Shoulder Arthroscopy - An Educational Pamphlet

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. S H O U L D E R

. A R T H R O S C O P Y : · ' . '

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Fixing a Problem Shoulder

J

The shoulder is your body's most flexible joint. It is designed to

let the arm move in almost any direction. But this flexibility has

a price-it makes the joint prone to injury. Ifyou have a shoulder

problem, a surgical procedure called arthroscopy can help. This

technique lets your doctor examine and treat problems in your

shoulder. Read this booklet to learn more.

The Foundation

Bones provide the foundation of the shoulder joint. The bones

fit together in a way that allows the arm to move freely.jAcromion

• The humeral head is the ball at the /~ ~Clavicletop of the humerus (arm bone). Humeral head~~

• The scapula is the shoulder blade. .~~Humerus Xhe coracoid and acromion are

two parts of the scapula.

• The glenoid is a shallow socket on

the scapula. The labrum is a ring of

cartilage around the rim of the glenoid.

• The clavicle is the collarbone.Labrum

The Connections

Soft tissues include muscles, tendons, and ligaments.

These connect the shoulder bones together, provide

stability, and move the joint.Coracoacromial

ligament

• The rotator cuff is made up of muscles

and tendons. These connect shoulder

bones and move the joint.

• The bursa is a fluid-filled sac that

cushions the rotator cuff.

• The capsule is a sheet of tough fibers

that encloses the joint. The capsule

attaches to the labrum.

• The coracoacromialligament connects

the acromion to the coracoid.

Bursa

tendons

2

This booklet is not intended as a substitute for professional medical care.Onlyyour doctor can diagnose and treat a medical problem.

©2005The StayWellCompany. www.krames.com 800-333-3032All rights reserved. Lithographed in Canada. Last reviewed November 2009.

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Arthroscopy: Looking Inside Your Joint

Arthroscopy allows your doctor to see and work inside your shoulder

joint through small incisions. A long, thin, lighted instrument called

an arthroscope is used. During surgery, the arthroscope sends live

video images from inside the joint to a monitor. Using these images,

the doctor can diagnose and treat your shoulder problem. Because

arthroscopy uses much smaller incisions, recovery is often shorter

and less painful than recovery after open surgery.

Your Orthopaedic Evaluation

Your doctor will ask you about your

symptoms and the history of yourshoulder problem. Your shoulder will

be examined. And diagnostic tests,

such as an x-ray or an MRI, may be

done. These help your doctor find

the cause-of your shoulder problem.

I - ~!

l

fIt~~

• Infection

• Damage to nerves orblood vessels

Risks and possible complications of arthroscopy include:

• Stiffness or ongoing pain

inyour shoulder

• Bleeding or blood clots

3



Treating Your Shoulder Problems with Arthroscopy

You will be told how to prepare for your surgery and when you

should arrive at the hospital or surgery center. Just before surgery!

a doctor will talk to you about the anesthesia that will be used to

keep you free of pain during surgery. You may be asked by several

people to confirm which shoulder is being operated on. This is for

your safety. Below are common shoulder problems and how they are

treated during arthroscopy.

Repeated ove rhead m ovem en ts canin flam e yo ur ro tato r cu ff and b ursa,

A b one spu r m ay also fo rm . T his cause s

pain and pro blem s w ith ce rtain arm

m o vem en ts. Im pingem en t is also

cal led bursi ti s o r t end in it is .

Torn Rotator Cuff

A ro tato r cu ff can te ar due to a sudden

in ju ry o r fro m overuse . T his c an c au se

pain , w eakne ss, and lo ss o f no rm al

sh ou ld er m o ve m en t.

4

During su rge ry , an in flam ed bu rsa m ay b e rem oved . Bone m ayb e trim m ed . A nd the co raco acro m ialligam en t m ay b e de tached .

T he se steps m ake m o re ro om , re liev ing pre ssu re and allo wing

the arm to move m o re fre ely .

---,.-------------~- ..~-

D uring su rge ry , to rn ro tato r cu ff tendons m ay b e tr im m ed . The

tendons are then re attached to th e hum erus, Th is is do n e w ith

su tu re s, an ch ors, o r su rg ical tack s.



Stretched Capsule

A stretch ed capsu le w ill rem ain lo o se.

A lo o se capsu le can't ho ld the jo in t

fir m ly in p la ce . T he b o ne s o f th e jo in t

m ay feel like they m o ve to o m u ch.

D u rin g a rth ro sco p y, a str etch ed ca psu le is fo ld ed o ve r itse lf

and su tu red in place. (This is do ne fro m inside the capsu le.)

This tightens the capsu le, help ing m ake the sho u lder jo in t

m o re sta ble .

.torn Labrum

The labru m m ay tear o ff the r im o f the

gleno id. This can cau se the jo in t to

catch o r feel like it's slipp ing o u t o f

p la ce . The s ho u l de r may e ven d is lo c ate .

A to rn labru m is repaired by reattaching it to the gleno id. This

is o ften do ne w ith specia l ancho rs pu t in to the gleno id bo ne.

Su tu res attached to the ancho rs are tied to ho ld the labru m

in p la ce. The jo in t then feels m o re stable.

Arthritis and Loose Bodies

A rthr itis is dam age to jo in t car tilage

w ith age and u se. In ju ry o r d isease can

a lso cau se it. W ear and tear m ay also

lead to lo o se bo dies (p ieces o f bo ne

o r car tilage ) o r bo ne spu rs in a j o in t.

L oo se b od yremo ved car tilage

Du ring su rgery, bo ne spu rs are rem oved. Ro ugh par ts o f

the jo in t are sm oo thed. Any lo ose bo dy is rem oved fro m the

jo in t. Bo ne m ay also be scraped o r shaved to pro mo te new

car tila ge g row th .

5



After Arthroscopy

After your arthroscopy, you will recover in the hospital or

surgery center for a few hours. In some cases, you may

stay overnight. When you are able to go home, you will beinstructed how to relieve any pain and how to care for your

shoulder as it heals. To help with healing, a program of

physical therapy (PT) may be prescribed.

In the Recovery Room

After surgery, you'll be taken

to a recovery area to rest.

You'll have a bandage to

protect your incisions, and

a sling to hold your arm in

place. Nurses will give you

medications to help relieve

pain. Adevice is sometimes

used to deliver pain medica-

tion directly into the joint.

In some cases, cold packs ora cooling unit may be used

to reduce swelling in your

shoulder.

Going Home

Before leaving the hospital

or surgery center, be sure

to know how to care for your

shoulder at home. Ask any

questions you have. Also

know who to contact ifyou

have questions later. When

you are ready to leave the

hospital or surgery center,

an adult family member

or friend will need to driveyou home.

6

Y o u w ill wear a sling to help rest the sho u lder while it heals.

Be prepared to have so meo ne else dr ive yo u

ho me fro m yo ur su rgery.



Your Home Recovery

At home, follow any instructions you've been given. Your doctor

may want to see you during the first weeks after arthroscopy to

check your healing. When you're ready, PT may be prescribed.

Relieving Pain

• Take prescribed pain medications

as directed. Don't wait for pain to get

bad before you take them.

• Ice your shoulder 3 times a day for

20 minutes at a time. Use an ice

machine (if given one) or a bag of

ice or frozen peas. Put a thin cloth

between your skin and the ice source.

• Wear your sling as directed.

Call your doctor if you have:

• Fever over lOPF (38.3°C)

• Bleeding from an incision

• Increased shoulder pain

or swelling

• A red or oozing incision

• Numbness or tingling that

doesn't go away 24 hours

after surgery

Physical Therapy

Physical therapy is a program of guidedexercise that will help you regain movement

and strength in your shoulder. This program

is tailored to your shoulder pro blem and

the surgery done to treat it. You will start

PT when your doctor feels you are ready,

often shortly after surgery.

Icin g yo u r sh ou lder after su r ge ry h elp s

p reven t swe lling .

Physica l therapy can help yo u regain fu ll u se o f yo u r sho u lder .

7



Your Surgical Checklist

Use this checklist to remind you what to do before and after

your surgery. Ask your doctor or nurse to fil l in the blanks.

He or she can also write down any special instructions.

Before Surgery

o Tell your doctor what medications,

supplements, or herbal remedies

you take. Ask if you should stop

taking any of them before surgery.

o Stop taking aspirin, ibuprofen,

or other medications as directed___ days before surgery.

o Confirm what time you should

arrive at the hospital or surgery

center. Arrange for an adult

family member or friend to give

you a ride to and from surgery.

o Don't eat or drink anything aftermidnight, the night before your

surgery.

Consultant:

A. Shabi Khan. MD. Orthopaedic Surgery

Contributions by:

David Bartlett , MD, Orthopaedic Surgery

Edward V. Craig, MD, Orthopaedic Surgery

Jack A. Michalsld, MD. Orthopaedic Surgery

Roger E. Pack. MPT, OCS, Physical Therapy

Craig Tifford, MD, Orthopaedic Surgery

Michael A. Wirth, MD, Orthopaedic Surgery

After Surgery

o Use ice as instructed to reduce

swelling and pain.

o Take care of your incisions as

directed. You can begin bathing

again in days.

o See your doctor for a follow-up

visit on this date: _

o Wear your sling as directed

for days/weeks.

o Do physical therapy exercises

as prescribed.

o Ask your doctor what activitiesyou should avoid:

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Shoulder Arthroscopy - An Educational Pamphlet