Keyhole surgery – referred to as shoulder arthroscopy – is an effective way to diagnose and treat problems within your shoulder joint.
Unfortunately there is no cure for arthritis, which is a degenerative condition that worsens over time, however there are treatments that can potentially slow the deterioration of the affected joint and relieve the symptoms. One of these is shoulder arthroscopy, which may be used to treat mild to moderate shoulder arthritis that cannot be managed effectively with painkillers, physiotherapy or other, less invasive treatments such as injections of corticosteroids.
How arthroscopy (keyhole surgery) is used to treat shoulder arthritis
An arthroscope is a thin, hollow, flexible instrument with a camera and light on one end. It is inserted into the shoulder joint, under anaesthetic, through a small incision in the skin. The joint is filled with saline solution to give the surgeon a clear view of the inside of the shoulder joint and the subacromial bursa. Using tiny surgical instruments, the surgeon can trim away any damaged areas of cartilage and remove loose fragments of bone and bony spurs from within the shoulder joint. Damaged joint surfaces may be subjected to microfractures to promote bleeding and healing, and the underside of the acromion may be smoothed. If there is tightness in the sleeve surrounding the joint, this can be released and the axillary nerve may be decompressed.
The benefits and risks of arthroscopy for shoulder arthritis
A Comprehensive Arthroscopic Management (CAM) procedure can be an effective way to relieve arthritis-related pain and improve joint function in the short to medium-term. It may delay the need for shoulder replacement surgery, which is a major surgical procedure with a long recovery time and a possible risk of complications. However, it appears to be most effective in patients who have mild to moderate osteoarthritis where the ball is well centred on the socket. Unfortunately this means that the procedure is not suitable for the majority of patients because their arthritis is usually more advanced or the joint is not well centred on first visit to a surgeon.
The risks associated with arthroscopic surgery are relatively minor compared to open surgery. Nevertheless, there may be a small risk of infection, injury to the axillary nerve, short-term pain and swelling, bruising and bleeding. In rare cases, the shoulder may become stiff after surgery, although exercises recommended by the physiotherapist are designed to prevent this. It is important to follow the aftercare advice provided by the surgical team to minimise the risk of complications. You will be given a follow-up appointment three to four weeks after surgery to check on your progress, but always contact your doctor if you are concerned or experiencing unexpected symptoms.
What is shoulder arthritis?
There are different forms of arthritis but the most common is osteoarthritis, which is a condition that causes the cartilage covering the ends of the bone of the ball and socket to wear and become rough. It is most common in people above the age of 50, hence its name ‘wear and tear’ arthritis. As the cartilage wears away, the protective space between the joints decreases and the bones might start to rub against each other. You may also develop arthritis following a major tear of the rotator cuff tendon. When this occurs, the tendon cannot hold the head of the upper arm bone within the shoulder socket so it may start to rub against the acromion. This can damage the surfaces of the bones and lead to arthritis.
Symptoms of shoulder arthritis
In the early stages, the symptoms may be fairly mild, but they normally worsen as the condition develops. Pain is the most obvious symptom of shoulder arthritis. If the acromioclavicular joint is affected, the pain is normally located at the top of the shoulder and may radiate to the side of the neck. Less common is arthritis in the main ball and socket glenohumeral joint, which causes pain the side or back of the shoulder that can feel like a deep ache within the joint. Alongside pain, you may experience a loss of movement in your shoulder joint, stiffness and crepitus which is a grinding sensation or snapping sound as you move your shoulder.
Diagnosing shoulder arthritis
Your doctor will carry out a physical examination, including assessing your shoulder for weakness, pain and tenderness to the touch, crepitus and signs of injury to the soft tissues around the joint. You may be given an X-ray to check for the formation of bone spurs, which is a sign of arthritis, as well as loss of space within the joint and changes to the bone structure. If surgery is considered then a CT or MRI scan is normally done to check how advance the arthritis is and how well centred the ball is on the on the socket.
If you have been diagnosed with shoulder arthritis and would like more information about keyhole surgery and other possible treatments, contact us.
Orthopaedic Consultant & Surgeon | London
Thames Shoulder & Elbow are able to provide advice and support to anyone experiencing symptoms affecting the upper limbs (shoulder, upper arm, elbow, forearm and wrist).
Telephone: 020 376 15987
Email: admin@thamesshoulderandelbow.co.uk
Our Locations
Hospital of St John and St Elizabeth, St John’s Wood – Directions
BMI The Syon Clinic, Brentford – Directions
HCA Chiswick Medical Centre, Chiswick – Directions
West Middlesex University Hospital, Chelsea and Westminster Foundation Trust, Isleworth – Directions
