Before any surgery requiring anesthesia a short preoperative exam will be done by an anesthesiologist. During this exam your anesthesiologist will be assessing whether you have any conditions that may affect the course of your anesthesia. During the preoperative interview, your anesthesiologist will ask questions pertaining to any allergies you may have, and medications you may be taking. He or she will also ask about any prior anesthetics that you have had and your reaction to them. Your anesthesiologist will ask about any health conditions you have experienced, any physical symptoms you currently have, and your current lifestyle.
Your anesthesiologist will perform a brief physical exam. This exam will include an assessment of your heart and lungs. He or she will also perform an exam of your airway to assure that you will not have any breathing difficulty during your surgery.
A general anesthetic is usually the anesthesia of choice for a shoulder arthroscopy. It is possible to use other methods. Your anesthesiologist, with your input, will determine the anesthetic that assures the best outcome for your procedure. Regardless of the type of anesthesia, your anesthesiologist will monitor your condition throughout the surgical process.
How is arthroscopy performed?
The length of time shoulder arthroscopy takes varies, depending on what is done during the surgery. Generally, it takes one to two hours for the surgery, depending on the patient and his or her individual situation.
Shoulder arthroscopy is performed under sterile conditions. During surgery you will be placed in the "beach chair" position. This position puts you in a semi-sitting position on the surgical bed. Your head and neck are supported with a cushioned head frame and a pillow will be put under your knees. Padding is used for your ankles and feet, and a cushioned arm board for your non-operative arm.
A small incision is made in the back of your shoulder to introduce the arthroscope. Attached to this is a camera and light source. These, in turn are attached to a T. V. monitor to view and record the findings. The arthroscope is also connected to a pump to precisely monitor the amount and pressure of sterile saline used to irrigate and fill the joint space for better viewing. A second small incision is made in the front of the shoulder to allow passage of arthroscopic instruments. Pictures may be taken and saved for later reference. A third incision may be made to introduce instruments for repair and to correct injuries.
The surgeon will inspect the entire joint first. He will have an assistant to help move, rotate, and reposition the arm for visualization of the entire joint. Surgeons use a motorized "shaving" instrument to shave away torn cartilage, excessive growth and tissues, which may cause friction and pain. Biopsies can be taken. A cautery tool may be used to burn off excess tissue growth. This instrument can also smooth rough surfaces, help with repairs, shrink the capsule of the joint for better stability, and lessen bleeding.
The amount of surgery required and recovery time will depend on the complexity of your problem. Occasionally, during arthroscopy, the surgeon may discover that the injury or disease cannot be treated adequately with arthroscopy alone. The "open" surgery may be performed while you are still anesthetized, or at a later date after you have discussed the findings with your surgeon.
Upon completion of the procedure, the entire joint is irrigated until it is clear of blood and loose particles. The surgeon will inject a long acting local anesthetic into the joint to help with post-operative pain. The surgeon may close the small incisions with stitches or apply steri-strips. The area is covered with a sterile dressing and a sling or KnappSakTM is applied. This brace is very helpful because it allows frequent exercise of the elbow, wrist, and the hand. Additionally, it places the arm in a position that promotes better blood circulation and relieves stress on the repaired tissues.
What happens immediately after surgery?
After your arthroscopy you will go to the post anesthesia care unit (PACU). You will remain there until the effects of your anesthetic have begun to wear off. You will remain in the PACU until you can eat, drink and urinate without difficulty. Specially trained nurses work in the PACU and will monitor your progress and give you verbal and written discharge instructions. Your surgeon or anesthesiologist will discharge you from the PACU to home or your hospital room. However, you will not be able to drive home after surgery and should have someone stay with you overnight.
What is the recovery in the immediate post-operative period?
Ice is applied immediately after surgery and thereafter intermittently for the first 7 days. This reduces swelling and relieves pain. The small puncture wounds take several days to heal. The shoulder dressing is usually kept on for 24 to 48 hours. A smaller, waterproof dressing may be placed by the nurse at this time and left in place until your first postoperative visit, usually 7 days following surgery.
Pumping your hand, moving your wrist and bending and straightening your elbow are encourage as this keeps fluid from building up in your hand and arm.
Although the puncture wounds are small, post-operative pain ranges from little or none to very significant. Your physician will prescribe post-operative pain medication, anti-inflammatory medication and possibly an antibiotic. Instructions and side effects should be reviewed carefully, as some may cause constipation and drowsiness.
During recovery from shoulder arthroscopy, it is normal to feel some mild soreness and a slight grinding sensation for a day or two. However, if you develop:
- pain that is severe or persistent,
- inability to move the shoulder, or
- a fever, or foul smelling drainage
Call your doctor right away. You may have developed a complication that requires medical attention.
You will be able to resume driving after a few days to several weeks following surgery.
During the follow-up visit, the surgeon will inspect your incisions; sutures if present will be removed, if present; and discuss your rehabilitation program.
Your doctor, nurse and physical therapist will instruct you on specific exercises to restore muscle function and strength. They will also instruct you on movements you should avoid. Physical therapy will be ordered for you on an outpatient basis. Most patients are allowed to return to work within a week, depending on the nature of your job.
When can I return to normal activities?
It is not unusual for patients to go back to work or school or resume daily activities within a few days. Remember, though, that people who have arthroscopy can have many different diagnoses and preexisting conditions, so each patient's arthroscopic surgery is unique to that person. Recovery time will reflect that individuality. It takes several weeks to months for the joint to maximally recover. A specific activity and rehabilitation program will be suggested to speed your recover and protect future joint function.
Following minor arthroscopic procedures, limited sports activities can usually be started by the fourth week.
In general, after major reconstruction it is never less than 3 months and rarely more than 6 months for return to full sporting activities. Professional athletes will require considerably more time than this to return to competitive form. Compliance with gradual resumption of activities is necessary for proper healing and rehabilitation. Vigorous physical activity should not be done without your doctor's permission.
Please feel free to ask any additional questions you may have.