Shoulder arthroscopy
Shoulder arthroscopy means looking inside the shoulder joint and examining it with long telescopic cameras called arthroscopes. It is performed under general anaesthesia in an operating theatre under sterile conditions, with a camera and surgical instruments inserted through 1 cm holes at the front and back of the shoulder.
The advantages of shoulder arthroscopy can be summarised as follows: because it is done through small holes, recovery after surgery is shorter than with open methods. Because the joint is not cut open, the risk of infection is lower. The patient also feels less pain after surgery. It speeds up the return to sport, especially for athletes.
Which conditions can be treated with shoulder arthroscopy?
Shoulder arthroscopy is a frequently used surgical method. It is most often used for recurrent shoulder dislocations and tears of the rotator cuff that surrounds the shoulder. In recurrent dislocations the tear in the shoulder capsule is repaired; in rotator cuff tears the torn tendon is reattached to the bone. Other common uses are cartilage injuries and removal of loose cartilage fragments.
What are the complications of arthroscopy?
Although arthroscopy is a closed method, it has a low rate of complications, which can be summarised as infection in the joint and damage to cartilage during surgery. The surgeon and anaesthetist take the necessary precautions, and getting the patient moving early after surgery and restoring physical activity minimises possible complications.
Shoulder osteoarthritis
Shoulder osteoarthritis, popularly known as shoulder "calcification", is a progressive disease caused by wear of the cartilage covering the joint surface. It may result from another disease (a previous shoulder joint infection, rheumatic diseases, avascular necrosis of the humeral head, a chronic rotator cuff tear, haemophilia) or a previous injury, or it may arise by itself without any other disease. If there is arthrosis in the family, the likelihood increases.
The most common complaints are shoulder pain, catching, restricted shoulder movement and weakness. Complaints usually extend over many years, although sudden increases in pain may be seen. As the disease progresses, painkillers stop helping and the pain continues even at rest.
For diagnosis it is important to listen to the patient's complaints and assess the joint by physical examination. An X-ray of the joint is sufficient for the diagnosis.
Treatment
Several important factors determine the treatment of shoulder osteoarthritis: how advanced the arthrosis is on X-ray, how long the complaints have lasted, how much the pain affects quality of life, the patient's age and level of physical activity, whether the pain goes away with rest, and what the patient expects from treatment. After evaluating these factors, the patient is given information about the disease and the treatment alternatives are explained. The patient should choose the treatment; the doctor can only guide and should not insist.
In advanced shoulder osteoarthritis the treatment options are limited. If the pain seriously affects the patient's quality of life and the patient accepts surgery, total joint replacement (total shoulder prosthesis) is the most suitable option. Shoulder prostheses have been tested for many years with successful results. They are made of metal alloys and almost never cause reactions such as metal allergy. Once implanted, a prosthesis lasts on average about 15 years.
The prostheses used in total shoulder replacement are generally cemented – that is, they are fixed to the bone with a material called cement that hardens in the body.
The aim of replacement surgery is to relieve the patient's pain: to use the hand and arm without pain and to manage daily needs independently. After surgery, patients can take up sports such as swimming, golf, cycling, skiing and table tennis, but expecting more than this would not be realistic.
Complications of shoulder replacement
Joint replacement is one of the most serious operations in orthopaedics. There are rules to follow before and after surgery, and every possible precaution must be taken during surgery to prevent complications. Any other illnesses the patient has are assessed in detail to see whether they pose a risk for surgery and, if so, how much, and this is explained to the patient. When patients are informed about their operation, its risks are also explained in detail.
Possible complications of joint replacement include: those related to anaesthesia, vessel and nerve injuries during surgery, bone fracture while placing the prosthesis, excessive blood loss, infection around the prosthesis after surgery, restricted movement after surgery and early loosening of the prosthesis.
The surgeon and anaesthetist take the necessary precautions against these complications before and after surgery and give the patient the necessary preventive medical treatment. Getting the patient up early after surgery and back to daily life as soon as possible minimises complications.
Recurrent shoulder dislocation
Recurrent shoulder dislocation usually appears after a shoulder dislocation at a young age, with the shoulder then dislocating frequently and easily. When the first dislocation occurs, the capsule at the front of the shoulder tears away from the bone, so the shoulder later dislocates easily. This detached capsule tear is called a Bankart lesion and is very often found in recurrent dislocations. After the first dislocation the pain quickly passes and the patient returns to normal life, but later the shoulder easily dislocates when putting on a jacket, throwing a stone or reaching to the back seat of a car. Some patients even dislocate the shoulder in their sleep. These recurrent dislocations cause a compression fracture in the round head of the humerus, called a Hill-Sachs lesion, which grows larger as dislocations increase. Recurrent dislocations that seriously affect daily life create a feeling of insecurity, and patients always have to protect their shoulder.
The diagnosis is made by a specialist through physical examination and imaging (X-ray, MRI). Plain MRI often cannot show the Bankart lesion, but it can usually be seen on MRI with contrast. The images are also checked for a compression fracture of the humeral head.
Treatment
The treatment of recurrent shoulder dislocation is surgical. Using an arthroscopic (closed) technique, the capsule that has separated from the bone is stitched back in place with small screws called suture anchors. Because the operation is done through a few holes, there is little pain after surgery and patients can regain normal shoulder movement within two months. An arm sling is used for about four weeks after surgery, during which patients do their exercises three or four times a day; return to strenuous activities and sport is usually possible after eight months.
Complications of arthroscopic surgery for recurrent dislocation
Because it is an arthroscopic procedure, the complication rate is low. The most common complication is recurrence of the dislocation after surgery, at a rate below 10%. There is no difference in recurrence between open and closed operations. Other possible complications are damage to cartilage during surgery, an inadequate repair and restricted shoulder movement after surgery. The doctor takes the necessary precautions, follows the patient closely after surgery and arranges rehabilitation appropriately.
The information on this page is for general information only and does not replace an examination and diagnosis.