Arthroscopic shoulder surgery is used to diagnose and treat injuries or disease of the shoulder joint. This minimally invasive procedure allows gentle surgical treatment of injuries to the biceps tendon or rotator cuff. Calcifications or constrictions in the shoulder joint can also be treated with arthroscopy.

Arthroscopic shoulder surgery is used to diagnose and treat injuries or disease of the shoulder joint. This minimally invasive procedure allows gentle surgical treatment of injuries to the biceps tendon or rotator cuff. Calcifications or constrictions in the shoulder joint can also be treated with arthroscopy.

Arthroscopic shoulder surgery at a glance

Arthroscopic shoulder surgery, also known as shoulder arthroscopy or arthroscopy of the shoulder, is a minimally invasive intervention for the diagnosis and treatment of shoulder complaints. During the procedure, a camera (arthroscope) and special instruments are inserted into the shoulder joint via small incisions in the skin in order to assess injuries or disease that are often difficult to detect with conventional radiological examinations. These may include damage to the biceps tendon, lesions of the rotator cuff, entrapment of soft tissue in a narrowed joint space (shoulder impingement syndrome), shoulder dislocation (shoulder luxation) and calcification in the shoulder joint. In many cases, the injuries or disease discovered with arthroscopy can also be treated during the same procedure.

Treatment goal

The main objective of arthroscopic shoulder surgery is to relieve pain and improve the function of the shoulder joint. Typical indications for this intervention are:

Torn rotator cuff

Surgery is not always necessary if the rotator cuff has shifted. However, in the case of persistent complaints and a repairable rotator cuff rupture, surgical reconstruction is often advisable.

Calcific tendinopathy (calcific tendonitis)

Calcific tendinopathy, also known as calcific tendonitis (sometimes spelled ‘calcific tendinitis’), is a chronic inflammation caused by painful calcium deposits in the tendons of the rotator cuff, usually in the supraspinatus tendon or in the adjacent fluid-filled sac known as a bursa (calcific bursitis). If conservative therapy is unsuccessful, the calcium deposits are removed during arthroscopic surgery. The tendon is opened in a minimally invasive way and the deposits are rinsed out. If major damage to the tendon then becomes apparent, it may be necessary to suture or fix it back into place.

Shoulder instability

Shoulder instability often results in repeated shoulder dislocation, i.e. the head of the humerus bone popping out of the joint socket. This can happen due to accidents, overexertion or congenital connective tissue weakness. Repeated dislocations can lead to damage to the joint capsule, ligaments or surrounding muscles. To restore the stability of the joint, surgical tightening of the joint capsule may be necessary. This intervention is often performed arthroscopically and is aimed at reducing the size of the worn out or damaged joint capsule and tightening. As a result, the humerus head becomes firmly held in the joint socket again, preventing further dislocations.

Subacromial impingement syndrome (SAIS)

Subacromial impingement is caused by a narrowing of the space under the piece of bone at the top of the shoulder called the acromion. This is often caused by a prominent acromion, by chronic tendonitis or by overloading the joint. This tightness leads to painful irritation of the subacromial bursa and can also damage the underlying tendon if the strain is prolonged. The treatment for this is subacromial decompression surgery. This consists of two procedures: an acromioplasty, where the acromion is straightened or reduced, and a bursectomy, in which the inflamed bursa is removed in order to make enough space for the affected structures.

Biceps tendon

The biceps muscle connects the shoulder blade to the forearm and is important for flexing the elbow and turning the hand outwards (supination). Its two tendons – a strong short tendon and a thinner long one – are fixed to the shoulder blade. The long biceps tendon runs through the shoulder joint, curving over at the top at about a 90-degree angle. This makes it particularly susceptible to injury or inflammation, which often occurs due to chronic overload or accidents. If surgery is required, various procedures are available. In SLAP refixation, the attachment of the tendon to the bone is stabilised. In biceps tenodesis surgery, the damaged end of the tendon is removed, and the end of the remaining tendon is fixed inside a narrow tunnel drilled into the bone by the surgeon.

Shoulder arthroscopy procedure

Arthroscopy of the shoulder is generally performed on an outpatient basis. The intervention is usually performed with regional spinal anaesthesia, or, less frequently, under general anaesthesia. During the surgery, the patient sits in a ‘beach chair’ position. After the surgical area has been disinfected and covered, small skin incisions are made through which the arthroscope and instruments are inserted into the shoulder joint. A built-in mini-camera transmits enlarged images from the inside of the joint onto a screen. To expand the operating space in the joint, the joint is then filled either with a special fluid or with air. The surgeon examines the joint structures and, if necessary, carries out immediate treatments, such as removing calcium deposits or repairing tendons. Finally, the fluid or air is sucked out of the joint space and the skin incisions are closed. The intervention usually takes 20 to 40 minutes.

Preparation and precautions

Before the surgery, a detailed medical history and physical examination is carried out. Blood tests and imaging techniques such as X-rays or MRI scans may be necessary. Patients should inform their doctor about any medication they take, as certain blood-thinning agents must be discontinued before the intervention. The patient should fast on the day of the operation.

Aftercare and recovery

Depending on the type of intervention, arthroscopic shoulder surgery may require a hospital stay of 1 to 3 days. The physiotherapist will teach you targeted exercises. These are crucial for the success of the treatment and to maintain the shoulder’s full ability to move. The healing process lasts about 6 to 12 weeks and is monitored by means of regular check-ups. Depending on the type of injury, you will need to be off work for between 2 weeks and 6 months.

Potential complications

Arthroscopic shoulder surgery is a gentle procedure and significantly less stressful for the shoulder joint than open surgery. Today, it is considered a standard procedure with good results, particularly in the case of torn tendons, ruptures of the rotator cuff, calcifications and impingement syndrome.

Although shoulder arthroscopy is considered a low-risk, routine procedure, infections, nerve injury, secondary bleeding or blood clots may occur. In rare cases, joint stiffening can occur. Compared to open shoulder surgery, however, the risks of arthroscopy are significantly lower.

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