There is often a debate among patients and surgeons about which is better, arthroscopic or 'open' surgery. Open surgery, a procedure using larger incisions and enabling the surgeon to look inside the joint, may be better for certain procedures under certain circumstances. Arthroscopic surgery has some advantages-smaller incisions, less tissue damage-but these are usually not helpful if the overall procedure cannot be performed as well. You need to discuss with your surgeon if a particular procedure can be done arthroscopically.
There are debates among orthopedic surgeons about how to best perform different types of surgery. For example, many shoulder surgeons disagree about whether or not rotator cuff repairscan be performed as well arthroscopicallyas they can open.
Treatment of rotator cuff tears with shoulder arthroscopy is controversial. Some orthopedic surgeons treat all rotator cuff tears arthroscopically, some choose particular tears, and others treat them all open. There is no consensus which one is better.
Labral Tears
Labral tears, such as Bankart tearsand SLAP tears, are commonly treated with arthroscopy. It is very important that patients who have arthroscopic surgery for these procedures follow their post-operative rehab protocol very closely. Patients are often tempted to do too much too soon!
Patients with shoulder bursitis, also called impingement syndrome, that is not cured with simple treatments may consider a procedure called an arthroscopicsubacromial decompression. This procedure removes the inflamed bursa and some bone from the irritated area around the rotator cuff tendons. By removing this tissue, more space is created for the tendons and the inflammation often subsides.
The biceps tendon can become irritated and inflamed as an isolated problem or in association with problems such as impingement syndrome and rotator cuff tears. When the biceps tendon is damaged and causing pain, a procedure called a biceps tenodesiscan be performed. This procedure usually causes no functional difference, but often relieves symptoms.
Frozen shoulder seldom requires operative treatment, and treatment for many months or years is often necessary before considering operative treatment. When frozen shoulder must be treated surgically, it is of utmost importance to begin aggressive physical therapy immediately following surgery. Without this, it is likely the problem will return.
The AC joint, or acromioclavicular joint, is occasionally affected by arthritis. When arthritis of the AC joint is severe, the end of the clavicle (collarbone) can be removed. By removing the damaged joint, the symptoms of AC arthritis are often relieved.
The recovery depends on what type of surgery is performed. One of the problems with shoulder arthroscopy is that the procedure hurts much less than open shoulder surgery, and therefore patients may tend to do too much, too soon. It is very important that you only perform activities that your surgeon recommends following a shoulder arthroscopy. Even though your shoulder may feel fine, you need to allow time for repaired tissues to adequately heal. This is especially important for patients who have rotator cuff repairs and labral repairs.
Complications of shoulder arthroscopy are uncommon, but do occur. Infection rates tend to be very low. The most common complication of surgery on the shoulder is stiffness after surgery, and prolonged rehabilitation. This can usually be managed with physical therapy. Occasionally, shoulder arthroscopy can lead to a frozen shoulderthat can make rehab challenging. One rare complication of shoulder arthroscopy is called chondrolysis. This is a very usual, but particularly serious complication seen after arthroscopic shoulder surgery.
