Treating Shoulder Dislocation / Subluxation (Instability) and Associated Pain with Minimally Invasive Arthroscopy
Last updated Thursday, May 29, 2008
Figure 11 - Mobilized tissue with a shaving instrument seen through a yellow cannula Figure 12 - Bony surface prepared by removal of scar tissue Figure 13 - Repairing ligaments to restore proper ligament tension in the front of the shoulder. Figure 14 - Very sturdy repair with normalized ligament tension throughout the shoulder. About the procedureTechnical details
During arthroscopic
shoulder surgery, the patient is on his side, with the damaged shoulder exposed
upward and its arm out slightly from the body. After the general anesthetic is
administered and the shoulder is prepared, the surgeon makes three or four 1 cm
incisions, two at the anterior shoulder and one or two at the posterior.
Incisions would be slightly above the axilla (armpit).
Cannulas (5 mm to 8 mm
diameter) are plastic tubes inserted into these incisions, functioning as
portals through which the surgeon passes the arthroscope, instruments and
sutures. The arthroscope can extend approximately 3 inches inside the patient.
The surgeon first mobilizes
the muscles and other tissues near the shoulder by removing any scar tissue
which has accumulated and which may be preventing cartilage from reattaching to
the bone (Figure 11). To repair the
labrum, the surgeon will stimulate the glenoid
bone
by
lightly rasping it, then must insert three or four tiny, moly-bolt-like
anchors into the glenoid’s rim where the cartilage has been torn away (Figure 12). Holes for the anchors are
drilled in the glenoid using a 2.7 mm bit
(Figure 13). The surgeon captures the cartilage and ligaments with the
sutures, which are connected to the anchors (Figure 14).
For
shoulders in which the soft tissues provide insufficient stability to the
shoulder, capsulorraphy can tighten any of ligaments – the ones connecting the glenoid
and humerus, and the attachments of the biceps tendon to the bone. To tighten
the ligaments, the surgeon will sometimes take a tuck in the ligament, slightly
folding it over itself, and suturing it in a shortened form.
In the open approach, the
surgery is much the same, though the surgeon must first divide the
subscapularis tendon on the anterior shoulder to reach the capsule layer. (The
arthroscopic approach goes between tendons instead of through them.)Anesthetic Arthroscopic labral repair and capsulorraphy may be performed under a general anesthetic or
under a brachial plexus nerve block. A brachial plexus block can provide
anesthesia for several hours after the surgery. The patient may wish to discuss
their preferences with the anesthesiologist before surgery.Length of arthroscopic labral repair/capsulorraphy The
arthroscopic shoulder repair procedure usually takes one to two hours, and the
preoperative preparation and the postoperative recovery may add several hours
to this time. Patients often spend an hour in the recovery room and are
discharged the same day. In patients
with other medical problems, or requiring more invasive surgeries may stay
overnight in the hospital after surgery.Surgery for Cartilage and ligament tears in the shoulder at the University of Washington If you are interested in making an appointment to discuss this procedure, you can request an appointment using our online referrals website. To request a referral online, please click here. You can also call 206-598-4288 (outside the Seattle area: 800-440-3280) to make an appointment.
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