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Shoulder arthroscopy

Shoulder arthroscopy is a procedure that is commonly used to diagnose and treat shoulder pain, or to clean out an infected shoulder joint. It’s a type of keyhole surgery, performed through small cuts in your skin. It involves using a tiny camera to look inside your shoulder joint to diagnose the problems and repair any damage.

Your doctor may suggest a shoulder arthroscopy if you have damage from an injury, arthritis or certain other health conditions.

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Details

  • Preparation Preparing for shoulder arthroscopy

    Your surgeon will explain how to prepare for your procedure. If you smoke, for example, you will be asked to stop. Smoking increases your risk of getting a chest or wound infection, which can slow down your recovery. It can also make your surgery less effective and lead to complications.

    Shoulder arthroscopy is usually done as a day-case procedure in a hospital. This means you have the procedure and go home on the same day.

    You will usually have a general anaesthetic for a shoulder arthroscopy. This means you’ll be asleep during the operation. Sometimes, your surgeon may use a combination of both local and general anaesthetics. A local anaesthetic stops you feeling any pain in your shoulder area. You have the procedure under general anaesthetic, but the surgeon injects a local anaesthetic before you wake up, to help control pain afterwards.

    If you can’t have a general anaesthetic for any reason, your surgeon may be able to do your arthroscopy using a nerve block. This means that the surgeon injects local anaesthetic around the nerves that control the shoulder. It makes your arm completely numb and you won’t be able to move it. You won’t feel anything during the procedure but you will be awake. Ask your surgeon if you would like something to make you drowsy and help you relax.

    If you're having a general anaesthetic, you won’t be able to eat or drink anything for about six hours before your surgery. This is for your own safety while you are under anaesthetic so 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 nurse or surgeon will discuss with you what will happen before, during and after your procedure, including any pain you might have. If you’re unsure about anything, don’t be afraid to ask. No question is too small. It’s important that you feel fully informed so you feel happy to give your consent for the procedure to go ahead. Your surgeon may ask you to do this by signing a consent form.

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  • Alternatives What are the alternatives to shoulder arthroscopy?

    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. You may also need to have some imaging tests, such as an X-ray, an ultrasound or an MRI scan.

    The best treatment for your shoulder problem will depend on:

    • how much damage there is to your shoulder
    • how long your shoulder has been troublesome
    • how much it affects you day-to-day

    Sometimes, your symptoms will improve on their own without any surgical treatment. Your doctor may suggest ice packs and anti-inflammatory medicines, as well as stretching exercises. Once you are able to move your shoulder again without pain, you can start exercises to strengthen the muscles around your shoulder. This is usually around four weeks later. You may be referred to a physiotherapist for help with the exercises. Another treatment that can be helpful for shoulder problems is a steroid injection. Talk to your doctor about which treatment options are the right ones for you.

  • The procedure What happens during shoulder arthroscopy?

    A shoulder arthroscopy often takes less than an hour. The length of your procedure will depend on how much work your surgeon needs to do inside your shoulder joint. You may have the surgery sitting in a deckchair position or lying on your side.

    Once the anaesthetic has worked, your surgeon will make small cuts in the skin around your shoulder joint. They will then put the arthroscope in. This is a tiny camera that your surgeon can use to look inside your shoulder joint.

    Your surgeon will examine your shoulder joint by looking at images from the arthroscope on a monitor. If there’s any damage in your shoulder, they will use surgical instruments to repair it. Your surgeon will also remove any damaged tissue that stops you moving your shoulder properly and causes pain.

    Afterwards, your surgeon will close the cuts with stitches or adhesive strips. They will then wrap a dressing and a bandage around your shoulder.

    It’s possible that your surgeon may need to change to open surgery during the procedure. This might be if they need to make a larger cut to repair a larger muscle tear. Your surgeon will talk to you about this risk before you consent to the procedure.

  • Shoulder treatments on demand

    You can access a range of our health and wellbeing services on a pay-as-you-go basis, including shoulder treatment.

  • Aftercare What to expect afterwards

    You will need to rest until the effects of the anaesthetic have worn off. After a local anaesthetic, it may be several hours before the feeling comes back into your shoulder. Take special care not to bump or knock the area. You may have some discomfort as the anaesthetic wears off. Do tell your nurse so that you can have the pain relief you need.

    You will usually be able to go home when you feel ready. You'll need to arrange for someone to drive you home. If you live alone, try to arrange for a friend or relative to stay with you for the first 24 hours.

    Having a general anaesthetic or sedative affects everyone differently. You may find that you’re not so coordinated or that it’s difficult to think clearly. This should pass within 24 hours. In the meantime, don’t drive, drink alcohol, operate machinery or sign anything important. Always follow your surgeon’s advice.

    Your nurse will give you some advice about caring for your wounds before you go home. They should explain about how and when the stitches will be removed if they need to be. This would usually happen around 10 to 12 days after the operation, and may be done by a district nurse who visits you at home. You may also be given a date for a follow-up appointment with your surgeon.

    Your shoulder joint is likely to feel sore and stiff after surgery. Try to rest your arm. Applying a cold compress such as an ice pack or a bag of frozen peas wrapped in a towel may help to reduce swelling and bruising. But don’t apply ice directly to your bare shoulder as it can damage your skin. 

  • Recovery Recovering from shoulder arthroscopy

    You may need to keep your arm in a sling after the operation. This will keep your shoulder in the right position to recover properly and will reduce any pain and swelling. The sling will also protect your shoulder from further damage until it’s fully recovered. Your surgeon will tell you how long you need to wear a sling for.

    You may struggle to dress and wash yourself at first – you may want to ask your partner, a relative or friend to be on hand to help you. The first few weeks will be the most difficult – it should start to get easier after this.

    Some people find lying down at night pulls their shoulder and is uncomfortable. You may find it more comfortable to sleep propped up at first, either in bed or in a reclining chair.

    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. If you have any questions, ask your pharmacist for advice.

    Your physiotherapist will recommend some exercises for you. Doing these regularly will help your shoulder to heal and may help you to recover more quickly.

    It usually takes several weeks to recover from shoulder arthroscopy. Most people regain full movement of their shoulder afterwards, but this can take several months. Your recovery time will depend on the type of repair your surgeon has had to do on your shoulder joint. How fit you were before your surgery will also make a difference. It's important to follow your surgeon's advice.

    You can usually drive once you’re fully mobile, but check with your doctor and motor insurance company first.

  • Risks Risks of shoulder arthroscopy

    As with every procedure, there are some risks associated with shoulder arthroscopy. But how these risks apply to you will be different to how they apply to others. Be sure to ask for more information if you have any concerns.

    Side-effects

    Side-effects are the unwanted but mostly temporary effects that you may have after a procedure. Some specific side-effects of shoulder arthroscopy are:

    • small scars on your shoulder, where the surgeon made the small cuts to put in the instruments
    • pain and stiffness around your shoulder

    How long pain and stiffness will take to go is very individual. Your exercises will help you to regain movement, strengthen your shoulder and get rid of stiffness. You can help yourself recover by doing these as often as your doctor or physiotherapist has recommended.

    Complications

    Complications are when problems occur during or after a 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 your leg (called deep vein thrombosis or DVT).

    Specific complications of arthroscopy include.

    • an infection
    • excessive bleeding into your joint
    • damage to surrounding blood vessels or nerves

    It's possible that the procedure won't work and you may need to have it again. This is more likely to happen if you smoke. For more information about smoking and shoulder arthroscopy, see our FAQ on What can I do to make my recovery easier.

    Remember – all medical procedures come with some risks. How these risks apply to you will be different from how they apply to others. Be sure to ask for more information if you have any concerns.

  • FAQ: Making your recovery easier FAQ: What can I do to make my recovery easier?

    It’s a good idea to be as fit and healthy as possible before your operation. It’s also important to follow your surgeon’s advice during your recovery.

    If you smoke, your surgeon is likely to ask you to stop smoking before your operation. Smoking can slow down your recovery because it increases your risk of getting a chest or wound infection. Smoking can also increase the risk that the shoulder arthroscopy won’t work and that you’ll need to have the surgery again. Your surgeon may also ask you to lose weight before you have your operation if you’re very overweight.

    The most important thing is to do the exercises your surgeon or physiotherapist shows you after your operation. These will improve the strength and movement of your shoulder. This may help to speed up your recovery and help you to return to work and get back to normal activities more quickly. Speak to your physiotherapist if you have any concerns.

  • FAQ: Shoulder arthroscopy compared to open surgery FAQ: Is shoulder arthroscopy better for me than open surgery?

    Arthroscopic surgery is sometimes better than open surgery. You may have less pain and need to spend less time in hospital than you would with open surgery.

    The arthroscope and the surgical instruments used in a shoulder arthroscopy are very thin. This means your surgeon can make small cuts in your shoulder rather than the large cut that’s needed for open surgery. Any scars from arthroscopic surgery should be very small. An arthroscopy is also generally quicker than open surgery.

    You may have less pain and stiffness after an arthroscopy, compared with open surgery. You are also more likely to get your full range of shoulder movement and strength back more quickly after arthroscopic surgery than after open surgery. 

    Some shoulder conditions are not suitable for arthroscopic surgery. Your surgeon will advise you if this is the case.

  • FAQ: Time off work after shoulder arthroscopy FAQ: How much time will I have to spend off work after having shoulder arthroscopy?

    It may take you several weeks or months to make a full recovery after shoulder arthroscopy. 

    You can usually go home on the day of your surgery. Your recovery time will depend on the severity of your shoulder problems and the treatment your surgeon has carried out on your shoulder joint.

    It’s important to remember that everyone is different. The fitter you are before your surgery, the more quickly you’re likely to recover afterwards. Not surprisingly, it will also depend on the type of work you do. If you’ve had a minor repair, do office work and the arm you’ve had treated is not the one you write with, you should be able to go back to work within days. If you do very physical work and you’ve had a major repair, it could be months. Some people have physio for up to a year.

    It’s best to discuss this with your surgeon before you have your operation. Then you can make any plans you need to about your return to work. 

    Make sure you do all the exercises that your surgeon and physiotherapist have given you. These exercises are important to help you get back to work and make a full recovery. 

  • FAQ: Driving after shoulder arthroscopy FAQ: When can I drive again after shoulder arthroscopy?

    There are no specific instructions about driving after a shoulder arthroscopy. You don’t have to inform the Driving and Vehicle Licensing Agency (DVLA) when you’ve had an operation unless it is likely to affect your ability to drive for more than three months. However, they do stress that all drivers are legally responsible for ensuring that they are fit to drive. They say that you need to decide with your doctor when you are safe to be back behind the wheel.

    The recovery time after shoulder arthroscopy can be weeks or months, depending on many factors, including what you’ve had done and how badly damaged your shoulder joint was. The main thing is to be confident that you can move your arm as you need to when driving and are not distracted by pain or stiffness. If you have a manual car, reaching this point may take a bit longer, particularly if the operation was on your left shoulder.

    If you are taking painkillers, you also need to be sure that they are not making you drowsy, for instance. Not only is that potentially dangerous for you and others, it is illegal to drive while under the influence of drugs and that includes medications that you’ve been prescribed.

  • Other helpful websites Other helpful websites

    Further information

    Sources

    • Oxford Handbook of Operative Surgery. Oxford Medicine Online. oxfordmedicine.com, published May 2017
    • Oxford Handbook of Adult Nursing. Oxford Medicine Online. oxfordmedicine.com, published 2010
    • Rotator Cuff Pathology Treatment & Management. Medscape. emedicine.medscape.com, last updated November 2015
    • What are the treatments for arthritis? Arthritis Research UK. arthritisresearchuk.org, accessed November 2017
    • Oxford Handbook of Operative Surgery. Oxford Medicine Online. oxfordmedicine.com, published May 2017
    • Shoulder arthroscopy. American Academy of Orthopaedic Surgeons. orthoinfo.aaos.org, last updated April 2011
    • Calcifying tendonitis. Medscape. emedicine.medscape.com, last updated November 2015
    • Rotator cuff injury. BMJ Best Practice. bestpractice.bmj.com, last updated November 2017
    • Joint briefing: smoking and surgery. Action on Smoking and Health. ash.org.uk, published April 2016
    • Commissioning Guide 2014: Subacromial Shoulder Pain. Royal College of Surgeons. rcseng.ac.uk, published August 2014
    • Nerve blocks for surgery on the shoulder, arm or hand. Royal College of Anaesthetists. rcoa.ac.uk, published April 2015
    • Oxford Handbook of Clinical Surgery. Oxford Medicine Online. oxfordmedicine.com, published online March 2013
    • Walton JR, Murrell GA. A two-year clinical outcomes study of 400 patients, comparing open surgery and arthroscopy for rotator cuff repair. Bone Joint Res 2012; 1(9):210–17. doi: 10.1302/2046-3758.19.2000072
    • Shoulder arthroscopy. Medline Plus. medlineplus.gov, last updated May 2017
    • Anaesthesia explained. Royal College of Anaesthetists. rcoa.ac.uk, published 2015
    • Shoulder surgery – discharge. Medline Plus. medlineplus.gov, last updated November 2017
    • Arthroscopic shoulder surgery for the treatment of rotator cuff tears. University of Washington Orthopaedics and Sports Medicine. orthop.washington.edu, accessed November 2017
    • Fermont AJ, Wolterbeek N, Wessel RN, et al. Prognostic Factors for Successful Recovery After Arthroscopic Rotator Cuff Repair: A Systematic Literature Review. J Orthop Sports Phys Ther 2014; 44(3):153–63. doi: 10.2519/jospt.2014.4832
    • Assessing fitness to drive – a guide for medical professionals. Driver and Vehicle Licensing Agency. gov.uk, published October 2017

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    Reviewed by Graham Pembrey, Bupa Lead Health Editor, Bupa Health Content Team, February 2018
    Expert reviewer, Dr Roger Tillman, Consultant Orthopaedic Surgeon
    Next review due February 2021

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