Shoulder arthritis

Shoulder problems occur mostly due to age-related wear and tear, overuse, and injury. To relieve painful symptoms of damage to the labrum, rotator cuff tendons, and sometimes other joints and soft tissues, your doctor performs shoulder arthroscopy, a type of keyhole surgery.

In the past, complex surgeries for shoulder injuries treat arthritis were performed. Their recovery periods were longer. When medical and physical therapy techniques fail to treat your shoulder pain, you need to undergo a total shoulder replacement or arthroscopy.

For shoulder pathologies, arthroscopy has become the technique of choice. It provides a complete view of the inside and enables the treatment of structures within your shoulder. Shoulder arthroscopy is a minimally-invasive technique that allows the treatment of injuries of various structures that make up the shoulder joint.

Shoulder arthroscopy preparation 

The surgeon will explain to you how to get prepared for the procedure. In case, if you smoke, you need to stop smoking. This is due to the reason that smoking slows down your recovery process. And the risk of infection is also very high. Furthermore, If you are a smoker, it will make your surgery less effective and may lead to many complications.

It is for shoulder arthritis is usually a day-case procedure in a hospital. It means that the surgical procedure is not long and you can go home on the same day. A general anesthetic is given for shoulder arthroscopy(1). With this, you will be asleep during the operation. The surgeon may sometimes use a combination of both general and local anesthetics.

When you have your procedure under general anesthetic, your surgeon injects a local anesthetic to control pain in your shoulder afterward. It is a precautionary measure to less joint pain and avoid the risk of a frozen shoulder or shoulders.

If you are not given general anesthetic for any reason, your doctor will perform an arthroscopy by using a nerve block(2). By this method, your surgeon will give you an injection of local anesthesia around the nerves that control the range of motion shoulder. By doing this your arm will be completely numb and you will not feel pain during and even after the procedure.

The procedure of shoulder arthroscopy

You will be in a deckchair position or lying on your side while your surgery will be going on. After giving you the anaesthetic, your surgeon will perform open surgery(3). The surgeon gives a small cut in the skin around your shoulder joint and puts in the arthroscope. It contains a small camera that your surgeon uses to look inside your whole shoulder socket.

This helps your surgeon to examine what’s wrong going on within your shoulder. Surgical instruments are available if there’s any damage to your shoulder. Next, your surgeon removes swollen soft tissues (ligaments and bursa) and bone spurs in your shoulder joint to widen the space around your rotator cuff tendons. The procedure also involves the removal of damaged soft tissues collar bone that stop your shoulder from moving properly. Later, your surgeon will close the cuts with stitches and adhesive strips. And then you are done with the arthroscopy.

What to expect subsequently?

As the anesthetic wears off, you may feel some discomfort. You need to take complete rest until the effects of the anaesthetic wear off. However, if you feel severe pain, do tell your nurse so that you can have the pain relief you need.

Your healthcare provider examines you whether you are ready to go home or if you need some more time to spend under the observation. In case of clearance, you need someone to drive you home. If you are living alone, you should have a responsible adult to stay with you for at least the first 24 hours.

General anesthetics or sedation affects everyone differently. In this phase, you may not able to think clearly and find yourself coordinated. But this should pass within the first 24 hours. Always follow your surgeon’s advice. During this period, you should not drink alcohol, or drive, or sign anything important.

When you leave for home, your nurse will give you some advice about the safest method to heal your wounds. It includes how and when you will remove your stitches. It will take around 12 to 14 days after the operation. You will be assigned a date for a follow-up appointment with your surgeon and you should strictly follow it for your speedy recovery.

Process of recovery from shoulder arthroscopy

When you have a local anesthetic injection, it will probably take 48 hours before the feeling comes back completely into your shoulder. During this time, you need to take special care not to injure your shoulder.  After the operation, need to keep your arm in a sling. It will protect your shoulder from further damage and will keep your shoulder in the correct position needed for rapid healing.

After surgery, your shoulder is likely to feel stiff and sore. You have to remove your sutures about 1 to 2 weeks after your surgery. You may struggle to perform your tasks as well as daily household activities. In the meantime, you need to ask your partner, a friend, or a relative to be there to help you perform the task. With time, it will get easier for you to do the work on your own. But, the first few weeks will be difficult. After your shoulder arthroscopy, you may feel pain or discomfort for several weeks. You must take pain medications to relieve pain so you can perform your daily activities easily.

Physiotherapy is highly recommended for a speedy recovery(4). For this, the physiotherapist will recommend you some exercise. By doing these exercises regularly, the shoulder arthritis symptoms and pain in your shoulder will heal properly and help you to recover.

Complications

Complications of shoulder surgery or shoulder arthroscopy are very rare. But, it varies from patient to patient(5). Usually, they are minor and treatable if any. Blood clots, damage to blood vessels or nerves, and shoulder impingement are the conditions that patients usually complain of. When your acromion rubs on your rotator cuff, including the bursa and bicep tendon, it will cause inflammation in your shoulder. The orthopaedic surgeon will discuss all the possible complications with you before the operation.

Other treatment options

Prolotherapy

In recent years, Prolotherapy has built its reputation within the medical community for its clinically proven ability to treat shoulder arthritis.

Published research has proven its pain-relieving, anti-inflammatory and regenerative benefits.

Prolotherapy involves injecting a natural regenerative solution with tiny needles. This has been shown to stimulate the production of collagen cells, the small cells needed to repair the damage and help shoulder arthritis.

As prolotherapy is helping to treat the root cause of shoulder arthritis, it is deemed to be a permanent fix, preventing the symptoms from returning.

Conclusion

Before your surgery, a full physical exam and examination is mandatory to diagnose the problem. It includes blood tests and x-ray. Shoulder pain gets worse with time and you need proper medical attention if you have any complaints of such pain. Physiotherapy and medications will provide relief to shoulder arthritis treated some extent. However, you need shoulder arthroscopy in order to diagnose the exact deformity in your shoulder and treat it. After this diagnostic procedure is done, you may undergo orthopaedic surgery for the treatment of your shoulder condition.

Frequently Asked Questions

How long does it take to recover from arthroscopic shoulder surgery?

After shoulder arthroscopy is performed, your joint will take weeks to months to heal completely. In the initial days, you will notice pain and swelling in ac joint. It will continue for at least several weeks. Ice and medications can help with pain relief. After your surgery, you can also try sleeping propped up on a bed or chair. For the protection of your shoulder, your surgeon will recommend you a sling.

A rehabilitation plan includes physical therapy and gentle exercise. It can increase your shoulder strength and movement. A  rehab plan will be given to you by your health care provider, which will help you with your shoulder surgery.

Is shoulder arthroscopy a major surgery?

Shoulder arthroscopy is a minimally invasive shoulder joint replacement surgery. Shoulder Arthroscopy treats shoulder problems including rotator cuff tears and shoulder impingement. The procedure is a minor one that it completes within one hour. After some rest, your health care provider will give you some painkillers to take with you home. Mostly, people can go back to school or work in a few days. You can achieve full recovery from shoulder replacement surgery by taking proper precautions.

Are you put to sleep for arthroscopic shoulder surgery?

Mostly, in shoulder surgeries, the surgeon will give you general anaesthesia. It will put you to sleep. But if due to any reason, the general anaesthesia is not given, the surgeon will give you local anaesthesia. In this case, you will sleep but only a part of your body is numb.

What can you not do after shoulder arthroscopy?

After shoulder arthroscopy, it is advised to have complete rest. You should not do any heavy work such as lifting, pushing, reaching or pulling with your shoulder for at least after the first six weeks of your shoulder surgery.

Sometimes, you will not be able to perform personal activities. To avoid complications, you should follow the guidelines provided by your health care provider. It will speed up your recovery time. You will only be able to join your workplace or school if you heal properly.

Is a shoulder arthroscopy painful?

It is normal to experience some swelling or discomfort after shoulder arthroscopy. It will be relieved by using ice and medications. Rotator cuff and shoulder blade exercises are recommended for Shoulder instability. Shoulder arthroscopy is not painful that much. It involves small incisions so the loss of blood is minimal in shoulder arthroscopy. So, less pain is experienced by the patient.

What is the most painful shoulder surgery?

Rotator cuff repair is the most painful shoulder surgery(6). You may experience pain in the first postoperative days. Due to lack of movement, the shoulder will be stiff and it will increase your pain even more. Rotator cuff surgery is a major operation where rotator cuff tendons are seen back to the upper arm bone (humerus) and glenoid. As compared to other arthroscopic surgery it is the most painful one.

References

1. 1. Brown, A. R., Weiss, R., Greenberg, C., Flatow, E. L., & Bigliani, L. U. (1993). Interscalene block for shoulder arthroscopy: Comparison with general anesthesia. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 9(3), 295–300. https://doi.org/10.1016/s0749-8063(05)80425-6
   2. Barber, F. A. (2005). Suprascapular Nerve Block for Shoulder Arthroscopy. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 21(8), 1015.e1–1015.e4. https://doi.org/10.1016/j.arthro.2005.05.033
   3. Sperling, J. W., Smith, A. M., Cofield, R. H., & Barnes, S. (2007). Patient Perceptions of Open and Arthroscopic Shoulder Surgery. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 23(4), 361–366. https://doi.org/10.1016/j.arthro.2006.12.006
   4. van der Heijden, G. J. M. G., van der Windt, D. A. W. M., & de Winter, A. F. (1997). Physiotherapy for patients with soft tissue shoulder disorders: a systematic review of randomised clinical trials. BMJ, 315(7099), 25–30. https://doi.org/10.1136/bmj.315.7099.25
   5. Moen, T. C., Rudolph, G. H., Caswell, K., Espinoza, C., Burkhead, W. Z. J., & Krishnan, S. G. (2014). Complications of Shoulder Arthroscopy. JAAOS – Journal of the American Academy of Orthopaedic Surgeons, 22(7), 410–419. https://doi.org/10.5435/JAAOS-22-07-410
   6. Calvo, E., Torres, M. D., Morcillo, D., & Leal, V. (2018). Rotator cuff repair is more painful than other arthroscopic shoulder procedures. Archives of Orthopaedic and Trauma Surgery, 139(5), 669–674. https://doi.org/10.1007/s00402-018-3100-0