Shoulder Arthroscopic Stabilisation.Information for patients.

Dr Geoffrey SmithAnatomic images courtesy of www.biodigital.com

What is shoulder arthroscopy?

• Keyhole surgery of the shoulder joint.

• Many conditions are amenable to arthroscopic treatment

• Usually performed under general anaesthetic (asleep).

• An additional local anaesthetic nerve block may be used

• The patient is then carefully positioned on a special operating table

What happens?

• Several small (0.5cm) incisions are made• A camera and other instruments are inserted• The camera has an angled lens which can be

rotated around to give a view all around• We also change the camera position to get the

best possible view and angle for out working instruments

• Visualisation is improved by running fluid into the shoulder

Bones

• The shoulder (glenohumeral joint) is a ball and socket joint.

• The ball is at the top of the arm bone (the humerus).

• The socket is the glenoid which is part of the shoulder blade (scapula).

Humerus Scapula

Glenoid

• The glenoid bone is pear shaped

• It is surrounded by a rim of cartilage (the labrum)

• The biceps tendon attaches to the labrum at the top of the glenoid

Labrum Biceps

Glenoid

Soft tissue

• The glenohumeral joint is surrounded by a sleeve of tissue (the capsule).

• The capsule is thick in places & forms ligaments.

Capsule

What happens when a shoulder dislocates?

• Viewing from underneath the glenohumeral joint looks like a golf ball sitting on a golf tee

• The labrum and capsule stop the ball of the humeral head falling off the glenoid (the tee)

What happens when a shoulder dislocates?

• The labrum and capsule are detached from the glenoid

• The soft bone of the humeral head is crushed down by the corner of the glenoid

• This compression fracture is called a ‘Hill-Sachs’ lesion

What happens when a shoulder dislocates?

• When the shoulder is put back in place the labrum and the capsule stay detached from the glenoid

• The Hill-Sachs lesion is still present

• These injuries result in a predisposition to recurrent dislocations

Repair

• This arthroscopic picture is taken viewing the shoulder from behind

• The labrum is normal

• In this picture the labral detachment is easily seen

Repair

• The camera has now been moved so that the back of the humerus can be evaluated

• The Hill-Sachs lesion can be seen

• Most repairs involve reattachment of the labrum to the glenoid

• The Hill-Sachs lesion usually does not need to be treated

Repair

• The torn labrum and capsule are grasped with strong suture material

• The suture is passed through the eyelet of an anchor

• The anchor is inserted into a drill hole in the glenoid

• Several anchors are used to complete the repair

Anchor

Completed repair

After Surgery

• You usually go home on the same day or the day after surgery

• A sling is worn for 6 weeks• Strengthening is allowed after 6 weeks• A return to full activities is expected after 4-6

months