Shoulder Arthroscopy

What is shoulder arthroscopy?

A surgical procedure performed inside the shoulder using an optical fiber and a camera inserted into the shoulder, through which the inside of the shoulder can be seen on a screen and surgical procedures can be carried out.

The operation is performed under general anesthesia. In most operations I also add regional anesthesia, which is similar to the numbing injection a dentist gives in the jaw. After the operation the whole arm may stay numb for up to 24 hours. This anesthesia allows minimal use of anesthetic drugs during surgery, an easy and quick recovery, and no pain immediately after the operation – the time when pain is at its worst.

The whole operation is performed through several small incisions of 0.5–1 cm.

For simple procedures two incisions are enough; for complex procedures more incisions are added as needed. The number of incisions does not substantially change the operation itself.

The advantages of arthroscopic surgery compared with open surgery are many

• In open surgery there is a relatively large incision with access to a limited area of the shoulder. In arthroscopic surgery, as many incisions as needed can be made, and every part of the shoulder can be seen and reached.
• Damage to the surrounding tissues is extremely small, and there is no difficulty at all with repeat surgery if needed, because there is no scarring.
• The chance of complications such as bleeding or infection is almost zero in arthroscopic surgery.
• Recovery is easier and the cosmetic result is better with arthroscopic surgery.

To allow work in a confined space such as a joint, fluid (saline – salt water, similar to the solutions used for intravenous fluids) is pumped in through a special pump that keeps a constant pressure inside the joint.

Some of the fluid is absorbed into the tissues around the shoulder, so after the operation the shoulder will be swollen. The fluid is absorbed by the tissue and does not cause any damage. Usually the shoulder returns to its normal shape within a few hours.

Performing arthroscopic surgery requires a lot of dedicated equipment, including: a fluid pump, a camera, a light source, equipment for cauterizing tissue and stopping bleeding, as well as dedicated instruments for working inside the joint and dedicated implants for the joint.

My personal preference is to perform operations arthroscopically as far as possible. Most surgical procedures in the shoulder, including complex procedures such as the Latarjet procedure for recurrent dislocations and even the repair of some shoulder fractures, are performed by me with an arthroscopic technique. The only operations performed with an open technique are joint replacements and complex fractures.

For details about specific operations, see: rotator cuff repair · Latarjet procedure · Bankart repair.

Explanatory video

Rotator cuff tears – diagnosis and treatment – A detailed explanation of rotator cuff tendon tears: the types of tear, symptoms, diagnosis with MRI and the treatment options – from physiotherapy to minimally invasive surgery. The video is in Hebrew.