Shoulder arthroscopy


Orthopaedic surgery in Lithuania
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When shoulder arthroscopy recommended?
Preparation for shoulder arthroscopy
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Shoulder arthroscopy technique
Possible complications
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Shoulder arthroscopy surgery is a high skill orthopedic operation done using a very small diameter fiber optic camera (arthroscope) inserted into the joint through a small incision. This camera allows the surgeon to see a high definition view of the joint and, if needed, to insert needle-thin instruments through another cut for manipulation. These procedures allow faster healing and less scaring than traditional open surgery. It also has a lesser risk for infection. Sometimes it can be done as a one day surgery.

When shoulder arthroscopy is recommended?

This procedure is performed to repair damaged or torn joint cartilage ring (labrum), ligaments, tendons and in some cases to fix the rotator cuff and shoulder instability.

It can also lessen the pain and improve joint function when joint cartilage is damaged due to a long term inflammation (like rheumatoid arthritis) and to treat shoulder impingement syndrome. It can also help to safely remove loose tissue or cartilage bodies from the joint.

Shoulder arthroscopy operation sometimes is performed on patients whom previous traditional open surgery had failed. The shoulder joint is a very complex structure. Sometimes it is hard to determine a correct clinical diagnosis, therefore arthroscopy is exceptionally helpful in this case. It also can reveal an additional pathology.

Shoulder anrthroscopy operation should be considered for patients with chronic illness only when physiotherapy and exercises combined with anti-inflammatory medication and other conservative treatment have failed. In cases of traumas and rapidly progressing symptoms in may be considered as soon as possible.

This procedure cannot be performed if the joint is severely damaged. In cases like this only traditional open surgery is possible. Other contraindications are active infection or severe illness (such as uncontrolled diabetes mellitus) that effects the anesthesia and the healing process.

Preparation for shoulder arthroscopy

A week or two before the operation drugs that effect blood clotting (like aspirin, naproxen etc) have to be stopped. Also routine preoperative tests and radiogprapic or magnetic resonance images of the shoulder joint and chest are necessary. Electrocardiogram and other tests might be indicated as well. The patient should stop smoking and drinking since bad habits increase the risk of infection and have a negative effect on the healing processes.

At least six to twelve hours before the operation the patient is not allowed to eat or drink anything except water. These fasting instructions are given to greatly decrease the complication rate of general anesthesia.

Shoulder arthroscopy usually begins by putting the patient under general anaesthesia. In some cases local anesthesia can be used as well.

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Shoulder arthroscopy technique

When anaesthesia takes effect, the surgeon injects some sterile fluid into the joint. This is not dangerous and makes more room for manipulation, clears the view and reduces bleeding. After this the surgeon makes a small cut in the skin (less then 1 cm long) and gently separates the deeper tissue to insert the arthroscope into the shoulder. The surgeon then systematically inspects all structures in and around the joint - the bones, the cartilages and the soft tissues. If the problem is clearly identified and manipulations are needed, 1-3 incisions are made for inserting needle like instruments through them. Using these instruments the surgeon can cut, shave, suture, knot ties and do others tasks.

At the end of the surgery the instruments are removed, fluids drained, incisions closed, stitched and dressed with sterile bandages. Usually the procedure takes less than an hour. During the procedure most surgeons take pictures of the view through the arthroscope. If the patient wishes he or she can see them later.

Recovery after shoulder arthroscopy

When arthoscopy is finished the patient usually stays in the hospital for a few hours and if no early complications are present is free to go home. However, a patient is not advised to attempt to drive by himself.

After the procedure the shoulder can be swelled and painful due to natural healing processes. The pain may remain up to a few days or a week and is treated with over-the-counter painkillers such as paracetamol or ibuprofen. The pain can last longer if arthritis is present.

A sling or a special immobilizer is usually needed for a few weeks.

Full recovery usually takes a few months, sometimes up to half a year. Physical therapy and rehabilitation can help to regain motion and heal faster.

Possible complications

Shoulder arthroscopy procedure has the same or similar risks as any other surgical procedure: this includes bleeding, infection, and a formation of a dangerous blood clot.

It also has some specific risks, like shoulder stiffness and weakness, usually due to an injury to a blood vessel or nerve. But these complications are considerably rare due to the small opening and specialized tools used to perform the operation.

Although the procedure has got a very high ratio of success, failures to relieve the symptoms or repair the damage can also occur.

The procedure has got little side effects. Most noticeable are little scars on the skin.

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