By Ashley Anderson, MD
When shoulder injuries fail to improve with rest, physical therapy or medication, minimally invasive arthroscopic surgery is an option for treating many common shoulder problems. Arthroscopy often results in less pain and stiffness, fewer complications, faster recovery and rarely requires an overnight hospital stay compared to traditional open surgery that may be necessary for severe shoulder injuries. Arthroscopic surgery is performed with small incisions that are less susceptible to infection than the larger incisions of open surgery.
Shoulder arthroscopy uses a small camera called an arthroscope that is inserted into the patient’s upper arm through a small incision. The surgeon inspects the shoulder joint and tissues with the camera that projects the images to a video monitor in the operating room. If repairs are needed, the surgeon inserts small instruments through a few minor incisions to perform the surgery. General anesthesia or a nerve block are typically used for arthroscopic shoulder surgery. The procedure takes from one to three hours depending on the repairs needed.
What causes shoulder injuries?
The shoulder is the most mobile joint in your body, and the joint’s flexibility can make it prone to injury. This often happens when tissues that stabilize the shoulder are damaged. The most common shoulder injuries are:
- Trauma to the shoulder from a car accident or fall onto an outstretched arm can trigger sprains.
- Shoulder strains can result when the shoulder remains in one position for long periods of time, such as when carrying a heavy backpack over one shoulder. Playing sports that require repeated overhead movements of the arms, such as swimming or tennis, also increase the risk of shoulder strain.
- Shoulder tears are injuries to the soft tissues that give the joint range of motion and stability. A tear can occur in the tendons, or the labrum, a rim of fibrous tissue that stabilizes the shoulder. Repetitive arm motions or sudden injury of the shoulder can cause a tear.
How are shoulder injuries diagnosed?
Diagnosis begins with a physical exam of the joint to evaluate range of motion and assess pain, which are symptoms in most shoulder injuries. Advanced diagnostic procedures may include:
- X-rays to examine the shoulder and bones and determine if any bone spurs are present or if there is a fracture.
- Ultrasound to reveal any tears in tendons or impingement, which is when a tendon gets caught under the shoulder blade during arm movement.
- MRI scans to show subtle damage to tendons in the rotator cuff and biceps. These scans can determine whether a tear is partial or complete and confirm the exact location of a tear.
When is arthroscopic surgery recommended?
If conservative treatments are ineffective and the shoulder injury causes consistent pain that limits a patient’s daily activities, arthroscopic surgery can restore shoulder function and relieve pain. A decision to have surgery may be based on the severity of the injury, as well as how much the injury affects a patient’s quality of life. If the injury is not causing significant pain or dysfunction, surgery may not be necessary.
What can you to expect after your surgery?
Arthroscopic surgery is an outpatient procedure, so you can expect to return home within hours of surgery. Patients may use prescription pain medication for the first week or two after surgery, followed by over-the-counter pain relievers. An arm sling may be needed for four to six weeks to keep the shoulder immobile. Physical therapy to rebuild muscle strength and restore range of motion may be needed after healing. The length of recovery depends on the size and type of shoulder tear.
Dr. Ashley Anderson is an Ithaca native, and grew up participating in local athletics including figure skating, lacrosse, tennis and skiing. She received her medical degree from Rosalind Franklin University of Medicine and Science in Chicago, completed her orthopedic residency at Upstate Medical University in Syracuse and did fellowship training in arthroscopy and sports medicine at Penn State in State College, Pa. She can be reached at Cayuga Orthopedics at (607) 272-7000.