Shoulder arthroscopy represents a minimally invasive technique to evaluate and treat injuries of the rotator cuff and the shoulder joint. Many of these shoulder problems are seen in our orthopedic office. During your initial evaluation, a recommendation will be made as to whether your injury can be managed by minimally invasive arthroscopic surgery.
Rotator cuff Tears
The rotator cuff is a set of four muscles, which "drive" the shoulder. All of these muscles start on the shoulder blade (scapula), and attach to the ball (humeral head). These four muscles are the supraspinatus, infraspinatus, subscapularis, and the teres minor. The most commonly injured tendon is the supraspinatus muscle, which is located over the top of the shoulder joint. Frequent complaints include difficulty sleeping on the affected side, pain with lifting the arm, and pain that radiates down the side of the arm.
Rotator cuff tears frequently occur as the result of a traumatic episode such as a fall. The tendon then tears from its normal insertion into the humeral head (ball). Once the tendon has torn, it does not re-attach itself to the humeral head. The only method of attaching the tendon is to surgically place it where it belongs.
Arthroscopic rotator cuff repair represents a very successful method of re-attaching the rotator cuff tendon to its normal site. This usually requires making three to four puncture sites (poke-holes) around the shoulder, which heal very quickly. Small titanium or absorbable anchors may be placed within the bone in order to attach the tendon to the bone. In most cases, this is performed as an outpatient surgery in the ambulatory surgery center, and you are able to return home later on the day of surgery.
Return to work is usually dependent on the size of the tear and the type of work that you do. Recommendations on return to work will be made by your doctor and will be discussed with you before your surgery.
Rotator cuff rehabilitation is generally quite lengthy. The arm is usually immobilized in a sling or brace for approximately six weeks. Supervised orthopedic therapy is required to assist with range of motion, strengthening, and functional use of the shoulder.
The labrum is a rim of soft cartilage that serves to "deepen" the socket of the shoulder joint. It helps to stabilize the shoulder joint. Tearing of the labrum may lead to a sense of instability of the shoulder, or the shoulder "slipping" out of joint. In some cases, the shoulder may actually dislocate (the ball comes completely out of the socket).
Conservative treatment usually consists of strengthening exercises directed at conditioning the rotator cuff and shoulder muscles to assist with "dynamically" stabilizing the joint. This is often successful.
Surgical repair of the labrum can usually be performed arthroscopically, through a minimally invasive approach. This is done using small absorbable anchors that are placed onto the edge of the socket. The labrum is then re-attached to the socket in order to regain stability of the shoulder joint.
Post-operative rehabilitation is an extremely important component of the procedure and usually involved supervised orthopedic therapy. Return to normal athletic activities is usually allowed 6 months following surgery.