Diagnostic or therapeutic, shoulder arthroscopy involves the practice of very small skin incisions at the shoulder level and the use of an instrument called an arthroscope.
Shoulder arthroscopy procedures require some preparation, which is however very simple to perform.
After a shoulder arthroscopy, everything related to recovery, healing times and return to daily activities depends on various factors, including the purpose of the procedure and the attention that the patient pays to physiotherapy rehabilitation.
Brief anatomical recall of the Shoulder
- The shoulder is the even region of the trunk, located in a latero-superior position, on which three very important bones meet: the clavicle, the scapula and the humerus.
- At the shoulder level, there are 5 joints: the scapulohumeral joint, the acromioclavicular joint, the sternoclavicular joint, the scapulothoracic joint and the subdeltoid joint. upper limbs, whose name is rotator cuff, and the tendon origins of the brachial biceps muscle.
Who practices Shoulder Arthroscopy?
Shoulder arthroscopy is one of the skills of the orthopedic doctor, especially the one who specializes in the diagnosis and treatment of shoulder pain.
, did not provide enough data to make a definitive diagnosis of a shoulder problem.
Shoulder arthroscopy for diagnostic purposes allows to identify / confirm conditions such as:
- The injury of one or more components of the rotator cuff;
- Calcific tendonitis of the shoulder, a pain characterized by the formation of calcium deposits on one of the tendons of the rotator cuff;
- Subacromial impingement syndrome (o impingement subacromial);
- The injury of one or more ligaments of the various shoulder joints (possible outcome of a shoulder dislocation);
- The lesion of the cartilage constituting the glenoid labrum of the scapulohumeral joint (possible outcome of a dislocation of the shoulder);
- The long head injury of the brachial biceps muscle (N.B: sometimes this type of injury is associated with the lesion of the glenoid labrum).
Shoulder arthroscopy also offers the possibility of clearly highlighting the results of arthrosis in the shoulder joint, such as osteophytes.
It may happen that a "shoulder arthroscopy performed initially for diagnostic purposes becomes therapeutic, when the performing physician has clarified the present problem and has decided to resolve it during the same operation.
Shoulder Arthroscopy with Therapeutic Purpose
Shoulder arthroscopy for therapeutic purposes is indicated in the presence of joint or muscle-tendon problems that have proved resistant to non-surgical treatments or can only be cured by surgery.
Shoulder arthroscopy for therapeutic purposes allows to carry out:
- Repair of lesions affecting one of the constituent elements of the rotator cuff;
- Repair of injuries to one of the ligaments belonging to the shoulder joints;
- The cleaning of tendons suffering from the presence of calcifications;
- Repair of damage to the glenoid labrum;
- The decompression, in the presence of subacromial impingement syndrome, of the tendon of the supraspinatus muscle;
- The repair of injuries affecting the origin of the long head of the brachial biceps muscle;
- The elimination of osteophytes due to arthrosis.
What is the typical patient?
Usually, shoulder arthroscopy has for patients:
- The elderly with arthrosis problems in the shoulder;
- Those who practice contact sports (e.g. rugby, boxing, judo) and sports in which the repeated lifting of the upper limbs above the head is required (e.g. volleyball, tennis, basketball, bodybuilding, artistic gymnastics);
- Those who carry out a "work activity that involves the repeated lifting of the upper limbs above the head (eg: porter, warehouse worker).
Tests to establish the patient's suitability
The cognitive clinical examinations basically consist of: an accurate physical examination, a complete blood test, a cardiological examination and a thorough evaluation of the clinical history.
The use of these investigations serves to establish whether or not there are the health conditions essential for the success of the shoulder arthroscopy operation.
Pre-operative rules
The pre-operative rules are indications that the patient must follow to the letter, in order for the shoulder arthroscopy to be successful.
These indications consist of:
- Discontinue any anticoagulant drug therapy to avoid excessive blood loss from surgical incisions.
- On the day of the procedure, have a complete fast for at least 8-10 hours (you can only drink water a few hours before the procedure).
- To return home, ask for support from a family member or friend, because anesthesia impairs attention and vigilance skills.
For shoulder arthroscopy procedures, orthopedists tend to use general anesthesia; in some cases, however, they also use local anesthesia combined with mild general anesthesia.
The anesthetist is practiced by an anesthetist, that is, a doctor specialized in anesthetic and resuscitation practices.
General anesthesia causes the patient to fall asleep (who is therefore unconscious) and makes him insensitive to any type of stimulus (painful or not).
Operational phase
The operative phase of shoulder arthroscopy begins after the anesthetist confirms that the anesthesia has taken place.
This crucial phase of the procedure is entirely up to the orthopedist and foresees in the order:
- Hair removal (only if necessary) and disinfection of the entire shoulder area, so as to minimize the risk of infection;
- The practice of a mini-incision (maximum one centimeter) at the level of the shoulder;
- Through the mini-incision just made, the injection of a saline solution with a detergent action towards the articular and muscle-tendon structures, and the introduction of the arthroscope;
- The patrol, using an arthroscope, of the inside of the shoulder, in search of the problem to be diagnosed or treated;
- The practice of "another or two other mini-incisions, in order to insert the surgical instruments necessary to treat the present / detected problem;
- At the end of the therapeutic action, the extraction of the arthroscope and any surgical instruments;
- The suturing of the mini-incisions through absorbable stitches and the application of a harness or a band on the shoulder, in order to protect the latter and limit the most abrupt movements.
It should be noted that when shoulder arthroscopy is therapeutic, the orthopedist could make all the necessary incisions at the same time.
Is Shoulder Arthroscopy painful?
Because it is performed under general anesthesia, shoulder arthroscopy is not painful.
How long does it last?
Shoulder arthroscopy procedures can last from 15 to 30 minutes, when they are diagnostic only, and from 40 to 60 minutes, when they are therapeutic (in these circumstances, the complexity of the pathology to be treated has a decisive influence).
, dizziness and lightheadedness.What are the after-effects of the surgery?
In the first few days following a shoulder arthroscopy procedure, the shoulder will be painful and swollen, so that daily activities such as washing or dressing will be difficult; however, unless they are persistent, pain and swelling should not be alarming, as they are more than normal consequences of the procedure in question.
As for the surgical incisions, they heal within 7-14 days.
What can help relieve pain and swelling?
- To rest;
- Take a pain reliever (e.g. acetaminophen, aspirin and ibuprofen);
- Make ice packs (4-5 packs a day lasting 15-20 minutes);
- Sleep with the trunk slightly elevated or in a reclining chair.
When is resorption of the sutures expected?
The reabsorption of the sutures occurs in the first 7-14 days following the surgery.
How long should the shoulder harness be kept?
Generally, the sling (or band) specifically applied to the shoulder at the end of the arthroscopy must remain in place for at least one week; however, if the condition undergoing treatment was particularly serious, the time spent by this guardian could be lengthened.
;It should also be noted that there is a remote possibility that shoulder arthroscopy fails in its purpose and that it needs to be repeated.
