Ehlers-Danlos syndrome is a disorder that affects your connective tissues – primarily your skin, joints, and blood vessel walls. These connective tissues provide strength and elasticity to the structures of the body. People with this disorder usually have over-flexible (lax) joints and stretchy skin. Flexible joints can result in joint dislocations and early arthritis.
If the shoulder is dislocated, this can stretch or tear the capsule and damage other parts of the joint. Once this is stretched, the shoulder has an increased probability of sustaining recurrent instability events (subluxation or dislocation).
What is shoulder arthroscopy?
Until recently, shoulder surgical procedures were done by making large incisions over the operative area. This resulted in somewhat large scars and significant discomfort after surgery. With the advancement of optical and orthopedic technology, we are now able to perform most procedures in the shoulder by making very small incisions and using a camera (arthroscope) to view the inside of the shoulder and fix it. Every year, new instruments are introduced which make arthroscopic surgery easier and more successful. Dr. Anthony Romeo has been very instrumental in the introduction and design of many of the shoulder arthroscopic procedures performed today. He performs over 300 shoulder arthroscopies a year.
How is it done?
Prior to surgery, most patients are given a numbing block in their shoulder and neck to anesthesize the nerves connected to the shoulder. This makes the patients require much less anesthesia and makes it possible for them to go home the same day and have a more comfortable recovey.
After anesthesia is administered, the patient is either placed in a sitting position (beach chair) or lying-on-the-side position (lateral decubitus). This is decided based on the area of the shoulder which requires attention.
Two to four small (under ¼”) incisions (portals) are made around the shoulder. The arthroscope (camera) is then introduced in the main shoulder joint. Sterile salt water is used to inflate the joint and allow safe placement of instruments in the shoulder. Small instruments are placed to diagnose any abnormalities or tears. Photographs and videos are taken of the different parts of the shoulder to document its condition. Shavers and sutures are utilized to fix any torn or damaged tissues.
At the conclusion of the procedure, sutures are used to close the small portal sites and small band-aids (steri-strips) are placed over the incisions with sterile dressings. When the patient wakes up, they will find a blue cuff over their shoulder which is called a polar-care cuff. This cuff is connected to a cooler filled with ice and circulates cold water to control post-operative pain. In addition, the patient is placed in a sling which helps protect the repair and gives the shoulder comfort and support.
After surgery, a sling is worn for six weeks. For the first six weeks, the patient is able to move their wrist and hand but is restricted from any motion at the shoulder. From six to twelve weeks, activity is directed by a physical therapist who helps to progress to active range of motion. Strengthening begins at three months after surgery after which the patient can gradually progress with activity. Approximate time of recovery is eight to twelve months.