The head of the humerus, the bone in the upper arm, fits into a shallow depression, called the glenoid, at the end of the scapula, or shoulder blade, to form a ball and socket joint. A ring of fibrous cartilage, known as the labrum, surrounds the joint and helps to stabilise it. In addition, a group of four muscles and tendons, known as the rotator cuff, also encircles the joint, providing added stability and 360 degrees of mobility. Owing to its complexity, successful surgery on this joint is a relatively recent achievement. However, shoulder arthroscopy for diagnostic purposes and surgical repairs to its more vulnerable components is performed routinely at many orthopaedic centres.
While surgery on this joint is performed less often than on the hip or knee, it is prone to various injuries, some of which can be extremely painful. Often these can be treated by applying ice packs and resting for a few days. Falls and sports injuries are commonly responsible for the damage, but osteoarthritis and rheumatoid arthritis can also take their toll.
Fortunately, shoulder arthroscopy now provides a minimally invasive surgical alternative to more traumatic open procedures in many cases. Instead of exposing the entire joint, the surgeon makes a tiny incision through which to insert an instrument, known as an arthroscope. The scope consists of a flexible tube attached to a light source and a video camera that relays magnified images of the joint’s interior to a monitor screen.
Next, the surgeon will make two or three additional small incisions to provide the portals for other instruments when proceeding with the surgery. Performing shoulder arthroscopy rather than open surgery offers some benefits for the patient. There is less risk of excessive blood loss and infection, and the patients will require less time for post-surgical recovery.
Tears to the labrum or rotator cuff are among the most common injuries to this joint. They are usually the result of overexertion. If not too serious, surgery may be unnecessary. However, without rest, the tears can worsen, leading to increased pain and even loss of mobility, signs that you might need shoulder arthroscopy.
In addition to labral and rotator cuff tears, impingement syndrome and instability in the joint are other indications for performing arthroscopic surgery. The former condition is due to the formation of bony outgrowths that sometimes form on an extension of the scapula, known as the acromion. Movement causes the spurs to rub against the rotator cuff, causing pain and restricting movement.