What is arthroscopic shoulder stabilisation?
Arthroscopic shoulder stabilisation is minimally invasive surgical treatment for recurrent shoulder instability. Shoulder instability describes a loose shoulder joint. If it is so loose that the ball of the joint slips out of the socket of the joint, then the shoulder is dislocated. The instability if often due to a tear in labrum or rotator cuff.
An arthroscope is a tiny camera that is inserted into a joint through a small incision (‘arthro’ means joint and ‘scope’ refers to seeing). The camera transmits an image onto a large screen, which allows your surgeon to see the inside of the joint and then use tiny instruments (inserted through other small incisions) to make necessary repairs.
Arthroscopy is often called keyhole or minimally invasive surgery because it only requires small incisions. Compared to open surgery, arthroscopic procedures usually cause less pain and have shorter recovery periods.
How does arthroscopic shoulder stabilisation work?
Arthroscopic shoulder stabilisation is usually done under either general anaesthesia as a day procedure, which means you may be able to be go home on the same day as the surgery. If you do need to stay in hospital, it’s likely to only be for one night. We will contact you before admission to let you know how long you can expect to stay in hospital.
After your shoulder is cleaned and prepared for surgery, your surgeon will make a small incision (about 1 cm) through your skin into the shoulder joint to allow the arthroscope to be inserted.
Once the arthroscope is in the shoulder joint, your surgeon will then be able to see the inside of the joint on a large screen and identify any problems. Fluid flows continually through the arthroscope to keep the image clear.
With the problem or problems identified, your surgeon can then insert tiny instruments through other small incisions. With these instruments, your surgeon repair tears in your rotator cuff and anchor the repair to the upper part of the humerus.
The instruments and arthroscope are then removed and the small incisions are closed with tape or sutures. A dressing is applied to the skin to protect the wound.
What is involved and what to expect with arthroscopic shoulder stabilisation?
‘Pre-habilitation’ is recommended to build strength in the muscles that support your shoulder. Starting physiotherapy before surgery tends to improve your recovery after surgery.
Day 1 to 3 weeks
For the first 3 weeks you will wear a sling, but you will still be able to start your rehabilitation physiotherapy program.
Before you leave hospital, your therapist will teach you how to keep your armpit clean and some initial exercises including:
- postural awareness and scapular setting
- core stability exercises, as appropriate
- proprioceptive exercises (minimal weight bearing below 90 degrees)
- active assisted flexion, as comfortable
- active assisted external rotation, as comfortable
It’s important not to force or stretch your shoulder at this time as it may cause pain and delay healing.
During this time, you will wean off wearing the sling and progress your exercises as directed by your physiotherapist. By week 6, you should be able raise your arm to your pre-surgery level.
If you have an office-style job, you will be able to return to work during this period, if you can manage it.
Your physiotherapy program will continue to work on regaining scapula and glenohumeral stability, aiming to achieve shoulder joint control rather than range. Your program will involve:
- gradually increasing your range of motion
- strengthening exercises
- increasing proprioception through open and closed chain exercise
- core stability exercises
- incorporating sports-specific rehabilitation
- plyometrics and pertubation training
By 6–8 weeks you should be able to resume driving and start swimming breaststroke for exercise.
By 12 weeks you can expect at least 80% range of external rotation compared to your other side and normal movement patterns throughout the range. At this stage, you might be able to resume manual work, swim freestyle, play golf, lift heavier objects and play contact/impact sports. Your surgeon will be able to advise you on what is appropriate at the time.