Shoulder Arthroscopy

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Shoulder arthroscopy is a minimally invasive surgery, in which the surgeon uses a tiny camera (arthroscope) to examine, diagnose, or repair tissues inside or surrounding the shoulder joint. Surgeons use several small incisions (usually 1cm or smaller) to insert the arthroscope and other surgical instruments into the shoulder joint. At Hospital for Special Surgery, patients typically receive regional anesthesia, which means that their arm is numb, but they are breathing on their own. Shoulder arthroscopy offers the advantages of using smaller incisions and incurring less damage to the surrounding tissue. Consequently, shoulder arthroscopy has a very low infection rate and is usually less painful than an open shoulder surgery. Due to the decreased pain, patients must be cautions not to return to normal activity too quickly. It is vital to adhere to the doctor’s recommendations and restrictions on activity to allow for adequate tissue healing after surgery.

Shoulder arthroscopy may be recommended if a patient’s condition is unresponsive to conservative, nonsurgical treatment such as rest, physical therapy, medication and injections. Drs. David and Joshua Dines have performed more than 6000 shoulder arthroscopies to treat many conditions such as:

Subacromial Impingement

  • A painful condition where the rotator cuff tendons and bursal sac (fluid filled sac) which allows the shoulder to glide smoothly, rub against the acromion, a bony projection of the shoulder blade.
  • Arthroscopy can be performed to shave the underside of the acromion to increase the amount of space beteween the acromion and the rotator cuff, thus reducing pain and inflammation and allowing for improved range of motion.
  • Arthroscopy can also be performed to clean out inflamed and damaged tissue.

Rotator Cuff Tears

  • Torn rotator cuff tendons can be reattached to bone using suture anchors arthroscopically.
  • Suture anchors are typically made of plastic-like biomaterials that do not have to be removed after surgery.

Labral Tears

  • Arthroscopy can be performed to repair a torn labrum, which is the cartilage that lines the rim of the shoulder socket, and the ligaments that normally attach to the labrum.
  • This includes:
    • Bankart Lesions: tears of the lower part of the labrum
    • SLAP lesions: tears of the top part of the labrum and ligament
  • Shoulder instability can be treated by repairing a torn labrum

Biceps Tendonitis

  • The upper biceps tendon (long head of the biceps tendon), which connects the biceps muscle to the shoulder superior labrum (in the shoulder joint) can become inflamed, torn or irritated.
  • Biceps tendonitis is commonly associated with overhead activities, such as baseball, tennis, swimming and volleyball.
  • Biceps tendonitis can be treated arthroscopically in three ways:
    • The damaged portion of the biceps can be repaired and left normally attached to the superior labrum
    • The damaged portion of the biceps can also be removed, with the remaining tendon reattached to the upper arm bone (humerus) in a process called biceps tenodesis. (normal function can resume after biceps tenodesis).
    • If the biceps tendon is severely damaged, the biceps tendon can be released from its attachment at the superior labrum in a process called biceps tenotomy.

The ideal treatment for long head biceps lesions depends on a patient’s age, activity level and expectations.