Is shoulder arthroscopy better for me than open surgery?
Arthroscopic surgery is sometimes better than open surgery as it may reduce the amount of pain you have after surgery and the amount of time you need to spend in hospital.
Shoulder arthroscopy is a type of keyhole surgery that is used to look inside and treat damage to your shoulder caused by an injury, arthritis or certain health conditions.
You will meet the surgeon carrying out your procedure to discuss your care. It may differ from what is described here as it will be designed to meet your individual needs.
Your surgeon will perform shoulder arthroscopy through small cuts in your skin. He or she will use a special telescope (arthroscope) attached to a video camera. This will display pictures on a monitor and your surgeon may use these images to guide small surgical instruments. Compared with open surgery, arthroscopy has a faster recovery time.
Your doctor may suggest you have a shoulder arthroscopy to repair damage to your shoulder, which is caused by an injury or certain conditions that affect your shoulder. Shoulder arthroscopy is thought to help treat some shoulder problems, including:
Not everyone who has a problem with their shoulder will need to have an arthroscopy. Your doctor will usually be able to diagnose your shoulder problem by examining you and by using other tests such as an X-ray or an MRI scan.
Depending on what has caused the damage, your shoulder problem may improve on its own without treatment or with self-help measures, such as following an exercise programme to strengthen the muscles around your shoulder. Other treatments for shoulder problems may include physiotherapy, and medicines. Talk to your doctor about what treatment options are available for you.
Your orthopaedic surgeon (a doctor who specialises in bone surgery) will explain how to prepare for your procedure. For example, if you smoke you will be asked to stop, as smoking increases your risk of getting a chest and wound infection, which can slow your recovery.
Shoulder arthroscopy is routinely done as a day-case procedure. This means you have the procedure and go home the same day.
The operation is usually done under general anaesthesia but it may also be done under a combination of both local and general anaesthesia. General anaesthesia means you will be asleep during the operation. Local anaesthesia completely blocks pain from the shoulder area. Sometimes, the whole operation can be done under local anaesthesia, which means you will stay awake during the operation. Your surgeon may offer you a sedative with a local anaesthetic, which relieves anxiety and helps you to relax during the operation.
If you're having a general anaesthetic, you will be asked to follow fasting instructions. This means not eating or drinking, typically for about six hours beforehand. However, it’s important to follow your anaesthetist’s advice.
You may be asked to wear compression stockings to help prevent blood clots forming in the veins in your legs. You may need to have an injection of an anticlotting medicine called heparin as well as, or instead of, wearing compression stockings.
Your surgeon will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to understand what will happen, and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead, which you may be asked to do by signing a consent form.
A shoulder arthroscopy often takes less than an hour, but the time your procedure will take will depend on how much work your surgeon needs to do inside your shoulder joint.
Once the anaesthetic has taken effect, your surgeon will make small cuts in the skin around your shoulder joint. He or she will pump sterile fluid into your joint to help produce a clearer picture and then insert the arthroscope.
Your surgeon will examine your shoulder joint by looking at images sent by the arthroscope to a monitor. If necessary, he or she will insert surgical instruments to repair damage or remove material that interferes with the movement in your shoulder and causes pain.
Afterwards, your surgeon will drain the fluid and close the cuts with stitches or adhesive strips. He or she will then wrap a dressing and a bandage around your shoulder.
You may need to rest until the effects of the anaesthetic have passed. After a local anaesthetic it may take several hours before the feeling comes back into your shoulder. Take special care not to bump or knock the area.
You may need pain relief to help with any discomfort as the anaesthetic wears off.
You will usually be able to go home when you feel ready. You will need to arrange for someone to drive you home. Try to have a friend or relative stay with you for the first 24 hours after your shoulder arthroscopy.
If you have had general anaesthesia or sedation, this temporarily affects your co-ordination and reasoning skills, so you must not drive, drink alcohol, operate machinery or sign legal documents for 24 hours afterwards. If you're in any doubt about driving, contact your motor insurer so that you're aware of their recommendations, and always follow your surgeon’s advice.
Your nurse will give you some advice about caring for your healing wounds before you go home. You may be given a date for a follow-up appointment.
The amount of time your dissolvable stitches will take to disappear depends on the type of stitches you have. However, for this procedure, they should usually disappear in about six weeks but check with your surgeon.
It usually takes several weeks to make a full recovery from shoulder arthroscopy, but this varies between individuals, so it's important to follow your surgeon's advice.
If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice.
It’s important to continue to do any exercises your physiotherapist recommends. These will help you to heal and may help you to recover more quickly.
You may need to keep your arm in a sling after the operation – your surgeon will tell you how long you will need to wear it for. Your shoulder joint is likely to feel sore and swollen for at least a week. This can last longer if you have arthritis. Try to rest your arm and apply a cold compress such as ice or a bag of frozen peas wrapped in a towel to reduce swelling and bruising. Don’t apply ice directly to your skin as it can damage your skin.
Your recovery time will depend on what, if any, treatment your surgeon performs on your shoulder joint. This may vary from a few days to several weeks depending on the severity of your shoulder problem and your level of fitness.
As with every procedure, there are some risks associated with shoulder arthroscopy. We have not included the chance of these happening as they are specific to you and differ for every person. Ask your surgeon to explain how these risks apply to you.
Side-effects are the unwanted but mostly temporary effects you may get after having the procedure.
After a shoulder arthroscopy you may have small scars on your shoulder from the cuts. Your shoulder and arm may be painful or uncomfortable for several weeks. You may also have some swelling and stiffness around your shoulder.
Complications are when problems occur during or after the procedure. The possible complications of any operation include an unexpected reaction to the anaesthetic, excessive bleeding or developing a blood clot, usually in a vein in the leg (deep vein thrombosis, DVT).
Complications of arthroscopy include:
It’s possible that the procedure won’t work and you may need to have it again.
Produced by Rachael Mayfield-Blake, Bupa Health Information Team, July 2013.
For answers to frequently asked questions on this topic, see FAQs.
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This information was published by Bupa's Health Information Team and is based on reputable sources of medical evidence. It has been reviewed by appropriate medical or clinical professionals. Photos are only for illustrative purposes and do not reflect every presentation of a condition. The content is intended only for general information and does not replace the need for personal advice from a qualified health professional. For more details on how we produce our content and its sources, visit the about our health information page.
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