Shoulder arthroscopy

Shoulder arthroscopy is a type of keyhole surgery used to see, diagnose and treat problems in your shoulder. Your surgeon uses a tiny camera to look inside your shoulder joint.

Preparation for a shoulder replacement

Your surgeon will explain how to get ready for your procedure. If you smoke, they’ll encourage you to stop smoking before your surgery. Smoking makes you more likely to get a wound infection after surgery. This 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 hospital. This means you have the procedure and go home on the same day.

Your surgeon will discuss with you what will happen before, during, and after your procedure, including any pain you may have. If you’re unsure about anything, don’t be afraid to ask. It’s important that you feel fully informed and are happy for the operation to go ahead. You’ll be asked to sign a consent form.

Having an anaesthetic

You’ll usually have a general anaesthetic for a shoulder arthroscopy. This means you’ll be asleep during the operation.

Your surgeon may use a combination of both a local anaesthetic and a general anaesthetic. You have the procedure under general anaesthetic, but your surgeon will inject a local anaesthetic before you wake up. They’ll inject it into the nerves that give you movement and sensation in your shoulder. This will help to control pain in your shoulder 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. You’ll have an injection of local anaesthetic around the nerves that control your shoulder. This will make your arm completely numb. You won’t feel anything during the procedure but you’ll be awake. Your anaesthetist may give you medicines, if you’d like something to help you relax.

If you’re having a general anaesthetic, you shouldn’t eat or drink for a time before your surgery – your hospital will tell you how long. This is for your own safety while you’re under anaesthetic so it’s important to follow your anaesthetist’s advice.

The shoulder arthroscopy procedure

You may have a shoulder arthroscopy while sitting in a ‘deckchair’ position or lying on your side.

Once the anaesthetic has taken effect, your surgeon will make small cuts in the skin around your shoulder joint. They’ll put a small tube through the cut and pass the arthroscope into your joint. An arthroscope is a tiny camera. Your surgeon will use the arthroscope to look around your shoulder joint and will inject some salt water (saline) into your joint to help them get a clearer view.

Your surgeon will examine your shoulder joint by looking at images from the camera on a monitor. If there’s any damage in your shoulder, they can use surgical instruments to repair it. Your surgeon will also take out any damaged tissue that may be stopping you from moving your shoulder properly, or causing pain.

Afterwards, your surgeon will close the cuts with stitches or sticky plasters. They’ll then place a dressing and a sling around your shoulder.

Aftercare following shoulder arthroscopy

You’ll need to rest until the effects of the anaesthetic have worn off. You may have some discomfort as the anaesthetic wears off. If this happens, tell your nurse so they can give you pain relief.

You’ll usually be able to go home when you feel ready. Arrange for someone to drive you home. If you live alone, ask a friend or family member 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 feeling should go away 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 how and when the stitches will be removed (if they need to be). This is usually around 10 to 14 days after your operation. You may also be given a date for a follow-up appointment with your surgeon.

Recovery following shoulder arthroscopy

If you had a local anaesthetic injection, it may be up to 24 hours before the feeling comes back completely into your shoulder. Take special care not to injure your arm while you wait for the feeling to come back.

You might need to keep your arm in a sling while you recover after shoulder arthroscopy. This will keep your shoulder in the correct position to recover properly and protect it from further damage. Your surgeon will tell you how long you need to wear a sling for.

Your shoulder joint is likely to feel sore and stiff after surgery. And when you lie down at night, you might find it pulls your shoulder and is uncomfortable. You may find it more comfortable to sleep propped up at first, either in bed or in a reclining chair.

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

Pain relief

You may have some pain or discomfort for several weeks after your shoulder arthroscopy.

You may be given some painkillers to take home when you leave hospital. Or 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 a pharmacist for advice.

It may help to put a cold compress, such as an ice pack or a bag of frozen peas wrapped in a towel on your shoulder to reduce swelling and bruising. Don’t apply ice directly to your bare shoulder as it can damage your skin.

Regaining movement

Your physiotherapist will recommend some exercises and advise you when to start doing them. If you do these regularly, it will help your shoulder to heal and may help you to recover more quickly.

It may take you several weeks to several months, or even a year or more to recover from shoulder arthroscopy. Most people get full movement of their shoulder back afterwards, but this can take time. Ask your surgeon if you have any questions about doing specific activities, and always follow their advice.

Driving after shoulder arthroscopy

You don’t need to notify the Driver and Vehicle Licensing Agency (DVLA) about your surgery as long as your recovery doesn’t affect your ability to drive.

Driving may be affected by:

• pain and stiffness in your shoulder – especially if you drive a manual car
• taking painkillers that make you drowsy or stop you thinking clearly
• whether you need to wear a sling

It’s important to speak to your surgeon about when you can drive again after your operation. It may take some time before your shoulder recovers enough to feel safe driving – perhaps weeks or months. Check that you’re covered by your insurance too.

Side-effects of shoulder arthroscopy

Side-effects are the unwanted, but mainly temporary, effects that you may have after a procedure. Side-effects of shoulder arthroscopy include:

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

How long pain and stiffness last varies from person to person. Your exercises will help you to get your movement back. They’ll also strengthen your shoulder and get rid of any stiffness. You can help yourself recover by doing these as often as your doctor or physiotherapist recommends.

Complications of shoulder arthroscopy

Complications are when problems occur during or after a procedure. Most people who have a shoulder arthroscopy don’t get any problems, but all procedures carry some risk.

Complications of arthroscopy include:

• damage to surrounding blood vessels or nerves
• an infection
• a blood clot in your arm
• occasional stiffness (frozen shoulder) – physiotherapy can usually help with this

Alternatives to shoulder arthroscopy

Shoulder arthroscopy may be used to diagnose shoulder problems, or to treat them, so the alternatives will depend on why you’re having it.

Diagnosis

Not everyone who has a problem with their shoulder will need to have 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
• a magnetic resonance imaging (MRI) scan

Treatment

The best treatment for your shoulder problem will depend on:

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

Your symptoms may get better on their own without any surgical treatment and your doctor may suggest:

• ice packs
• anti-inflammatory medicines
• stretching exercises

Once you’re able to move your shoulder again without pain, you can start exercises to strengthen the muscles around your shoulder. Your doctor may refer you to a physiotherapist for help with the exercises after four to six weeks .

Another treatment that can be helpful for shoulder problems is a steroid injection. Talk to your doctor about which treatment is right for you.