Shoulder Arthroscopy - Shoulder Joint Arthroscopy - Arthroscopic Shoulder Surgery
In the past, shoulder surgeries have been high-risk procedures, whereby the results were often only moderately successful. Due to modern, minimal invasive surgery procedures, today shoulder operations bear only low risks and are very effective when performed by an experienced surgeon. Shoulder arthroscopy, meaning the repairing of damages at the shoulder joint without having to actually cut into the shoulder, was first performed about 10 years ago, and its unparalleled success is today an indispensable procedure in modern shoulder surgery. Arthroscopy can achieve full recovery for those who previously suffered from pain and discomfort in the shoulder throughout their lifetime.
Definition – Shoulder Arthroscopy
The term originates from the Greek word 'arthro'. The combined form 'arthron' means literally 'pertaining to the joint'. 'Scope' means 'look' functioning as a combining form meaning 'instrument for viewing'. When we speak about arthroscopy today, we do not only mean to look into something, but we rather refer to the minimal invasive repair of joint damages.
Technique – Shoulder Arthroscopy
In a shoulder arthroscopy, there are generally only two or three 3mm incisions are needed for the surgery itself. An endoscope, a device with a a light source attached to it, is inserted through one of the incisions into the shoulder joint. A miniature camera also attached to this device, reflects the inside of the joint with all its important structures (tendons, ligaments, synovial bursa, cartilage, etc.) on a monitor.
Through an additional 3mm incision, the surgeon then inserts special surgical instruments into the shoulder joint to repair the damage. These instruments are mechanical instruments, such as miniature scissors shavers, knives, and other motorized and non-motorized instruments. A solution (i.e. physiological saline) is pumped into the joint for a better view, and to rinse the joint of debris.
Advantages – Shoulder Arthroscopy
The actual advantage in comparison to open surgery with large incisions and complete opening of the shoulder joint is that in an arthroscopy surgery the healthy structures are not unnecessarily injured in order to access the actually damaged structures. Thus, a shoulder arthroscopic surgery bears lower risks and is less traumatic for the patient. Additionally, there is less pain during the healing process. The shoulder joint recovers relatively quickly and is soon after the surgery fully functional again.
Smaller arthroscopic surgeries, e.g. impingement syndrome or calcified shoulder surgeries, can most often be performed on an outpatient basis. A more extensive surgery, such a reconstruction of the tendon, requires in most cases a two to three day stay at the clinic.
Risks – Shoulder Arthroscopy
Like with any other medical treatment, there are certain risks. These include infections, prolonged bleeding, injury to the surrounding skin and nerves, joint stiffness, etc. However, in an arthroscopic surgery these risks are considerably lower than in an open surgery.
Prior to performing a shoulder arthroscopy, the actual damage(s) of the shoulder joint should be assessed critically. Additionally, the shoulder experts must be able to assess whether the joint damage can be repaired satisfactorily with an arthroscopic procedure or whether at a minimum the risks for future damages, such as the development of a tendon tear can be reduced. Important is here the medical history of the patient, a thorough examination by a shoulder surgeon, and possibly other laboratory examinations, such as X-rays, ultra sound or magnetic resonance imaging (MRI).
Even a minimal invasive surgery must be performed with the utmost care. Although, the risks of an arthroscopic surgery are comparatively low compared to open surgery, complications (like everywhere else in life!) are not to be excluded 100%. For a successful procedure, the experience and expertise of the surgeon and his team are of utmost significance.
Anesthesia – Shoulder Arthroscopy
An arthroscopic shoulder surgery does require general anesthesia. What kind of anesthesia is necessary must be decided upon individually in each case and requires an examination of the patient by the anesthesiologist.
Often the general anesthesia is combined with a local anesthesia of the nerve plexus ( plexus cervicalis) at the shoulder. This combined anesthesia calls for less medication in the general anesthesia and can thus be tolerated better by the patient.
Postoperative treatment – Shoulder Arthroscopy
Even a minimal invasive surgery, such as an arthroscopy of the shoulder, requires post-surgical therapy that is adequate to support the healing process. The post-surgical treatment should be discussed comprehensively between the surgeon and the patient prior to the surgery.
Primarily full recovery depends on the type of damage repaired in the shoulder joint. The most often occurring questions are:
- How long after the surgery should I not strain my arm?
- Will my arm be immobilized in a sling after the surgery?
- When will I be able to return to work?
- How often do I have to go to physical therapy?
- How can I myself contribute to an optimal healing process?
- When can I return to active sports again?
Specialists: Shoulder Arthroscopy
For an optimal treatment of an arthroscopic surgery of the shoulder, the shoulder experts at the Klinik am Ring are particularly well-qualified. Stefan Preis, M.D. and Jörg Schroeder, M.D., senior physicians at the Practice and Department of Orthopedics and Sports Traumatology at the Klinik am Ring in Cologne, specialize together with their team in the treatment of knee and shoulder disorders. In 2004, they founded the WEST GERMAN SHOULDER KNEE & CENTER, Cologne. The team consisting of eight specialists treats more than 10,000 patients per year. The team performs more than 2500 surgeries per year of which about 1000 are arthroscopic surgeries of the shoulder.