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The shoulder is a shallow ball and socket joint. This allows fantastic range of movement. The joint capsule, ligaments and rotator cuff muscles are important for shoulder stability, but also need to be flexible and elastic to allow movement to occur. It is made up of three bones: your upper arm bone (humerus), your shoulder blade (scapula), and your collarbone (clavicle).
Your doctor may recommend shoulder arthroscopy if you have a pain that does not respond to conservative/ nonsurgical treatment. Nonsurgical treatment includes rest, physical therapy, and medications or injections that can reduce inflammation. Inflammation is one of your body’s normal reactions to injury or disease. In an injured or diseased shoulder joint, inflammation causes swelling, pain, and stiffness.
Injury, overuse, and age-related wear and tear are the major reasons for most shoulder problems. Shoulder arthroscopy may provide relief from painful symptoms of many problems that damage the rotator cuff tendons, labrum, articular cartilage, and other soft tissues around the joint.
Common arthroscopic procedures include:
Repair for recurrent shoulder dislocation
Arthroscopy is a popular surgical treatment that is minimally invasive in its technique. It is a medical practice through which orthopedic surgeons inspect, diagnose, and repair the problem areas inside a joint. The word arthroscopy is derived from the Greek words, ‘arthro’ (joint) and ‘skopein’ (to look). The term literally stands for ‘to look within the joint’. Since 1970, shoulder arthroscopy has been performed it has proven to be beneficial as a treatment in comparison to the traditional process. Improvements to shoulder arthroscopy continue to occur every year as new instruments and techniques are developed.
Shoulder arthroscopy is often used to visualize, diagnose, and treat various problems inside the shoulder joint and in the space surrounding the rotator cuff. The rotator cuff comprises a group of muscles and their tendons that form a cuff over the shoulder joint. These muscles and tendons hold the arm in the shoulder joint and help the shoulder move in different directions offering you immense flexibility. The tendons in the rotator cuff can tear when they are overused or injured.
During the surgery, small incisions about 1 centimeter each are made that allow the surgeon to insert specialized instruments such as the arthroscope – a pencil-sized tool that contains magnifying lenses and a light source. A small camera is attached to the device that projects a clear image of the shoulder joint and its internal structure on a TV monitor. These include all the tissues of your shoulder joint and the area above the joint such as cartilage, bones, tendons, and ligaments.
Arthroscopic shoulder surgery can treat a variety of common shoulder ailments, including arthritis, tendonitis, laberal tears and shoulder instability among others. Ususally, in cases where other treatment routes such as physical therapy, anti-inflammatory medications, rest, etc, do not show results, than arthroscopy can be considered.
An orthopedic surgeon may do one or more of these procedures during the shoulder operation subjective to the damage in the patient’s joints. Common arthroscopic procedures include:
Once the surgery is complete, the incisions will be closed with stitches and covered with a dressing or bandage). Most surgeons take pictures from the video monitor during the procedure to show you what they found and the repairs that were made.
There are very few cases of complications in arthroscopy surgery which may include bleeding, infection, blood clots, nerve or blood vessel injury, persistent pain and the need for further surgery.
The shoulder joint is among the most flexible joints in your body. It is a ball-and-socket joint and is made up of three bones: the upper arm bone (humerus), shoulder blade (scapula) and collarbone (clavicle). The ball at the top end of the arm bone fits into the small socket ‘glenoid’ of the shoulder blade to form the shoulder’s glenohumeral joint. This is surrounded by the soft tissue labrum. The articular cartilage which is a smooth, durable surface on the head of the arm bone, along with the thin inner lining synovium of the joint allows the smooth motion of the shoulder.
The shoulder joint also comprises a thin sheet of fibers called capsule that surrounds the shoulder joint which allows a wide range of motion, yet provides stability. The rotator cuff is a group of muscles and tendons that attach your upper arm to your shoulder blade and is an integral part of the joint. The rotator cuff covers the shoulder joint and joint capsule. The muscles attached to the rotator cuff enables one to move and rotate their arms in multiple directions such as front, above, to the side, and behind your body.
But with this flexibility, the shoulder also becomes vulnerable to instability and injury. Timely and proper diagnosis helps avoid severe repercussions later and treat the joint before the condition worsens. If the complication or ailment in the shoulder is quite serious, then the joint surgeon may go for open shoulder surgery instead of arthroscopy.
While the orthopedic surgeon before recommending any surgery will try a range of non-surgical treatments such as anti-inflammatory medication, ice & heat application, physical therapy, ask you to follow a list of certain dos and don’ts, etc. But surgery may be advised if:
Though experienced joint replacement and orthopedic surgeons will first opt for arthroscopic surgery as it is minimally invasive and offers quicker recovery, but in some cases if the joint is majorly affected, then open surgery where even total shoulder replacement will have to be done. A large incision is made in the shoulder wherein the shoulder muscle is detached to give the surgeon direct access to your tendon. This is helpful if your tendon or shoulder joint needs to be replaced.
Arthritis of the shoulder can be treated with a total shoulder replacement for patients who have severe shoulder pain and minimum ability of shoulder movement. The procedure involves removing the damaged and degenerated part of the shoulder and replacing them with artificial components, just as in other joint replacement surgeries such as hip or knee replacement surgery.
In recent years, a new type of shoulder replacement, the “Reverse” shoulder has gained popularity amongst shoulder surgeons to treat arthritis. In some types of arthritis, these tendons are severely damaged, torn, or non functional. Because of this, an anatomic shoulder has no soft tissue to hold it in place and or to move it.
The design of the reverse shoulder puts the ball on the patient’s own socket, and it is the plastic socket which is placed on the humerus bone. The reverse design has more stability and does not need the tendons to hold it in place. It also is moved by the deltoid muscle, not the rotator cuff tendon, so it is an ideal choice when the damaged shoulder needs new surfaces, but does not have healthy enough soft tissues for stabilization and movement.
Generally speaking, recovery from arthroscopic surgery is typically quicker than open shoulder surgeries. Although with modern technology and high grade infection control the results are good but few basic precautions have to be taken care of such as:
Patients who religiously comply with all the therapies prescribed by their orthopedic surgeon will have the best medical results after surgery. Have a detailed discussion with the orthopedic doctor to ensure that one is able to take the best care of their joint after undergoing surgery.