Guide to Shoulder Arthoscopy
What is arthroscopy? The arthoscope is a fiberoptic instrument that is placed into the Shoulder thorough a tine incision, thereby allowing the surgeon to view the jointâ€™s components, including the ligaments of the shoulder joint, the biceps tendon, the rotator cuff, the joint lining tissue, capsule, labrum and the joint surfaces, on a television screen. The fiberoptic lenses and surgical instrument are very small, thus permitting a great deal of surgery to be done throughout tiny incisions. Before the development of arthoscopy, large incisions had to be made over the shoulder in order for the surgeon to clearly see the entire joint. Todayâ€™s arthroscopic techniques allow more accurate evaluation of the damaged joint while greatly accelerating the rehabilitation process. What kinds of procedures can be done with the arthroscope? Arthroscopy allows the surgeon to view the interior of the shoulder joint to evaluate the extent of damage and to perform a variety of surgeries. Procedures include shoulder stabilization for patients with loose or dislocating shoulders and the removal or repair of labral tears (torn cartilage). Subacromial decompression, which involves removing bone spurs and bursa tissue to give the rotator cuff more room to move, can be accomplished easily with minimal incisions for patients with rotator cuff tendinitis or partial tears. Do I need to have any tests prior to surgery? Within two weeks of your surgery, you will need several medical tests. These are done on an outpatient basis. Most people need blood tests and urinalysis. A chest x-ray and an EKG are required if you are over 40. Some patients will be required to see an internist before surgery. What type of anesthesia is used? For most shoulder arthroscopic, general anesthesia is used. Prior to surgery, an anesthesiologist will meet with you, explain your anesthesia alternatives and address questions that you may have concerning anesthesia. On the morning of surgery, an anesthesiologist will again review your anesthesia plan with you.
What happens on the day of surgery? You will arrive at the hospital and report to the Registration Department. The surgery will take about one hour. After surgery, you will be taken to the recovery room, where you will stay until you are fully awake- usually an hour or two. What do I do after surgery? You will need someone to drive you home after the surgery since you may be drowsy from the anesthesia. You will leave the hospital with a bandage over your shoulder and you may be given a sling for your comfort. You will also be given a prescription for pain medication to make you more comfortable. How should I care for my shoulder? Apply ice to your shoulder several times a day for 20 minutes at a time for the first three days after surgery. You will be able to remove the bandage two or three days following your two or three days following your surgery. There will be several small incisions with stitches under the bandages. You may put small bandage over the incisions. If there is a larger incision, there will be steri-strips (paper tapes) over it. Keep the steri-strips in place. You will be able to shower two or three days after the surgery. To give your wound time to heal, do not soak your operated shoulder under water, i.e., in a tub or whirlpool, for seven to ten days following surgery. Make a follow-up appointment for approximately seven to ten days following surgery. At that time, the stitches will be removed and you will be instructed in what activities you may do. What type of exercises should I do? Immediately following surgery, you will be able to begin some gentle exercises. These will help with shoulder stiffness. You shoulder squeeze a sponge or soft ball, bend and straighten your elbow, and do pendulum exercises several times a day. After your follow-up appointment, you will be instructed in more exercises and you may begin physical therapy to regain motion, strength and function of your shoulder. When can I return to work? Full recovery may take one to six months depending on the nature of the original problem the type of procedure and how much time and effort is devoted to therapy. Except for patients who have had shoulder stabilization, you will be permitted to use the arm for daily activities as your comfort allows. Your physician will let you know when
you are able to return to your desired activity level. The muscles surrounding the shoulder must regain their strength. Most people achieve this in six to eight weeks. Every case is different depending on what type of shoulder problem you have. If you have had shoulder stabilization, you will need to wear the sling for about one month so that the tissue can heal. Passive motion exercises and certain isometric exercises will be begun immediately. After six weeks, you will begin resistive exercises to strength the arm and shoulder muscles. Exercise- Early postoperative period 1. Pendulum exercise Lean forward and let your arm dangle. Move it in circles, clockwise and counter clockwise, then side to side, then forward and backward. Begin with five to ten repetitions in each direction, three times a day. Gradually progress to 30 repetitions, three times a day. 2. Gripping Squeeze a soft sponge or soft ball in your operated hand 30 repetitions, three times a day. 3. Active assisted exercises Hold onto a cane or umbrella with both hands and use your good arm to elevate your other arm forward and sideways. Begin with five repetitions in each direction three times a day. Gradually progress to fifteen repetitions three times a day. 4. Pulley exercises As comfort permits, you will begin a gentle range of motion exercises using a pulley that will be given to you during your first postoperative visit. Your therapist will discuss more elaborate exercises.