Arthroscopic Shoulder Surgery
Arthroscopic shoulder surgery is an intricate procedure, irrespective of the nature and severity of the underlying shoulder problem. It requires an expert orthopedic surgeon with experience in arthroscopic surgical techniques to perform one successfully. Without doubt, proper preoperative evaluation and a good anesthetist help a long way to do the procedure well.
The procedure is done under general anesthetic so the patient is out cold. In fact the breathing is also done artificially using ventilators during the procedure as the patient’s voluntary breathing is stopped in general anesthesia. During the procedure, the patient is kept in sitting position or lying on one side.
Two or three small incisions of about 0.5 cm are made around the shoulder joint. They are called portals. Through these portals, a camera and light source are passed. These are held in slim flexible fiber optic tubes which are passed through the portals in to the shoulder joint to see the structure, nature of the injury and the type of surgery or repair that will be needed to cure it. A liquid called “normal saline” is pumped in to the joint to distend it. Doing this is essential to view the anatomical structures inside the shoulder joint, both normal and abnormal.
Besides accommodating the camera and light source, the portals also permit flexible cables serving as sources for inserting various cutting, scraping, suturing and other needed instruments through them, enabling the orthopedic surgeon to carry out various types of repair inside the joint.
Whatever the pre-operative diagnosis, during the actual procedure, the joint structures and the surrounding tissues can be viewed. Specific attention is paid to check the biceps tendon, glenoid labrum, shoulder joint capsule, ligaments, articular surfaces of the humerus and scapula and rotator cuff muscles and tendons. The acromion is inspected carefully to assess the size and shape and to remove any spurs impeding the smooth movement of the rotator cuff (supraspinatus) tendon.
After the diagnostic arthroscopy is completed, the surgeon concentrates on the actual further procedure needed by the patient.
Rotator cuff tears are the commonest arthroscopic shoulder surgery repair procedures performed.
Here the tear is inspected through the side portal to ascertain the pattern and extent of the tear. The jagged and fragmented portions of the tendon are trimmed. To encourage new blood vessel formation, the portion of the bone where the tendon is planned to be reattached is debrided. The tendon is tied by passing sutures through it, thereby pulling the tendon close to the prepared bone surface to enable reattachment.
Following the repair, a long acting local anesthetic injection is given inside the shoulder to block pain once the patient wakes up from anesthesia. The flexible fiber optic tubes are removed. The portals are closed with non-absorbable nylon or prolene sutures. A sterile dressing is applied over the wound and the joint. Sometimes a shoulder pad is applied to provide cold treatment. The patient’s shoulder is immobilised in a sling and is transferred to the postoperative ward.
The patient is kept for about 2 more hours in the post operative ward following which they are discharged with the necessary pain killers and other instructions regarding home care and rehabilitation, and details of follow-up appointment times with the surgeon.