Shoulder arthroscopy is a surgical approach that uses a tiny camera called an arthroscope to examine or / or repair the tissues inside or around your shoulder joint. The arthroscope is inserted through a small cut (incision) in your skin.
During this procedure, your surgeon inserts the arthroscope into your shoulder through one or more small incision. The arthroscope is connected to a video monitor in the operating room, so that your surgeon is able to inspect all the tissues of your shoulder joint and the area above the joint. These tissues include the cartilage, bones, tendons, and ligaments. Utilising the same incisions your surgeon is then able repairs any damaged tissues.
You will likely receive general anaesthesia for this surgery. This means you will be asleep and unable to feel pain. Or, you may have regional anaesthesia. Your arm and shoulder area will be numbed so that you do not feel any pain. If you receive regional anaesthesia, you will also be given medicine to make you very sleepy during the operation.
Acromioplasty
An acromioplasty is performed for patients suffering from Impingement Syndrome. The inflammation in the shoulder is caused by the acromion “pinching” the rotator cuff with arm in elevation. During the procedure the undersurface of the acromion is burred away to increase the sub-acromial space. In cases where a rotator cuff tear needs to be repaired an acromioplasty is also performed routinely. This provides an increase space for the surgical repair and prevents future pinching that causes the tendon to re-rupture.
Procedure duration: As a stand alone procedure, is around 30 minutes. Two puncture wounds are made in the shoulder for the camera and arthroscopic burr.
Post operative: Rehabilitation entails the wearing of a sling (shoulder immobiliser) for 2 weeks whereafter rehabilitation (under physiotherapy guidance) may commence. Driving is not recommended during this period. Complete recovery usually occurs at between 6 weeks and 3 months.
AC Joint Excision
An acromioclavicular Joint excision is often performed in conjunction with an acromioplasty or rotator cuff repair. The AC joint arthritis (with its associated osteophytes) can contribute to the development of Impingement Syndrome. This arthritis may contribute to the development of rotator cuff tears. During this procedure the lateral (outer-edge) end of the clavicle is removed. This prevents further pain due to arthritic bony contact but also removes the associated osteophytes.
Procedure duration: Coupled with an acromioplasty this procedure is around 45 minutes. Two puncture wounds are made in the shoulder for the camera and arthroscopic burr.
Post operative: Rehabilitation entails the wearing of a sling (shoulder immobiliser) for 2 weeks whereafter rehabilitation (under physiotherapy guidance) may commence. Driving is not recommended during this period. Complete recovery usually occurs at between 6 weeks and 3 months.
Rotator Cuff Repair
A rotator cuff surgical repair procedure is performed in cases where one (or more) of the four rotator cuff tendons have ruptured. Repair is essential as a ruptured tendon cannot heal / reattach spontaneously onto its footprint. Note that this applies to full thickness tears only. A partial rotator cuff tear is a different diagnosis and its management differs from a full thickness tear. Rotator cuff tears can present at different stages of progression such as massive, large, small or partial. These different stages as well as other patient related factors influence surgical outcomes.
Procedure duration: This is dependant on the mutitude of factors and therefore unique to each individual case. In general the duration is between 60-90 minutes.
Post operative: Rehabilitation entails the wearing of a sling (shoulder immobiliser) for 6 weeks whereafter rehabilitation can commence. During this 6 week period the sling is worn for 24 hours a day, 7 days a week. The sling may only be removed during the patients home exercise routine (which will be provided before discharge) or when showering. Driving with the sling is dangerous and is strongly discouraged. Driving without the sling can compromise the repair and therefore the success of the surgery. Complete and full recovery occurs between 3 to 6 months.
Bicep Tenodesis / Tenotomy
A bicep tenodesis or tenotomy is often performed in combination with an arthroscopic rotator cuff repair. The long head of M.Biceps enters the glenohumeral joint at the rotator interval. Due to its close proximity to the acromion the long head of M. Biceps it is often also comprised. A degenerative biceps tendon may cause a lot of pain and is addressed by either just cutting the tendon (tenotomy) or cutting it and fixating the distal end to the proximal humerus (tenodesis). The decision on which to perform depends on various factors and is therefore individualised.
Procedure duration: This usually adds an additional 15 to 20 minutes to the main procedure such as a rotator cuff repair or acromioplasty.
Post operative: Immobilisation usually entails 2 weeks in a sling but is also influenced by any additional procedures that had to be performed.
Capsular Release (Frozen Shoulder)
A capsular release is usually the last resort for patients suffering from adhesive capsulitis (frozen shoulder) that is severe, debilitating and of a chronic nature. Conservative measures should also be exhausted before having this surgery. These include extensive physiotherapy and pain management. During the arthroscopic procedure the adhered capsule is completely removed. Post operative physiotherapy is started early in hospital and should be regular after discharge.
Procedure duration: 60 minutes.
Post operative rehabilitation: The patient will be discharged with a shoulder sling, but the idea is to start using the shoulder as much and as soon as possible after surgery. Physiotherapy commences in hospital and should continue regularly post operative. The success of the surgery lies in the post operative rehabilitation.
SLAP Repair
The surgical repair of a SLAP lesion entails the reattachment of the M.Biceps anchor back onto the superior glenoid rim. The glenoid bone is prepared (roughened) and with the help of an arthroscopic anchor and suturing material reattached. This repair can only be performed by arthroscopic means.
Procedure duration: 60 minutes.
Post operative rehabilitation: The patient will wear a sling (shoulder immobiliser) for 6 weeks whereafter rehabilitation can commence. During this 6 week period the sling is worn for 24 hours a day, 7 days a week. The sling may only be removed during the patients home exercise routine (which will be provided before discharge) or when showering. Driving with the sling is dangerous and is strongly discouraged. Driving without the sling can compromise the repair and therefore the success of the surgery. Complete and full recovery occurs between 3 to 6 months.
Anterior / Posterior Bankart Repair
A bankart surgical repair procedure is performed for patients with anterior or posterior instability complaints. During the procedure the anterior or posterior glenoid bony rim is prepared by roughening the surface. The detached labrum is thereafter reattached to the bone by means of an arthroscopic anchor and sutures.
Procedure duration: Depending on the extent of the injury, 60-90 minutes.
Post operative rehabilitation: The patient will wear a sling (shoulder immobiliser) for 6 weeks whereafter rehabilitation can commence. During this 6 week period the sling should be worn for 24 hours a day, 7 days a week. The sling may only be removed during the patients home exercise routine (which will be provided before discharge) or when taking a shower. Driving with the sling is dangerous and is strongly discouraged. Driving without the sling can compromise the repair and therefore the success of the surgery. Complete and full recovery is expected at 3 to 6 months post surgery.