Arthroscopy has led us to understand the shoulder and treat it better. Arthroscopy is performed using three small openings (1 cm) called portals, in the front and back of the shoulder. Depending on the requirement, additional portals can be made. Patients are operated under General Anaesthesia. Before the induction of anaesthesia, an injection is given to block the pain from the shoulder (Supraclavicular block). This block will give prolonged pain relief even after the patient comes out of anaesthesia.
Patients are admitted the day before the surgery, to get accustomed to the hospital and also to be assessed by the anaesthetist. The hospital stay is usually two days. Patients are instructed about physiotherapy and a detailed program is given to them. The patients are seen periodically thereafter.
Arthroscopy of the shoulder is a great boon to the treatment of SHOLDER DISLOCATION. In Arthroscopy, three small holes are created in the front and back of shoulder, through which delicate instruments and telescopes are passed into the joint. The inside of the joint is visualized in the TV monitor. During dislocation, the labrum along with ligaments is pulled off from the glenoid rim (Bankart's lesion). By arthroscopy, the torn labrum along with the displaced ligaments are brought into their original position over the glenoid rim and fixed using implants called suture anchors. A suture anchor is a tiny screw with a thread attached to it. The screw part goes into the bone and the sutures hold on to the labrum. The repair requires the use of delicate instruments and knot management techniques. In addition, any looseness of the joint, if present, is treated by reducing the volume of the joint by a procedure called capsular plication.
All shoulder dislocations can be treated arthroscopically, but in a small percentage that present very late with bony deficiency, additional open procedure for a bone transfer becomes essential. Procedure known as LATARJE or Bone block procedure. People whose shoulder instability is mainly due to looseness of the capsule (joint laxity), may need an open procedure (Capsular Shift) to tighten the joint.
