Of the 360 joints in the human body, it is those that act as a hinge or consist of a ball and socket on which we depend most for the wide range of movements of which a healthy human is capable. We are seldom aware of the stresses and strains to which we subject them until injury or disease leaves them swollen, painful or even incapable of movement. However, thanks to shoulder arthroscopy and similar procedures for use on the hips, knees and other major joints, orthopaedic surgeons can now treat most, if not all, joint problems quickly and effectively.
Joints are complex structures composed of two or more bones joined by ligaments and moved by the contraction of muscles connected to them by tendons. The bones’ articulating surfaces are covered with a layer of cartilage to smooth their movements, and a fluid-filled membrane surrounding the joint provides additional lubrication. When injuries or disease affect the shoulder, arthroscopy is often necessary to determine their nature and perform whatever remedial action may be most appropriate.
The Arthroscope and Its Use
The diagnostic step and, very often, any treatment that may prove necessary can be performed using an instrument known as an arthroscope. The latter consists of a flexible tube connected to a light source and a miniature video camera. By feeding the video images to a monitor, the setup furnishes an orthopaedic surgeon with a magnified, real-time view of the interior of a joint. Over the past few decades, shoulder arthroscopy and similar techniques to address hip and knee problems have gradually gained favour as a minimally invasive alternative to many open surgical procedures previously used to explore and treat these joints.
For diagnostic purposes alone, a single tiny incision through which to insert the scope may be enough. When proceeding with the treatment, one or two additional small incisions provide the surgeon with portals to accommodate the necessary miniature surgical instruments.
Some Common Applications
Joints are a common focus of injuries, often through overexertion or accidents. When performing surgery on the shoulder, arthroscopy has become the preferred approach when treating several conditions that often affect this joint.
Dislocations of this joint are common, especially among those who play sports like tennis, rugby and cricket. Generally, the team’s medic will perform a reduction on the field and, after a few weeks’ rest, the joint will be as good as new. However, in some individuals, dislocations occur more easily and more often. This instability results from a tear in the upper or lower part of the labrum and may also involve ligament damage. Typically, shoulder arthroscopy will be necessary to repair any tears and damaged ligaments to stabilise the joint.
Another common condition treated in this fashion is impingement syndrome, in which an abnormal outgrowth of bone from the scapula causes pain and swelling. The surgeon will shave away excess bony tissue and smooth the damaged surfaces arthroscopically to alleviate the discomfort. Other indications for minimally invasive surgery on this joint include a torn rotator cuff or biceps tendon, and inflammation and damage caused by rheumatoid arthritis.
Compared to the conventional approach of exposing the entire joint, although shoulder arthroscopy requires additional skills from the surgeon, it also offers the patient several significant benefits.
Firstly, avoiding the need to expose the entire joint can significantly reduce the risk of post-operative infection, and the likelihood of excessive blood loss is also lower. The reduced trauma also means that patients who undergo arthroscopic procedures experience less pain and stiffness, display minimal scarring and require a shorter hospital stay, if any, than those who received open surgery. Many need less recovery time too, but this will also depend on the extent of the surgery performed.