Overview
Shoulder arthroscopy is a minimally invasive surgical technique that allows virtually all common shoulder procedures to be performed through small portals rather than a large open incision. As a fellowship-trained Sports Medicine surgeon, arthroscopic surgery is one of the foundations of my practice. One of the greatest advantages of arthroscopy is that it allows me to preserve the surrounding muscles and soft tissues while treating complex shoulder problems through very small incisions. This typically results in less tissue damage, less postoperative discomfort, and faster healing of the surgical incisions.
I perform virtually all of my shoulder procedures arthroscopically. With the exception of shoulder arthroplasty (shoulder replacement), virtually every shoulder procedure I perform can be accomplished arthroscopically. Patients undergo general anesthesia, often combined with an interscalene nerve block. The nerve block is performed immediately before surgery and temporarily numbs the shoulder and arm, providing excellent pain control for approximately 1–3 days, depending on the medications used.
How Arthroscopy Works
The operation is performed through small openings in the skin called portals. Depending on the procedure, anywhere from two to five portals are typically required. A small camera is inserted through one portal and projects a magnified image onto a high-definition monitor.
Specialized instruments are inserted through the remaining portals to perform the surgery. Sterile fluid continuously circulates through the shoulder, gently expanding the joint while keeping the view clear throughout the procedure. The instruments pass through cannulas, which are essentially large straws that allow repeated entry into and out of the shoulder without unnecessary trauma to the surrounding tissues. Through these portals, virtually every common arthroscopic shoulder procedure can be performed. Recovery depends far more on what is repaired than on the arthroscopy itself.
Common Arthroscopic Procedures
Debridement
This procedure cleans up damaged tissue, including unstable cartilage flaps, degenerative labral tissue, partial tendon fraying, inflamed tissue, and loose debris.
Subacromial Decompression
This procedure removes inflamed bursa and reshapes the undersurface of the acromion to allow smoother passage of the rotator cuff with less impingement.
Distal Clavicle Excision
This procedure removes a small portion of the end of the clavicle to eliminate painful bone-on-bone contact from AC joint arthritis.
Rotator Cuff Repair
This procedure restores the torn tendon back to bone using absorbable suture anchors and permanent sutures.
Rotator Cuff Patch Augmentation
This procedure places a biologic patch to reinforce tendon healing or augment a repair in selected patients.
Biceps Tenodesis
This procedure releases the diseased biceps tendon from inside the shoulder and reattaches it lower on the humerus, removing the damaged portion from the working part of the shoulder.
Instability (Bankart) Repair
This procedure reattaches the torn ligament/labrum complex back to bone using absorbable suture anchors to restore stability.
Superior Labral (SLAP) Repair
In selected younger overhead athletes, this procedure repairs the superior labrum and biceps attachment back to the glenoid. Most other patients are better served with a biceps tenodesis.
After Surgery
Temporary swelling of the shoulder, upper arm, chest wall, and occasionally the neck is common because of the irrigation fluid used during arthroscopy. This gradually resolves over several days and is not a cause for concern. Bruising may also travel down the arm or across the chest due to gravity. Although it can appear dramatic, this is a normal part of the healing process.