Shoulder surgery has significantly improved in the past few decades. For injuries like rotator cuff and labral tears, surgeons are now more likely to use a less-invasive option called the arthroscopic approach.
What Is Arthroscopic Shoulder Surgery?
“Shoulder arthroscopy is a minimally invasive procedure whereby a camera at the end of a fiber optic tube is inserted into the joint through a small incision,” says Bradley F. Giannotti, MD, a UPMC orthopaedic surgeon specializing in joint replacement and sports medicine.
“The joint is visualized on a monitor in real time,” he says. “Other specialized, small arthroscopic instruments are used to repair various problems in the joint without making a large incision.”
The arthroscopic approach is the least invasive technique for shoulder repairs. This surgery is a good option for fixing or replacing ligaments or tendons in the joint.
Surgeons can’t use this technique to replace the joint — that still requires shoulder replacement surgery.
Benefits of arthroscopic shoulder surgery
Arthroscopic shoulder surgery causes less soft tissue damage — a major benefit over open surgery, which requires as much as a 4-inch incision. Plus, to get to the joint, the surgeon often must cut the tendon and then repair it afterward.
“The benefits of this approach aren’t just cosmetic,” says Dr. Giannotti. “It makes for less scarring, lower risk of infection, less pain, and oftentimes, a faster recovery.”
Another bonus: Arthroscopic shoulder surgery also allows the surgeon to examine the joint in real time.
Dr. Giannotti performs several hundred arthroscopic procedures a year. That experience matters — arthroscopic surgery requires precision and technique, and a surgeon must understand exactly how to manipulate the arthroscopic tools.
The Most Common Arthroscopic Shoulder Surgeries
The most common arthroscopic shoulder surgery Dr. Giannotti performs is rotator cuff repair. But other conditions call for arthroscopy, such as:
- Bone spurs.
- Impingement syndrome.
- Labral tears.
- Shoulder instability.
Labral tears and rotator cuff tears are two distinct injuries. They tend to affect different populations and happen for different reasons.
Less invasive surgery for labral tear
The labrum is the ring of cartilage that keeps the ball of your arm bone in its shoulder socket. It’s what allows you to move your shoulder smoothly. When you injure that ring of cartilage, it’s a labral tear, which can make the shoulder pop in and out of the socket.
Labral tears are generally a young person’s injury, affecting mostly people under 35 and athletes. Labral tears in the front of the shoulder are most common in football and lacrosse and often happen as a result of a shoulder dislocation.
Labral tears in the back tend to happen when the shoulder pushes back. Bench pressing too much weight or overusing that “pressing” motion can lead to a labral tear. Overhead athletes, like baseball and tennis players, are also at risk.
The benefit of having a labral tear fixed arthroscopically is that it helps you retain more motion in your shoulder. This is due to reduced scar tissue development, which allows for better external rotation. For athletes, that range of motion is everything.
Recovery for labral tears fixed arthroscopically is about six months for contact sports and up to five months for noncontact sports.
Less invasive surgery for rotator cuff tear
Four different tendons surround your shoulder joint. Together with muscles, these tendons make up your rotator cuff.
The rotator cuff keeps the top of your arm bone in your shoulder socket. It also helps you rotate and move your shoulder. Injuries to the rotator cuff can become more likely with age, as the tendons experience wear and tear.
You can tear your rotator cuff in a traumatic injury, like a direct hit or a car accident. But more commonly, repetitive overhead arm motion causes tears. These tears usually cause chronic pain, meaning pain that lasts six to 12 months.
Rotator cuff pain tends to feel sharp. The classic rotator cuff test is whether it hurts to reach into the back seat of your car. Pain when reaching behind you or reaching up to grab something off a high shelf is usually the rotator cuff.
Recovery time for arthroscopic repair of your rotator cuff depends on the size of the tear. But usually, it’s between four and six months. As with most surgeries, you’ll get the best results if you do physical therapy as part of your rehab.
Who Should Have Arthroscopic Shoulder Surgery?
Based in Coudersport, Pa., Dr. Giannotti provides orthopaedic surgery and orthopaedic sports medicine services to people in North Central Pa. He recommends arthroscopic surgery as a good option for most people who need shoulder repair.
“As long as the patient is healthy enough to undergo surgery, anyone with any of these issues is a candidate after failing a nonoperative treatment plan when appropriate,” he says.
Editor's Note: This article was originally published on , and was last reviewed on .