Shoulder Arthroscopy

Indication

Arthroscopy is prescribed whenever there is a requirement to confirm any kind of medical doubts generated during previous diagnostic tests like MRI scans, CT scans, X-ray scans and physical examinations, which have indicated towards a certain problem in a particular joint area.

Usually, undertaken as the final diagnostic step, arthroscopy is known to be more accurate than open surgery or X-rays as the process allows surgeons to visualize internal details of the joint on a magnified screen. Bones, cartilages, muscles, tendons and ligaments experience injury and damage during various diseases and also during accidents. Following are the main conditions that make orthopedics prescribe arthroscopy:

#1 Inflamation

Inflammation at the joint area is often seen in diseased conditions wherein the lining in the knee, wrist, shoulder and ankle suffers from synovitis. A complete diagnosis through arthroscopy is required to finally determine the process.

#2 Injury

Joints often suffer acute or chronic injuries which could be in the shoulder, knee, wrist or elbow region. The most common form of injury is the occurrence of loose bodies of cartilage and bones that happen due to partial fracture suffered in minor accidents.

Other important injuries may include tendon tear (rotator cuff), impingement syndrome ad recurring dislocations in the shoulder joint, cartilage tears (meniscus), chondromalacia (cartilage cushion wearing), and ligament tears (often with instability in the knee joints, carpal tunnel syndrome in wrists, and other ligament or tendon injuries in joints.

#3 Arthritis

Problems related to arthritis like cartilage wearing and inflammation are also treated using arthroscopy. The process is often used over multiple times to ensure proper arthritis treatment.

Arthroscopy is also undertaken along with other important surgeries which include rotator cuff surgery, repair and resection of torn cartilage from knee or shoulder, carpal tunnel removal, torn ligament repairs, ligament repair and reconstruction, and removal of loose bones and cartilage in the joint area.

Pre-Procedure

The process of arthroscopy is simple and easy to understand. The patient is asked to change into an operating gown and an anesthetic is administered either locally or generally. A small incision in the skin is made above the joint and the arthroscope is inserted in to the joint area. The extent of damage is observed on a large screen and if treatable surgically, the appropriate surgical process is administered. The complete view of the joint is recorded in the computer and once the procedure is complete, the incision is sealed using small stitches or surgical staplers or simple dressing.

In recent times, multiple buttonhole like incisions are made in different parts of the joint and similar tools are inserted all at the same time to give a complete view of the interiors to the surgeon. These incisions are tiny and do not cause blood loss to patients and are sealed using proper dressings, which allow the incisions to close naturally over time.

Arthroscopy is often a compulsory element of surgeries that involve knee, shoulder, elbow, ankle, hip, and wrist corrections. Other joints may be treated more frequently in the future with more development in orthopaedic techniques and advances in fiberoptic technology.

• The patient will be asked to stop certain medications that cause blood thinning or that suppress the immune system, at least two weeks prior to the surgery.
• Smoking should also be stopped at least two weeks before the surgery as it interferes with the healing process.
• The patient will be on fasting for 8-12 hours before the surgery.

During-Procedure

• The surgery is done by an orthopedic surgeon under general anesthesia/spinal or epidural anesthesia. The procedure can take up to two hours.
• An incision is made on the area where osteotomy is to be done.
• In high tibial osteotomy, a precise wedge of bone is removed from below the knee cap, which causes the leg to bend slightly inwards. The weight is transferred to the outside/lateral portion of the knee.
• Staples/plates/screws may be used to close the gap. Bone graft from the patient/ donor or synthetic bone graft may be used to fill out the wedge.
• The new knee alignment will be checked again and the surgical wound will be closed.

Post-Procedure

The process is not time consuming and is usually completed within one or two hours.

All patients are required to have normal breathing and pulse rate before being shifted to the recovery ward as the anesthetic administered is either local, general or a spinal. After the patient is shifted to a recovery ward, he/she is observed for swelling or any secondary reaction after the surgery.

There is no need for pain killers at any stage since most arthroscopic procedures help in reducing or diagnosing the cause of pain and does not trigger new pain unless there is a complication. Excessive pain must be reported to the doctor immediately. The findings of the process can be discussed and the patient can opt for a bigger open surgery on a later date or the family may allow it while under the same anesthesia. Post-op care for arthroscopy is mainly geared towards healing of the incisions and recovery of normal movement in the joint area. The doctor prescribes certain measures to allow quick healing of the incisions followed by a few exercises to allow normal activity in the treated joint. For the joint to heal, he may prescribe a few sessions with the physiotherapist. For the incisions, he prescribes the right dressing medication. The doctor also schedules follow-ups to check the rate of healing and remove sutures if any.

Risk and Complication

Every procedure has some risks or the other. Some of the common risks of this process are as follows:

#1 Injury

Although designed to detect and rectify injury, the process of arthroscopy may lead to accidental injury to nerves and blood vessels surrounding the joint, leading to unwanted bleeding and numbness. This condition however, occurs rarely. It is important to note that bleeding at the test site can cause obstruction in visualizing the interior details of the joint and therefore, impede with the process making it longer than usual. The skill of the surgeon is to be highly reliable in this regard.

#2 Infection

There are minimal chances of infection in arthroscopy as the incision is small and the tools used are highly sterilized. However, accidents like breakage of tools (reported in only one percent of these surgeries) may require creating a larger incision to retrieve external elements from within the body and this might lead to an infection.

#3 Blood Clots

Reported rarely, blood clots in the vessels in and around the joint may occur when obstructive flow happens during the process of arthroscopy. This is a minor risk and can be treated with suitable medication when detected. However, if the clot goes undetected, it may lead to pain and swelling at a later stage.