What is Shoulder Arthroscopy

Shoulder arthroscopy is a surgery to examine the inside of the shoulder joint to diagnose and repair any damage. This surgery may be used to:

• Repair a torn ligament. Ligaments are tissues that connect bones to each other.
• Repair a tear in the cartilage that lines the rim of the shoulder socket (labral tear).
• Repair pinched connective tissues (tendons) that surround the shoulder joint (impingement).
• Repair a tear in the muscles and tendons that support the upper arm bone and shoulder (rotator cuff injury).
• Remove an overgrowth of bone that has caused damage to soft tissue (bone spur).
• Remove a fluid-filled sac (cyst).
• Treat an advanced infection in the shoulder (septic joint).
• Repair a broken bone (fracture) in the shoulder.

Arthroscopic surgery is done using a thin tube that has a light and camera on the end of it (arthroscope). The arthroscope is placed through a small incision, and the camera sends images to a screen in the operating room. The images are used to help perform the surgery.

Tell a health care provider about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with anesthetic medicines.
• Any blood disorders you have.
• Any surgeries you have had.
• Any medical conditions you have.
• Whether you are pregnant or may be pregnant.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Infection.
• Bleeding.
• Allergic reactions to medicines.
• Damage to blood vessels, nerves, or other tissues in the shoulder.
• A blood clot that forms in the arm or leg and travels to the lung (pulmonary embolism).
• Stiffness and pain that does not go away.

What happens before the procedure?

Staying hydrated

Follow instructions from your health care provider about hydration, which may include:

• Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.

Eating and drinking restrictions

Follow instructions from your health care provider about eating and drinking, which may include:

• 8 hours before the procedure – stop eating heavy meals or foods such as meat, fried foods, or fatty foods.
• 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
• 6 hours before the procedure – stop drinking milk or drinks that contain milk.
• 2 hours before the procedure – stop drinking clear liquids.

Medicines

Ask your health care provider about:

• Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
• Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines unless your health care provider tells you to take them.
• Taking over-the-counter medicines, vitamins, herbs, and supplements.

Testing

• Your health care provider may move your shoulder or ask you to move it in specific ways to see how much motion you have.
• You may have:
  • Blood tests.
  • Imaging tests, such as an X-ray, MRI, or CT scan.
  • A test that records electrical activity in the heart (electrocardiogram, ECG).

General instructions

• Do not drink alcohol unless your health care provider approves.
• Starting one month or more before surgery, do not use any products that contain nicotine or tobacco. These include cigarettes and e-cigarettes. If you need help quitting, ask your health care provider.
• Plan to have someone take you home from the hospital or clinic.
• Plan to have a responsible adult care for you for at least 24 hours after you leave the hospital or clinic. This is important.
• Ask your health care team what steps will be taken to prevent infection. These may include:
  • Removing hair at the surgery site, if needed.
  • Washing the skin with germ-killing soap.
  • Antibiotic medicine.

What happens during the procedure?

• An IV will be inserted into one of your veins.
• You will be given one or more of the following:
  • A medicine to help you relax (sedative).
  • A medicine to numb the shoulder area (local anesthetic).
  • A medicine to make you fall asleep (general anesthetic).
  • A medicine that is injected into an area of your body to numb everything below the injection site (regional anesthetic).
• You will be placed in the proper position for surgery, such as lying on your side or sitting up.
• Several small incisions will be made in your shoulder.
• Your shoulder joint will be rinsed out (flushed) and filled with a germ-free solution (sterile saline). This expands the area to allow your surgeon to see the joint more clearly.
• An arthroscope will be passed through one of your incisions, into your shoulder joint.
• Other surgical instruments will be passed through the other incisions. Your surgeon will examine and repair your shoulder as needed.
• The sterile fluid will be drained from your shoulder.
• Your incisions will be closed with adhesive strips or stitches (sutures) and covered with a bandage (dressing).
• Your arm may be placed in a sling or a different device to keep it in place while you heal (immobilizer).

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until you leave the hospital or clinic.
• The blood vessel and nerve function in your affected arm will be checked.
• You will be given pain medicine as needed.
• Do not drive until your health care provider approves.

Summary

• Shoulder arthroscopy is a surgery to examine the inside of the shoulder joint to diagnose or repair any damage.
• Plan to have someone take you home from the hospital or clinic and care for you for 24 hours.
• Your arm may be placed in a sling or a different device to keep it in place while you heal (immobilizer).
• Do not drive until your healthcare provider approves.

Shoulder Arthroscopy, Care After

This sheet gives you information about how to care for yourself after your procedure. Your health care provider may also give you more specific instructions. If you have problems or questions, contact your health care provider.

What can I expect after the procedure?

After the procedure, it is common to have:

• Pain that can be relieved by taking pain medicine.
• Swelling.
• A small amount of fluid from the incision.
• Stiffness that improves over time.

Follow these instructions at home:

If you have a sling or immobilizer:

• Wear the sling or immobilizer as told by your health care provider. Remove it only as told by your health care provider. These devices protect your shoulder and help it heal by keeping it in place.
• Loosen the sling or immobilizer if your fingers tingle, become numb, or turn cold and blue.
• Keep the sling or immobilizer clean.
• Ask if you may remove the sling or immobilizer for bathing. If you need to keep it on while bathing and it is not waterproof:
  • Do not let it get wet.
  • Cover it with a watertight covering when you take a bath or a shower.

Incision care

• Follow instructions from your health care provider about how to take care of your incisions. Make sure you:
  • Wash your hands with soap and water before you change your bandage (dressing). If soap and water are not available, use hand sanitizer.
  • Change your dressing as told by your health care provider.
  • Leave stitches (sutures), staples, skin glue, or adhesive strips in place. These skin closures may need to stay in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do not remove adhesive strips completely unless your health care provider tells you to do that.
• Check your incision areas every day for signs of infection. Check for:
  • Redness
  • More swelling or pain.
  • Blood or more fluid.
  • Warmth.
  • Pus or a bad smell.

Bathing

• Do not take baths, swim, or use a hot tub until your health care provider approves. Ask your health care provider if you may take showers. You may only be allowed to take sponge baths.

Activity

• Ask your health care provider what activities are safe for you during recovery, and ask what activities you need to avoid.
• Do not lift with your affected shoulder until your health care provider approves.
• Avoid pulling and pushing with the arm on your affected side.
• If physical therapy was prescribed, do exercises as directed. Doing exercises may help to improve shoulder movement and flexibility (range of motion).

Driving

• Do not drive until your health care provider approves.
• Do not drive or use heavy machinery while taking prescription pain medicine.

Managing pain, stiffness, and swelling

• If lying down flat causes shoulder discomfort, it may help to sleep in a sitting position for a few days after your procedure. Try sleeping in a reclining chair or propping yourself up with extra pillows in bed.
• If directed, put ice on the affected area:
  • Put ice in a plastic bag or use the icing device (cold therapy unit) that you were given. Follow instructions from your health care provider about how to use the icing device.
  • Place a towel between your skin and the bag or between your skin and the icing device.
  • Leave the ice on for 20 minutes, 2–3 times a day.
• Move your fingers often to avoid stiffness and to lessen swelling.

General instructions

• Take over-the-counter and prescription medicines only as told by your health care provider.
• If you are taking prescription pain medicine, take actions to prevent or treat constipation. Your health care provider may recommend that you:
  • Drink enough fluid to keep your urine pale yellow.
  • Eat foods that are high in fiber, such as fresh fruits and vegetables, whole grains, and beans.
  • Limit foods that are high in fat and processed sugars, such as fried or sweet foods.
  • Take an over-the-counter or prescription medicine for constipation.
• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. These can delay incision or bone healing. If you need help quitting, ask your health care provider.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if you:

• Have a fever.
• Have severe pain.
• Have redness around an incision.
• Have more swelling or pain in an incision area.
• Have blood or more fluid coming from an incision.
• Notice that an incision feels warm to the touch.
• Notice pus or a bad smell coming from an incision.
• Notice that an incision has opened up.
• Develop a rash.

Get help right away if you:

• Have difficulty breathing.
• Have chest pain.
• Notice that your fingers tingle, are numb, or are cold and blue even after you loosen your sling or immobilizer.
• Develop pain in your lower leg or at the back of your knee.

Summary

• If you have a sling or immobilizer, wear it as told by your health care provider. These devices protect your shoulder and help it heal by keeping it in place.
• If lying down flat causes shoulder discomfort, it may help to sleep in a sitting position for a few days after your procedure. Try sleeping in a reclining chair, or try propping yourself up with extra pillows in bed.
• If physical therapy was prescribed, do exercises as directed. Doing exercises may help to improve shoulder movement and flexibility (range of motion).
• Keep all follow-up visits as told by your health care provider. This is important.