Effective and safe method of dealing with most problems of a complex joint
Ioannis Vosinakis
Orthopaedic
Scientific Head of the Orthopedic Department of ANASSA General Clinic
The shoulder joint is formed by the scapula and the humerus. The shoulder exhibits the greatest range of motion of any joint in the human body. The stability as well as the movement of the joint is determined by the surrounding muscles, tendons and ligaments. Neighboring joints, especially the acromioclavicular joint, also play an important role in the smooth functioning of the shoulder.
The large range of motion and instability of the shoulder joint leads to significant stresses and makes it prone to injuries, overuse syndromes and chronic changes (resulting in pain, instability, limitation of motion etc.). Many of the injuries and chronic injuries of the shoulder require surgical treatment. Classical open shoulder surgery is associated with postoperative pain, blood loss, and delayed functional recovery.
Shoulder arthroscopy is a minimally invasive surgical method, which has been successfully applied for many years for the diagnosis and treatment of various injuries and alterations of the joint. In contrast to open surgical methods, during arthroscopy the necessary thin surgical instruments are inserted through very small holes in the skin. Through these holes the arthroscope is inserted, which offers an overview under direct vision and magnification as well as the appropriate tools to check the joint and adjacent structures and apply the appropriate treatment.
The main indications for shoulder arthroscopy are:
- Hypocromial impingement syndrome
- Rupture of the rotator tendons of the shoulder
- Damage of the articular cartilage
- Rupture of labial cartilage
- Broken links
- Shoulder stiffness and frozen shoulder
- Removal of free bodies
- Diseases of the acromioclavicular joint
- Diseases of the biceps tendon
- Advantages of arthroscopy
- Improved visibility, especially in hard-to-reach areas of the joint
- Much less trauma and less chance of complications (perfusion, chronic pain, etc.)
- Significant reduction of postoperative pain
- Faster recovery and leaving the clinic
- Rapid return to normal activities and work
- Better aesthetic result
With shoulder arthroscopy the possibility of complications is extremely small. All surgical procedures can have complications such as infection, edema, bleeding, nerve damage, venous thrombosis, etc. The minimally invasive surgical technique during shoulder arthroscopy and the systematic postoperative monitoring make such situations unlikely.
Basic elements for the successful treatment of diseases in the shoulder area through arthroscopy and avoiding complications are:
The exact diagnosis of the condition before surgery, through a detailed clinical examination and appropriate imaging tests (e.g. ultrasound, X-ray, MRI)
The surgeon’s experience and expertise in shoulder arthroscopy
The appropriate technical equipment
The systematic postoperative monitoring of the patient
The consistent implementation of the physical therapy program after surgery
How is a shoulder arthroscopy performed?
The most commonly used anesthesia is combined (regional and light general with laryngeal mask). The patient is placed in a semi-sitting or lateral position. Through a small 5 mm long incision on the back surface of the shoulder, the arthroscope (camera) is inserted into the joint. With a special pump, normal saline is injected into the joint cavity, which stretches the joint. The entire joint is checked for pathological conditions and then, through two or more holes in the anterior and lateral surface of the shoulder, the necessary tools are inserted to treat the respective problem. The joint is rinsed and drained of fluid, the small incisions are sutured and bandaged. Usually, the upper end is immobilized in a special folder. The operation is recorded on DVD.
Stitches are removed after 10-12 days.
The exit from the clinic takes place in 1-2 days, with simple analgesics and post-operative monitoring. Depending on the case, specialized physical therapy – rehabilitation follows. The duration of rehabilitation ranges from two to five months, and depends on the severity of the pre-existing problem and the speed with which each patient responds.
Recovery after arthroscopy develops in 4 phases:
First phase: passive mobilization of the shoulder by the physical therapist.
Second phase: active – assisted mobilization
Phase three: active mobilization and
Finally: muscle strengthening phase (active resistance movement).
Functional rehabilitation after shoulder arthroscopy is of great importance and requires both the collaboration of the attending physician and the physical therapist, as well as the active and determined participation of the patient, to achieve better result.