Shoulder Arthroscopic Surgery
Arthroscopic surgery, also known as key-hole surgery, is a minimally invasive surgical procedure used to diagnose and treat problems involving the shoulder joint. It involves making small incisions (portals) to insert a thin telescope and other miniaturized instruments into the joint, allowing the surgeon to visualise the inside of the joint on a video monitor and perform necessary repairs or reconstruction.
It is a minimally invasive technique since it involves using very small incisions without having to open the joint. It helps to minimise the surgical pain and allows for faster recovery times and early return to function.
Common Shoulder Conditions Treated with Arthroscopy
- Rotator Cuff Tears: Rotator cuff tears occur when one or more of the tendons which make up the rotator cuff are torn, either due to injury or repetitive movements. Symptoms may include pain, weakness, and a limited range of motion. Arthroscopy allows the surgeon to visualise the tear and repair the damaged tendons wherever possible.
Some cases with massive tears may require additional procedures like superior capsular reconstruction, application of a biologic or synthetic patch and insertion of a spacer balloon (Inspace balloon). - Labral Tears: The labrum is a fibro-cartilaginous tissue which is crucial for shoulder joint stability. A tear in the labrum may be caused due to a sporting shoulder injury or a fall. Symptoms include pain, clicking, and a feeling of instability. Arthroscopic surgery allows to repair of the torn labrum, restores joint stability, and improves shoulder function.
- Shoulder Instability (recurrent shoulder dislocations): Shoulder joint is one of the most mobile joints in the body, allowing for a wide range of movements in practically all directions. This also makes the shoulder joint more unstable and vulnerable to dislocations, giving rise to instability.
Shoulder instability may be caused by an injury or due to some inherent laxity of the joint capsule. It is associated with a tear of the labrum or stretching of the joint capsule. Arthroscopy can address the underlying issues causing instability, such as repairing ta orn labrum and tightening the joint capsule (Bankart’s repair). In some patients additional procedure called the Remplissage procedure may be required restore stability and prevent future dislocations.
In some cases, with multiple dislocations or those with previous failed surgery, a Latarjet procedure, which involves transferring a bone along with muscle (coracoid procedure) may be required. - Biceps Tendon Disorders: Biceps tendon disorders involve inflammation or tears of the long head of the biceps tendon, which can cause pain and weakness in the shoulder and arm. Arthroscopy allows for the assessment and treatment of these issues, including cutting away the tendon (biceps tenotomy) or reattachment of the tendon (biceps tenodesis) to relieve symptoms and restore function.
- Frozen Shoulder (Periarthritis): This is a very common condition which is caused due to widespread inflammation inside the shoulder joint as well as in the tissues around the shoulder joint (periarthritis). It causes severe pain and stiffness in the shoulder. It tends to run a very prolonged course but is known correct itself (self-limiting) over a period of time.
Most patients will respond well to treatment with medication, physiotherapy, and, if required, an injection in the joint. Some patients with severe symptoms who do not respond to treatment may require arthroscopic surgery in the form of debridement (cleaning up) and release of the tight capsular structures.
Why Choose Shoulder Arthroscopy?
Shoulder arthroscopy is a minimally invasive surgical technique that uses a small camera (arthroscope) and specialized instruments to diagnose and treat shoulder conditions. This approach offers several benefits:
Minimally Invasive: Smaller incisions result in less tissue damage, reduced scarring, and a shorter recovery time compared to traditional open surgery.
Enhanced Precision: The arthroscope provides a clear view of the shoulder joint, allowing for accurate diagnosis and targeted treatment.
Faster Recovery: Many patients experience less pain and a quicker return to normal activities due to the minimally invasive nature of the procedure.
Open surgery for certain shoulder conditions
Some shoulder injuries or shoulder conditions may require an open surgery or a combination of arthroscopic and open surgery:
Surgery for irreparable rotator cuff tears
In some patients with a massive rotator cuff tear it may not possible to repair the tear either because it is severely retracted, or due to poor tissue quality. Such cases may require one or more of the following procedures which are performed as open surgeries or with arthroscopic assistance:
(i) Superior capsular reconstruction (SCR)
This involves taking a patch of tissue taken from the patient’s thigh (fascia lata) and placing it over the torn rotator cuff.
(ii) Tendon transfers
This involves transferring healthy muscles and tendons from around the shoulder to replace the function of the damaged rotator cuff tendon, aiming to restore shoulder strength and function of the shoulder. Commonly used tendon transfers include the latissimus dorsi, teres major, lower trapezius, and pectoralis major transfers, depending on the location and extent of the rotator cuff tear.
(iii) Muscle slide surgery
This is reserved for massive rotator cuff tears which have retracted making it difficult to repair. This procedure involves releasing the torn muscle from its bony attachment on the scapula, allowing it to slide laterally, thus allowing it to be attached back to the humeral head for repair.
(iv) Reverse shoulder arthroplasty
This involves implanting an artificial shoulder implant which is specifically designed for use in cases with where there is advanced arthritis and a severely damaged rotator cuff (known a rotator cuff arthropathy).
Surgery for patients with multiple dislocations of the shoulder
In patients who have a significant bone damage (bone loss) involving the glenoid socket, or in whom a previous surgery for recurrent dislocation has failed or where the tissue quality of the damaged labrum and capsule is poor, a conventional procedure to repair the labrum and capsule (Bankart repair) may not succeed.
In such cases, a Latarjet procedure, wherein a bone along with its attached muscle and tendon (coracoid process and conjoined tendon) or a bone block procedure using an iliac crest bone (hip bone) is used to achieve stability and function.
Patients in whom the shoulder has dislocated multiple times, or in those in a previous surgery has failed, as well as patients with a massive and irreparable rotator cuff tear, require a careful evaluation of their injury and choosing the best possible surgical option to regain optimal function. Dr. Korday, with his vast experience and expertise in treating such patients, will help you in choosing the best treatment modality for you.