This brief article will give you the lowdown on what exactly is meant by a “shoulder arthroscopy” surgery, also termed “shoulder scope.”
Shoulder arthroscopy is a type of advanced surgery which utilizes specialized equipment and small incisions (each incision is just a couple of millimeters) to allow the surgeon to treat injuries with minimal surgical trauma to the patient. The special equipment consists of a camera (called an "arthroscope") with varying angles at the tip and a pump system. The camera displays video images on a monitor and the surgeon uses these images in real-time to guide her as she operates specialized miniature instruments. Arthroscopy technology allows the surgeon to see everything inside the shoulder joint and frequently allows better visualization of the inside of the shoulder than what can be achieved with a conventional large incision.
This is the typical appearance of a shoulder undergoing arthroscopy. The arthroscope is to the left and a portal with an instrument called a shaver is to the right.
Optimal visualization during arthroscopic surgery is accomplished through the use of an arthroscopic pump. The pump introduces sterile fluid into the inside of the shoulder, opening up space for the surgeon to see and to operate. The pump maintains a safe pressure that lets the surgeon see while making sure that the patient is safe.
Examples of what the surgeon sees on the monitor during an arthroscopic rotator cuff repair. The left image shows a rotator cuff tear (RC) before the repair. The right image shows the rotator cuff after it has been repaired arthroscopically.
To start the procedure, the surgeon typically makes a very small incision and then inserts a small plastic cannula through that incision. The cannula is a portal that is then used throughout the surgery to safely introduce instruments and specialized implants into the shoulder. All of arthroscopic shoulder instruments are designed to go through these cannulas and to function within the close quarters inside the shoulder. Rotator cuff repairs, debridement's, labral repairs, and removal of loose bodies (to name just a few procedures) can all be performed through these small portals. The instruments can be inserted repeatedly without any injury to the soft tissue.
Cannulas used during shoulder arthroscopy
When the procedure is completed, all of the instruments are removed from the shoulder and the cannulas are then removed as well. The portal incisions are typically each closed with a single suture and then a small waterproof dressing is placed to cover the incision.
Examples of instruments used during various shoulder arthroscopic procedures.
Dr. Jurek performs many surgeries such as rotator cuff repair surgery and labral repair surgery arthroscopically and has undergone specialized training focused specifically on these advanced techniques. If you are interested in seeing some examples of what she sees and does during a shoulder arthroscopy surgery, check out her Instagram page for pictures and videos.