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Arthroscopic Shoulder Surgery - General Description

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Published on Monday, 05 October 2009 01:59

Written by Vic Goradia, M.D.

Shoulder Arthroscopy - by Vic Goradia, M.D.

Arthroscopy is a technology that allows the doctor to visualize the inside of your shoulder joint and the space above the joint (subacromial space) through two to four small incisions. The joint or space is filled with fluid and a tube about the size of a pencil is inserted through one of the small incisions. The tube has a fiber optic camera attached to its end that allows your doctor to see inside your shoulder. Instruments are inserted through the other incisions so damaged structures can be treated, or tissue and bone can be removed as needed. Arthroscopy is also helpful in diagnosing certain problems with your shoulder that other tests such as X-rays and MRI scans may not show.

Shoulder Arthroscopy for Labral tears.

Arthroscopy is useful to diagnose and treat damage to the labrum (the ring of cartilage that deepens the socket), defects in the articular cartilage (the covering on the end of the bone), loose pieces of cartilage or bone, damage to the ligaments, and rotator cuff tears (the small muscles surrounding the shoulder joint).

Treatment of the torn labrum (cartilage ring) most often results in removal of the damaged portion. Sometimes, metal suture anchors or absorbable tacks can be used to repair and secure the labrum back to bone.

Ligaments pulled loose when the shoulder comes out of place can occasionally be fixed through the arthroscope with similar suture anchors or absorbable tacks. But sometimes it is necessary to open the shoulder through an incision.

In select cases of shoulder “looseness,” a thermal probe, inserted arthroscopically, can be used to “shrink” and “tighten” the ligaments and joint lining. Even though shrinkage with lasers has been used since the 80s, the thermal shrinkage procedure has only become popular over the past five years.

In appropriately selected cases, the procedure has excellent results up to two to four years after surgery. Unfortunately, the long-term outcomes, defined as five to 10 years, have not yet been studied. It is certainly possible that the tissue will stretch and cause the shoulder to become loose again. For this reason, some insurance companies regard this as an “experimental procedure.” I disagree. A large number of shoulder surgeons and sports medicine specialists around the country routinely use this technology to prevent patients from requiring an incision and a much more extensive operation. If your insurance company fails to cover this procedure, ask your surgeon to send a letter explaining the reasons and indicate it is a standard technique used by many surgeons.