The simple idea of creating an instrument to explore the internal structure of a joint has opened up new possibilities and revolutionised the practice of orthopaedic medicine. While the X-ray machine represented a welcome breakthrough in the diagnosis and reduction of fractures, the arthroscope offered surgeons a long-awaited means to view magnified, full-colour images of both the bones and the associated soft tissues in situ. Although shoulder arthroscopy was not the first application for this new instrument, the procedure is now performed regularly for diagnostic and therapeutic purposes.
The arthroscope is one of a group of instruments known collectively as endoscopes. The name derives from the Greek words for “inside” and “study”. Depending upon the area under study, the generic prefix “endo-” is replaced by a more specific one, such as “cysto-“, which indicates an instrument used to examine the bladder and urinary tract. By the same logic, the device used to perform shoulder arthroscopy takes its name from “arthrosi”, the Greek word for joint.
Although orthopaedics may have been the most recent medical discipline to benefit from this technology, its adoption has led to numerous advances in diagnosing and treating diseased and damaged joints. Undoubtedly, the most significant of these has been the ability to perform minimally invasive surgery. While it would once have been necessary to expose the entire joint to undertake such procedures, hip knee and, eventually, shoulder arthroscopy has since enabled surgeons to perform complex repairs to the bones, tendons and ligaments of these joints with just two or three tiny incisions.
Despite having a protective coating of cartilage and being enclosed within a fluid-filled membrane, the body’s joints often display varying degrees of wear and tear over the years. In addition, accidents and overexertion, often due to sporting activities, can cause premature damage. When painkillers, physiotherapy and rest fail to provide relief, surgery is usually the only option. For labral tears and injury to the rotator cuff, shoulder arthroscopy is frequently the surgical technique of choice.
While arthroscopic surgery requires additional training and experience on the surgeon’s part, it offers some significant benefits to their patients. Because it is minimally invasive, the risk of excessive blood loss and infection is lower and post-operative recovery times are significantly shorter than those undergoing open surgery. The procedure can often be performed under local anaesthetic, allowing patients to return home after a brief rest. However, shoulder arthroscopy is a specialised procedure that requires a surgeon with proven skills and extensive experience.