Arthroscopy of the Shoulder 2017-06-09T10:26:31+00:00

Arthroscopy of the Shoulder

What is shoulder arthroscopy?

Arthroscopy is a Minimally Invasive Surgery technique, which gives the Orthopaedic Surgeon the ability to examine the joint in detail and then deal with various problems and pathologies in the area. It is performed with the use of special rigid endoscope, called arthroscope, which enters the joint through small-sized incisions -about half a centimeter.

What are the advantages?

This surgical technique allows the specialized Orthopaedic Surgeon to precisely confirm the diagnosis and directly intervene therapeutically, in an increasing range of joint problems.

Moreover, during the last years, arthroscopy is used increasingly in the shoulder joint. Specialized Orthopaedic Surgeons are able to treat with arthroscopic surgery almost all the problems and pathologies of the shoulder joint, with very low morbidity, minimum hospitalization days and rapid postoperative recovery.

What pathologies of the shoulder can be treated?

The most common pathologies of the shoulder joint are:

  • The rupture of the rotator cuff, which can be sutured and fully restored with arthroscopic technique.
  • The instability of the shoulder, known as Bankart lesion, where the labral detachment is restored with arthroscopy, with all its attendant problems.
  •  The subacromial impingement syndrome, where arthroscopy is used to remove the withers’ osteofyto, on which triturates the supraspinatus tendon.
  • The SLAP lesion, common for volleyball and handball athletes, as well as athletes who perform various throws. Arthroscopy is used, in order the outgrowth of the long head of the biceps tendon can be stitched and restored.
  • The removal of chondral or osteochondral fragments, due to traumatic or other etiology.

SLAP lesion

What is a SLAP lesion and how is it treated?

The term SLAP lesion was first used in the 90’s by S.J. Snyder, an acrostic word basically that means Lesion of the Superior Labrum from Anterior to Posterior. It describes a lesion lesion occurs when there is damage to the superior –uppermost- area of the labrum The diagnosis is made by clinical examination and is confirmed by Magnetic Resonance Imaging.

When does it appear?

This pathology appears mainly to throwers, weight lifting athletes, as well as volleyball, handball, water polo and tennis athletes, who are constantly charging the shoulder in elevation, abduction and external rotation.

Moreover, it can also appear to others, athletes or not, who were injured after a fall or sudden movement of abduction and external rotation. It is also possible to coexist with chronic shoulder instability, after multiple dislocations or subluxations.

What are the symptoms and how are they treated?

The SLAP type lesion causes a feeling of instability and severe pain, while the patient is lifting or turning the hand above the shoulder height. Physical therapy and improvement of shoulder joint kinesiology definitely help the symptoms in many cases.

However, if conservative therapy proves unsuccessful, or if the patient –athlete or not- is unable to return to the desired level of activity, surgical treatment of SLAP lesion is necessary.

Can arthroscopy help?

Arthroscopic fixation of the SLAP lesion is a technically demanding procedure, performed by experienced Orthopaedic Surgeons, specialized in sports injuries, with Minimally Invasive Surgery techniques. Arthroscopy is a low morbidity surgical operation and allows the patient to leave the hospital the same day, while the post-operative recovery is significantly faster.

What happens after the surgery?

There is always a need for a personalized physiotherapy program –physical and muscle strengthening-, after the arthroscopic surgery.

The patient can return to daily activities, as well as everyday work responsibilities, after a period of few weeks, while mild sports activities are usually possible after 2-3 months.

Anterior Shoulder Instability

What is the anterior instability of the shoulder?

The primary dislocation of the shoulder comes, most of the times, as the result of significant violence during sports activity, an accident or a fall, when major shoulder ligaments are detached or relaxed. When the dislocation occurs, the patient is obliged to avoid participation in sports, as the shoulder is unstable and it can completely lose its position even with the minimum of extra violence. This medical condition is called anterior instability of the shoulder, and it can influence the patient’s quality of life. The diagnosis is made by clinical examination and confirmed by Magnetic Resonance Imaging (MRI).

How can it be treated?

The significant instability caused after the dislocation of the shoulder necessitates surgical treatment, for the majority of cases. Arthroscopy of the shoulder joints, in order to establish stability, is a technically demanding procedure, performed by experienced Orthopaedic Surgeons, specialized in sports injuries, with Minimally Invasive Surgery techniques. Arthroscopy is a low morbidity surgical operation and allows the patient to leave the hospital the same day, while the post-operative recovery is significantly faster.

What happens after the surgery?

There is always a need for a personalized physiotherapy program –physical and muscle strengthening-, after the arthroscopic surgery.

The patient can return to daily activities, as well as everyday work responsibilities, after a period of few weeks, while mild sports activities are usually possible after two to three (2-3) months.

Calcific Tendonitis

What is calcific tendonitis and how does it appear?

Calcific tendonitis is a painful medical condition, during which calcium crystals -often a significant amount of them- are deposited in the area of the supraspinatus tendon or/and in the area of the infraspinatus muscle, located in the shoulder. The deposition of calcium salts is not connected to nutritional or other endogenous metabolic factors, while, in many cases, it occurs due to a lingering inflammation.

The deposition of calcium salts within the tendon muscle leads to an ongoing inflammation, while the patient experiences significant pain when moving his hand or even during resting time -in advanced stages. The diagnosis is made initially by clinical examination and confirmed by X-Rays, while important information are given to the Doctor by ultrasound and Magnetic Resonance Imaging (MRI).

How it can be treated?

Initial treatment includes resting, medication with anti-inflammatory drugs and physiotherapy. Temporary relief can also be provided by injecting limited quantity of steroids directly to the tendon, as well as local anesthetics in the subacromial space.

If the above non-invasive methods prove to be unsuccessful, surgical removal of calcium tuff, deposited within the tendon, is necessary. With the use of arthroscopy, the specialized Orthopaedic Surgeon is able to confirm the initial diagnosis and remove accurately as much calcium as possible, causing the minimum of harm to the muscle. The last stage of the procedure includes restoration of the muscle; the Orthopedic Surgeon can also treat any other pathology may coexist.

Arthroscopic removal of calcium in cases of calcific tendonitis is a low morbidity, Minimally Invasive Surgery procedure, and allows the patient to leave the hospital the same day, while the post-operative recovery is significantly faster.

Subacromial Impingement Syndrome

What is the subacromial impingement syndrome and how does it appear?

The subacromial impingement syndrome is an extremely painful medical condition; it occurs when the supraspinatus tendon is triturated/encounters to the withers, during abduction of the upper extremity. This usually happens when osteophytes have been developed at the lower surface of the withers.

The trituration of the supraspinatus tendon on these osteophytes leads to an intense inflammation of the tendon, causing serious pain, especially when the patient moves the upper extremity. Additionally, and it is likely to contribute indirectly and possible rupture of the supraspinatus tendon. The diagnosis is made clinically and confirmed by Magnetic Resonance Imaging (MRI).

How it can be treated;

Initial treatment includes resting, medication with anti-inflammatory drugs and physiotherapy. Temporary relief can also be provided by injecting limited quantity of steroids directly to the tendon, as well as local anesthetics in the subacromial space.

If the above non-invasive methods prove to be unsuccessful, surgical removal of the osteophytes is necessary. With the use of arthroscopy, the specialized Orthopaedic Surgeon is able to perform acromioplasty, a special Minimally Invasive Surgery procedure, for the removal of all osteophytes. At the same time, the Orthopaedic Surgeon can also treat any other pathology may coexist in the area.

Arthroscopic acromioplasty is an operation of low morbidity, with particularly high success rates, that allows the patient to leave the hospital the same day it is performed. Additionally, the postoperative recovery is rapid.