Arthroscopic shoulder surgery
What is arthroscopy?
The arthroscope is a fiber optic instrument (narrower than pen) which is put into the shoulder joint through small incisions. A camera is attached to the arthroscope and the image is viewed on a TV monitor. The arthroscope allows me to fully evaluate the entire shoulder joint, including the ligaments, the rotator cuff, the biceps tendon, the joint lining, and the cartilage surface. Small instruments ranging form 3-5 millimeters in size are inserted through additional incisions so that I can feel the joint structures for any damage, diagnose the injury, and the repair, reconstruct, or remove the damaged tissue. Before the development of arthroscopy, large incisions had to be made over the shoulder joint to treat or diagnose injuries. Today’s arthroscopic techniques allow more complete evaluations of the shoulder joint while accelerating the rehabilitation process.
What kinds of procedures can be performed with the arthroscope?
Arthroscopy allows the surgeon to view the inside of the shoulder joint, and perform a variety of surgeries. These surgeries include:
- A complete evaluation of the joint (diagnostic arthroscopy)
- Subacromial Decompression (in cases of Rotator Cuff Impingement)
- Repair of a damaged or torn biceps tendon (SLAP Repair or Biceps Tenodesis)
- Evaluation and repair of the rotator cuff (in cases of rotator cuff tendonitis or tears)
- Removal of the end of the clavicle (in cases of A/C joint arthritis)
- Repair of torn or damaged cartilage or ligaments of the shoulder in cases of shoulder instability.
What are some of the possible complications of surgery?
While complications are not common, all surgery has associated risk. Possible complications include stiffness of the shoulder after surgery or recurrent pain. Other complications include an infection, bleeding, nerve damage, or problems with the anesthesia.
What do I need to do to prepare for surgery?
Our staff will help to set up the surgery through your insurance company and will instruct you on any paperwork that may be necessary. If you are over the age of 50, or have significant health conditions you may require an EKG and chest x-ray. You may also need to see your internist or family doctor to obtain a Letter of Medical Clearance. The day before the surgery, a member of the hospital or surgery center staff will contact you about what time to arrive for surgery. You may not eat or drink anything after midnight before your surgery.
How long will I be in the hospital?
Almost all patients are able to have surgery and go home the same day. Occasionally, patients will be admitted for an overnight stay.
What happens the day of surgery?
The day before surgery you will be told what time to report to the hospital. You will be admitted and taken to a pre-operative holding area where you are prepared for surgery. You will be asked several times which extremity I am operating on, this question is asked many times on purpose.
After the operation, you will be taken to the recovery room to be monitored. Once the effects of anesthesia have worn off and your pain is under control, you will be given your post-operative instructions and a prescription for pain medication. Please be aware that the process of getting checked in, prepared for surgery, undergoing the operation, and recovering from the anesthesia takes the majority of the day. I would recommend that you and your family members bring some reading material to help make the process easier.
How should I care for my shoulder after surgery?
Prior to your discharge, you will be given specific instructions on how to care for your shoulder. In general you can expect the following:
Resume your regular diet as soon as tolerated. It is best to start with clear liquids before advancing to solid food.
You will be given a prescription for pain medication before you go home.
You will have a sling, which you will use for the first 2 to 4 weeks. You can remove the sling for showering, performing your home exercise program.
You should apply ice over the dressing for 30 minutes every 1 to 2 hours for several days. Do not use heat the first week after surgery.
If I use absorbable sutures to close the small incisions they do not need to be removed. There may be non-absorbable suture, and it will be removed on your first post-operative visit.
Follow-up office visit:
You will be instructed on when to follow-up in the office. This is usually 2 weeks after surgery.
You will be instructed prior to your surgery on exercise to begin the day after your surgery.
Return to school or work:
You can return to school or work within 3-5 days without using the affected side. If you need to use the arm to return, you may be out of work or school for a longer period of time.
What will rehabilitation involve?
The rehabilitation is based on several goals: 1) allowing the tissue to heal; 2) regaining your range of motion; 3) regaining strength; 4) return to full duty at work, or return to sports.
When can I return to sports?
In general, you will be allowed to return to sports in 3 – 6 months after surgery. You must have good motion, strength, and control of your shoulder and arm. How quickly you return to sports depends on several factors, including: 1) your own rate of healing; 2) the damage found at surgery; 3) if you have any complications (like stiffness); 4) how well you follow the post-operative instructions; 5) how hard you work in rehabilitation.
When can I return to full duty at work?
This depends on what I see and do when I get into your shoulder. I will talk with you about your return to work status both before and after surgery.