What is shoulder arthroscopy?
Shoulder arthroscopy is a minimally invasive technique that allows access and treatment of many injuries and diseases of the various structures that make up the shoulder joint. The joint is accessed through 2 or 3 small incisions of less than one centimeter in size.
Arthroscopy has become the technique of choice for shoulder pathology, since it is possible to approach shoulder structures that are difficult to access, allowing a complete view from the inside.
Arthroscopy allows the lesion to be approached with minimal invasion of the joint.
Why is it performed?
Shoulder arthroscopy allows the treatment of shoulder problems that appear in patients with shoulder pain or limitation of movement and that have not improved with medical and physiotherapeutic treatment. For this type of injury, much more complex surgeries were previously required, with longer recovery periods. Specifically, shoulder arthroscopy is used for 4 groups of pathologies:
- Subacromial syndrome
- Rotator cuff tear
- Shoulder instability and shoulder dislocation
- Traumatic injuries: glenoid fractures, acromio-clavicular dislocation and soft tissue injuries.
What does it consist of?
Shoulder arthroscopy is performed with the patient in the operating room, in a semi-sitting position or on the side, with a traction-subjection device of the arm to be operated on. Through a posterior portal of vision the specialist introduces the arthroscope into the gleno-humeral joint and then makes an anterior portal to inspect the joint. Subsequently, he will visualize the subacromial space where the bursa, the rotator cuff and the acromion are located, which are the anatomical structures where the subacromial pathology is located. Once the surgery is finished, the specialist will suture the portals, place a compressive bandage and a sling.
Locoregional anesthesia will be applied at the level of the brachial plexus to numb the nerves that go to the arm, in addition to sedation. In this way the postoperative period will be more comfortable and with less pain than conventional shoulder surgery. The surgery itself lasts between 30 and 90 minutes, depending on the injury and the pathology to be intervened by the specialist in Traumatology.
Normally, after the intervention, the patient will spend one night in the hospital, and will be discharged the following day, with the recommendations to be followed.
Preparation for shoulder arthroscopy
Before the shoulder arthroscopy procedure, the following should be done:
- Previously assess the injury in consultation, so that the specialist can decide the specific aspects of the intervention.
- Inform the specialist of the medication you are taking.
- Perform a preoperative study based on blood count, biochemistry, coagulation, chest X-ray and ECG.
- Do not take solid food or liquids during the 8 hours prior to surgery.
Care after the operation
It is very likely that the patient will feel discomfort in the first days after the operation, as well as swelling. However, this will disappear after a short time, with the medication recommended by the surgeon.
It is also necessary for the patient to wear a sling to immobilize and keep the operated arm at rest for 2 to 4 weeks. The patient should combine the sling with elbow flexion-extensions, as well as moving the fingers of the hand. The specialist will recommend how to do this.
On the other hand, the incisions should not be wet until the stitches are removed, 5-10 days after the intervention. Once the stitches are removed, rehabilitation treatment will be necessary, which may last up to 8 weeks. Gradually, and as the rehabilitation progresses, the patient will be able to do more activities, such as driving and, after 2-4 months, to do physical exercise.
Alternatives to this treatment
The alternative to shoulder arthroscopy will be any conventional surgical technique. However, all of them involve more invasion of the joint and a more complicated postoperative period, with more pain and immobilization time.