Introduction
The shoulder joint is uniquely capable of a wide range of movements, more than any other joint in the body. This versatility, however, makes it susceptible to various injuries and stress-related conditions, particularly in athletes involved in sports requiring overhead motions.
The shoulder is stabilized by robust tissues that connect its bones. Unfortunately, these soft tissues can be more easily affected by stress and injury than the bones themselves. When these tissues stretch or tear, it can lead to weakness, instability, or even dislocation of the shoulder. While some shoulder issues can be managed conservatively, others may necessitate surgical intervention. Arthroscopy is a minimally invasive technique that allows surgeons to visualize, diagnose, and treat conditions within the shoulder joint.
Traditionally, shoulder surgeries involved large incisions, which could disrupt surrounding tissues. In contrast, arthroscopy involves small incisions and a specialized viewing instrument, resulting in a lower risk of infection and a quicker recovery.
Anatomy
The shoulder consists of three primary bones: the humerus (upper arm bone), the clavicle (collarbone), and the scapula (shoulder blade). The acromion, a part of the scapula, forms the top of the shoulder. Together, these bones create the main shoulder joint known as the glenohumeral joint.
Multiple ligaments stabilize the shoulder by connecting the bones. Unlike the true ball-and-socket structure of the hip, the glenohumeral joint has a ball-shaped top of the humerus that fits into a shallow cavity (the glenoid) on the scapula. The joint capsule, formed by ligaments, keeps the humeral head in place.
Tendons, which link muscles to bones, facilitate arm movement. The biceps tendon, located at the front of the shoulder, aids in elbow flexion and provides stability during lifting.
The rotator cuff, comprised of tendons and muscles, enables shoulder rotation and elevation. A fluid-filled sac called the subacromial bursa reduces friction, allowing smooth movement of the rotator cuff tendons during activities such as reaching overhead.
Causes
Shoulder issues are prevalent, often affecting the muscles, ligaments, and tendons more than the bones. Conditions may arise due to injury, degeneration from overuse, age, or diseases like arthritis. Arthroscopic surgery is frequently employed to address issues such as instability, dislocations, rotator cuff tears, and impingement syndrome.
Shoulder instability can occur when muscles or ligaments are overstretched or weakened, potentially leading to dislocation. The glenohumeral joint's structure makes it particularly vulnerable to dislocations.
Rotator cuff injuries are common, especially as we age, when the tendons may deteriorate or become damaged from overuse, like in repetitive sports actions.
Shoulder impingement syndrome occurs when bone spurs or inflammation narrow the space for rotator cuff tendons, leading to pain and potential tears.
Symptoms
Common symptoms of shoulder conditions include pain, stiffness, and weakness. Pain may intensify at night or during movement. Instability may cause a sensation of the shoulder "popping" out of place, while a torn rotator cuff may result in pain and weakness, although not all tears are painful.
Diagnosis
A physician will assess your shoulder through a physical exam and imaging studies. During the evaluation, you may be asked about your symptoms and medical history, as well as perform basic movements to assess strength and stability.
X-rays can reveal bone conditions, including arthritis or bone spurs, while an MRI can provide detailed images of soft tissues in the shoulder, aiding in diagnosing injuries not visible on X-rays.
Treatment
Many shoulder conditions respond well to non-surgical treatments, including physical therapy, occupational therapy, and anti-inflammatory medications. Cortisone injections may also provide relief. If symptoms persist despite these treatments, arthroscopic surgery may be recommended to repair ligaments or remove damaged tissues.
Surgery
Most arthroscopic shoulder surgeries are performed on an outpatient basis under anesthesia. The surgeon makes several small incisions near the joint and fills the space with a sterile saline solution for better visualization. An arthroscope is then inserted, allowing the surgeon to see the joint structures.
Additional small incisions may be made for other specialized instruments, and techniques such as thermal capsulorrhaphy may be employed. The small incisions typically heal with minimal scarring.
Recovery
Post-surgery, the shoulder will require several weeks to heal. Movement restrictions will be enforced, and an arm sling may be necessary. Recovery duration varies based on the specific procedure performed, but many patients regain function and strength within four to six months.
Arthroscopic surgery generally offers quicker recovery compared to traditional open surgeries, as it involves less tissue disruption, resulting in less pain and a lower risk of infection. Most patients experience positive outcomes.
Prevention
To maintain shoulder strength, stability, and flexibility, regular exercise is beneficial. Limiting repetitive overhead movements can help prevent worsening conditions. It’s also crucial to adhere to your physician’s advice regarding weight lifting and movement restrictions.
