective randomized clinical trial. Am J Sports Med. 2006;34(11):1730-1737.
3. Burkhart SS, Lo IKY. Arthroscopic rotator cuff repair. J Am Acad Orthop Surg. 2006;14(6):333-346.
4. Ciccone WJ. Arthroscopic posterior labral repair and capsular shift with a lateralized posterior portal. Arthrosc Tech. 2013;2(4);323-326.
5. Lindley K, Jones GL. Outcomes of arthroscopic versus open rotator cuff repair: A systematic review of the literature. The American Journal of Orthopedics. 2010;39(12):592-600.
6. Mazzocca AD, Brown FM, Carreira DS, Hayden J, et al. Arthroscopic anterior shoulder stabilization of collision and contact athletes. Am J Sports Med. 2005;33(1):52-60.