Shoulder Arthroscopy

Shoulder Arthroscopy is now  one of the common procedures at our clinic. The Shoulder joint is one of the big joint which allows a good access to all its areas to Arthroscopy. The fact that it has a big ball and a shallow cup gives a straight access to arthroscopic surgeon  to asses all areas and to almost all pathologies.

Shoulder Arthroscopy is a simple procedure In which through a small puncture portal at the back of the shoulder a Arthroscope (Telescope) of 4.5 mm is introduced into the shoulder joint proper and a detailed examination and testing of each and every structure of the joint is performed. The head of Humerus(the arm bone), the glenoid(shoulder blade –forming the cup), the biceps, subscapularis muscle, the rotator cuff, the ligaments both in front and back of shoulder are commonly  examined . This helps in picking up of common problems like early arthritis of shoulder, infective arthritis(septic lesions), Rheumatoid arthritis, biceps tear, SLAP lesions, Rotator cuff lesion, impingement syndrome, ligament tear, recurrent dislocation of shoulder(Bankart lesion), instability, hyper laxity, laberal tear and cyst, Hills-sach’s lesion, Frozen shoulder, loose body, bursitis, tendonitis  etc. The other joint in shoulder joint complex subacromial joint, acromio-clavicular joint are easily examined giving access to rotator cuff lesions, acromion pathology, clavicular problems and can be dealt  satisfactorily.

Shoulder Arthroscopy is a daycare procedure where 80% of the shoulder problems can be assed  and treated with a key hole access with very low morbidity and a very short (only one day) stay in hospital. The shoulder arthroscopy is performed through a very cosmetic approach with small incision 4.5 mm at the back of shoulder in the strap region along with one and sometimes two in the front which is almost invisible.

In shoulder arthroscopy the patient is put in either semi sitting or lying position with hand by the side. The arthroscope is introduced into the shoulder  from the back access. The telescope is connected to a high power  camera which displays the picture on the TV monitor. Fluid like saline/glycine are used to inflate the joint  and make the movement of telescope easy. Surgeon is able to visualize and access the structures that we have mentioned above and they are further tested by a hook for the integrity and  also for any existing pathology  and also extent of pathology. 

The hook is introduced by 2nd access portal anteriorly  (in front of shoulder).Once the pathology is identified ,it is treated with the help of very specialized instruments like arthroscopic shoulder punches , drills, suture passing devices etc.

After the procedure the arm is kept in an immobilizer and patient is discharged home in the evening . Doctor  review is organized at his office in 48 hour and depending on the procedure done, mobilization  is started . Rehab is a very important part of shoulder arthroscopy..

The commonest pathology in shoulder is recurrent dislocation which is very elegantly addressed by shoulder arthroscopy instead of an unsightly  scar of an open stabilization of shoulder  the  procedure is accomplished  with 3 small tiny 5-6 mm marks .Shoulder arthroscopy  in fact is  able to address the problem better because the visualization of the pathology  i.e.  bankart lesion  is much better  and under shoulder arthroscopy control ,the bony bed is prepared and 2-3 anchors are seated on the bone on which the capsule is closed in to obliterating the defect in capsulo-labral complex. The rehab is quick  and in 3 months patient is able to  regain full ROM as compared to open  where rehab last for  4-5 months and still some restriction of movement persist .

The other common pathology  is rotator cuff tear where the rotator cuff muscles are torn from their attachment on the humeral head which can be  properly reattached by shoulder arthroscopy .Again by 3 small 5-6 mm marks the full procedure is accomplished. Not only that , it address the pathology anatomically with help of rotator cuff anchors. Shoulder arthroscopy allows t to reconstruct the broad anatomical footprint of rotator cuff and now the old single row cuff repair has been replaced by double row repair giving even better functional result of the repair.