ARTHROSCOPIC SHOULDER SURGERY

When using the arthroscopic procedure, a surgeon repairs a shoulder injury as follows:

• Once the patient has been anesthetized, they are placed in a seated position or laid on their side, at the surgeon’s choice.
• The surgeon proceeds to mark anatomical landmarks on the patient’s shoulder that serve as a guide to locate the small (7-8mm long) entry points (what we call arthroscopic portals).
• Each portal allows access to different areas of the shoulder. A distinction can be made between vision portals (which are preferably used to see, using the arthroscope and sending images of the inside of the shoulder to a TV monitor) and work portals (which are used to introduce various instruments and manage sutures).
• With the help of a water pump, the joint is filled with saline at a certain pressure to improve vision. This is achieved by reducing the patient’s bleeding and expanding and enlarging the reduced space in the shoulder where the surgeon has to work.
• The first step in the surgical procedure is to identify the injury. To do this, the arthroscope is introduced at the level of the glenohumeral space. Some of the injuries that can be found in this joint are capsulo-ligamentous injuries, labrum injuries, tendon injuries, bone injuries, and more. If an injury is found here, it is repaired by the surgeon using athroscopic instruments.
• If no injury is found in the glenohumeral area, another arthroscope is inserted into the subacromial space (where the bursa, the acromion, and the rotator cuff are found) and needed repairs are performed. The most common injuries found in the subacromial space are subacromial bursitis, acromioclavicular joint injuries, and rotator cuff injuries. You can find more information on all these injuries on their dedicated website pages.
• Once the surgery is finished, the arthroscopic portals are sutured and a compression bandage and a sling are put in place.

Once at home, the patient will have to carefully follow all the recommendations that have been given in the hospital, which include:

• Use of the sling. Unless the surgeon indicates otherwise, the patient must use a sling for a period that can range from a few days to 3-6 weeks, depending on the surgery that has been performed.
• Home exercises. The surgeon, rehabilitation specialist or physiotherapist will instruct the patient in regards to the exercises that need to be performed at home and in rehabilitation sessions.
• Surgical wound care. It is essential not to remove dressings during the first few days. During this time, the patient should also avoid getting them wet. Wounds should be kept clean and dry.
• Follow-up. After 10-15 days, a follow-up review is performed in an outpatient clinic and the patient’s stitches are removed.

Infection

Pain. Pain is very common after shoulder repair, being more intense at night. New anesthetic procedures (truncal blocks) allow this complication to be drastically reduced. Truncal blocks consist of administering localized anesthesia with an injection at the armpit/neck level to mitigate postoperative pain. Once the patient is discharged, pain will be controlled by:

• Taking the appropriate anti-inflammatory medication and painkillers.
• Applying cold compresses a minimum of 3-4 times a day for 20 minutes, avoiding direct contact with the skin.
• Sleeping on your back with your chest slightly raised placing your weight on the unaffected shoulder. Placing cushions between your arm and chest or under the operated arm, or even sleeping in an armchair is also advised.

To learn more about complications of arthroscopic procedures related to specific injuries, consult our pages regarding that injury.