Whether applied to the hip, the knee or the shoulder, arthroscopy can be best described as “inspecting the internal structure of a joint”. More importantly, it is an option that has been instrumental in extending the capabilities of the orthopaedic surgeon considerably. To obtain a view of the joint’s components, the surgeon inserts a narrow tube through a tiny incision. In modern versions, the tube holds an electrical light source and a miniature video camera to record the illuminated view.
Similar instruments for examining the interior of the alimentary canal and bladder have been in use since the early 1900s. However, shoulder and other forms of arthroscopy only became feasible procedures during the mid-50s. Since then, however, there have been a series of significant improvements to the scope’s design. In turn, these improvements have not only upgraded the instrument’s performance but have also served to create additional applications for this technology. Though initially developed as a diagnostic tool, the new and improved arthroscope has since gained an essential role in treating some of the very conditions it was designed to investigate.
In practice, it was a while before surgeons first attempted shoulder arthroscopy. Until then, most of the pioneering work with this new instrument was directed at the hip and knee joints. It was only during the 1970s that the technique was eventually applied to the glenohumeral joint, to cite its anatomical name. Like the hip, it is a ball and socket joint but, unlike the articulation between the femur and acetabulum, it is capable of a much wider range of movements, including a full 360° of rotation.
Ironically, it is the exceptional mobility of this joint that frequently leads to it becoming overexerted, typically whilst engaged in manual labour or sport. Shoulder arthroscopy provides the orthopaedic specialist with a close-up view of each component of the joint. The findings of this detailed examination enable him or her to determine the location, nature, and extent of any damage to one or more of those components while also helping to determine the most effective way to rectify it.
Reasons to Perform This Procedure
With the hip and knee joints, the evolution from a diagnostic tool to a minimally invasive surgical option took a while. However, the experience gained from that transition ensured that the therapeutic potential for shoulder arthroscopy was already established.
While dislocations of this joint are a frequent occurrence, especially among sports enthusiasts, they are easy to identify by physical examination alone and can be treated without the need for surgical intervention. However, other injuries in this region may require both closer scrutiny and surgical repair. One of the most common of these involves a group of muscles and tendons known as the rotator cuff. A tear in this region will sometimes respond to conservative treatment. However, in severe cases, shoulder arthroscopy to re-attach the torn tendon to the bone will be necessary.
Another condition is known as impingement syndrome, which also affects the rotator cuff. Swelling in the region reduces the space available for movement and results in the tendons rubbing against the bone, causing further swelling and pain. Bony outgrowths may also form on the surface of the acromion, resulting in more soft tissue damage. Once again, if pain medication and conservative measures prove ineffective, arthroscopic surgery will inevitably be the next step.
Labral tears can also be repaired during shoulder arthroscopy. A labrum is a rim of cartilage surrounding a ball and socket joint to provide a protective lining. Labral tears contribute to instability within the joint that, in turn, tends to increase the risk of dislocation. While a torn labrum is generally more common in athletes, it can also occur because of a bad fall. Arthroscopic surgery is the preferred approach when performing the necessary repair.
Joint replacement has been widely hailed as the most successful orthopaedic intervention to date. Prosthetic knee and hip implants total more than 900 000 a year in the US alone. More recently, shoulder arthroscopy has offered specialist orthopaedic surgeons a minimally invasive approach to replace this joint.
That said, the arthroscope is just a tool, and it is the skill and experience of surgeons such as those at Pretoria’s Wilgers Life Hospital that have been changing the lives of those burdened by joint pain and loss of mobility.