Shoulder arthroscopy is a closed surgical method performed by inserting a camera and surgical instruments into the shoulder joint through small incisions. Over the last twenty years it has become the gold standard in shoulder surgery, and many pathologies that previously required large open operations are now treated arthroscopically. Less muscle damage, less postoperative pain, and an earlier start to rehabilitation are its most pronounced advantages.
The most common application of arthroscopic shoulder surgery is rotator cuff repair. The rotator cuff is a structure made of four muscles that hold the humeral head in the joint socket. The tendons of these muscles can tear with age or after trauma. In arthroscopic repair, the torn tendon is reattached to the bone with the help of suture anchors. Depending on the size of the tear, the operation takes one to two and a half hours. In full-thickness tears, the results of early repair are significantly better than delayed repair, because the tendon retracts over time and undergoes fatty degeneration.
Subacromial impingement syndrome is one of the most common causes of shoulder pain. Bony outgrowths on the underside of the acromion compress the rotator cuff tendons, causing pain and limited movement. In patients who do not respond to conservative treatment (physical therapy, injection), arthroscopic subacromial decompression is applied. In this procedure, the underside of the acromion is shaved to create space for the tendon. The operation takes about thirty minutes, and recovery time is shorter than for other shoulder operations.
Labral tears are another common indication for shoulder arthroscopy. A superior labrum anterior-posterior (SLAP) lesion is the detachment of the upper part of the labrum from the biceps tendon attachment, and it is common in overhead athletes (volleyball, swimming, baseball). Treatment is planned according to the patient’s age and activity level: arthroscopic repair in young athletes, while biceps tenotomy or tenodesis may be preferred over the age of forty.
In the preoperative evaluation, clinical examination is as important as MRI. Pathology is localized with rotator cuff tests (Jobe, lift-off, bear-hug), impingement tests (Neer, Hawkins), and labral tests (O’Brien, anterior apprehension). MR arthrography is a special MRI technique performed with a contrast injection and provides higher diagnostic accuracy than standard MRI in labral tears.
The operation is performed under general anesthesia, with the patient in the lateral decubitus (side-lying) or beach-chair (semi-seated) position. Three to five small portals are made. The operation time varies from thirty minutes to two and a half hours depending on the procedure. A one-night hospital stay is usual. The duration of arm-sling use after surgery depends on the procedure performed: one to two weeks after subacromial decompression, four to six weeks after rotator cuff repair.
Rehabilitation is the most critical factor determining the outcome after shoulder arthroscopy. After rotator cuff repair, only passive movements are allowed in the first six weeks — the patient is forbidden to lift the arm with their own strength. From the sixth week, active movements begin, and from the third month, strengthening exercises. Full strength and function are usually regained at the sixth month. After subacromial decompression, active movements can begin from the first week.
When should surgery be considered in shoulder arthroscopy? As a rule, if pain and loss of function persist despite three to six months of physical therapy and conservative treatment, surgery becomes an option. However, in conditions such as acute full-thickness rotator cuff tears and traumatic labral tears in young patients, early surgery gives better results. Your surgeon determines the timing by evaluating the clinical examination, imaging, and your expectations together.