Shoulder arthroscopy - Overview
SLAP repair; Acromioplasty; Bankart; Shoulder repair; Shoulder surgery
Definition of 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.
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. The spur can be a cause of inflammation and pain in your shoulder.
- 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.
Why the Procedure Is Performed:
Arthroscopy may be recommended for these shoulder problems:
- A torn or damaged cartilage ring (labrum) or ligaments
- Shoulder instability, where the shoulder joint is loose and slides around too much or becomes dislocated (slips out of the ball and socket joint)
- A torn or damaged biceps tendon
- A torn rotator cuff
- A bone spur or inflammation around the rotator cuff
- Inflammation or damaged lining of the joint. Often this is caused by an illness, such as rheumatoid arthritis.
- Arthritis of the end of the clavicle (collarbone)
- Loose tissue need to be removed
- Shoulder impingement syndrome, to make more room for the shoulder to move around
- Reviewed last on: 6/30/2011
- C. Benjamin Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery; and Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
Elkousy HA, Edwards TB. Shoulder: Development of skills for shoulder surgery. In: DeLee JC, Drez D Jr, Miller MD, eds. DeLee and Drez’s Orthopaedic Sports Medicine. 3rd ed. Philadelphia, Pa: Saunders Elsevier; 2009:chap 17, section Q.
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.
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