Shoulder arthroscopy is a minimally invasive procedure that allows the surgeon to view the shoulder joint to diagnose and treat internal injuries. The word arthroscopy is borrowed from German arthroskopie which was introduced by the swiss surgeon and politician Eugen Bircher (1882-1956). This originally comes from the Greek words “arthro” (joint) and “scopy” (skopion – to look at, examine). Performed by Bircher, arthroscopy was purely a diagnostic procedure, with repair or removal of tissue being done by open surgery.
(“Arthroscopy” – Merriam Webster.com Dictionary, Merriam-Webster, https://www.merriam-webster.com/dictionary/arthroscopy)
With advances in technology, arthroscopic surgery has steadily replaced many open procedures for shoulder injuries. During shoulder arthroscopy the surgeon makes 2-3 small incisions to insert a small camera (arthroscope), into the shoulder joint.
The high-definition camera displays images on a video monitor and the surgeon uses small miniature surgical instruments to treat and manage internal injuries such as rotator cuff tears. The small incisions rather than large incisions or a full open procedure result in less pain and joint stiffness for patients, and often shortens the recovery time. The procedure is done as an outpatient and people are up and around in a few days and back to their regular activities and more intense activities within a several weeks.
The shoulder is a complex joint that has more motion than any other joint in the body. It is a suspensory joint, meaning muscles, tendons and ligaments maintain the joint alignment for proper positioning and function. The shoulder joint is a ball and socket joint that is encased in a capsule, surrounded by rotator cuff muscles and has a gel sac bursa between the glenohumeral joint (shoulder) and the acromion above.
The head of your humerus fits into a rounded socket in the shoulder blade called the glenoid. The bone ends are covered with articular cartilage which provides a slippery, smooth, frictionless surface that helps the bones glide easily across each other. The glenoid is ringed by strong fibrous cartilage called the labrum. The labrum forms a gasket around the socket, adding stability, and cushions the glenohumeral joint.
The glenohumeral joint is surrounded by bands of tissue called ligaments. They form a capsule that holds the joint together. Four tendons surround the shoulder capsule and help keep humeral head centered on the glenoid. This thick tendon material is called the rotator cuff. The cuff covers the head of the humerus and attaches it to the shoulder blade.
There is a lubricating sac called a bursa between the rotator cuff and the acromion (bone on top of shoulder joint). The bursa helps the rotator cuff tendons glide smoothly when the arm is moved.
When is shoulder arthroscopy recommended?
There are several indications why your surgeon may recommend shoulder replacement surgery. People who benefit from shoulder replacement often have:
- severe shoulder pain that interferes with everyday activities, such as reaching into a cabinet, dressing, toileting, and washing.
- moderate to severe pain while resting. This pain may be severe enough to prevent sleep
- loss of motion and/or weakness in the shoulder
- failure to substantially improve with other treatments such as anti-inflammatory medications, cortisone
injections, and/or physical therapy
- chronic rotator cuff tears with loss of function in addition to shoulder arthritis