For diagnosis and treatment of certain shoulder conditions surgery may be needed to look inside the shoulder joint. This procedure is called shoulder arthroscopy and is often indicated for rotator cuff tears (group of muscles responsible for rotation of the arm), labrum tears (cartilaginous structure that provides shoulder stability), chondromalacia (smooth cartilage defects), impingement syndrome, frozen shoulder, biceps tendinits, AC joint arthritis, and other conditions.
Shoulder arthroscopy is usually performed under general anesthesia. Oftentimes, inerscalene block is offered to the patient as an addition anesthetic that provides postoperative comfort in the shoulder for 24-48 hour period. This is especially helpful for patients who need to start working on their shoulder motion almost immediately after surgery. The anesthesiologist goes over all the options with the patient prior to entering the operating room. After the patient is brought into the room and positioned on the operating table, the anesthesiologist takes his time to administer appropriate anesthesia.
As soon as the patient is asleep or relaxed, Dr. Rubin examines both of the patient’s shoulders. He checks for possible instability and evaluates the range of motion. For patients with adhesive capsulitis (frozen shoulder) he performs manipulation of the effected shoulder to improve motion.
After the patient is properly prepped and draped, Dr. Rubin makes two to three small incisions that are less than a half-inch in length. He inserts an arthroscope (an instrument used to visualize the interior of the joint cavity) through one of the portals (incisions) into the shoulder joint and thoroughly examines it by looking at the TV monitor. During arthroscopy multiple photos are taken with the scope, which Dr. Rubin or his Physician Assistant uses to go over the procedure in detail with the patient during his or her first appointment.
Attention is then directed toward the main problem. If smooth cartilage is damaged, Dr. Rubin makes sure the surface is stable and smooth as much as it can be. Labrum and rotator cuff are often repaired with appropriate sutures and absorbable anchors. Removal of inflamed bursa and shaving the undersurface of the acromion provides relief in patients with impingement syndrome. For patients with significant acromioclavicular joint arthritis Dr. Rubin excises (removes) the distal clavicle.
After the work is completed, the incisions are closed and sterile dressing is applied. If the interscalene block was not done preoperatively, which numbs up the entire upper extremity, Dr. Rubin injects the shoulder with a local anesthetic to provide pain relief for the next 5-6 hours until the patient gets the appropriate pain medication. Usually a shoulder cryocuff is applied, which keeps the shoulder cool for additional comfort and pain control. A shoulder immobilizer is fitted if postoperative stability is important.
Because shoulder arthroscopy is an outpatient procedure, the patient goes home the same day. A follow-up in 1-2 weeks with Dr. Rubin or his Physician Assistant is arranged by the hospital nurse, who also provides the home instructions and other important information for the patient.