Arthroscopy is a minimally invasive operation on the shoulder joint. With it, the doctor conducts a comprehensive restoration of the shoulder joint, reduces the risk of complications and facilitates the rehabilitation of the patient. Arthroscopy can be performed on various mobile joints in the human body, including the shoulder. During surgery, the surgeon receives a picture on the monitor and, according to what he saw, carries out all the manipulations. This type of operation began in 1970. According to the frequency of execution, the procedure is in second place after arthroscopy of the knee joint.
Who is scheduled for surgery?
Damage to the shoulder joint is a common occurrence. It can be explained by the characteristic features of the anatomy of this department and increased motor activity. The area of contact of the shoulder head and joint surface is small, in contrast to the range of movements. Shoulder arthroscopy surgery is indicated for:
- subluxation or dislocation of the joint of this department;
- with the development of chondromatosis;
- getting injured tendons;
- with problems with mobility;
- cuff rupture;
- subacromental bursitis;
- post-traumatic arthrosis;
- violation of the condition of the synovial membrane.
Contraindications to the procedure
Repeated surgery is prescribed in case of recurrence of concomitant diseases in the patient or with the development of new symptoms of the disease, as well as if the shoulder completely loses its mobility.
Arthroscopic surgery on the shoulder joint is contraindicated for people with intolerance to anesthesia or bone and fibrous ankylosis. For a while, those who suffer from acute and chronic infections, purulent lesions of the skin of the shoulder will have to forget about the operation. With a decrease in the joint cavity, the decision to conduct surgery will be made by the attending specialist after diagnosing the patient's condition.
The benefits of the procedure
Treatment of the shoulder joint with arthroscopy is performed using several punctures (the incision is not used in this case). Using this technique, the surgeon has many opportunities:
- if the ligamentous apparatus was severely damaged or displaced to the side, the doctor re-fixes it;
- with displacement and any slippery damages: the cartilage lining is cut and repeated fixing is carried out;
- when the ligaments are pinched by bone formations or tendons: the ligaments are neatly truncated and once again fixed in one position, after tissue fusion passes;
- for problems with cuff rotation, it is important to visualize the sore spot, as well as reconstruction (truncation and fusion of joint tissues);
- when the position of the joints of the joint of the internal type is changed, restoration is performed by compression, after which bone formations are joined in the joint bag;
- when fragments of cartilage tissue penetrate into the cavity of the articular bag, excess fragments must be eliminated, and sharpen sharp ones;
- when ruptured tendons in the shoulder, the specialist performs excision and splicing, in some cases, repeated fixation of the position is required;
- with rheumatoid arthritis, the film is removed from the synovitis bag, which is located in the joint itself.
In case of violations in the cartilage pad, the doctor performs resurfacing, and if bursitis has been determined in the patient, then the joint bag is opened, all thickenings and other extra formations are removed from it, then the organ cavity is treated with antiseptics.
The main advantages of the procedure
Unlike simple open surgery on the shoulder joint, arthroscopy has a large number of advantages. The main ones include:
- minimal risk of injury and other complications during surgery;
- there is a chance to maintain the integrity of the joints;
- after the procedure, no noticeable scars remain on the patient’s body;
- short and painless patient rehabilitation;
- quick restoration of former joint mobility;
- The risk of complications is minimized.
Recovery time
After surgery on the shoulder joint, recovery lasts for 7 days, and the patient remains in the hospital for only one day. The risk of complications will directly depend on the professionalism of the attending physician: if all the basic rules and rules of the procedure are followed, such a risk is equal to zero.
Arthroscopy allows you to restore the patient’s condition, and with the development of chronic diseases increases the duration of remission. After such an operation, the patient's mobility of the joint is completely restored, and the constant pain syndrome goes away and the patient's condition improves significantly.
The principle of the operation
During the procedure, the surgeon uses an arthroscope - a device in which a small camera is built-in. Such an instrument is inserted into the joint, and on a separate monitor an image of a many-fold enlarged articular cavity is displayed.
The use of an arthroscope is permitted even in case of loss or instability of the joint. Most often, this method of treatment is considered the only one that helps to consider the state of the organ fully and determine all the processes taking place inside the cavity.
Most often, during treatment, local anesthesia is used, injecting it. With a reduced pain threshold, other anesthesia methods can be used in the patient. In order for the doctor to gain full access to the joint and be able to restore its mobility, it is important to choose a suitable position for the patient’s position.
Typically, the patient is laid on a healthy side, the arm with a sore shoulder is raised and taken to the side through a specialized system of blocks, which sets it in one position. In rare cases, axial traction along two axes is used. With it, the hand is securely fixed at once in several places through the unit with the load. There is another method of fixation - sedentary: with it, the patient is seated in a chair and the body of his body is tilted forward slightly, the diseased arm remains hanging over the edge of the table.
The diseased part of the body is treated with antiseptics and labeled: the doctor at the same time indicates the injection sites of the instruments. The first puncture is carried out into the joint cavity using a puncture needle. If the synovial fluid begins to emerge, then a small dose of saline is additionally injected into the joint.
The doctor makes a small longitudinal section and embeds a trocar into it, which passes through an arthroscope. The second incision is made to insert a plastic cannula, with the help of such a device, excess fluid is pumped out of the joint. If necessary, other tools can additionally be used.
What complications can arise?
If the treating specialist performed the procedure correctly and followed the basic norms and rules, and the patient did not neglect the recommendations of the doctor, then complications after surgery should not be expected. But arthroscopy, like any other type of operation, has some risks. During the procedure, the following unpleasant situations may occur:
- cartilage tissue damage;
- vein damage;
- the beginning of the inflammatory process;
- impaired functioning of nerves in the area where the procedure is performed.
Signs of complications
Immediately after surgery, a tumor may form on the operated area of the body, and the risk of developing swelling and hematomas is also high. Such negative symptoms do not last long and disappear without a trace after a couple of days, often this does not even require additional treatment.
After the operation, the usual dislocation of the shoulder joint inside it and on the puncture site will continue to persist for some time. But she also leaves on her own. You can reduce the severity of pain in a patient by taking special pain medications.
Rehabilitation course
In order for the patient to recover as soon as possible, it is important to follow a set of measures to restore the body. From the first day after the procedure, it is important to start taking certain medications that will help eliminate inflammation and pain in the joint. While the patient continues to stay in a hospital, a cold compress is regularly applied to the doctor’s shoulder. At each change in the bandage on the shoulder, the surgeon should carefully examine the site for inflammation and other negative signs.
The main thing in the rehabilitation of surgery on the shoulder joint is the performance of special gymnastic exercises. You can begin to perform gymnastics in the first days after the operation. Strict compliance with the instructions of specialists during surgery on the shoulder joint will help speed up the process of patient recovery.
LFK course
You can start exercise therapy when the arm is in a fixed state and relaxed as much as possible. When performing the first movements, the joints of the arm on which the operation was performed should be involved. Also, exercises should be performed with a healthy hand. After five days from the moment of immobilization, you can begin to have a minimal effect on the entire shoulder joint.
In the first three weeks after surgery, you can perform the following exercises:
- to squeeze fingers with a special simulator or without it;
- muscle contraction without moving;
- bend the wrist joint;
- perform accelerated brush movements;
- rhythmically reduce and raise the shoulder blades;
- rotate and raise the forearm.
After surgery, the shoulder should be in a bandage for the next 3 weeks. Eliminate myogenic contracture in the normal condition of the scar is possible only with the help of physical education. The main goal of medical gymnastics is to stimulate blood circulation to the arm with minimal mobility. In this case, the patient should monitor the sensations of his body: if swelling occurs, and the movement is complicated by pain, then the load should be stopped and go to the doctor who performed the operation.
Types of operation
The main types of surgery in the treatment of the shoulder joint include:
- arthrodesis of the shoulder joint;
- arthrotomy;
- arthroplasty;
- surgery for habitual dislocation of the shoulder;
- operation with hanging the shoulder.
The doctor will choose the operation based on the patient’s health status and the results of the tests. The price of surgery on the shoulder joint starts at 50,000 rubles.