What is arthroscopic shoulder surgery?

Shoulder arthroscopy is surgery that uses a tiny camera called an arthroscope to examine or repair the tissues inside or around your shoulder joint. The arthroscope is inserted through a small cut (incision) in your skin.

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Dr. Patrick Chin, MD, MBA, FRCSC, Orthopedic Surgeon, discusses arthroscopic shoulder surgery.

Quiz: Do You Understand Shoulder Surgery?

Test your knowledge by answering the following questions:

Questions
True
False
1

The usual treatment for shoulder injuries is surgical options.

Explanation:
The usual treatment for shoulder injuries is non-surgical options such as medications, bracing and physiotherapy. Shoulder surgery is generally only explored if the non-operative options fail.
2

Arthroscopic shoulder surgery is often performed to repair soft tissue injuries.

Explanation:
Arthroscopic shoulder surgery (otherwise known as keyhole surgery) can be a good option for some patients. It is often performed to repair soft tissue injuries, and enables surgeons to introduce a fiber optic camera through a two- to three- millimeter incision.
3

For more severe shoulder injuries, surgeons may recommend a reverse shoulder replacement surgery.

Explanation:
For more severe shoulder injuries, surgeons may recommend a reverse shoulder replacement surgery. It is often done to repair rotator cuff tendons that have been damaged, often by arthritis.
4

Patients with recurrent shoulder dislocations may won't benefit from surgical reconstruction, only from non-surgical options.

Explanation:
Patients with recurrent shoulder dislocations may benefit from surgical reconstruction of the damaged tissues in the shoulder joint. This usually involves an arthroscopic day procedure, where the surgeon identifies the torn labrum or ligaments that have occurred with each shoulder dislocation.
5

Following shoulder surgery, most patients will benefit from physiotherapy.

Explanation:
Following shoulder surgery, most patients will benefit from physiotherapy to get their range of motion back, decrease pain and increase strength.
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Audrey Spielmann, MD FRCP(C), discusses shoulder CT scans.

Dr. Patrick Chin, MD, MBA, FRCSC, Orthopedic Surgeon, discusses arthroscopic shoulder surgery.

Treatment of Shoulder Pain

The patient should exhaust all non-operative type options such as medications, anti-inflammatory medication, analgesic medication, physiotherapy to keep the joints supple, stretching to keep the joints supple.

A lot of naturopathic type options are available, too. There are other joint injection options, either steroid or synthetic viscous supplementation.

If the non-operative options fail, then the patient is looking at surgical options. The surgical options obviously would be, depending on the state of disease, one could offer the option of an arthroscopic cleanup of the joint, a debridement of the joint, in early stage disease.

In later stage disease then the option would be a joint replacement. In any joint replacement the option would be to either replace part of the joint that pretty much means a partial joint replacement versus replacing the entire joint.

The shoulder is a ball and socket joint so you replace the ball and you replace the socket, just like the hip actually. You will have a smooth metal ball or hemisphere, actually, with a stemmed implant followed by on the socket side is usually a high molecular weight polyethylene material – plastic material – for the socket side.

And it could be either grouted in or inserted in what we call a press fit fashion where the bone can actually grow into the material.

The long-term survival rates of shoulder replacement surgery has actually improved over the last two or three decades. You could expect survivability of implants lasting up to 10 to 15 years now to maintain the patient satisfaction of between 80 and 90 percent.

At the end of the day the goal of surgery is to relieve a patient’s pain in the shoulder.  Obviously if the pain is holding back the patient from functioning well, then obviously the function can also improve.

But most patients probably won’t regain the full motion in the shoulder from a shoulder replacement operation, but they sure would have good pain relief and pretty good strength. Local Physiotherapist

Presenter: Dr. Patrick Chin, Orthopaedic Surgeon, Vancouver, BC

Local Practitioners: Orthopaedic Surgeon

Arthroscopic Shoulder Surgery-Orthopedic Surgery

Arthroscopic shoulder surgery is otherwise known as keyhole surgery into the shoulder.

In the past, or historically, we used to make a large incision in an attempt to gain access into the joint. In the shoulder it is challenging at time for the surgeon to actually see these structures in a tight joint space.

Arthroscopic surgery has enabled us to introduce a fiber optic camera through a two to three millimeter skin incision. That’s inserted either into a shoulder joint or above the shoulder joint depending on what we are trying to achieve for that specific patient.

What that enables us then is to magnify the structures on a TV screen and subsequently enable us to actually perform the procedures in more finer detail per se.

The surgeries that we perform arthroscopically comes about mainly soft tissue type repairs, for example shoulder instability issues. When a patient traumatically dislocates a shoulder we can now perform the procedure to stabilize the shoulder arthroscopically.

Other types of more common shoulder arthroscopic procedures would be for example a rotator cuff tear where now we can perform the repair of the torn rotator cuff using arthroscopic techniques.

The benefits of arthroscopic shoulder surgery potentially relates to shorter healing time for the patient immediately following the surgery given that it is less invasive, and potentially also starting rehab much earlier following surgery.

Again, if a patient has any preferences or questions it’s best that they contact their own physician about this.

Presenter: Dr. Patrick Chin, Orthopaedic Surgeon, Vancouver, BC

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