What is Shoulder Arthroscopy?
Shoulder arthroscopy is a minimally invasive or so called “key-hole” surgery. It allows direct inspection, diagnosis, and treatment of many shoulder conditions via small surgical incisions. Mr Lyons performs this type of surgery while you are under a general anaesthetic. The Anaesthetist will also recommend the additional use of a local anaesthetic injection technique which is known as an Inter-Scalene Nerve Block.
The arthroscope is a fibre optic instrument that is 4.5mm in diameter and about the length of a pencil. It is passed into the shoulder through a small incision. Saline fluid under gentle pressure expands the spaces within the shoulder to enhance vision and control bleeding. The arthroscope accesses the main shoulder joint. However the instrument can also be used to access the sub-acromial space and sub-acromial bursa as well as the AC Joint.
Light is passed through optical fibres to illuminate the joint. A small digital camera at the outer end of the arthroscope transmits live images of the interior of the shoulder to a high resolution video screen. Video or still images can be captured to document the surgery findings. Mr Lyons will be able to show you relevant images at your post-surgery consultation. This may assist your understanding of your shoulder problem.
Separate small incisions are made to allow the insertion of various miniaturised instruments. These might include shaving, grinding, snipping, grasping, suction or electrical instruments depending upon the type of condition being treated.
Indications of Shoulder Arthroscopy
Shoulder Arthroscopy can be a valuable method for confirmation of a suspected diagnosis. This is referred to as a “Diagnostic Arthroscopy”. Shoulder arthroscopy may be indicated in the treatment of many shoulder conditions when conservative or non-surgical treatments have failed. Some of the many indications for Shoulder Arthroscopy include:
- Diagnostic Arthroscopy
- Treatment of Shoulder Impingement
- Rotator Cuff Decompression
- Sub-acromial Bursectomy
- Rotator Cuff Repair or Debridement
- Capsular Release for Frozen Shoulder
- Debridement of Osteoarthritis
- Repair of a SLAP Tear
- Shoulder Stabilisation / Labral Repair
- Shoulder Synovectomy
- AC Joint Arthroplasty or Excision
- Removal of Bone or Cartilage Loose Bodies
- Washing Out Infected Shoulder Joint
Open Vs Arthroscopic Surgery
Shoulder Arthroscopy is not necessarily the best or only surgical method suited to your condition. Although the smaller incisions used for “key-hole” surgery are often equated with less pain and a quicker recovery this is not always the case. Arthroscopic procedures are not without some post-operative pain.
It is also important to bear in mind that arthroscopic surgical repair of a soft tissue structure in the shoulder cannot actually speed the healing time. What a surgery does, whether arthroscopic or through a slightly larger open incision, is set the scene for that tissue to heal correctly. The biologic process of that healing cannot be accelerated by the surgery as such.
There may also be some circumstances where both an arthroscopic and open component to the surgery is required. Mr Lyons will discuss the pros and cons of each technique as appropriate to you particular shoulder condition.
Postoperative Care for Shoulder Arthroscopy
Mr Lyons performs most of his surgeries on an afternoon operating list. You will be admitted to hospital late morning. Surgery will take place during the afternoon. Although you might be able to return home in the evening, Mr Lyons recommends that you stay in hospital overnight. That will allow him and the hospital staff to be satisfied that you feel well enough and comfortable enough to be discharged from hospital the following morning. Mr Lyons will always visit you in the ward before discharge the morning after surgery. Your anaesthetic will have worn off so he will be able to explain clearly what to do between going home and returning for your first post-surgery appointment.
The physiotherapist will also show you how to start some gentle rehabilitation exercises at home appropriate to the type of arthroscopic surgery you have had. Mr Lyons will advise whether you need extra physiotherapy depending upon your progress.
You will have small band-aid type dressings on your shoulder. You will be able to get these wet briefly in the shower and pat them dry. If they happen to lift off they do not need to be replaced. Mr Lyons will advise whether you need to use a sling. After most arthroscopic surgeries you will be able to remove the sling for light waist level tasks. It is usually a good idea to have it with you in crowded situations or travelling in a car. Mr Lyons recommends that you not drive until your first post-surgery visit.
Your first review will take place approximately 2 weeks after surgery. Further appointments will be scheduled as necessary until such time the best possible outcome of surgery is achieved.
If you have any concerns at any time Mr Lyons can be contacted at his office or by contacting the hospital where you had your surgery.