Arthroscopic Surgery of the Wrist & Shoulder

Shoulder Anatomy

The shoulder joint is made up of a ball and socket joint, where the head of the humerus (upper arm bone) articulates with the socket of the scapula (shoulder blade), which is called the glenoid. The two articulating surfaces of the bones are covered with cartilage, which prevents friction between the moving bones, enabling smooth movement. Tendons and ligaments around the shoulder joint provide strength and stability to the joint.

Disease Overview

Injury and disease to the bones or soft tissues of the shoulder joint can make it unstable, and lead to pain, inflammation and reduced mobility.

What is Shoulder Arthroscopy?

Arthroscopy is a minimally invasive diagnostic and surgical procedure performed for joint problems. Shoulder arthroscopy is performed using a pencil-sized instrument called an arthroscope. The arthroscope consists of a light system and camera that projects images of the surgical site onto a computer screen for your doctor to clearly view. Arthroscopy is used to treat disease conditions and injuries involving the bones, cartilage, tendons, ligaments, and muscles of the shoulder joint.

Indications of Shoulder Arthroscopy

Shoulder arthroscopy is indicated to treat the following shoulder conditions when conservative treatment such as medication and therapy fail to relieve pain and disability:

• Shoulder impingement
• Rotator cuff tear
• Frozen shoulder or stiffness of the shoulder joint
• Shoulder instability
• Biceps rupture
• Damaged cartilage or ligaments
• Bone spurs or bony projections
• Arthritis of the collarbone

Shoulder Arthroscopy Procedure

Your surgeon performs shoulder arthroscopy under general or regional anesthesia. You may be positioned lying down on your side with your arm propped up or sitting in a semi-seated position. Sterile fluid is injected into the shoulder joint to expand the surgical area, so your surgeon has a clear view of the damage and room to work. A button-sized hole is made in the shoulder and the arthroscope is inserted. Your surgeon can view images captured by the camera in the arthroscope on a large monitor. Surgical instruments are introduced into the joint through separate small holes to remove and repair the damage to the joint. After surgery, the instruments are removed, and the incisions are closed with stitches or small sterile bandage strips.

Postoperative Care for Shoulder Arthroscopy

After the surgery, the small surgical wounds take a few days to heal and the surgical dressing is replaced by simple Band-Aids. The recovery time depends on the type and extent of the problem for which the procedure was performed. Pain medications are prescribed to keep you comfortable. The arm of the affected shoulder is placed in a sling for a short period. Physical therapy is advised to improve shoulder mobility and strength after the surgery.

Advantages of Shoulder Arthroscopy

The advantages of arthroscopy compared to open surgery with a large incision include:

• Less pain
• Fewer complications
• Shorter hospital stays
• Faster recovery

Risks and complications of Shoulder Arthroscopy

Complications of shoulder arthroscopy include infection, bleeding, damage to nearby nerves or blood vessels, or delayed healing after the surgery. In certain cases, stiffness of the shoulder joint may occur after the surgery. It is important to participate actively in your physical therapy to prevent this from occurring.

Disease Overview

Your wrist is a complex joint made up of eight small bones called carpal bones. These bones are supported by connecting ligaments. Various conditions can affect your wrist joint such as carpal tunnel syndrome, osteoarthritis and others.

What is Wrist Arthroscopy?

Wrist arthroscopy is a minimally invasive surgical procedure performed to view, diagnose and treat problems of your wrist joint.

Indications for Wrist Arthroscopy

Wrist arthroscopy may be necessary to help in diagnosing:

• Stiffness
• Unexplained pain
• Swelling
• Giving way or popping of the joint

Wrist arthroscopy is also used to treat conditions such as:

• Arthritis
• Chronic wrist pain
• Wrist fractures
• Ligament tears
• Ganglion cysts
• Carpal tunnel syndrome

Wrist Arthroscopy Procedure

Wrist arthroscopy is usually performed under regional anesthesia. You may be given a sedative to keep you relaxed.

Your doctor will make one or two small half-inch incisions, known as portals, on the back of your wrist. The portals are placed in specific locations on the wrist, depending on the areas that need to be visualized. The arthroscope and special surgical instruments are inserted into your wrist through these portals. The arthroscope is a thin tube with a camera, lens and light source. Your doctor will be guided by the images relayed from the arthroscope onto a video monitor throughout your procedure. Your doctor will perform any necessary repairs depending on your problem.

After the procedure, the portals are closed with small stitches and a dressing is applied. You may be instructed to wear a splint for a short time after the procedure.

Postoperative Care following Wrist Arthroscopy

Keep your hand elevated above the level of your heart for the first 2 to 3 days after your procedure. Keep your bandage clean, dry and intact. You may apply ice over the operated area to reduce swelling and discomfort. You will be instructed on special exercises to regain strength and mobility of your wrist. You will be prescribed pain medications to relieve any pain.

Advantages of Wrist Arthroscopy

Recovery following wrist arthroscopy is generally more comfortable than an open surgery, which requires a larger incision. There is usually less pain following the procedure and the healing time is faster when compared to an open procedure. Wrist arthroscopy is performed as a day surgery where most often you can go home within several hours after their surgery.

Risks and Complications of Wrist Arthroscopy

Complications are rare with wrist arthroscopy. However, some of the possible complications that can occur include scarring, bleeding, swelling, infection, numbness and injury to adjoining structures.