Shoulder Arthroscopy Overview: Shoulder arthroscopy is a minimally invasive surgical procedure used to diagnose and treat various shoulder joint problems. It involves inserting a small camera, called an arthroscope, into the shoulder joint through small incisions. This allows the surgeon to view the joint's interior on a screen and perform necessary repairs using specialized instruments, which reduces recovery time and pain compared to traditional open surgery.
Indications for Shoulder Arthroscopy:
Rotator Cuff Tears: Arthroscopy is commonly used to repair both partial and complete tears of the rotator cuff tendons, which can cause pain, weakness, and limited range of motion.
Shoulder Impingement Syndrome: This condition involves inflammation or damage to the tendons or bursa, leading to pain and restricted shoulder movement. Arthroscopy can help in removing inflamed tissue or adjusting the bone structure to relieve impingement.
Labral Tears: The labrum, a ring of cartilage around the shoulder socket, can tear, causing instability or pain. Arthroscopy allows for repair or debridement of the labrum.
Shoulder Instability: This includes conditions where the shoulder joint is prone to dislocations or subluxations, often corrected with arthroscopic stabilization procedures.
Loose Bodies: Arthroscopy can remove loose pieces of bone or cartilage within the joint that might cause pain or locking sensations.
Frozen Shoulder: For those with adhesive capsulitis, arthroscopy can help release the tight joint capsule.
Arthritis: Debridement of damaged cartilage or removal of bone spurs in cases of osteoarthritis can be managed arthroscopically.
Techniques of Shoulder Arthroscopy:
Patient Positioning: Patients can be positioned in either the beach chair or lateral decubitus position based on surgeon preference and the specifics of the procedure. The beach chair position is semi-seated, while lateral decubitus has the patient lying on their side.
Portals: Surgeons make small incisions or portals through which the arthroscope and instruments are inserted. Common portals include posterior, anterior, and sometimes additional portals depending on the surgical need.
Visualization and Repair:
Diagnostic: Initially, the arthroscope is used to assess the joint's condition. This involves a systematic evaluation often described as a "2-circle approach" to ensure all areas of the glenohumeral joint are viewed.
Surgical Techniques:
Debridement: Removal of damaged tissue or loose bodies.
Repair: For rotator cuff tears, this might involve sutures and anchors to reattach the tendon to bone. Labral tears might be repaired with sutures.
Subacromial Decompression: Involves removing part of the acromion bone to create more space for the rotator cuff tendons.
Anaesthesia: Often includes a combination of general anesthesia with regional blocks like interscalene nerve blocks for postoperative pain control.
Fluid Management: Arthroscopic procedures use fluid to expand the joint for better visibility, managed through systems that control pressure and flow to minimize complications like fluid extravasation.
This procedure has become standard due to its benefits in terms of recovery, pain management, and minimal disruption to the shoulder's anatomy. However, the specifics of the technique can vary based on the surgeon's experience and the patient's unique pathology.