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?.
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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:  o 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. o 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.  o 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.
Shoulder Anatomy Shoulder Tendonitis Rotator Cuff Tears Shoulder Instability More Shoulder Problems How it´s made Shoulder Arthroscopy ? Shoulder Recovery
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 surgical vision.

How It´s made Shoulder Arthroscopy ?

Anaesthetist performing an interscalene block using ultrasound for left shoulder arthroscopy.
Consent Form in Sholuder Arthorscopy (Spanish)
Introducing arthroscope through a posterior portal to enter the subacromial space [Dr. Mudarra].
Suturing a rotator cuff tear. [Dr. Mudarra].
TV monitor displaying the surgeon after repair of Rotator Cuff [Dr. Mudarra].
Bomba peristáltica para Artroscopia
Pump for introducing saline into the shoulder to improve vision and reduce bleeding.
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An anaesthetized patient in a sitting position.
Artroscopia de Hombro. Bloqueo interescalénico. Operación Artroscopia de Hombro. Reparación Manguito de los Rotadores. Artroscopia de Hombro. Operación sutura Supraespinoso. Artroscopia de Hombro. Posición decúbito lateral. Artroscopia de HOmbro. Anestesia general.

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 surgery. 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].
Operación Artroscopia de Hombro. Portales artroscópicos. Artroscopia de Hombro. Entrando en espacio subacromial. Artroscopia de Hombro. Posición silla de playa. ¿ Cómo se hace una Artroscopia de Hombro ?.
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.                                                                                 
Última revisión de este contenido: mayo  2013.
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SHOULDER ARTHROSCOPY: ■ 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 Injuries. 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. OTRAS ARTROSCOPIAS ■ Artroscopia de Codo, Muñeca y Tobillo.
ARTROSCOPIA DE RODILLA: ■ Lesiones Menisco, Sutura Meniscal, Rotura  Ligamento Cruzado Anterior y Posterior, Tríada, Inestabilidad Rótula, Lesiones Osteocondrales, Mosaicoplastia. ARTROSIS: ■ 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. OTROS PROCEDIMIENTOS: ■ FACTORES DE CRECIMIENTO. ■ CIRUGÍA MENOR: Síndrome del Tunel Carpiano, Dedo en Resorte, ...
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