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Recent Medical Video

Shoulder Arthroscopy Print E-mail

In order to see a video related to arthroscopical treatment of shoulder instability (recurrent dislocation) ,please, press HERE

 

What is Shoulder Arthroscopy?

S.A. is  a close surgical technique using the arthroscope to penetrate and repair shoulder pathologies. Through two or more than two holes-depends on the damage and surgeon's decisions- of 5 to 10 mm length each, we introduce the arthroscope and the necessary instruments to fix the problem. Specific thin instruments and material as well (stitches, anchors etc) are placed in position, while we can monitor and record our performance .


 


Which cases can be treated with arthroscope?

Shoulder arthroscopy can be used to treat the following diseases:

Tear or detachement of the labrum (slap lesion)
Ruptures of the ligaments of the shoulder in cases of dislocation- instability
• Pathology of the long head of biceps tendon
Rotator cuff pathology (tear, rupture)-Impingement syndrome

• Shoulder contracture- Frozen Shoulder
• Articular cartilage degeneration
• A few types of fractures 

• Specific treatment of Arthritis
• Shoulder Bursitis
• Acromioclavicular joint disorders



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How can  arthroscopy take place ?

Under general anaesthesia a patient is placed in beach chair position or lateral decubitus. A small incision 5 mm is taking place at the posterior area of the shoulder. The arthroscope is introduced in the joint through this portal. The scope (specific video camera) is connected to a machine which provides "cold light" and to a monitor where surgeon can see what is happening. We infuse in the joint normal solution via specific pump, which widens the intraarticular space and lessens the difficulties. Using the specific camera we can examinate the joint area indicating the damages and pathologies at the labrum, ligmants, tendons and articular cartilage.





If an arthroscopical procedure is necessary, we penetrate the skin through 2 or more (if necessary) 5mm holes through which special instruments are inserted in order to proceed with the surgery.





After surgery, the fluid is drained, all small incisions are stitched, appropriate dressing is applied and a special immobilizing system is fitted. The arthroscopic operation is recorded on DVD and can be demonstrated to the patient during the postoperative period.
The stitches are removed after 10 days.

 

How long does the shoulder arthroscopy last?

The time required to perform a shoulder arthroscopy depends on the severity and chronicity of the respective problem. In most cases, arthroscopy of the shoulder lasts between 60 and 120 minutes. However, the time required for the patient’s preoperative preparation and recovery after surgery, rises the residence time of the patient at the surgery surroundings in 2-3 hours.



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What kind of anesthesia will I receive in shoulder arthroscopy?

Shoulder arthroscopy is made in combination with regional and light general anesthesia.

By applying the laryngeal mask, we use a new kind of "light" general anesthesia, where the patient is "asleep" but breathing on his own during the surgery.

Older methods of general anesthesia require nervous system depressants and muscle relaxants, the patient is intubated, his own breathing is suspended and his ventilation is performed by a machine, the ventilator.

Instead, by the laryngeal mask method, the patient retains his own breathing and inhales an anesthetic gas which is stopped at the end of surgery. Then, he "wakes up" immediately, with an excellent level of consciousness and mental clarity and without the side effects of general anesthesia.

By regional anesthesia, when the patient sleeps, a local anesthetic is injected in the area where the nerves of the operating shoulder are, ensuring complete analgesia, both during surgery and for a period of 12-24h postoperatively. Finding the right infusion place and ensuring the security and integrity of the nerves is achieved by using a special device called neurostimulant which informs us about the location of nerves, so that they are protected. This method of anesthesia and analgesia is highly successful and fully satisfies almost all patients, who evaluate the entire surgical experience as quite positive.



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How much will it hurt after shoulder surgery?

After the operation the shoulder and the entire arm are numb and the patient does not feel any pain. This is due to regional anesthesia during surgery.
The serum is removed a few hours after surgery and the patient can be mobilized and fed immediately after surgery without vomiting and dizziness.

Postoperatively, only mild painkillers are administered (tablets Voltaren and Depon), to virtually eliminate pain after regional anesthesia’s effect seizes.

In selected cases and if the surgery is expected to be particularly painful, a thin 1mm tube is placed in the area where upper limp’s nerves are, which is connected to a special bottle of local anesthetic administered continuously at a very low dose, to ensure complete analgesia for 48 hours.


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How long will I remain in the hospital?

For the invasive arthroscopic shoulder operation, the postoperative period of the patient’s hospitalization is less than 24 hours. The patient, during his stay in the hospital, is under plain nursing supervision and takes only mild analgesic medication. Usually, before the end of 24 hours the patient can return safely to his place of residence.


Are there any risks?

In any medical procedure some theoretical risks may exist. The risk after arthroscopy of the shoulder is very small and the potential complications are extremely rare.
Practically, all problems are fully dealt with by early diagnosis and appropriate treatment.
The most common postoperative problem is the patients’ failure during the postoperative rehabilitation program (physiotherapy).


How long does physiotherapy rehabilitation after shoulder surgery last?

The duration of the recovery depends on the severity of the problem addressed and on the speed with which each patient responds to the operation.

The recovery duration varies between 2 and 5 months. During this period the patient regularly visits the physician or physiotherapist with a frequency of average 2-3 times a week, in order to carry out the rehabilitation program.


Rehabilitation progresses in three stages. In the first stage, the motion of the shoulder is passive and achieved only by the physician / physiotherapist. In the second stage, the movement is active but assisted. In the third stage, the movement is active. Finally, the phase of muscle strengthening follows (active motion under resistance).

 
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