Arthroscopic shoulder surgery

When the minimally invasive procedure is warranted.

Arthroscopy is a popular technique for shoulder surgery because it involves a small incision. While it used to be the case that surgeons could see the shoulder tissues better with traditional open (large-incision) surgery, that has changed. “Our techniques have advanced to the point where sometimes we can see what’s happening better with the scope than with open surgery,” says Dr. Eric Berkson, director of the Sports Performance Center at Harvard-affiliated Massachusetts General Hospital. But when your surgeon will use arthroscopy depends on the particular condition that requires surgery.

The Surgery

With arthroscopy, the surgeon makes a small incision and inserts long, thin surgical instruments, including one with a video camera that provides the inside view. “Because you can see better with arthroscopy, you can accomplish a repair without risking damage to the nearby deltoid muscle,” says Dr. Berkson. “That cuts down on complications.”

Traditional benefits of minimally invasive surgery are smaller incisions and faster recovery times than open surgery. But shoulder arthroscopy is different. The incisions may heal faster, but Dr. Berkson says there’s not much difference in the total time for recovery. “It’s the same as open surgery because the work being done on the inside is the same,” he explains. In addition, he says that research has shown the strength of the repair is the same, whether you have open or arthroscopic surgery, and that there’s no difference in the rate of infection after surgery. Recovery lengths vary depending on the condition being treated. For example, a rotator cuff repair may take six months of recovery, including physical therapy.

When it’s warranted

Arthroscopy is recommended most often to repair torn rotator cuff tendons (which keep your arm bone in your shoulder socket), a dislocated shoulder, and torn ligaments, as well as to remove bone spurs and loose cartilage. Open surgery is recommended for larger operations, such as a shoulder replacement, or replacing bone in the shoulder socket.

What you should do

If your doctor recommends shoulder surgery, Dr. Berkson advises not to worry if it will be open or arthroscopic, “It’s more important to find a surgeon who can do the procedure the right way, no matter which approach it is,” he says. That means going to see an orthopedic surgeon who is a specialist in the shoulder, who has experience doing that surgery on a daily basis. Remember, too, that it’s not just how the surgery is performed that makes a difference. The rehabilitation program after surgery is also very important. “It’s the quality of the assessment and the ability to work in a coordinated rehabilitation program that lets a minimally invasive approach be truly successful,” says Dr. Berkson.

Harvard Health Letter

April 2013