What is a Shoulder Arthroscopy?

A shoulder arthroscopy, also known as a shoulder arthroscopic procedure or shoulder arthroscopic surgery, is a minimally invasive surgical technique used to diagnose and treat various shoulder joint conditions and injuries. It involves using a small, specialised camera called an ‘arthroscope’, which is inserted through small incisions in the shoulder to view the joint's interior. The arthroscope allows the surgeon to visualise the structures within the shoulder, including the rotator cuff, glenoid-labrum, ligaments, and the joint itself.

How is a Shoulder Arthroscopy Done?

1. Anaesthesia: The patient is typically placed under either general anaesthesia (completely unconscious) or regional anaesthesia (numbing only the shoulder area).

2. Incisions: The surgeon makes small incisions in the shoulder area, usually about the size of a pencil eraser.

3. Arthroscopy: The arthroscope is inserted through one of the incisions, while small surgical instruments are inserted through the other incisions.

4. Visualization: The camera on the arthroscope displays real-time images of the shoulder joint on a monitor in the operating room. This allows the surgeon to assess the condition of the joint and identify any issues.

5. Treatment: Depending on the findings, the surgeon may perform various procedures during the arthroscopy. Standard methods include repairing a torn rotator cuff, removing damaged tissue, repairing a glenoid-labral tear, or addressing other shoulder joint problems.

6. Closure: After completing the necessary procedures, the instruments are removed, and the incisions are closed with stitches or surgical tape.

Shoulder arthroscopy offers several advantages over traditional open surgery, including smaller incisions, less tissue damage, reduced pain, faster recovery times, and a lower risk of complications. It is commonly used to treat rotator cuff tears, glenoid-labral tears, shoulder impingement, and loose cartilage or tissue fragments within the joint.

When is Arthroscopic Surgery needed?

You might need a shoulder arthroscopy for multiple reasons, including but not limited to having had numerous shoulder dislocations, having a shoulder labral tear, a SLAP tear, a Bankhart lesion or ongoing rotator cuff tear, and wear and tear over time. Surgery for these reasons is primarily determined by severity, pain, and function. It’s best to see a physio for further advice if you aren’t already, as they can guide you towards either the surgical or nonsurgical route.

Dislocation: Dislocation is quite joint in the shoulder due to the structure of the joint. It is a ball and socket joint, like the hip. However, it is much shallower to allow for more range of movement. Force on the shoulder, especially while the arm is overhead, places the joint in a vulnerable position where there is most minor contact between the ball (humeral head) and socket (glenoid). Joint laxity because of repeat dislocations or otherwise excessive mobility are both subject to spontaneous instability episodes such as subluxations (where the joint partially moves away from the socket) and increases the likelihood of a dislocation to occur.

Glenoid-Labral Tears: The glenoid-labrum is the cartilage rim that lines the shoulder joint and allows smooth movement throughout its available range. Cartilage, ligaments, and tendons surrounding the joint can also be damaged through various trauma, such as sports injuries, particularly those involved in throwing or weightlifting. The most diagnosed forms of shoulder-labral tears are:

SLAP tear: SLAP (or superior labral anterior to posterior) means damage to your shoulder joint's top or front part. This typically occurs when the biceps have undergone too much load too quickly, causing it to pull away from its attachment site. For example, following dislocation, a direct blow to the shoulder, or needing to catch a heavy object suddenly. Damage to the surrounding cartilage (or shoulder-labrum) and the rotator cuff will likely occur.

Bankhart Lesion: This can occur during a shoulder dislocation, where a bit of bone is chipped away from the rim of the labrum as the arm bone (humeral head) is shifted away from the joint.

Rotator cuff tears: The rotator cuff is a group of four muscles that merge into one common tendon and wrap around the entire shoulder socket. Their role is to hold the joint in place they must be while still allowing it to move freely through range without dislocating. Therefore, they must be intact and functioning optimally. Through injury, one or more of this muscle group can be damaged (what a physio would refer to as either a partial or complete tear)

What is the recovery following a Shoulder Arthroscopy?

The rehabilitation following shoulder Arthroscopy is a physiotherapy-led process that will flow through three main stages over three months. However, the time frames for each phase might look slightly different between individuals.

Acute (0-4 weeks)

You will be in a sling following surgery with treatment aimed at reducing pain and swelling, helping with scar healing, and gradually restoring entire movement through massage and other manual therapies. It’s essential to keep the surrounding areas mobile and robust, so until shoulder re-strengthening can be started, there will be more of the focus to not lose strength through the arm, upper back, neck, core, etc. Then, towards the end of this phase, some light strength exercises for the shoulder will be added and progressed towards heavier loads as the shoulder adapts.

Intermediate (4-8 weeks)

This phase aims to restore strength and movement throughout the range with reasonable control (what we call functional capacity), all without further use of a sling or other supportive devices. The Rotator cuff and muscles that control the movement of your shoulder blades (aka scapulae) are the priority here, as these will determine how stable and robust your shoulder is longer-term and will help prevent re-injury.

Late phase (> eight weeks)

You will have regained most of your range by now. You will also have rebuilt the basics in strength and your ability to control the shoulder during movement. This is where high-level strength and more complex/unpredictable drills will come in. For example, sport-specific exercises such as throwing and catching and tasks that challenge your balance and reaction time. This is where rehab might start to look a bit different for each person because it is based more on what activities you aim to get back to.

How Much is a Shoulder Arthroscopy?

The cost of a shoulder arthroscopy procedure in Australia can vary significantly depending on several factors, including the location of the medical facility, the surgeon's fees, the complexity of the procedure, and whether you have private health insurance. Here are some general considerations:

1. Public Healthcare System: If you are covered by Australia's public healthcare system (Medicare), you may be able to have a shoulder arthroscopy procedure in a public hospital at a subsidised cost or no cost at all. However, there may be waiting times for non-urgent operations.

2. Private Health Insurance: Many Australians have private health insurance, which can cover some or all of the costs associated with shoulder arthroscopy. The amount covered will depend on your specific insurance policy, including your level of coverage and any excess or co-payment requirements.

3. Out-of-Pocket Expenses: Even with private health insurance, you may still have out-of-pocket expenses, including surgeon fees, anesthesiologist fees, hospital charges, and any additional costs related to the procedure.

4. Surgeon's Fees: The surgeon's fees can vary based on their experience, reputation, and the complexity of the procedure. Obtaining a quote from your surgeon before the surgery is essential to understand the costs involved.

5. Hospital Charges: The cost of using a private hospital or a specific surgical facility can vary. Private hospitals often have a daily rate, and the length of your hospital stay can impact the overall cost.

6. Additional Costs: There may be additional costs associated with pre-operative consultations, diagnostic tests, post-operative follow-up appointments, and physical therapy.

It's essential to discuss the specific costs and payment arrangements with your surgeon and the medical facility where the procedure will occur. Additionally, check with your private health insurance provider to understand what portion of the costs they will cover and any out-of-pocket expenses you may incur.

How Long is Shoulder Arthroscopy Surgery?

The duration of shoulder arthroscopy surgery can vary depending on several factors, including the specific procedure being performed, the surgeon's experience, and the case’s complexity. A straightforward shoulder arthroscopy procedure may take approximately 30 minutes to 2 hours.

Joint shoulder arthroscopy procedures include:

1. Rotator cuff repair: This procedure can take 1 to 2 hours or longer, depending on the size and severity of the tear.

2. Glenoid-labral repair or SLAP (superior-labrum anterior to posterior) repair typically takes 1 to 2 hours.

3. Subacromial decompression: This procedure aims to create more space in the shoulder joint and can take around 30 minutes to an hour.

4. Removal of loose bodies or debris: If there are loose fragments or debris in the shoulder joint, the surgery to remove them may take 30 minutes to 1 hour.

5. Bankart repair: This procedure stabilises the shoulder joint after recurrent dislocations and can take 1 to 2 hours.

Remember that these are general time estimates, and the duration may vary. More complex cases or the need for additional repairs or procedures can extend the surgery time. Your surgeon can provide a more accurate estimate based on your condition and the planned surgical approach. Additionally, the time it takes to prepare the patient for surgery and for the patient to recover from anesthesia is not included in these estimates.