Shoulder arthroscopy

About shoulder arthroscopy

Shoulder arthroscopy is performed through small cuts in your skin, using a special telescope (arthroscope) attached to a video camera. Compared with open surgery, arthroscopy has a faster recovery time.

Your doctor may suggest you have a shoulder arthroscopy to repair damage to your shoulder caused by injury or certain conditions affecting your shoulder. Shoulder arthroscopy is considered effective for some shoulder problems, including:

  • injury to the shoulder joint
  • damage to the ligaments or tendons
  • cartilage problems
  • wear and tear of the joint

What are the alternatives?

Not everyone who has shoulder problems needs to have an arthroscopy. Your doctor will usually be able to diagnose your shoulder problem using physical examination and other tests such as an X-ray or an MRI scan.

Depending on what has caused the damage, your shoulder problem may improve on its own without treatment or with self-help measures, such as following an exercise programme to strengthen the muscles around your shoulder. Other treatments for shoulder problems may include physiotherapy and medicines. Talk to your doctor about what treatment options are available for you.

Preparing for a shoulder arthroscopy

Your orthopaedic surgeon (a doctor who specialises in bone surgery) will explain how to prepare for your procedure. For example, if you smoke you will be asked to stop, as smoking increases your risk of getting a chest and wound infection, which can slow your recovery.

The operation is usually done as a day case, which means you won’t have to stay in hospital overnight.

The operation may be done under general anaesthesia, but it can be combined with local anaesthesia, to give you pain relief after the operation. General anaesthesia means you will be asleep during the operation. Local anaesthetic completely blocks pain from the shoulder area. Sometimes, the whole operation can be done under local anaesthesia, which means you will stay awake during the operation. Your surgeon may offer you a sedative with a local anaesthetic, which relieves anxiety and helps you to relax during the operation.

If you're having a general anaesthetic, you will be asked to follow fasting instructions. This means not eating or drinking, typically for about six hours beforehand. However, it’s important to follow your surgeon’s advice.

Your surgeon will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to understand what will happen, and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead, which you may be asked to do by signing a consent form.

You may be asked to wear compression stockings to help prevent blood clots forming in the veins in your legs. You may need to have an injection of an anticlotting medicine called heparin as well as, or instead of, wearing compression stockings.

What happens during a shoulder arthroscopy

A shoulder arthroscopy often takes less than an hour, depending on how much work your surgeon needs to do inside your shoulder joint. Once the anaesthetic has taken effect, your surgeon will make small cuts in the skin around your shoulder joint. He or she will pump sterile fluid into your joint to help produce a clearer picture and then insert the arthroscope.

Your surgeon will examine your shoulder joint by looking at images sent by the arthroscope to a monitor. If necessary, he or she can insert surgical instruments to repair damage or remove material that interferes with movement and causes pain in your shoulder.

Afterwards, your surgeon will drain the fluid and close the cuts with stitches or adhesive strips. He or she will then wrap a dressing and a bandage around your shoulder.

What to expect afterwards

You may need to rest until the effects of the anaesthetic have passed. It may take several hours before the feeling comes back into your shoulder area. Take special care not to bump or knock the area.

You may need pain relief to help with any discomfort as the anaesthetic wears off.

You will usually be able to go home when you feel ready. You will need to arrange for someone to drive you home. Try to have a friend or relative stay with you for the first 24 hours.

Your nurse will give you some advice about caring for your healing wounds before you go home. You may be given a date for a follow-up appointment.

The amount of time your dissolvable stitches will take to disappear depends on the type of stitches you have. However, for this procedure, they should usually disappear in about six weeks.

Recovering from shoulder arthroscopy

It usually takes several weeks to make a full recovery from shoulder arthroscopy, but this varies between individuals, so it's important to follow your surgeon's advice.

If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information leaflet that comes with the medicine and if you have any questions, ask your pharmacist for advice.

It’s important to continue with the exercises recommended by your physiotherapist. These will aid healing and may help you to recover more quickly.

You may need to keep your arm in a sling for several weeks after the operation. Your shoulder joint is likely to feel sore and swollen for at least a week. This can last longer if you have arthritis. Try to rest your arm and apply a cold compress such as ice or a bag of frozen peas, wrapped in a towel, to help reduce swelling and bruising. Don’t apply ice directly to your skin as it can damage your skin.

Your recovery time will depend on what, if any, treatment your surgeon performs on your shoulder joint. This may vary from a few days to several weeks depending on the severity of your shoulder problem and your level of fitness.

What are the risks?

As with every procedure, there are some risks associated with shoulder arthroscopy. We have not included the chance of these happening as they are specific to you and differ for every person. Ask your surgeon to explain how these risks apply to you.

Side-effects

Side-effects are the unwanted but mostly temporary effects you may get after having the procedure.

After a shoulder arthroscopy you may have small scars on your shoulder from the cuts. Your shoulder and arm may be painful or uncomfortable for several weeks. You may also have some swelling and stiffness around your shoulder.

Complications

Complications are when problems occur during or after the operation. The possible complications of any operation include an unexpected reaction to the anaesthetic, excessive bleeding or developing a blood clot, usually in a vein in the leg (deep vein thrombosis, DVT).

Arthroscopy complications include:

  • accidental damage to the inside of your joint
  • infection
  • numbness or tingling over your shoulder
  • excessive bleeding into your joint
  • unsuccessful surgery that may need to be repeated

What can I do to make my recovery easier?

Answer

It’s a good idea to be as fit and healthy as possible before your operation and to follow your surgeon’s advice.

Explanation

Try to be as fit and healthy as possible before your operation if you’re having shoulder arthroscopy. This may help to speed up your recovery.

If you smoke, you will be asked to stop as smoking increases your risk of getting a chest or wound infection, which can slow your recovery. Your surgeon may recommend losing excess weight if you’re overweight before you have your operation.

Start any physiotherapy exercises when your surgeon or physiotherapist recommends. It’s important to continue with these exercises and speak to your physiotherapist if you have any concerns. This may help to speed up your recovery and help you to return to work and get back to normal activities more quickly.

It’s important to follow your surgeon’s advice about your recovery.

Is shoulder arthroscopy better for me than open surgery?

Answer

Arthroscopic surgery is sometimes better than open surgery as it may reduce the amount of pain you have after surgery and the amount of time you need to spend in hospital.

Explanation

An arthroscope and the surgical instruments used are thin so your surgeon can make small cuts in your shoulder rather than a large cut needed for open surgery. Compared with open surgery, arthroscopy has a faster recovery time. The type of physiotherapy you need after surgery will depend on the cause of your shoulder problems, rather than the type of operation you have had.

How much time will I have to spend off work after having shoulder arthroscopy?

Answer

It may take several weeks to make a full recovery after shoulder arthroscopy, however, this varies from person to person and depends on the type of work that you do.

Explanation

Most people can usually go home on the day or the day after shoulder arthroscopy. Your recovery time will depend on what, if any, treatment your surgeon performs on your shoulder joint. This may vary from a few days to several weeks depending on the severity of your shoulder problems and your level of fitness.

It’s important to remember that everyone is different – some people may need to rest for longer whereas others may return to work a few days after shoulder arthroscopy. If you have a manual job that requires heavy lifting, you may need to recover for longer before you can get back to your normal work.

Continuing to do any exercises that your surgeon and physiotherapist have given you will be important to help you get back to work and make a full recovery.