Shoulder and Elbow

Arthroscopy

Shoulder arthroscopy is a type of surgery that uses a small camera (arthroscope) inserted through a small incision to examine or repair the tissues inside or around your shoulder joint.

The surgeon makes a small incision, about one-quarter inch (0.25") long, near the shoulder joint. A small camera (arthroscope) is then inserted into the joint. The camera is attached to a video monitor to allow the surgeon to see inside the joint.

Most people are asleep during the surgery. Therefore, you will be unable to watch the video monitor. A nerve block may be used to numb your shoulder and arm to help reduce pain after surgery.

A salt solution (saline) is pumped into the shoulder to expand the joint. This helps the surgeon see the joint and helps control any bleeding.

The surgeon will look around the entire joint to check the cartilage, tendons, and ligaments of the shoulder. If damaged tissues need to be repaired, the surgeon will make 1 to 3 additional small incisions to insert other instruments. These may include a blunt hook to pull on tissues, a shaver to remove damaged or unwanted tissues, and a burr to remove bone.

In addition to working on the shoulder joint, the surgeon often places the camera in the space above the rotator cuff tendons (the subacromial space). The surgeon can evaluate the area above the rotator cuff, clean out inflamed or damaged tissue, remove a bone spur, and fix a rotator cuff tear.

At the end of the surgery, the fluid is drained from the shoulder, the small incisions are closed, and a dressing is applied. Your surgeon will probably take pictures of the procedure from the video monitor to show you what was found and what was done.

Arthroscopic Rotator Cuff Repair

What is the Rotator Cuff?
The rotator cuff is composed of four muscles, each of which has a tendon that attaches to the upper arm bone (the humerus):

Supraspinatus
Infraspinatus
Teres Minor
Subscapularis

These tendons form a cuff around the head of the upper arm bone (humerus). These tendons attach to the front and side of the humerus and the greater and lesser tubercles (part of the upper humerus). The muscles associated with these tendons are located in the upper back, where they are attached to the shoulder blade (scapula).

The largest component of the rotator cuff is the supraspinatus tendon, which is essential for lifting the arm. The infraspinatus and teres minor rotate the arm outward, while the subscapularis rotates the arm inward.

Rotator Cuff Tendonitis
Rotator cuff tendinitis occurs when the tendons are injured, usually as a result of repetitive overhead reaching, pushing, or lifting with outstretched arms. Athletes who perform overhead activity, such as swimming, tennis, throwing, golf, weightlifting, volleyball, and gymnastics, are also at risk. Tendinitis is usually treated with ice, anti inflammatory drugs, and physical therapy.

Rotator Cuff Tear
The rotator cuff tendon(s) may be torn as a result of injury, chronic tendinopathy, or a combination of both. Typically the injury is caused by a fall, direct blow, or a rapid use of force (pulling on a starter cable, for instance). Tears are uncommon in people under the age of 30; less than 1 percent of shoulder injuries in people under the age of 30 are complete rotator cuff tears, while up to 35 percent of people over age 45 with shoulder pain have a complete rotator cuff tear.
The goals of treatment for a torn rotator cuff are to recover lost strength, improve the function of the shoulder, and treat any underlying tendinitis. Conservative treatment is adequate in the vast majority of people, although younger people with a medium- to large-sized tear, particularly affecting the dominant arm, may be candidates for surgical repair. Surgery may also be recommended for older people who have significant pain related to a rotator cuff tear.

People with small- to medium-size tears usually improve with physical therapy exercises, stopping painful activities, and, in some cases, injection of a steroid. If shoulder strength and function do not improve after completing three to six months of physical therapy, surgical repair may be considered.

Learn more about Rotator Cuff tears..

Arthroscopic SLAP Repair
Since orthopedic surgeons began using a tiny TV camera called an arthroscope to diagnose and treat shoulder problems, they have discovered several conditions that no one knew existed. One of these conditions is an injury to a small structure in the shoulder called the labrum. A labral tear can cause pain and a catching sensation in the shoulder. Labral tears can be very difficult to diagnose.

The shoulder is made up of three bones: the scapula (shoulder blade), the humerus (upper arm bone), and the clavicle (collarbone).

A part of the scapula, called the glenoid, makes up the socket of the shoulder. The glenoid is very shallow and flat. The labrum is a rim of soft tissue that makes the socket more like a cup. The labrum turns the flat surface of the glenoid into a deeper socket that molds to fit the head of the humerus.

The rotator cuff connects the humerus to the scapula. The rotator cuff is formed by the tendons of four muscles: the supraspinatus, infraspinatus, teres minor, and subscapularis.

Tendons attach muscles to bones. Muscles move the bones by pulling on the tendons. The rotator cuff helps raise and rotate the arm. As the arm is raised, the rotator cuff also keeps the humerus tightly in the glenoid of the scapula.

The soft labral tissue can be caught between the glenoid and the humerus. When this happens, the labrum may start to tear. If the tear gets worse, it may become a flap of tissue that can move in and out of the joint, getting caught between the head of the humerus and the glenoid. The flap can cause pain and catching when you move your shoulder. Several tendons and ligaments attach to the labrum that help maintain the stability of the shoulder. So when the labrum tears, the shoulder often becomes much less stable.

What causes labral tears?
Labral tears are often caused by a direct injury to the shoulder, such as falling on an outstretched hand. The labrum can also become torn from the wear and tear of activity, a condition called overuse. An injured labrum can lead to shoulder instability. The extra motion of the humerus within the socket causes additional damage to the labrum. An extremely unstable shoulder may slip or dislocate. This can also cause the labrum to tear.

The biceps tendon attaches to the front part of the labrum. The biceps is the large muscle on the front of your upper arm. Sports can cause injuries to the labrum when the biceps tendon pulls sharply against the front of the labrum. Baseball pitchers are prone to labral tears because the action of throwing causes the biceps tendon to pull strongly against the top part of the labrum. Weightlifters can have similar problems when pressing weights overhead. Golfers may tear their labrum if their club strikes the ground during the golf swing.

Please note: this information is for informational purposes only. It should not be used for diagnosing an injury, and the information provided should not be used to replace medical treatment.