The invention of the X-ray machine was a significant step forward for the orthopaedic specialist. However, while the images helped them assess the nature and extent of fractures and how best to approach their treatment, they provided limited insight when examining joints, where injuries often affect the soft tissues, invisible to X-rays. However, a little later, orthopaedic surgeons were introduced to a new diagnostic tool, enabling them to view the interior of a joint and, in time, to perform procedures like shoulder arthroscopy.
The concept was simple enough and had already been widely applied in other medical disciplines. Then, in 1918, a Japanese Professor named Kenji Takagi took the initiative and adapted a cystoscope, an instrument used to inspect the bladder. He inserted it into a knee to view the joint’s internal structure, launching a new era in orthopaedics.
Apart from its tubular design, the modern arthroscope bears little resemblance to Takagi’s prototype. Fibre optics, lenses, a miniature video camera and LED lighting now provide a brightly lit, magnified view of a joint and the surrounding soft tissues on a monitor screen, allowing surgeons to detect and fix problems in a single minimally invasive procedure.
Reasons You Might Need Shoulder Arthroscopy
A surgeon might decide to perform arthroscopy on your shoulder for several reasons. For example, an arthroscopic examination might reveal the cause of joint instability and suggest the best way to treat it. Other reasons include:
- To repair a torn or damaged biceps tendon or labrum (ring of cartilage)
- Repairs to a torn rotator cuff – a group of muscles and tendons surrounding the shoulder joint, keeping it stable while enabling a wide range of arm movements.
- Treatment of a frozen shoulder
- Joint replacement in cases of osteoarthritis
- Perform subacromial decompression to relieve pain in shoulder impingement – where a tendon rubs or catches on a nearby bone.
- To drain loose bodies like chips of bone and cartilage
- Drainage and debridement of an infected shoulder joint
Before the introduction of shoulder arthroscopy, these procedures would have required open surgery, exposing patients to an increased risk of blood loss and infection while necessitating significantly longer post-operative recovery time than this minimally invasive alternative.
Shoulder Arthroscopy – The Procedure
Arthroscopy is usually performed as an outpatient procedure. The patient will be seated in the “deckchair” position or asked to lay on their side before being given a general anaesthetic. Once the patient is anaesthetised, the surgeon will make some small incisions around the shoulder joint. One will be used to insert the arthroscope, and the others will serve as portals that allow the surgeon to manipulate the required miniature surgical instruments whilst monitoring their movements via the scope.
The surgeon will perform a preliminary inspection of the joint to confirm a diagnosis and decide on the appropriate intervention. After suturing and dressing the incisions, the surgeon may inject a local anaesthetic to dull the pain before discharging the patient.
Depending on the extent of the surgery, recovery can take from one to six months, and it might be necessary to wear a sling for the first few weeks. However, with painkillers, gentle exercise to aid recovery, and a skilled and experienced orthopaedic surgeon, shoulder arthroscopy can be life-changing.