Until recently, shoulder surgery required large incisions and digging deep into the shoulder. This traditional approach required long recoveries and often left scars. But with the advancement of optical and orthopaedic technology, we can now perform many shoulder procedures by making very small incisions and using a camera (arthroscope) to access the inside of the shoulder without disrupting other tissues.
“Dr. Romeo has been instrumental in the introduction and design of many of the shoulder arthroscopic procedures performed today.”
Why treatment is required
The advantages of shoulder arthroscopy are:
- Smaller scars
- Less anesthesia
- Less pain after surgery
- Faster recovery
Every year, new devices are introduced that make arthroscopic surgery easier and more successful. Dr. Romeo has been instrumental in the introduction and design of many of the shoulder arthroscopic procedures performed today. He performs all of his sports medicine procedures—including repairing torn rotator cuffs and stabilizing loose shoulders, as well as many others—using advanced arthroscopic techniques.
How treatment is performed
Prior to surgery, most patients are given a numbing injection, called a block, in their shoulder and neck to anesthetize the nerves connected to the shoulder. Because patients require much less anesthesia during arthroscopic surgery, they routinely go home the same day and have a more comfortable recovery.
After anesthesia is administered, the patient is either placed in a sitting position or a lying-on-the-side position. This is decided based on the area of the shoulder that requires attention.
Two to four small incisions (under ¼”) 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 room for the placement of other instruments into the shoulder. Small instruments are used to test the areas of concern and diagnose any abnormalities or tears.
Photographs and videos are taken of the different parts of the shoulder to document its condition. Shavers are used to remove damaged tissue, while sutures (stitches) and sometimes anchors are embedded into the bone allowing Dr. Romeo to repair torn tissues. At the conclusion of the procedure, sutures are used to close the small skin incisions, and small bandages (Steri-Strips™) are placed over the incisions with sterile dressings.
When possible, Dr. Romeo encourages the use of a cooling device after surgery to help reduce swelling and minimize pain, which allows the patient to reduce or stop pain medications more quickly after surgery.
After the surgery is completed and before the patient goes home, the surgical team will check the circulation in the arm and as well as look for excess swelling or other problems.
Want to see an arthroscopy in action? In this video, Dr. Romeo demonstrates arthroscopic shoulder surgery on a Major League Baseball player.
Risks and benefits
As your shoulder recovers, it is important to stay alert for any red flags of infection or other healing problems. Fortunately, these are rare. Warning signs include:
- Increasing numbness or tingling, especially if it radiates down into your hand
- Increasing pain near your incision
- Fever
- Chills
- Redness
- Bleeding or other discharge
- Swelling that is beyond what is expected
“Patients routinely go home the same day and have a comfortable recovery.”
Physical therapy
After surgery, a sling is worn for several weeks. While wearing the sling, people can move their elbow, wrist, and hand, but shoulder motion is generally restricted. After surgery, physical therapy will begin when it is safe to work on improving motion and then strength. A normal course of physical therapy often includes up to three months of supervision from the therapist, then a gradual transition to desired activities, sports, and work.
Pain control
Recovery from an arthroscopic procedure is quicker than recovery from major surgery because the healthy tissues around the shoulder are minimally affected by the small incisions and instruments used. Some swelling is a normal part of the recovery process. Cold therapy, either with a cooling pad or with ice packs applied to the shoulder several times a day, can help ease swelling and discomfort. Dr. Romeo will also give you specific instructions for post-op pain management.
Recovery time
Once a person has gone through the proper physical therapy protocols for about three months, a gradual transition can begin back to sports, work, and everyday life.
Results
The complete recovery process is different for each person. It can at times feel slow, but following your surgeon’s guidelines and advice is critical to having a successful outcome.
FAQs
What are common arthroscopic shoulder procedures?
Common procedures include:
- Repair of a torn rotator cuff
- Repair or removal of a torn labrum for recurrent shoulder dislocation (See Bankart repair)
- Tenodesis of an injured biceps tendon
- Repair of the labrum and capsule for shoulder instability
- Release of capsule for shoulder stiffness