SHOULDER ARTHROSCOPY

Many operations on the shoulder are performed arthroscopically (via key-hole surgery). The main proposed advantage of this is speed of recovery due to less pain. Another advantage is that it gives the surgeon the opportunity to view many more structures inside the shoulder than they would via an open approach, thus giving your shoulder a general thorough examination.

In our unit you will normally be offered a general anaesthetic (to be put to sleep) and also have a ‘nerve block’ as well. This means that when you are asleep, but before the surgery starts, the anaesthetist will do an injection of local anaesthetic into the base of your neck to numb the nerves that travel across the shoulder and down the arm. This is so that when you wake up after the surgery, your arm is comfortable (it will be numb). This is usually tremendously successful at making patients immediate post-operative recovery more comfortable and has revolutionised shoulder surgery making many procedures possible as day-cases. The block wears off naturally over a 24-48 hour period after your operation.

After both forms of anaesthetic, you are positioned in the theatre in the ‘beach-chair’ position where you are sat-up to about 60 degrees with your knees bent slightly. A small section of the operating table is removed from the back so that access can be gained to the back of your shoulder. Your head is safely supported in a cradle. Sometimes your arm is put in a little light traction to pull the shoulder down and forwards to enable the surgeon to get a better view of the joint inside.

When the skin is prepared (washed) with a surgical cleaning solution (anti-septic), drapes are placed around the shoulder and the operation can commence. The commonest place to make the first incision (portal) is on the back of the shoulder and the camera (arthroscope) is inserted until it slides in to the joint. The arthroscope is a little wider than a pencil but about as long. Down the arthroscope travels normal saline (water to inflate the joint) and a light. The inside of the joint is immediately visible on the monitor (a TV screen). Further portals may be made on the side and at the front to allow other instruments into the joint to examine structures more closely or move them around.

A thorough examination of the joint can be performed with the arthroscope in the back of the shoulder, with the surgeon being able to view most structures very well. The rest of the procedure depends on what the purpose of the arthroscopy was. After the surgery the portals can be stitched or just left to heal by themselves. Rather ironically, the smallest scars are often from the portals that were just left alone and not stitched. The skin usually heals well leaving scars between 0.5 and 1 cm long but there could be several (2 to 5) on the shoulder depending on what was done. Your shoulder will be placed in a sling and you will be transferred to the recovery room to come round from the anaesthetic.