About shoulder arthroscopy

Shoulder arthroscopy is a keyhole operation that is used to look inside the shoulder joint. This allows your surgeon to investigate the cause of your shoulder problems, which could include small, loose pieces of bone or cartilage, or damage to the ligaments and tendons. Shoulder arthroscopy can also be used to repair the shoulder joint after an injury or because of wear and tear.

The operation is usually performed using a narrow, tube-like, telescopic camera called an arthroscope, which is inserted into the joint through a small cut. This camera is linked to a video screen, allowing your surgeon to see inside the shoulder joint. Arthroscopic surgery is generally safe and has few complications.

Shoulder Arthroscopy

What are the alternatives?

For some people with a damaged shoulder joint, shoulder arthroscopy isn’t necessary. Your doctor may decide to use an X-ray, ultrasound or a magnetic resonance imaging (MRI) scan to diagnose your shoulder problems. An MRI scan uses magnets and radiowaves to produce images of the inside of your shoulder. An ultrasound scan uses sound waves to produce an image of the inside of your shoulder.

Whether or not you have surgery to repair your shoulder will depend on what is causing your problems and what treatments you have tried in the past. Your doctor may recommend that you try physiotherapy or steroid injections before having a shoulder arthroscopy.

Preparing for your operation

Your surgeon will explain how to prepare for your operation. For example, if you smoke, you will be asked to stop as smoking increases your risk of getting a chest or wound infection, which can slow your recovery.

The operation is routinely performed as a day case, which means you won’t have to stay overnight in the hospital.

The operation is usually performed under general anaesthesia, which means that you will be asleep during the procedure.

If you’re having general anaesthesia, you will be asked to follow fasting instructions. Typically you must not eat or drink for about six hours before a general anaesthetic. However, some anaesthetists allow occasional sips of water until two hours beforehand.

At the hospital, your nurse may check your heart rate and blood pressure, and test your urine.

Your surgeon will usually ask you to sign a consent form. This confirms that you understand the risks, benefits and possible alternatives to the procedure and have given your permission for it to go ahead.

About the operation

An arthroscopy can take up to one and a half hours, depending on whether your surgeon is finding out the cause of your shoulder pain or repairing the shoulder joint.

Once the anaesthesia has taken effect, small cuts (about 5mm long) are made in the skin around the shoulder that is being treated. Sterile fluid is injected into the joint to help produce a clearer picture. The arthroscope is inserted through one of these cuts into the joint.

Your surgeon will then look at the joint, either directly through the arthroscope, or at pictures it sends to the monitor. If necessary, other instruments can be inserted to repair any damage or remove material that may be interfering with movement or causing pain in the shoulder.

At the end of the procedure, the fluid is drained out of the joint and any cuts are closed. Dressings will be used to cover the cuts.

What to expect afterwards

You will need to rest until the effects of the anaesthetic have passed. General anaesthesia temporarily affects your coordination and reasoning skills, so you must not drive, drink alcohol, operate machinery or sign legal documents for 48 hours afterwards. If you’re in any doubt about driving, contact your motor insurer so that you’re aware of their recommendations, and always follow your surgeon’s advice.

If you had a local or regional anaesthetic, it may take several hours before the feeling comes back into the treated shoulder. Take special care not to bump or knock the area.

Before you go home, you may see your surgeon to discuss the outcome of the operation. A physiotherapist may also visit you to help you get the joint moving and to discuss exercising at home.

You will need to arrange for someone to drive you home. You should try to have a friend or relative stay with you for the first 24 hours.

Recovering from shoulder arthroscopy

It can take between one and six months to recover from a shoulder arthroscopy. This depends on the type of surgery that you have had.

If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.

You may need to wear a sling for the first week after your shoulder arthroscopy. You might also have some swelling or discomfort in your shoulder for a few weeks after surgery.

It’s important to continue with any exercises recommended by your physiotherapist, as these may help you to recover your strength and movements more quickly.

You must follow your surgeon’s advice about driving, returning to work and getting back to your usual physical activities. Don’t drive until you are confident that you could perform an emergency stop without discomfort. Most people can return to work a week after surgery, but it may be longer if your job involves lifting or carrying or if you have had more extensive surgery.

What are the risks?

Shoulder arthroscopy is commonly performed and generally safe. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications.

Side-effects

Side-effects are the unwanted but mostly temporary effects you may get after having shoulder arthroscopy.

You may have some pain and stiffness around the joint after surgery. This can make moving around quite uncomfortable at first.

Complications

This is when problems occur during or after the operation. Most people aren’t affected. The possible complications of any operation include an unexpected reaction to the anaesthetic, infection, excessive bleeding or developing a blood clot, usually in a vein in the leg (deep vein thrombosis, DVT).

One of the complications of shoulder arthroscopy is accidental damage to the inside of the joint or a loss of feeling in the skin over the shoulder. However, this is very rare. Another rare complication is an infection in the shoulder joint.

If you develop any of the following symptoms, they may indicate that you have an infection. You should contact your hospital immediately if your wound becomes hot, red or swollen, bleeds or becomes more painful. If you have a high temperature or your hand or arm feels numb or tingly you should also contact your hospital.

The exact risks are specific to you and differ for every person, so we have not included statistics here. Ask your surgeon to explain how these risks apply to you.