The invention of the arthroscope significantly improved the diagnosis of joint disorders. However, the instrument also offers surgeons a means to perform minimally invasive interventions, where feasible. While the hip and knee were this instrument’s earliest targets, shoulder arthroscopy is becoming a more common procedure today. The joint in question, which surgeons know as the glenohumeral joint, has a markedly more complex structure than the knee or hip. It is this complexity that makes possible this joint’s exceptional range of movement.
In practice, this increased flexibility often leads to injuries that are only reversible through surgical intervention. In the past, there was no alternative to conducting open surgery and exposing the joint’s damaged components fully. Today, however, shoulder arthroscopy can often provide a less radical option that offers the patient several significant benefits.
Firstly, this type of procedure will cause less scarring. The minimally invasive approach usually requires just two or three 5mm incisions instead of the single 4 to 6cm cut needed when performing the open technique. Other advantages of this approach include less blood loss, reduced risk of infection and a significantly shorter postoperative recovery period.
That said, viewing the operation site and manipulating instruments based on the video images displayed on a monitor calls for special skills from those surgeons who may choose to perform shoulder arthroscopy. So, what might this procedure be necessary?
Some Typical Applications
In a major injury such as a large rotator cuff tear, the minimally invasive option is likely to be unsuitable. However, there are many instances where the minimally invasive option can circumvent the need for an open procedure. One of the more common purposes is to stabilise the joint following a dislocation. A suitably qualified surgeon will often adopt shoulder arthroscopy as the method of choice when conducting a Bankart repair to attach the damaged labrum to the joint capsule and restore stability.
The labrum, a ring of cartilage encircling the joint, is subject to SLAP tears. The acronym is short for “Superior Labrum Anterior and Posterior” and indicates the tear affects both the front and back of the labrum. The labrum provides the attachment point for the tendon that secures the biceps, so a repair is essential, and shoulder arthroscopy offers a less-invasive solution than open surgery. Impingement syndrome, frozen shoulder, and minor rotator cuff injuries are also suitable candidates for this procedure.
Arthroscopic surgery is generally reserved for younger, fit and active patients who need to resume work as soon as possible. However, it may also be offered to older subjects who no longer respond to non-surgical treatment. For additional information about shoulder arthroscopy, contact orthopaedics at Pretoria’s Wilgers Life Hospital.