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What is
Shoulder Arthroscopy?
Shoulder
arthroscopy is a kind of surgery that is
done to explore or mend the tissues inside
or surrounding the shoulder joint. The
procedure makes use of a small camera,
called an arthroscope, which is inserted
through a small incision. Small surgical
instruments are also used if the doctor is
aimed at restoring the joint.
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Effects of
Shoulder Arthroscopy
Through arthroscopy, a patient can experience a reduced
amount of pain and stiffness, less
complications, shorter (if any) hospital
stays, and perhaps more rapid recovery time.
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Candidates for
Shoulder Arthroscopy
Arthroscopy may be suggested for patients
with shoulder problems such as a torn or
damaged cartilage ring or ligaments (in
cases of shoulder instability), a torn or
damaged biceps tendon, a torn rotator cuff
or a bone spur or inflammation around the
rotator cuff. This procedure is also for
those with stiffness of the shoulder,
inflammation or damaged lining of the joint,
and arthritis of the end of the clavicle (acromioclavicular
joint).
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Your
Consultation
Non-operative management consists of a thorough history of
the condition, details of the existing
symptoms and disability, current and
preceding medications and past medical
history.
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The Shoulder Arthroscopy
Procedure
The procedure starts with the surgeon making
a small incision, approximately one-quarter
inch (0.25") long, in the vicinity of the
shoulder joint. Then a small camera is then
inserted into the joint. Attached to the
camera is a video monitor to allow the
surgeon to look inside the joint.
During the procedure, saline (salt solution)
is pumped into the shoulder to enlarge the
joint. By doing this, the surgeon will see
the joint without difficulty and will be
able to control bleeding, if any. Then the
surgeon will look on all sides of the entire
joint to evaluate the cartilage, tendons and
ligaments of the shoulder. If damaged
tissues show the need to be repaired, the
surgeon will create one to three additional
small incisions to insert other instruments.
These instruments may contain a blunt hook
to pull on tissues, a shaver to remove
damaged or unwanted tissues, and a burr to
remove bone.
Aside from working on the shoulder joint,
the surgeon also locates the camera in the
space on top of the rotator cuff tendons
(this is named the subacromial space.) In so
doing, the surgeon can evaluate the area
above the rotator cuff, clean out inflamed
or damaged tissue, eliminate a bone spur and
fix a rotator cuff tear.
At the end of the surgery, the fluid is
drained from the shoulder, the small
incisions are closed, and a dressing is put
on. Plenty of surgeons take pictures of the
procedure from the video monitor to
illustrate to the patient what was found and
what was done.
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Recovery
The recovery period depends on the type of
surgery. One of the problems with shoulder
arthroscopy is that the procedure has
minimal pain compared to open shoulder
surgery, and consequently, patients may be
inclined to do too much, too soon. It is
important that you listen to your surgeon
about the limitations of your activities
after surgery. Even though your shoulder may
feel all right, it is imperative for to
allocate enough time for repaired tissues to
effectively heal. This is mainly significant
for patients who have rotator cuff repairs
and labral repairs.
The capacity for you to resume work or play
sports will rely on the type of surgery that
was carried out. This may vary from one week
to several months. A majority of procedures,
particularly if a repair was performed,
would require physical therapy to assist
rapid recovery. This will make it easier for
you to recover the motion and strength of
your shoulder. The duration of therapy will
depend on the repair that was performed.
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Risks
Anesthetic risks consist of allergic
reactions to medications and problems
breathing. On the other hand, the risks for
any surgery are bleeding, infection and
nerve damage. Further risks involve
stiffness of the shoulder, failure of the
surgery to alleviate symptoms, failure of
the repair to mend and weakness of the
shoulder.
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Frequently Asked
Questions
Q: What happens during the procedure?
A:
You will be given a general anesthetic and
will be asleep for the entire operation. The
surgeon will use an arthroscope that is
connected to a television, and will insert
it through one or two tiny half inch (about
1 cm) cuts in the region of your shoulder.
The surgeon will then make use of it to look
at the inside and the tendons over the
shoulder. After that, the cuts will be
closed with stitches, clips or paper tapes.
You may have to stay in the hospital one
night or so after the operation.
Q: Is arthroscopic surgery better than
"open" surgery?
A:
It depends on the patient’s condition. Open
surgery, a procedure which makes use of
larger incisions and allows the surgeon to
look inside the joint, may be better for
specific procedures under specific
conditions. Arthroscopic surgery may
encompass a number of advantages--smaller
incisions, less tissue damage--but these are
typically not beneficial if the overall
procedure cannot be achieved as well. You
have to confer with your surgeon if a
specific procedure can be done
arthroscopically.
Q: What should I expect after the surgery?
A:
Arthroscopy is an option to "open" surgery
that entirely exposes the shoulder joint.
Arthroscopy results in reduced pain and
stiffness, less complications, shorter (if
any) hospital stays and probably quicker
recovery time. The expectations differ
depending on the goal of the surgery. In
cases where repair is required, bear in mind
that the body still needs to heal after
arthroscopic surgery, similarly with an open
surgery. As a result, the general recovery
time may still be extensive. Surgery to
repair a cartilage tear is commonly executed
for the reason that the shoulder is not
stable. A lot of patients have a complete
recovery, and the symptoms of instability
disappear. Nevertheless, up to 10 to 20% of
patients can have sustained instability of
the shoulder even after arthroscopic repair.
Employing arthroscopy for rotator cuff
repairs or tendonitis typically alleviates
the pain, but the chance of determining how
well your strength will return is minimal.
Q: Are there complications in this
procedure?
A:
Rarely do complications occur
following arthroscopy. The surgeon is not
often capable of seeing everything he needs
to see. At times, arthroscopy does not come
up with any answers. Very rarely, there is
bleeding inside the joint, or a certain
infection that can be alleviated by taking
antibiotics for a few days. It is also rare
that more critical complications can come
about like further damage to the joint or
damage to the nerves or blood vessels in or
around the area of the operation. In this
case, you may well necessitate an additional
operation to deal with the problem.
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