Shoulder Pain and Arthroscopy
Shoulder problems are very common. Currently the most common shoulder surgery is
Arthroscopy. It is a complex surgery, in constant evolution, requiring an experienced
surgeon to obtain good results.
How it´s made a Shoulder Arthroscopy?. What will my recovery be?.
Shoulder Arthroscopy is a minimally invasive surgical technique that can be used
instead of conventional open surgery to fix many of the injuries that occur in the
shoulder. In recent years arthroscopy has experienced great advances in technical
complexity, and has become a subspecialty in the field of Orthopaedic Surgery. Open
surgery is still used for those procedures that require greater exposure of tissues, such
as revision surgery or shoulder replacement.
If your specialist has recommended Shoulder Arthroscopy for you, he will explain the surgical
procedure and complications that may occur, and you must sign a consent form to precede
with surgery. You will be referred to an anaesthetist prior to surgery for an anaesthetic
evaluation. This assessment usually includes a blood test, a chest radiograph,
electrocardiogram and clinical review by an anaesthetist, who will assess and discuss the
anaesthetic risks with you.
On the day of scheduled surgery you will need to come to hospital in a fasted state, and
having followed any other specific instructions from the surgeon or anaesthetist. Typically the
day after surgery you will be discharged from hospital and are able to go home. In some
cases (depending on the complexity of the surgery and your medical wellbeing), you can be
discharged home on the same day as surgery.
Anaesthesia in Shoulder Arthroscopy
During shoulder arthroscopic surgery it is necessary to maintain low blood pressures, in order to
reduce bleeding and to maximise surgical access and vision. If blood pressure is high, very small
amounts of bleeding (although they pose no risk to the patient), can prevent adequate vision
through the arthroscope camera and can affect the surgical procedure.
Operating on the shoulder can be painful, therefore special techniques are used by the anaesthetist
to minimise pain post-operatively whilst optimising conditions for the surgeon to operate. The
following anaesthetic techniques are usually employed:
Regional anaesthetic. The anaesthetist administers local anaesthetic into the neck
region which numbs the nerves supplying the shoulder muscles and pain fibres. This
procedure is called an interscalene block and is usually combined with sedation or
general anaesthetic to provide excellent post-operative pain relief and to allow better
control of bleeding during surgery.
The suprascapular block is another technique that is used when operating on the
shoulder and works in a similar way to the interscalene block, but acts on different
nerves. This is used in combination with a general anaesthetic during surgery and can
be supported with intravenous analgesia to control post-operative pain.
Sedation. Sedation can be used as an alternative to general anaesthetic in some
cases and is used in combination with an interscalene block. The patient is conscious
and breathes independently, but is given medication to make them sleepy so that they
are relaxed for surgery.
General Anaesthetic. This is the most common anaesthetic procedure in shoulder
arthroscopy, where the patient is unconscious and a respirator breathes for them. It is
generally used in combination with a regional anaesthetic to facilitate sustained
hypotension during surgery and to decrease postoperative pain.
Rotator Cuff Tears
More Shoulder Problems
How it´s made Shoulder
Anaesthetized patient in lateral decubitus position
with a drive to facilitate arthroscopic shoulder surgery.
Anaesthetic monitor. It is important to
maintain a low pressure during surgery
to prevent bleeding and to improve
How It´s made Shoulder Arthroscopy ?
Anaesthetist performing an interscalene
block using ultrasound for left shoulder
Consent Form in Sholuder Arthorscopy
Introducing arthroscope through a posterior
portal to enter the subacromial space [Dr.
Suturing a rotator cuff tear. [Dr. Mudarra].
TV monitor displaying the surgeon after
repair of Rotator Cuff [Dr. Mudarra].
Pump for introducing saline into the shoulder
to improve vision and reduce bleeding.
An anaesthetized patient in a sitting position.
Shoulder Arthroscopy: How is it done ?
The patient is anesthetized and placed in a sitting position or lateral position, depending on
surgeon preference. The surgeon marks anatomical references on the patient's shoulder to locate
entry points for the arthroscopic instruments and then makes small incisions of 7-8 mm to insert
the arthroscopic portals.
Each portal allows access to different areas of the shoulder. Some of the portals are used for the
arthroscope, which is a small camera that sends images of the inside of the shoulder to a TV
monitor. The other portals are used to introduce the surgical instruments needed to perform the
The shoulder joint is filled with saline at a certain pressure to widen the small space of the
shoulder, which improves the surgeon’s view and increases the area available to work in. The high
pressures created also act to decrease bleeding in the joint during surgery.
Through a posterior portal, the surgeon inserts the arthroscope into the glenohumeral joint and
then makes an anterior working portal to inspect the glenohumeral articulation. Exploration of the
shoulder during arthroscopy can detect injuries to the labrum, capsule, ligament and bone. Muscle
injuries can also be seen such as biceps tendon and rotator cuff tears. In the glenohumeral joint,
the most common injuries seen are bíceps tendonitis, changes to the joint associated with
repeated dislocations, and adhesive capsulitis (otherwise known as frozen shoulder), a
situation in which the shoulder has a loss global mobility with severe pain.
In the second step the subacromial bursa is explored. This is the space where the rotator cuff
passes underneath a bone called the acromion, and is the site of common pathologies such as
supraspinatus tendonitis and supraspinatus/rotator cuff tears
After surgery the arthroscopic portals are sutured and a bandage and sling is applied. Usually a
drain is not required in the shoulder.
How long does shoulder arthroscopy take?. It is a very common question among patients. The
time required for this operation is variable and depends on the surgeon's experience, the
characteristics of the patient and the features of the injured shoulder. Simple procedures such as
an acromioplasty (removal of excess bone to increase the available space for the tendons) takes
approximately 10-15 minutes, whereas complex repairs of rotator cuff injuries can require more
than 90 minutes of surgery. Regardless of the actual operating time, the whole process can take
several hours as time is required either side of the operation for giving the anaesthetic, positioning
and preparing the patient, operating time and recovery from the anaesthetic.
Due to the interscalene block and postoperative analgesia, the patient usually spends a
comfortable night in hospital following surgery and has minimal pain. The shoulder is usually
swollen for a few hours after surgery as the saline used in surgery slowly makes it way out of the
shoulder joint. Within hours the shoulder returns to its normal contour.
The next day the bandage is removed and the dressing is changed. The patient is instructed about
exercises they should be doing to aid recovery of the shoulder, is advised what medications to
take, and is discharged home.
You may be interested to know:
>> Recovery and Complications after Shoulder Arthroscopy. (Spanish)
>> Video: Tendonitis of the Shoulder. Surgeon Dr. Mudarra.
>> Video: Supraspinatus / Rotator Cuff. Arthroscopic Repair. Surgeon Dr. Mudarra.
Marking the arthroscopic portals [Dr. Mudarra].
The arthroscope is introduced through a portal and sends
video images to a TV monitor. The surgeon is performing a
suture of the labrum via another portal [Dr. Mudarra].
Hip Arthroscopy, Shoulder, Knee Surgery ... Sports. Minimally Invasive Surgery. Percutaneous
Surgery of the Foot. Growth Factors. PATIENT INFORMATION.
© 2013 Dr. Jesús Mudarra García. Cirujano Ortopeda y Traumatólogo. firstname.lastname@example.org
Última revisión de este contenido: mayo 2013.
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46450 Benifaio. Tel. +34 962 03 12 21
TRATAMIENTOS Y TÉCNICAS QUIRÚRGICAS QUE REALIZA EL DR. JESÚS MUDARRA
■ Supraspinatus Tendonitis, Supraespinatus Calcific
Tendonitis , Subacromial Syndrome, Bursitis,
Rotator Cuff and Supraspinatus Tears,
Subscapularis, Instability, Recurrent dislocation,
SLAP lesions, dislocation-acromioclavicular
instability. Adhesive Capsulitis. Shoulder Sports
ARTROSCOPIA DE CADERA:
■ Roturas del Labrum, Impimgement o Pinzamiento
Femoroacetabular, Displasia de Cadera, Rotura
Glúteo Medio, Bursitis Recalcitrante, Cadera en
Resorte Dolorosa, Dolor de Cadera en el Adulto
Joven, Cadera del Deportista.
■ Artroscopia de Codo, Muñeca y Tobillo.
ARTROSCOPIA DE RODILLA:
■ Lesiones Menisco, Sutura Meniscal, Rotura
Ligamento Cruzado Anterior y Posterior, Tríada,
Inestabilidad Rótula, Lesiones Osteocondrales,
■ Prótesis de Rodilla, Cadera y Hombro.
■ Artroscopia de la Artrosis.
CIRUGÍA PERCUÁNEA DEL PIE:
■ Hallux valgus (Juanetes), Dedos en Garra, Maza y
Martillo, Metatarsalgia, Hallux rigidus, Neuroma de
Morton, Fascitis Plantar.
■ FACTORES DE CRECIMIENTO.
■ CIRUGÍA MENOR: Síndrome del Tunel Carpiano,
Dedo en Resorte, ...
Revisión contenido de esta página: abril 2014