Arthroscopy Of The Shoulder

Arthroscopy of the Shoulder: The Operation

After the chosen anesthetic has been administered, the shoulder is thoroughly cleaned, usually with an iodine solution.

• Two to three tiny incisions, called portals, are made around the shoulder joint, in the back, front, and side of the shoulder.
• The surgeon usually inserts the arthroscope through a portal at the back of the shoulder (just below the outer bony prominence at the back of the shoulder).
• Specialized surgical instruments are inserted through the portal in the front of the shoulder.
• Instruments are frequently switched from portal to portal throughout the procedure.
• If you are having an acromioplasty for a rotator cuff injury or impingement syndrome, the surgeon will also create a portal at the side of the shoulder to insert additional surgical instruments.
• In some cases, the surgeon will also make a fourth portal at the top of the shoulder.

The arthroscope projects magnified images of the inside of the shoulder onto a television screen. Sterile saline solution is run into the joint through one of the portals. It is necessary to have this fluid in the joint in order to see with the arthroscope. Specialized instruments are inserted into the joint through the portals, and the appropriate procedure is performed.

In the case of acromioplasty, the surgeon shaves a small portion of the bone from the underside of the acromion using highly specialized rotating or oscillating burrs. This gives the tendons of the rotator cuff or an irritated bursa more room to move and prevents these tissues from being pinched. If there is an accompanying bursitis, the inflamed bursal tissue may be removed as well.

Rotator cuff repair is more involved:

• The surgeon removes a small portion of the undersurface and front aspect of the acromion to make sure the repaired rotator cuff will have enough room to move freely.

• The torn rotator cuff tendon is identified and any scar tissue that has built up on the tendon is removed.
• A small trough is carved at the top of the upper arm bone (humerus) to obtain a small area of bleeding bone that will speed the healing of the tendon to the bone.
• The torn tendon is reattached to the bone in the trough. This is achieved either using specialized anchor stitches which remain permanently inside the bone (though newer absorbable anchor sutures are now also used), or with regular tough sutures that are placed through tiny holes that have been drilled through the bone.
• During this operation, the surgeon removes any bone spurs and will release the ligament that contributes to the impingement problem (the coracoacromial ligament). The surgeon may resect the end of the clavicle if there is painful arthritis at the AC joint (acromioclavicular joint). If a bursa is inflamed, the surgeon will remove it.

Shoulder arthroscopy usually takes one to two hours. The length of the procedure will vary depending on the procedure and the extent of the damage within the shoulder.