Shoulder Arthroscopy is a procedure where orthopaedic surgeon uses a fine telescope to inspect, diagnose and repair problems inside the shoulder joint. A very small cut (port) are made rather than big incision that are needed for Open surgery. This results in very little pain for patient, shorten the time of recovery and early return to their favourite activities.
Shoulder joint is unique as it has very large range of movement in all directions and that is due to the fact that it is a complex joint made by three bones the arm bone (humerus), the shoulder blade(scapula) and the collar bone(clavicle). Shoulder joint has three parts of which main is glenohumeral joint which is between arm bone and shoulder blade, the other is between shoulder blades and chest wall and the third one is between the collar bone and shoulder blade. The motion happening at shoulder is a complex interaction of all these three joints. As shoulder has very great range of movement it is also susceptible to many injuries. The stability of the shoulder joint is mainly because of the capsule, ligaments and the muscles around the joints which helps to keep it stable through the wide range of movement it has.
Pain in shoulder is a common presentation seen in shoulder clinics and one may have to exclude instances where it may be arising from neck problems.
The common causes for shoulder pain are
– Soft issue injury
– Trauma resulting in fracture or ligament injury
– Over use/repetitive strain
– Degenerative changes
– Infective process.
Indications for Shoulder Arthroscopy
If you have pain in shoulder, inability to lie on or sleep on that shoulder side, difficulty in day to Day activity, problem in lifting the arm up, persistent swelling, clicking, feeling of weakness and instability which is persistent in spite of medical management and physiotherapy, then you may be a candidate who may benefit from shoulder Arthroscopic procedure.
The common indications for which shoulder Arthroscopy is performed are
– Instability/recurrent dislocation of shoulder
– Rotator cuff tear
– Synovitis of shoulder
– Tear/cyst of liberal tissue
– Biceps Injury/repair
– Debride meant and taking soft tissue biopsy
Shoulder Arthroscopy Surgery
During the procedure the person is under general anaesthesia and comfortable. Two or three small cuts are made through which a high-power telescope is put into the shoulder to see all the areas of the joint, which are inspected for any problem. Then by use of very fine and specialise instrument the problem is dealt in totality. Shoulder Arthroscopy generally takes anything in between 1 to 1 and half hours.
After the surgery they may put your arm in a sling in a support to give it rest.
Post operatively one is prescribed a good pain relief to make you comfortable and sometime a specialised pain relief modality called PCA – “patient controlled analgesia” is used to make person more comfortable.
Once at home you need to look after the shoulder, keep it in sling and rested. Use cold compress as suggested by the orthopaedic consultant to keep swelling and pain in control, keep your dressing nice and clean and continue with gentle exercises of hand and wrist as demonstrated by discharge team.
Some of the shoulder procedures may be associated with experience of discomfort /pain for few days for which regular medications will be prescribed. Some of the patient may find that lying flat causes increase in pain and for such people sitting in aeroplane chair position may help for first few days.
A review appointment will be set up at two weeks for removal of stitches and to start prescribed physiotherapy.
Most shoulder Arthroscopic procedures require a very well supervised rehab under the guidance of your orthopaedic surgeon and specialist physiotherapist at Aosm centre. Graduated physiotherapy when started early helps to reduce pain and swelling and regain some function in shoulder so that one can start certain day to day today activities.
The surgeon and therapist combine would chalk out a physiotherapy plan depending on the procedures you have undergone which will help you regain full function in shoulder. It is very important to diligently follow the rehab instructions in order to get good results.
Your surgeon at A+OSM may recommend shoulder arthroscopy if you have a painful condition that does not respond to nonsurgical treatment. Nonsurgical treatment includes rest, physical therapy, and medications or injections that can reduce inflammation.
Injury, overuse, and age-related wear and tear are responsible for most shoulder problems. Shoulder arthroscopy may relieve painful symptoms of many problems that damage the rotator cuff tendons, labrum, articular cartilage, and other soft tissues surrounding the joint.
Common arthroscopic procedures include:
After surgery, you will stay in the recovery room for 1 to 2 hours before being discharged home. Your arm will be in a sling. The shoulder may be a little painful. You will be given injection or tablet to control the pain, if pain is still worse then pain management team will give you a PCA Pump. You will most likely need a sling or special immobilizer to protect your shoulder. Surgeon will discuss with you how long the sling will be needed.
You will need someone to drive you home.
Although recovery from arthroscopy is often faster than recovery from open surgery, it may still take weeks for your shoulder joint to completely recover.
You can expect some pain and discomfort for at least a week after surgery. If you have had a more extensive surgery, however, it may take several weeks before your pain subsides. Ice will help relieve pain and swelling. Your doctor may prescribe pain medicine, if needed.
Many types of pain medication are available to help control pain, including opioids, nonsteroidal anti-inflammatory drugs (NSAIDs) and local anesthetics. Treating pain with medications can help you feel more comfortable, which will help your body heal faster and recover from surgery faster.
Lying flat may pull on your shoulder and cause discomfort. Some patients are more comfortable sleeping in a reclining chair or propped up in bed during the first days after surgery.
A change of dressing will be done after 48 hours and 14 days after the operation stiches will be removed. You may shower but try not to soak or scrub your incisions.
Rehabilitation plays an important role in getting you back to your daily activities. An exercise program will help you regain shoulder strength and motion. Your surgeon and the physio team at A+OSM will develop a rehabilitation plan based on the surgical procedures.
It is important that you make a strong effort at rehabilitation in order for your surgery to succeed.