The shoulder is an exceptional joint because between all the joints of our musculoskeletal system it is the most mobile.
The basic structure of the shoulder is similar to other joints – it is made up of bones and cartilage.
The shoulder joint is structured in three parts – scapula, humerus, and clavicle. The articulation of the shoulder consists of three joints – the articulation between the head of the humerus and the scapula, the articulation between the lateral part of the clavicle and the scapular acromion, and the joint between the scapula and the thorax. Coordinated movement in all three joints is necessary for proper shoulder function. An injury or damage to any of the mentioned joints can lead to a disturbed function of the whole shoulder.
When is shoulder arthroscopy required?
Shoulder arthroscopy is an operative method that allows diagnostics and treatment of minimally invasive lesions and injuries of the shoulder joint. The operation is performed under general anesthesia. Even in arthroscopy of the shoulder, as well as in arthroscopy of other joints, a small instrument called an arthroscope (an optic fiber connected to a camera) is introduced through a small skin incision of a few millimeters.
This is a tool as big as a pen, equipped with optical fibers able to illuminate where it is going to work; utilizing a unique optic connected to a mini-camera, it is thus possible to see all the fabrics on a television monitor.
Shoulder arthroscopy is used in the event of –
- Loss of bone fragments or cartilage – The hard articular surfaces affected by osteoarthritis or calcium deposits can be ruined and loose fragments of bone or cartilage that can be removed by arthroscopy.
- Damage to the ligaments or tendons – A lesion of the rotator cuff leads to an often painful and weak shoulder. This can be arthroscopically repaired, improving pain and shoulder strength.
- Shoulder instability – The reinforcing ligaments and shoulder tendons can be damaged by trauma or repeated use. This disease can cause dislocation of the joint. To remedy this condition, arthroscopically the damage of these structures can be repaired.
- Degeneration of the shoulder can cause a conflict between the underlying tendons, the clavicle, and the acromion. This decrease in space leads to inflammation and friction of the rotator cuff. The bone responsible for the conflict can be treated arthroscopically by removing inflammation.
Shoulder arthroscopy is usually performed in two steps
In the first step of the intervention, the surgeon introduces the arthroscope into the glenohumeral joint, which is the main joint of the shoulder where the humerus and the articular surface of the scapula called glenoid are joined. With the examination of the glenohumeral joint he can know If the problems are related to –
- The instability of the shoulder
- Damage to the glenoid lip
- Issues connected with the tendon of the long head of the biceps
- Partial rupture of one of the tendons of the rota-tor cuff from the inside
During the diagnostic examination of the articulation the surgeon can identify degenerative changes or lesions on the surfaces of the cartilage on the head of the humerus or on the glenoid of the scapula, free intra-articular bodies, bone defects as a consequence of continuous dislocations of the shoulder or a total rupture of one of the rotator cuff tendons.
In arthroscopy of the shoulder, he performs the planned operative intervention concerning the type of injury or disease. In this way the surgeon can treat the rupture of rota-tor cuff tendons, problems associated with instability and with chronic inflammation of the tendon of the long head of the biceps, chronic instability of the shoulder joint, degenerative changes in the atrioventricular joint, and many other problems.
The duration of the operation varies from 20 minutes to two hours depending on its complexity.
Treatment by multi specialty hospitals in India
The surgeon would need to first diagnose with an exploratory arthroscopy to find what is the exact nature of the problem, as noted above. This is followed by the actual surgery and bed rest. The patient would require physiotherapy for a month to gain back strength and mobility. The treatment is carried out at most multi-specialty hospitals in India with an orthopedic department. The Shoulder arthroscopy cost in India varies between INR 1.5 and 3 lakhs or USD 2,100 and 4,200 depending on the facility and reputation of the surgeon. It has no complications usually, and the hospital stay is minimal.