An introduction to arthroscopic surgery of the shoulder
‘Atheros’ means joint in Greek. The arthroscope is an instrument used by orthopaedic surgeons to look into joints. It is about 8 – 10 inches long and is as thick as a pencil. There is a fibre optic lens system which transmits light from a cold light source outside and relays the interior image to a medical television monitor. In other words, the arthroscope serves as a camera device to look into structures inside a joint. It is possible to diagnose pathological conditions not seen on X-rays and sometimes even on MRI scans.
Who is a candidate for shoulder surgery?
a) Rotator cuff tears, partial and complete
b) Recurrent dislocations
c) Frozen shoulder and adhesive capsulitis
d) Calcium deposition
e) Loose bodies
Advantages
As there are no large formal incisions, post-operative pain is minimal. Since muscles and tissues are not removed from their origins on bone, again the amount of inflammation is minimal. Recovery can be faster as it is not necessary for muscles to heal back. Cosmetically the procedure is very satisfying. There are no mental scars of open surgery. Return to sport or work is faster; hospital stays are shorter and hence bills are smaller. However arthroscopic equipment is expensive to hire or possess, and the surgeon has to recover the cost of dispensable items like shavers, suture anchors. This is offset by enormous patient satisfaction.
Shoulder surgery by its simple nature provides an opportunity to the orthopaedic surgeon to examine the interior of a joint. After Knee arthroscopy, the shoulder is the joint which is suited for shoulder surgery. Other joints are the ankle, wrist and elbow.
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The conditions treated by open surgery earlier are now treatable by shoulder surgery with remarkable success. Some hitherto unknown conditions have been diagnosed after the advent of arthroscopic surgery.
Any painful or unstable condition of the shoulder except end-stage arthritis can be treated by arthroscopic surgery. Shoulder replacement is not yet possible arthroscopically, but with minimally invasive orthopaedic surgery catching up, that may not be far off. It is certainly possible to introduce prosthesis for fracture fixation through key hole incisions and the same may be extended to joint replacement as well.
Arthroscopy can be diagnostic to confirm or make the diagnosis. X -rays do not reveal soft tissue pathology and many patients are frustrated when their orthopaedic surgeon dismisses their pain as of no significance just because the X-ray is normal. MRI and ultra sound are useful non-invasive investigations but is operator dependent and need good musculo skeletal radiologists to interpret them.
Rotator cuff disease, instability, impingement due to bony outgrowths from the clavicle or the acromio clavicular joint can be trimmed arthroscopically. Infections can be drained. Recalcitrant calcium deposits can be needled and a frozen shoulder can be released arthroscopically. SLAP lesions are debrided and reconstructed by this method through small key hole incisions.
How is the procedure done?
Arthroscopic surgery is an elective or planned surgery. It is done under general anaesthesia. It is done as a day case which means that you may be discharged the same day (Day care or surgery). The instrument is introduced into the joint through small incisions about half a centimetre long. Other instruments are also introduced and manoeuvred to achieve the therapeutic goal.