Arthroscopic Shoulder Surgery

Arthroscopy is a procedure that our orthopedic specialists use to inspect, diagnose, and repair problems inside a joint. During arthroscopic shoulder surgery, the surgeon will insert a tiny camera, called an arthroscope, into your shoulder joint area. This small video camera projects images onto a TV screen so the surgeon can guide miniature surgical instruments to repair damage inside the joint.

This common procedure has been performed thousands of times since the 1970s and it has made the diagnosis, treatment, and recovery of shoulder surgery easier and faster. What’s more, this results in less pain for you, the patient, and shortens the length of time it takes for you to recover.

When is Shoulder Arthroscopy Recommended?

If your condition is not responding to nonsurgical treatment, your orthopedic specialist may recommend arthroscopic shoulder surgery. Some causes of shoulder discomfort include inflammation that leads to pain, stiffness, and swelling; injury; overuse; and age-related wear-and-tear.

Some of the most common shoulder arthroscopic procedures include:

  • Repair of ligaments
  • Rotator cuff repair
  • Removal or repair of the labrum
  • Bone spur removal
  • Removal of inflamed tissue or loose cartilage
  • Repair for recurrent shoulder dislocation

What Happens during the Arthroscopic Surgical Procedure?

Your orthopedic specialist will perform this procedure in an operating room or day-surgery room. Once you are there, he will position you so it is easy for him to adjust the arthroscope to have a good look inside the shoulder joint. The most common positions are the beach chair position (you semi-seated in a reclining position) and the lateral decubitus position (you lying on your side).

The surgeon and his team remove all hair from the site and then spread an antiseptic solution on your skin to clean it. The shoulder will be draped with sterile pads and your arm will be in a holding device to keep it still and in place.

To inflate and clean out the joint area, the surgeon will inject fluid into your shoulder. This makes it easier for him to see the structures. He will them make a small buttonhole incision to insert the arthroscope. Once your orthopedic specialist clearly identifies the problem, he will use small instruments to repair it.

These specialized instruments are for tasks such as cutting, grasping, shaving, suturing, and tying. The surgeon will close these incisions when he is finished using stitches or small Band-Aid like structures called Steri-Strips. Then the surgical site will be covered with a soft, large bandage.

What Should I Expect after Shoulder Arthroscopy?

In most instances, you will be able to return home on the day of your surgery. You will need someone to drive you home, especially if general anesthesia was used. For some patients, the orthopedic specialist requires an overnight hospital stay. Here are some of the things you will need to know following your arthroscopic procedure:

Shoulder Immobility: The amount you are allowed to move your shoulder will all depend on what was done during surgery. Your doctor will give you instructions related to this and be sure you follow them closely. Your shoulder will be held in a sling, a swath, or a brace following the procedure.

Incision Care: The small incisions should be kept clean and dry. Dressings are usually light and kept on for a few days. Sometimes, the dressing will drain during the first 24 hours but it usually stops. Call your orthopedic specialist if the dressing is saturated with blood and the bleeding does not stop.

Ice: Most of our orthopedic specialists recommend that ice be used to the shoulder to control your pain and the swelling. Excessive swelling is not common and should be reported to your doctor. Use the ice for at least 20 minutes around three or four times each day. Do not place the ice directly on the skin but rather use a towel or soft cloth place between your skin and the ice bag.

Medications: There will be some medications prescribed for pain, usually in pill form. Your orthopedic specialist will control your pain as he sees necessary.

A New Treatment Option for Big Toe Arthritis?

Hallux Rigidus

Big toe arthritis, also called 1st metatarsophalangeal (MTP) arthritis or hallux rigidus, is a common condition affecting the foot and ankle. It is the most common site for arthritis in the foot. Patients typically develop symptoms between age 30 and 60, and females are more commonly affected than men.

Presentation
Patients typically develop stiffness and decreased range of motion at the big toe, which affects walking, running, and other athletic activities. Some patients develop large bone spurs on the top of the foot, which can cause pain with shoe wear and discomfort when going up on the toes.

Causes
Sometimes trauma (a fracture or crush injury) can lead to this condition, but for most patients there is no specific inciting event. Some patients are more likely than others to develop big toe arthritis, either because of some anatomic abnormality or because of genetic predisposition.

Diagnosis
A clinical exam and x-rays can confirm the diagnosis. Generally, advanced imaging like MRI or CT scan is not required.

Treatment
Non-surgical options include anti-inflammatories, shoe wear modifications, and over-the-counter or custom inserts (orthotics). Physical therapy can be helpful to maintain range of motion. Occasionally cortisone injections into the joint can decrease inflammation for a period of time.

Surgery can be used to treat cases that fail non-operative treatment. Traditionally, a procedure called a cheilectomy can be used to remove bone spurs from the top of the big toe joint. This is recommended for mild to moderate cases of hallux rigidus. This is a joint-sparing procedure. Recovery involves walking in a surgical sandal for about 3-4 weeks after the surgery.

For moderate to severe arthritis, a fusion has until recently been the only proven surgical option. This is a joint-sacrificing procedure, in which the bones on either side of the joint are fused together with screws and possibly a plate.

This reliably addresses pain symptoms but eliminates all motion at the joint. Recovery involves a period of non- or heel- weight bearing followed by fully weight bearing in a surgical sandal for 8 weeks or more after the surgery.

Cartiva

A New Surgical Treatment Option

A new option is Cartiva, which can be an alternative to the aforementioned procedures. Cartiva is an organic polymer engineered to match the properties of human cartilage, which is what wears out as arthritis progresses. Your surgeon implants the polymer into the head of the 1st metatarsal, to act as a new joint surface. This is a joint-sparing procedure which retains, and in many cases increases, range of motion.

Recent literature shows greater than 90% patient satisfaction after 5 years of implantation. Recovery is similar to that of cheilectomy, and involves fully weight bearing in a surgical sandal for about 3-4 weeks after the surgery. If the procedure does not resolve pain, a fusion is still a surgical option for you.

Summary

Hallux rigidus is a common condition that involves pain, swelling, stiffness and decreased range of motion of the big toe. Diagnosis is often straightforward and involves a clinical examination and x-ray. Several non-operative treatments exist, including NSAIDs, shoe wear modifications, shoe inserts, and injections.

When non-operative treatment fails, surgery is an appropriate option. Cartiva may be an appropriate treatment option to avoid fusion of the big toe. Please see a qualified foot and ankle orthopedic surgeon if you believe you may be a candidate.

Mark Reed, MD is a fellowship-trained foot and ankle orthopedic surgeon who has undergone training on the Cartiva procedure and has incorporated it in his practice. Please contact OSS to schedule an appointment for an in-depth evaluation.