Shoulder Arthroscopy has come of age
Journal Title: Punjab Orthopaedic Journal - Year 2018, Vol 0, Issue 0
Abstract
Arthroscopy of shoulder over the years has caught up with knee arthroscopy and isbeing used in various shoulder conditions. Increasing popularity of competitive sports in India has led to rise in incidence of shoulder injuries. Now increasingly these injuriesarebeingtreatedarthroscopically. Shoulder arthroscopy was irst performed by Burman in 1930's [1]buthasonly becomea usefultool inthepast10-15years.In that time two Japanese scientists, Tagaki and Watanabe, furtherreinedthetechnologyofarthroscope.[1]Innovations in the development of arthroscopes and development of specialized tools has moved shoulder arthroscopy from a diagnosticproceduretoatreatmentmodality. Theadvantages of arthroscopic surgery are; shorter hospital stay, smaller scars, reducedpostoperativepainandearlyreturntowork.[2] Shoulder arthroscopy can help in diagnosing a disease as sometimestwoormorepathologiesco-exist,hencediagnostic arthroscopy is useful before deinitive treatment of these pathologies isplanned. These pathologies may be treated by open or arthroscopic surgery. Common indications of shoulder arthroscopy include shoulder stiffness. Arthroscopic capsular release can be carried out if pain and stiffness persist despite 6-9 months of physiotherapy/conservative treatment. Basically shoulder stiffness can be idiopathic adhesive capsulitis, diabetic stiff shoulder, post traumatic stiffness and post-operative stiffness. [3] Recurrent dislocations, instability and labral pathologies are the commonest indications for arthroscopic treatment. Various arthroscopic procedures carried out for Instability and labral problems are as follows; Bankart repair- Labrum is reattached to glenoid using suture anchors. [2,4] SLAP lesions-When the labrum is detached from the glenoid in superior portion, the term used is SLAP lesion (Superior Labrum Antero-posterior). [5,6] For Type 1 SLAP lesions, arthroscopic debridement canbedone.For type II,IIIandtype IV SLAP, arthroscopic debridement and repair is carried out. [5,6] Shoulder instabilitieswhicharequite commonincompetitive sportsmen who are into overhead sports can be managed by capsular tightening procedures. [7,8] Impingementandrotatorcuffproblemsformanothergroupof pathologies which are now managed arthroscopically. HistoricallyNeer [9]proposed a three staged classiication of impingement syndrome and rotator cuff disease into stage IBursitis/Tendinitis, stage II-Partialthicknessrotator cufftear and stage III – Full thickness rotator cuff tear. Impingement syndrome is caused when the rotator cuff tendon rubs the underside of the acromion bone. Diagnosing these clinically remains a challenge.[10 } Chronic irritation can lead to weakening and even tearing of rotator cuff. Arthroscopic subacromial decompression can be carried out for impingement. [11] More space is created for rotator cuff tendons. [12] Partialthickness and full thickness rotator cuff tearscanberepairedarthroscopically.[13-15] Bicep tendon pathologies as tendonitis, partial tears of long head of biceps are usually associated with rotator cuff problems. Arthroscopic decompression, tenotomy or arthrodesis can be carried out. [16,17] However, all the above arthroscopic procedures have a long learning curve and require a good setup with trained staff to givethebest results inapatient.Thesurgeonmust beaware of allthe complications ofthe procedures. These can be general complications related to arthroscopy and complications speciic to the type of procedure performed. General complications such as infection and anesthesia problems continue to show lowincidences. Other complications one should be aware off are; luid extravasation, neuro -vascular injury, iatrogenic injury to tendon or cartilage, stiffness and implantorequipmentrelatedcomplications.Theawarenessof these complications will help the Orthopedic surgeon to promptlydiagnoseandtreattheseproblems.[18] Shoulderarthroscopycanbeasafeandeffectivetooltoperform a variety of diagnostic and therapeutic procedures about the shoulder and we can say it has come of age. It has vastly improved the surgical outcome in shoulder injuries and has changed the whole scenario of management of shoulder injuries. Referen
Authors and Affiliations
Harpreet Singh Gill, Som Dutt Abrol
Keywords
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Shoulder Arthroscopy has come of age
Arthroscopy of shoulder over the years has caught up with knee arthroscopy and isbeing used in various shoulder conditions. Increasing popularity of competitive sports in India has led to rise in incidence of shoulder in...