Arthroscopic shoulder surgery is a form of minimally invasive surgery (also known as “keyhole surgery”). Instead of making a long incision to open up the surgical site, the surgeon makes only very small incisions in the skin.
Through small incisions of about 5 mm, the surgeon inserts a camera probe into the joint. He can then view the affected tendons, ligaments, or cartilage areas magnified several times on a high-resolution monitor.
But shoulder arthroscopy is much more than just a diagnostic method. It can also be used to perform complex surgeries.
To do this, the surgeon inserts the necessary surgical instruments through additional tiny incisions, such as
- mini-scissors,
- suture loops, and
- suture material.
Implants can also be guided directly to the surgical site in this way, e.g.,
- suture anchors,
- dowels, or
- screws.
Using these tools, the surgeon can
- detach tissue or reattach it to the bone,
- break up adhesions, and
- remove joint structures.
Shoulder arthroscopy, illustrated by the treatment of an inflamed bursa © bilderzwerg | AdobeStock
The shoulder has several layers of muscles, with the vast majority of problems affecting the deep layer. In open surgery, surgeons must work through and around the superficial muscles—which are actually healthy—to reach the problem area. The resulting incision must be large enough to allow fingers and hands to pass through.
Arthroscopic shoulder surgery preserves the healthy tissue that lies just beneath the injured structures. No muscles need to be cut, and no joint capsule needs to be detached. This means
- less bleeding,
- smaller incisions, and
- a lower risk of infection.
In most cases, postoperative pain following arthroscopic shoulder surgery is much less severe than after conventional surgery. As a result, fewer pain medications are needed.
Due to
- less bleeding and bruising,
- smaller scars, and
- less pain
, the patient can also resume movement and begin shoulder exercises sooner after surgery.
Last but not least, there are also cosmetic benefits—in most cases, scars are barely visible once healing is complete.
Arthroscopic shoulder surgery is technically more complex than open surgery and requires a corresponding level of experience. The surgeon’s learning curve is steeper. This means it takes longer for the surgeon to perform an arthroscopic procedure with the same level of confidence as an open surgery.
In some cases, even when performed by an experienced surgeon, an arthroscopic procedure does not promise better results than open surgery.
And be aware! The patient must understand: Even an arthroscopic shoulder procedure is a surgery! Complications can also occur in arthroscopic shoulder surgery. Rehabilitation after an arthroscopic shoulder procedure takes just as long as after open surgery: until the repaired structures have fully healed.
The Anatomy of the Shoulder © bilderzwerg / Fotolia
Below, we provide some examples of common applications of arthroscopic shoulder surgery. However, this list is by no means exhaustive. As technical capabilities continue to advance, new applications naturally emerge every day.
Shoulder Instability
The first arthroscopic shoulder procedure was successfully performed 30 years ago. It was used to treat a shoulder dislocation—that is, a shoulder dislocation associated with chronic shoulder instability.
In a shoulder dislocation, a labrum tear has occurred. Using tiny suture anchors, the labrum can be reliably reattached, thereby reconstructing the injured ligamentous structure of the shoulder joint.
In many cases, this allows the damage to be completely repaired and normal function to be restored. No internal or visible external scars remain. This is particularly possible after a single dislocation of the shoulder joint. This arthroscopic Bankart procedure is now the gold standard for treating shoulder dislocation.
Repeated shoulder dislocations or chronic shoulder instability can damage the glenoid cavity. In such cases, or following extreme stress (e.g., in rugby or handball), a bone graft may be necessary. This procedure can also be performed arthroscopically today.
Subacromial Impingement
Some symptoms are caused by a lack of space under the acromion. In such cases, a relatively straightforward arthroscopic decompression procedure can be performed, known as arthroscopic subacromial decompression (ASAD). The procedure is minimally invasive, the surgical risk is low, and the chances of success are very high.
However, there is a risk today that this procedure is being performed too frequently, too early, and without sufficient clinical justification. In the vast majority of cases, conventional orthopedic and physical therapy treatment would also lead to a successful outcome.
If surgery is necessary, however, it should definitely be performed arthroscopically.
Rotator Cuff Repair
Even a rotator cuff tear can now be treated in the vast majority of cases through arthroscopic shoulder surgery. For this procedure, suture anchors are inserted into the bone at the head of the humerus. The torn tendons are securely attached to these anchors, allowing them to heal firmly to the bone.
An additional biological intervention involves injecting growth factors into the repaired tendon after surgery. This is known as ACP therapy (autologous conditioned plasma). It accelerates and improves healing.
Fractures
Many small fractures of the humeral head and the shoulder socket can now be treated arthroscopically. During the procedure, the surgeon safely reduces and stabilizes the bones.
Arthroscopic shoulder surgery also allows for the simultaneous treatment of associated injuries, such as tendon tears or tears of the labrum.
After the fracture has been treated, it is also possible to remove individual screws or small plates from the shoulder arthroscopically.
Cartilage Damage and Osteoarthritis Treatment
There have also been particularly interesting recent developments in the field of arthroscopic treatment of
. Today, there are a number of biological cartilage replacement materials that can be implanted into isolated cartilage defects via arthroscopic procedures.
In cases of advanced degeneration of the shoulder joint, the resulting spurs and edges (osteophytes) can also be removed arthroscopically. At the same time, the surgeon can smooth the joint surface and retrieve loose bodies. Finally, adhesions in the joint capsule are released, and pinched or compressed nerves are freed. In this way, even in cases of relatively advanced osteoarthritis, the need for a shoulder prosthesis can often be delayed.
Shoulder arthroscopy is a modern surgical procedure frequently used to treat shoulder pain; it is classified as both a shoulder arthroscopic procedure and, more generally, as an arthroscopic procedure. Shoulder arthroscopy, or arthroscopy of the shoulder joint, is performed arthroscopically as a minimally invasive procedure under sterile conditions via two small skin incisions and can be performed on an outpatient basis, for example, as part of a shoulder arthroscopy in Düsseldorf.
During the procedure, the surgeon can specifically assess the findings, examine tissue, and evaluate structures such as the rotator cuff tendons, the long biceps tendon, a ligament, the labrum of the shoulder, the bursa, or an inflamed bursa at the acromion.
Typical indications include impingement syndrome, shoulder impingement, calcific tendinitis, shoulder dislocation, and other damage or injuries to the shoulder joint that cause shoulder joint discomfort and pain.
After shoulder arthroscopy, the operated shoulder can usually bear weight quickly, and shoulder mobility is often restored; the healing time depends on the extent of the surgery and is also described in the *Shoulder Practice Manual*.
What is shoulder arthroscopy?
Shoulder arthroscopy is an arthroscopic procedure in which the shoulder joint is examined using an arthroscope through small incisions in the skin. It is used to diagnose and treat damage to the shoulder joint.
When is shoulder arthroscopy performed?
Shoulder arthroscopy is recommended for persistent shoulder pain, shoulder instability, calcific tendinitis, osteoarthritis, or rotator cuff injuries when conservative treatments are insufficient.
How is shoulder arthroscopy performed?
Shoulder arthroscopy is usually performed under general anesthesia or local anesthesia using an arthroscope. An arthroscope and surgical instruments are inserted into the shoulder joint through small incisions to address the condition.
Is shoulder arthroscopy an outpatient procedure?
In many cases, shoulder arthroscopy is performed on an outpatient basis. The patient can usually leave the hospital the same day, depending on the extent of the surgery.
How long does recovery take after shoulder arthroscopy?
The recovery time depends on the extent of the procedure and the follow-up care. Through targeted physical therapy, shoulder mobility can be gradually restored.
