In the last 20 years, arthroscopic shoulder surgery has gained immensely in importance. Today, it is already the norm and standard for most shoulder joint procedures. Here you will find further information and selected shoulder arthroscopy specialists and centers.
Arthroscopic shoulder surgery is a form of minimally invasive surgery (also known as "keyhole surgery"). The surgeon only makes very small incisions in the skin instead of opening the surgical area through a long incision.
The surgeon inserts a camera probe into the joint through small incisions of around 5 mm. The affected tendons, ligaments or areas of cartilage can now be seen enlarged several times on a high-resolution monitor.
However, shoulder arthroscopy is much more than just a diagnostic method. It can also be used to perform complex operations.
The surgeon uses additional tiny incisions to insert the necessary technical instruments, such as
Implants can also be guided directly to the surgical site, e.g.
With these means, the surgeon can
Shoulder arthroscopy using the example of treating an inflamed bursa © bilderzwerg | AdobeStock
The shoulder has several layers of muscles, with the vast majority of problems affecting the deep layer. In open procedures, it is necessary to work through and around the actually healthy superficial muscles in order to reach the problem area. The opening created must be large enough for fingers and hands to fit through.
Arthroscopic shoulder surgery spares the healthy tissue that lies superficially over the injured structures. No muscles need to be severed and no capsule needs to be detached. This means
In most cases, the wound pain following arthroscopic shoulder surgery is much less than after conventional surgery. This means that fewer painkillers are required.
Due to
the patient can also move and exercise the shoulder again more quickly after the operation.
Last but not least, there are also cosmetic advantages - in most cases there are hardly any visible scars after healing.
Arthroscopic shoulder surgery is technically more complicated than open shoulder surgery and therefore requires a lot of experience. The surgeon's learning curve is flatter. This means that it takes longer to perform an arthroscopic procedure with the same level of confidence as open surgery.
In some cases, an arthroscopic procedure does not promise better success than an open procedure, even in experienced hands.
And be careful! The patient must be aware of this: An arthroscopic procedure on the shoulder is also an operation! There are also complications in arthroscopic shoulder surgery. Rehabilitation after arthroscopic shoulder surgery takes just as long as after open surgery: until the repaired structures have healed completely.
The anatomy of the shoulder © bilderzwerg / Fotolia
The following are some examples of common areas of application for arthroscopic shoulder surgery. However, this list is by no means complete. As the technical possibilities continue to develop, new areas of application are of course emerging day by day.
The first arthroscopic procedure on the shoulder was successfully performed 30 years ago. This involved the treatment of a shoulder dislocation, i.e. a shoulder dislocation with chronic shoulder instability.
In shoulder dislocation, a joint lip is torn off. With the help of tiny suture anchors, it can be reliably reattached and the injured ligamentous apparatus of the shoulder joint reconstructed.
In many cases, the damage can be completely repaired and the normal condition restored. No internal or visible external traces remain. This is particularly possible after a single dislocation of the shoulder joint. Today, this arthroscopic Bankart operation is the gold standard for shoulder dislocation.
After multiple shoulder dislocations or due to chronic shoulder instability, the shoulder socket can be damaged. In this case, or after extreme strain (e.g. in rugby or handball), a bone graft may be necessary. Today, this procedure can also be performed arthroscopically.
Some complaints are caused by a spatial constriction under the acromion. In this case, a relatively uncomplicated arthroscopic relief operation can be performed, known as arthroscopic subacromial decompression (ASAD). The effort involved is low, the surgical risk is low and the chances of success are very good.
Nowadays, however, there is a risk that the procedure is performed too often, too early and uncritically. In the vast majority of cases, conventional orthopaedic and physiotherapeutic treatment would also lead to success.
However, if the operation has to be performed, it should definitely be done arthroscopically.
Today, a rotator cuff tear can also be treated in the vast majority of cases using arthroscopic shoulder surgery. For this purpose, suture anchors are inserted into the bone at the humeral head. These are used to secure the torn tendons and allow them to heal firmly to the bone.
An additional biological measure is the injection of growth factors into the repaired tendon after the operation. This is known as ACP therapy (autologous conditioned plasma). It accelerates and improves healing.
Many small fractures of the humeral head and the glenoid cavity of the shoulder can now be treated arthroscopically. The doctor reduces and fixes the bones securely.
Arthroscopic shoulder surgery also allows simultaneous treatment of concomitant injuries, such as tendon tears or tears in the joint labrum.
Once the fracture has been treated, it is also possible to remove individual screws or small plates from the shoulder arthroscopically.
There have also been particularly interesting developments recently in the field of arthroscopic treatment of
shoulder. For example, there are now a number of biological cartilage replacement materials that can be inserted into isolated cartilage defects using arthroscopic procedures.
In cases of advanced degeneration of the shoulder joint, the resulting spikes and edges (osteophytes) can also be removed arthroscopically. At the same time, the surgeon can smooth the joint surface and remove free joint bodies. Finally, adhesions on the capsule are released and trapped or pinched nerves are freed.
In this way, a shoulder prosthesis can often be postponed even in cases of relatively advanced osteoarthritis.
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