Shoulder Issues
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Medical Encyclopedia
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Shoulder arthroscopy
 
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Definition
Shoulder arthroscopy is a type of surgery to
examine or repair the tissues inside or around your shoulder joint. The
procedure uses a small camera, called an arthroscope,
which is inserted through a small incision. If the doctor is going to repair the
joint, small surgical instruments are also used.
Description
The surgeon makes a small incision, about
one-quarter inch (0.25") long, near the shoulder joint. A small camera is
then inserted into the joint. The camera is attached to a video monitor to allow
the surgeon to see inside the joint.
Unlike knee
arthroscopy, most patients are asleep during the surgery. Therefore, you
will be unable to watch the video monitor. A nerve block may be used to numb the
shoulder and arm to help reduce pain after surgery.
Saline (salt solution) is pumped into the
shoulder to expand the joint. This helps the surgeon see the joint and helps
control any bleeding.
The surgeon will look around the entire joint
to evaluate the cartilage, tendons, and ligaments of the shoulder. If damaged
tissues need to be repaired, the surgeon will make one to three additional small
incisions to insert other instruments. These may include a blunt hook to pull on
tissues, a shaver to remove damaged or unwanted tissues, and a burr to remove
bone.
In addition to working on the shoulder joint,
the surgeon often places the camera in the space above the rotator cuff tendons.
(This is called the subacromial space.) The surgeon can evaluate the area above
the rotator cuff, clean out inflamed or damaged tissue, remove a bone spur, and fix
a rotator cuff tear.
At the completion of the surgery, the fluid
is drained from the shoulder, the small incisions are closed, and a dressing is
applied. Most surgeons take pictures of the procedure from the video monitor to
show the patient what was found and what was done.
Indications
Arthroscopy may be recommended for shoulder
problems, such as:
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A torn or damaged cartilage ring (labrum) or ligaments (in cases of
shoulder instability)
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A torn or damaged biceps tendon
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A torn rotator cuff
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A bone spur or inflammation around the rotator cuff
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Stiffness of the shoulder
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Inflammation or damaged lining of the joint
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Arthritis of the end of the clavicle (acromioclavicular joint)
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Risks
The risks for any anesthesia are:
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Allergic reactions to medications
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Problems breathing
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The risks for any surgery are:
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Bleeding
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Infection
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Nerve damage
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Additional risks include:
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Stiffness of the shoulder
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Failure of the surgery to relieve symptoms
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Failure of the repair to heal
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Weakness of the shoulder
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Expectations after surgery
Arthroscopy is an alternative to
"open" surgery that completely exposes the shoulder joint. Arthroscopy
results in less pain and stiffness, fewer complications, shorter (if any)
hospital stays, and possibly faster recovery time.
The expectations vary depending on the
purpose of the surgery. In cases where repair is needed, remember that the body
still needs to heal after arthroscopic surgery, just as if the surgery was done
open. Therefore, the overall recovery time may still be lengthy.
Surgery to fix a cartilage tear is usually
performed because the shoulder is not stable. Many patients have a full
recovery, and the symptoms of instability go away. However, up to 10-20% of
patients can have continued instability of the shoulder even after arthroscopic
repair.
Using arthroscopy for rotator cuff repairs or
tendonitis usually relieves the pain, but it is less predictable how well your
strength will return.
Convalescence
Recovery can take anywhere from one to six
months, depending on the surgery that was performed. Most patients wear a sling
for the first week. If a more extensive repair was performed, the sling may be
worn longer. Pain medications are often used.
When you can return to work or play
sports will depend on the surgery that was performed, ranging from one week to
several months.
For many procedures, especially if a repair
is performed, physical therapy may help you regain the motion and strength of
your shoulder. The length of therapy will depend on the repair that was
performed.
Updated by: Andrew L. Chen, M.D., Steadman-Hawkins
Sports Medicine Foundation, Vail, CO. Review provided by VeriMed Healthcare
Network.

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