What to Expect Before, During, and After Shoulder Arthroscopy

Introduction

Shoulder arthroscopy is a minimally invasive surgical procedure that offers valuable insights into several common shoulder conditions. If you’re an athlete or someone who has suffered from annoying shoulder pain, learning some basics about the operative procedure of arthroscopy and its subsequent treatment course is essential. This blog takes you through the few anxious days before surgical intervention, the operative procedure, and the postoperative recovery process. 

What is Shoulder Arthroscopy?

Shoulder arthroscopy is a minimally invasive surgical procedure in which an arthroscope, a small camera, is used to examine or repair the tissues inside or around the shoulder joint. The surgeon makes tiny incisions and looks at the joint through a camera with a monitor, diagnosing the problem and using specialized instruments to perform the surgery, if needed. It provides faster recovery, less pain, and less scarring than traditional open-shoulder surgeries. Shoulder arthroscopy is a procedure of choice for many shoulder problems, to name a few like torn ligaments, rotator cuff tear, and bone spur removal.

When is Shoulder Arthroscopy Recommended?

Shoulder arthroscopy surgery is commonly used in the diagnosis and treatment of a variety of common shoulder problems. The following are conditions or problems that can be identified and, in some cases, treated using arthroscopy:

• Rotator Cuff Tears: Damage to one or more of the tendons connecting the muscles in the rotator cuff to the head of the humerus. This commonly occurs from a sports injury or degeneration of the tendons over time.
• Impingement: This occurs when the space between the humerus and rotator cuff narrows, and the acromion encroaches on the space, causing the tendons or bursa to be compressed, leading to pain and restricted motion, often worsened when raising the arm.
• Shoulder Instability: When the upper arm bone is forced out of the shoulder socket, either partially or fully. The ligaments keeping the shoulder stable may be either stretched or torn.
• Labral Tears: The ring of cartilage, called the labrum, that goes around the edge of the shoulder socket, keeping it in place can tear. A torn labrum will cause the shoulder to feel like it may slip out of place or catch.
• Bone Spurs: Osteoarthritis causes the cartilage that covers the head of the humerus to gradually wear away, driving several conditions that lead to pain and disability.
• Bursitis: Inflammation of the bursa. A bursa is a thin sack of fluid between certain tendons and the bone beneath the tendon.
• Frozen Shoulder (Adhesive Capsulitis): This condition causes pain and stiffness in the shoulder from scar tissue forming, thickening the shoulder joint lining.
• Arthritis: There are several types of arthritis, but in the shoulder, osteoarthritis is the most common, causing the protective cartilage that lines the ends of the bone to wear away gradually.
• Cartilage and Ligament Injuries: Damage to these structures can cause pain and instability.

It is important to note that not everyone may benefit from shoulder arthroscopy. A thorough evaluation with an orthopedic surgeon in Bangalore can help determine whether arthroscopy is right for you.

How to Prepare for Shoulder Arthroscopy?

Preparation is crucial for shoulder arthroscopy to guarantee smooth surgery and speedy recovery. The following actions can assist patients in preparing:

• Medical Evaluation: You will undergo a thorough medical evaluation and surgical clearance with your primary care provider or a clinical nurse specialist. Blood tests or other diagnostic tests may be ordered.
• Medication Review: Review all your current medications, including blood thinners and nonsteroidal anti-inflammatory drugs (NSAIDs), with your provider. Some over-the-counter drugs, supplements, or herbal products will have to be stopped before surgery.
• Fasting: It is essential to refrain from food or drink, even water, typically after midnight the evening before surgery, especially if you have general anesthesia.
• Plan Ahead: Make arrangements for someone to drive you home or accompany you following your surgery, as you will not be allowed to drive yourself.
• Physical Therapy: Some providers may order exercises you can begin before surgery that focus on strengthening your shoulder for improved post-surgical outcomes.
• Allergies: Ensure you have advised your care team of any allergies, particularly to any medications or anesthesia.
• Appropriate Clothing: Dress in comfortable clothing (you will get undressed into a patient gown, but you will be clothed again before leaving). Remembering your shoulder will be bandaged following the procedure, shirts with button fronts and comfortable, loose-fitting clothing are ideal.
• Patient Teaching: You may also receive written information about the surgery, as well as a video to watch if you choose. You will be reminded to avoid smoking and to make sure to cleanse the surgical area.

Doing these things ahead of time can make your recovery easier and help ensure the best possible outcome from your shoulder arthroscopy.

What Happens During a Shoulder Arthroscopy?

Shoulder arthroscopy is a minimally invasive, precise surgery. The general course of events during the procedure is broken down as follows:

• Anesthesia: Before your procedure starts, you’ll receive anesthesia. It could be general or regional anesthesia. An anesthesiologist will monitor your vital signs throughout the procedure.
• Positioning: Once you are anesthetized, you will be positioned so your shoulder is visible. You may be placed in the “beach chair” position or the lateral decubitus position.
• Preparing the Shoulder: The surgical area will be cleaned with an antiseptic solution. Sterile drapes will be placed around the shoulder.
• Creating a Portal: The surgeon inserts the arthroscope into the shoulder joint using a small incision (about the size of a buttonhole). Images from the arthroscope are sent to a large screen in the operating room, where the surgeon can view them in real time.
• Inspecting the Joint: The surgeon uses these images to inspect the entire joint and identify any damage or abnormalities.
• Creating More Portals: If necessary, the surgeon will make one or more extra small incisions to insert other instruments. These instruments remove bony spurs, fix tears or tendons, remove damaged tissues, or do other repair work.
• Procedure Specifics: Procedures that could be conducted according to the diagnosed shoulder pain involve:

• Repairing torn tendons or ligaments
• Taking out curtailed cartilage
• Reshaping bone to fix impingement
• Removing the loose items from the joint
• Treating an infection or inflammation.
• Closing the surgery: When the surgeon is done with surgery, the arthroscope and instruments are removed, and the incision will closed with stitches or steri-strips and covered with a sterile dressing.

After the procedure, you will be taken to the recovery room, where your vital signs will continue to be monitored as you wake up from the anesthesia. Once you are completely alert, you will be discharged with post-operative care instructions. In most cases, patients are discharged to go home on the day of surgery.

Recovery & Aftercare

Gaining complete shoulder function and a favorable result after shoulder arthroscopy depends heavily on recovery and aftercare. What to anticipate in the healing period and suggestions for aftercare are as follows:

• Immediate Post-Op: You will stay in the recovery room until you are completely awake and your vital signs are stabilized following the surgery. You will receive instructions on how to take care of yourself initially, along with painkillers if needed.
• Pain management: Following the surgery, you can feel pain and discomfort. To help you handle this, your doctor may likely prescribe medicines. It’s critical to take prescription drugs as prescribed and to report any adverse effects or concerns.
• Use of Sling or Immobilizer: To preserve the joint and allow tissues to recover, you may need to wear a sling or shoulder immobilizer for a few days to several weeks, depending on the type of surgery you had.
• Physical Therapy: Physical therapy exercises are crucial to recovery. Your surgeon or physical therapist will provide you with exercises to help strengthen your shoulder and maintain your range of motion.
• Wound Care: The surgical area must be kept clean and dry. You will be given instructions for care of your stitches or sterile strips, when you can shower, and when you should change dressings.
• Activity Restrictions: You should avoid using your operated shoulder to lift heavy objects and for demanding activities initially. As your shoulder heals, you will gradually be allowed to do gentle range of motion and strengthening exercises. 

It’s essential to strictly follow your doctor’s instructions and suggestions customized to your circumstances since individual experiences might differ.

Complications Associated with Shoulder Arthroscopy

• Infection: The surgical site may get infected. However, this is uncommon. Fever and chills are possible symptoms, as well as redness, edema, warmth, or discharge from the wound.
• Bleeding or Hematoma in the shoulder joint: As with any surgery, bleeding is a potential complication of total shoulder replacement. This may be just a tiny quantity of blood in the joint or may require removing blood from the joint due to pain and swelling.
• Nerve or Blood Vessel Injury: Both the nerves and blood vessels in the vicinity of the shoulder can potentially be damaged by any of the instruments used during the procedure. Damage to a nerve can cause numbness, tingling, weakness, or even vascular flow issues.
• Stiffness: Range of motion restrictions occur in a small number of patients when the incision is made in the same place as their previous rotator cuff surgery. 
• Chondrolysis: A rare complication where the cartilage in the joint breaks down rapidly after the surgery, leading to pain and loss of joint function.
• DVT (Deep Vein Thrombosis): The formation of blood clots occurs in deep veins initially. The danger occurs when these clots break free and travel to the lungs (pulmonary embolism).
• Anesthetic Complications: Any procedure that involves anesthesia carries with it the risk of complications, such as allergic reactions, breathing difficulties, or medication reactions.

Additionally, the impact of these challenges can be lessened by quickly recognizing and resolving any possible problems. If there could be issues following the procedure, always contact your healthcare practitioner.

Conclusion

Shoulder arthroscopy is a minimally invasive procedure that can diagnose and treat shoulder problems. The option of using smaller incisions means less scarring and a quicker recovery time. That is why a lot of people have come to consider or choose arthroscopy as their surgical treatment. However, as with any surgery, risks are involved, and you must be prepared for the procedure, understand it, and understand how to take care of your shoulder when the surgery is over. Also included in that expectation is the risk of what happens if things don’t go as planned and the well-documented complications from these procedures.

FAQs

1.  Will I have noticeable scars after the surgery?

Since arthroscopy is minimally invasive, scars are usually small. They may become less noticeable over time, but their appearance varies from person to person.

2. When can I drive after the procedure?

Generally, you should not drive while taking narcotic pain medications. Depending on your recovery, you may be able to drive within a week or two but always consult with your surgeon first.

3. Is shoulder arthroscopy covered by insurance?

Most health insurance plans cover shoulder arthroscopy, but coverage details and out-of-pocket costs can vary. Always check with your insurance provider beforehand.

4. How soon after the surgery can I shower?

You’ll typically need to wait 48 hours or until your post-operative check-up. The goal is to keep the surgical sites dry to prevent infection.

5. Is there an age limit for undergoing shoulder arthroscopy?

There’s no strict age limit. However, overall health, coexisting medical conditions, and the specific problem being addressed will determine whether arthroscopy is suitable.