Arthroscopic Shoulder Surgery
What is a shoulder arthroscopic surgery?
The arthroscope is a fiber optic instrument slightly narrower than a pen. It is placed into the shoulder through a tiny incision (called a portal). Attaching a small camera to the arthroscope, the surgeon is able to view the internal shoulder structures as they are projected onto a monitor. This allows the surgeon to view the joint’s components, including the ligaments of the shoulder joint, the biceps tendon, the rotator cuff, the capsule, labrum and the joint cartilage surfaces. The fiber optic lenses and surgical instruments are very small, thus permitting a great deal of surgery to be done through 2-4 tiny incisions.
In the past, many orthopaedic injuries required complicated operations with large incisions, long hospital stays, and extensive physical therapy. Today, many procedures are done entirely or in combination with the arthroscope, allowing for more accurate diagnosis, less invasive surgical intervention and an accelerated rehabilitation process. It must be kept in mind that not all surgery can be done through the arthroscope. Standard surgery is still the best way to treat certain sports injuries.
What type of procedures can be done with arthroscopy?
Some of the more common arthroscopic procedures for the shoulder are:
Shoulder stabilization for loose or dislocating shoulders
Repair or removal of labral tears (torn shoulder cartilage causing pain/instability)
Distal clavicle excision (removing AC joint arthritis) or AC joint repair/reconstruction (re-aligning AC joint)
Acrominoplasty/bursectomy (removing shoulder bone spurs and inflammatory tissue)
Repair or debridement of rotator cuff tears
What type of anesthesia is used?
General anesthesia or a nerve block with sedation can be used for arthroscopic shoulder surgery. An anesthesiologist is always present if there is a need for further sedation or pain control. Prior to surgery, an anesthesiologist will discuss with you the various options and answer your questions.
How long will I be in the hospital?
Most people go home the same day. Several factors, including your age, health status, other damage to the knee and the side effects of anesthesia, may affect your ability to go home the same day of surgery.
What happens the day of surgery?
The day before surgery you will be told what time to report to the hospital on the day of your procedure. It is very important to arrive on time. You will be taken to a pre-operative area where you will be prepared for your surgery. You will see your surgeon, and meet the nurses and anesthesiologist the day of surgery. Then, you will be taken to the operating room. After the operation, you will be taken to the recovery room. Here the staff will monitor that the effects of anesthesia are wearing off properly and they will provide you with medication for any pain you are experiencing. You will be given post-surgery instructions to follow at home and then discharged after you have adequately recovered.
How should I care for my shoulder after surgery?
Prior to your discharge from the hospital you will be given specific instructions on how to care for your shoulder. It is important to follow these instructions. In general, you can expect the following.
Diet: Resume your regular diet as soon as possible.
Medication: You will be given medication for pain. Follow the directions from your pharmacy.
Bandage: You will have a thick dressing on the shoulder. Keep it on until you are instructed to take it off, usually 3 days after surgery.
Bathing: You may shower after your dressings are removed, unless otherwise instructed. To give your wound time to heal, do not soak your shoulder under water (bathtub, pool, or whirlpool) for at least 2 weeks. Soaking the shoulder in water prior to this will increase the chance of infection.
Sling: In most cases, you will have your arm in a sling. You should leave it on unless you are instructed to take it off by your physician or by our office.
Ice: You may apply ice to the shoulder for 15-20 minutes, 3-4 times per day. Initially, you can apply this right over the dressing. Later you can apply it directly to the shoulder or with a cloth between the ice and your knee. DO NOT put any heat on your shoulder.
Exercise: If there are any exercises you should be doing at home, you will be instructed in them. At your first post-operative visit, approximately 10-12 days after your surgery, you will be given a prescription for formal rehabilitation to do with a physical therapist.
Follow-up Office Visit: You will be instructed to follow-up at our office after the first week of surgery. At that time, your stitches will be removed and you will be instructed on what activities you may do. You will also be instructed in making further post-operative appointments and starting physical therpy at this time.
What type of exercise should I do?
Immediately following surgery, you will begin some gentle exercises (unless otherwise instructed). These will help with shoulder stiffness. You will squeeze a sponge or a soft ball, bend and straighten your elbow, and do pendulum exercises several times a day. After your follow-up appointment, you will be instructed in more exercises and you may begin physical therapy to regain motion, strength and function.
When can I return to my previous activities?
Most people are able to return to their job or school within 1-2 weeks. The exception to this is for people who have a strenuous job that requires them to be lifting heavy objects, climbing or driving. These patients will return to more strenuous jobs when their shoulder and arm has regained its strength and flexibility. You will typically be able to begin driving once you are no longer in a sling, about 4-6 weeks from surgery.
What will rehabilitation involve?
Your rehabilitation will be based on guidelines we have developed based on what was done during your surgery. You will start out with very specific exercises and will be permitted to do more as you recover. In cases of rotator cuff repair, you can cause injury to your shoulder by not following the protocol.
How soon can I get back to sports?
There is no simple answer to this question. In general, you will be allowed to return to sports when you shoulder function has fully recovered. You must have good motion, strength and control of your arm. This whole process can take anywhere from 2-3 months for arthroscopic procedures to shave away bone and frayed rotator cuff edges, and 4-6 months for rotator cuff repairs, but it is truly different for everyone.
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