Shoulder arthroscopy

Shoulder arthroscopy is surgery that uses a tiny camera called an arthroscope to examine or repair the tissues inside or around your shoulder joint. The arthroscope is inserted through a small incision (cut) in your skin.

SLAP repair; Acromioplasty; Bankart; Shoulder repair; Shoulder surgery

The rotator cuff is a group of muscles and tendons that cover your shoulder joint. These muscles and tendons hold your arm in your ball and socket shoulder joint, and they help you move your shoulder in different directions. The tendons in the rotator cuff can tear when they are overused or injured.

Most people receive general anesthesia before this surgery. This means you will be unconscious and unable to feel pain. Or, you may have regional anesthesia. Your arm and shoulder area will be numbed so that you do not feel any pain in this area. If you receive regional anesthesia, you will also be given medicine to make you very sleepy during the operation.

First, your surgeon will examine your shoulder with the arthroscope. Your surgeon will:

• Insert the arthroscope into your shoulder through a small incision. The arthroscope is connected to a video monitor in the operating room.
• Inspect all the tissues of your shoulder joint and the area above the joint -- the cartilage, bones, tendons, and ligaments.
• Repair any damaged tissues. To do this, your surgeon will make 1 to 3 more small incisions and insert other instruments through them. A tear in a muscle, tendon, or cartilage will be fixed. Damaged tissue may need to be removed.

Your surgeon may do one or more of these procedures during your surgery:

• Rotator cuff repair: The edges of the muscles are brought together. The tendon is attached to the bone with sutures. Small rivets (called suture anchors) are often used to help attach the tendon to the bone. The anchors can be made of metal or plastic. They do not need to be removed after surgery.
• Surgery for impingement syndrome: Damaged or inflamed tissue is cleaned out in the area above the shoulder joint itself. Your surgeon may also cut a specific ligament, called the coracoacromial ligament, and shave off the under part of a bone. This under part of the bone is called the acromion.
• Surgery for shoulder instability: If you have a torn labrum, the rim of the shoulder joint that is made out of cartilage, your surgeon will repair it. Ligaments that attach to this area will also be repaired. The Bankart lesion is a tear on the labrum in the lower part of the shoulder joint. A SLAP lesion involves the labrum and the ligament on the top part of the shoulder joint.

At the end of the surgery using the arthroscope, your incisions will be closed with stitches and covered with a dressing (bandage). Most surgeons take pictures from the video monitor during the procedure to show you what they found and what repairs they made.

Your surgeon may need to do open surgery if there is a lot of damage. Open surgery means you will have a large incision so that the surgeon can get directly to your bones and tissues. Open surgery is a more complicated surgery.

Risks for any anesthesia are:

• Allergic reactions to medicines
• Breathing problems

The risks for any surgery are:

• Bleeding
• Infection
• Blood clot

Risks of shoulder arthroscopy are:

• Shoulder stiffness
• Failure of the surgery to relieve symptoms
• Failure of the repair to heal
• Weakness of the shoulder
• Injury to a blood vessel or nerve

Phillips BB. Recurrent dislocations. In: Canale ST, Beatty JH, eds. Campbell's Operative Orthopaedics. 11th ed. Philadelphia, Pa: Mosby Elsevier; 2007:chap 45.

Phillips BB. Arthroscopy of the upper extremity. In: Canale ST, Beatty JH, eds. Campbell's Operative Orthopaedics. 11th ed. Philadelphia, Pa: Mosby Elsevier; 2007:chap 49.