Shoulder arthroscopy is a procedure in which orthopedic surgeons inspect and repair pathology in the shoulder joint. The operation is performed at a hospital or outpatient surgical center and usually takes 30-45 minutes. A thin camera is inserted into the shoulder through 2 or 3 incisions each ¼ inch long. Sterile saline fluid is "pumped" into the shoulder joint for a clear view inside the shoulder capsule. Small hand and motorized tools are used to cut off torn flaps of cartilage, smooth rough joint surfaces, and grasp/remove loose tissue. The patient is discharged to home an hour or two later the day of surgery. Patients typically take oral pain medications for less than a week, return to desk work in 2-4 days, and are usually fully recovered in 2-4 weeks (for simple arthroscopic procedures such as subacromial decompression, labral debridement and distal clavicle excision to treat impingement). I recommend the patient wear a sling for only the first few days after surgery for comfort.
Patient outcomes vary, but can be predicted based on age and diagnosis. Generally, patients younger than 50 with only one problem (only a bursitis, only a small area of joint surface damage or only acromioclavicular joint [ACJ] arthritis) tend to have a higher rate of successful surgical outcomes. Patients over 50 with more than one disease process have less predictable outcomes after shoulder arthroscopy.
This surgical procedure is performed to treat impingement by creating more space for the rotator cuff. This procedure removes the inflamed portion of the bursa giving the rotator cuff more space thus reducing impingement symptoms.
Bone Spur Removal
This procedure is often performed concurrently with a subacromial decompression. It is done to remove the underside of the acromion (tip of the shoulder blade) that may be “digging” into the rotator cuff causing inflammation and bursitis.
Distal Clavicle Excision
Removing the outer third of the clavicle may help alleviate some pain and loss of motion caused by impingement and/or arthritis. The area where the bone is removed will fill-in with scar tissue which is more flexible reducing pinching of soft tissues against hard bone.
This procedure involves the surgeon removing the damaged portion of the biceps tendon and reattaching the remaining portion of the tendon to the humerus. Removing the damaged tissue can alleviate pain associated with the biceps tendon.
This differs from the biceps tenodesis in that for this procedure, the biceps tendon is released entirely and is not repaired or reattached to the humerus. This may have better results for a biceps tendon with more severe damage. Although the biceps tendon is cut near the shoulder, there is very little strength loss at the shoulder or elbow.
Labrum Repair / Removal
During this procedure, the surgeon will first evaluate the rim of the labrum as well as the integrity of the biceps tendon. If the labral tear does not involve the tendon the surgeon may merely trim the torn flap of labrum. Often times, when the biceps tendon is involved, the surgeon may need to repair and reattach the labrum and tendon using absorbable sutures or metal anchors. If the tear involves the lower portion of the labrum, the capsule is sometimes stabilized and “tightened down” by folding over the tissues with sutures.
Rotator Cuff Repair
Under normal circumstances, a rotator cuff repair is performed as an arthroscopic procedure. Although more invasive, occasionally an open procedure is required to perform the repair. If the rotator cuff is partially torn, the portion that is still intact will be cut and the entire tendon will be reattached to the surface of the bone. Regardless, with any repair of the rotator cuff, the tendon is brought back to the attachment site at the humerus and is secured with either absorbable or metal anchors.