Shoulder Arthroscopy
Introduction
Arthroscopy is a minimally invasive technique used by orthopaedic surgeons to examine and treat the interior of a joint. Two greek words make up arthroscopy including 'arthro' (meaning joint) and 'skopein' (meaning to look).The orthopaedic surgeon makes a small incision in the skin to begin the arthroscopic examination. Small instruments that contain a lighting system and a small lens allow the doctor to clearly see the joint. Fiber optics provide the light at the end of the arthroscope. This view is transmitted to a monitor where the doctor can make a more accurate diagnosis without the need for a large incision to see everything. Other small incisions are made as necessary to perform the operation with additional small instruments.
Shoulder arthroscopy is commonly performed today to treat conditions including but not limited to recurrent shoulder dislocations or instability, labral or SLAP tears, and rotator cuff tears. Labral injuries and shoulder dislocations are more common in younger age groups and athletes, while rotator cuff tears typically occur in patients over the age of 40. Shoulder arthroscopy allows us to perform repairs through multiple tiny incisions, which should result in less pain and a faster recovery from surgery. These same procedures were classically performed through larger incisions with significant dissection through muscles (open procedures). Arthroscopic procedures are typically performed on an outpatient basis, meaning you go home the day of surgery.
The need for arthroscopic surgery is based on your medical history, clinical examination, diagnostic tests, and response to other treatments. Diagnostic testing may include x-rays and magnetic resonance imaging (MRI). Other treatments may include medications, injections, physical therapy, activity modifications, and home exercise. This information should be discussed with your orthopedic surgeon to determine if you are a good candidate for an arthroscopic procedure. For discussion of a particular injury or the possible need for surgery, please contact us to schedule an appointment with Dr. Michael Burris, a local Austin orthopedic surgeon.
Superior Labral Tears or SLAP Lesions
Arthroscopic surgery is commonly used to treat tears of the superior labrum, often referred to as SLAP tears. The labrum is a rim of cartilage attached circumferentially around the shoulder socket or glenoid. These injuries often occur in overhead athletes such as baseball players. Physical examination in conjunction with an MRI is used to diagnose the injury. Surgical treatment ranges from debridement with removal of torn tissue to repair. Repair is performed by placing anchors into the shoulder socket with attached sutures placed through the adjacent labrum. Return to athletic activities after a repair is typically 3 months but highly dependent on the sport played. Recovery for a throwing athlete will typically be longer with a graduated throwing program instituted. Please see Rehabilitation Guidelines: SLAP Repair for further details.
Shoulder Instability
Arthroscopic surgery is also commonly used to treat recurrent shoulder instability such as shoulder dislocations. This procedure typically involves repairing a torn anterior labrum (Bankart tear) and/or tightening a lax joint capsule to the socket of the shoulder joint. The procedure is often referred to as a Bankart repair or capsulorraphy. The repair is performed by placing anchors into the shoulder socket with attached sutures placed through the adjacent labrum and capsule. Return to athletics is typically 3-4 months following surgery. Please see Post-operative instructions: Arthroscopic Bankart Repair and Rehab Guidelines: Arthroscopic Bankart Repair for more details on recovery from this procedure. Non-operative treatment also plays a significant role in treatment of this injury and should be discussed with your surgeon.
Rotator Cuff Tears
Rotator cuff tears can occur secondary to acute trauma or more commonly secondary to degeneration and repetitive use. Traumatic tears are likely to require surgical treatment. Chronic and degenerative tears will often be treated with a course of non-operative treatment prior to surgical consideration. This may include physical therapy, injections, medication, and home exercises. An MRI is often obtained to further evaluate the rotator cuff.
When rotator cuff repair is indicated, it can be performed using several different techniques or approaches. A minimally invasive, all arthroscopic repair is the preferred technique of Dr. Burris. Appropriate rehabilitation after a rotator cuff repair plays a significant role in your recovery. Restrictions placed on activities and exercises are necessary to allow healing. Range of motion, strength, and endurance are gradually increased through phases which are progressed over 3-4 months. The phases are designed to gradually restore function while protecting the repair. Please see Rehabilitation Guidelines: Arthroscopic Rotator Cuff Repair and Post-Operative Instructions: Arthroscopic Rotator Cuff Repair for more details.
This information is a brief summary regarding treatment of the above injuries and not intended to be a complete resource. Specific questions and surgical details should be discussed with your surgeon as opinions may vary.
Resources on Shoulder Arthroscopy
More information is available through the website of The American Academy of Orthopaedic Surgeons. Please click on the following link: http://orthoinfo.aaos.org/menus/arm.cfm.
A 3D animation library provided by the The American Orthopaedic Society for Sports Medicine and Understand.com is available through the following link, 3D Animation Videos. After clicking on the link, move the mouse over Shoulder Arthroscopy to view the available animations.
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