How is the procedure performed?
The procedure is performed under a combination of general and regional anaesthesia. An arthroscope is inserted into the joint after distending it with saline. The inside of the joint and subacromial bursa are examined. Bone spurs and loose fragments of bone in the joint are removed. Damaged areas of cartilage are trimmed. The worn surfaces of the joint may be drilled or subjected to microfracture using a pick to promote bleeding and healing with fibrocartilage. The tight sleeve of the joint is released. The axillary nerve may be decompressed. The biceps tendon may be released or tenodesed. The undersurface of the acromion is smoothened with the aid of an arthroscopic shaver (motorised burr). If required the lateral end of the clavicle may be excised.
Alternatives
Early stage arthritis of the shoulder may be treated with physiotherapy to help overcome stiffness. Injections of steroid or Hyaluronic acid may provide short term relief. Surgery is generally considered if symptoms have not responded to simple treatment measures such as physiotherapy or injections.
Benefits
The main benefit of the procedure is to relieve pain and improve movements. This may in turn allow an improvement in the function of the joint and ability to use the arm. The procedure may help delay the need for joint replacement surgery.
Risks
Pain - The shoulder may be painful for some days after surgery. This is usually managed by taking appropriate pain relieving medication and activity modification.
Swelling – During the procedure, the joint is distended with saline and this may lead to the shoulder remaining swollen for a day or two after surgery.
Bleeding – A small amount of bleeding from the arthroscopy portal sites is not unusual and will usually settle after a day or two.
Stiffness – This may occasionally occur after any form of shoulder surgery. Prevention is the key and it is essential to follow the instructions provided, perform daily stretching and exercises at home to maintain the range of movements.
Infection – Infection is a possibility but is rare after arthroscopic surgery.
Nerve injury – Injury to the nerves around the shoulder is possible but rare. The axillary nerve is specifically at risk but is protected.
Persistent symptoms – In some instances symptoms may persist despite surgery.
Worsening of symptoms – There is a small risk of symptoms worsening after surgery.
Aftercare
Following the procedure the arthroscopy portal sites (skin incisions) will be closed with sutures and tape and covered with shower-proof dressings. These dressings should be left undisturbed as far as possible for 5-7 days. If the dressings are removed for any reason they should be replaced with similar dressings or waterproof plasters. A sling will be provided to support the arm, but may be removed as tolerated to move the arm and is usually discarded after 2-3 days. A physiotherapist will provide instructions about mobilising the shoulder prior to discharge from hospital. Outpatient physiotherapy will be arranged.
Resuming activities
You may resume driving at approximately 4-5 days after surgery or when you have regained sufficient movements and control of the arm. Strenuous activities should be avoided for at least 3 months.
Follow-up
An appointment will be arranged for you in the outpatient clinic at three to four weeks after the procedure. Follow-up is required for at least 3-6 months after surgery or until a satisfactory recovery is achieved.