If your painful shoulder doesn’t respond to non-surgical treatment, your doctor may refer you to an orthopaedic surgeon who can assess you for arthroscopy.
Shoulder arthroscopy involves the use of a keyhole camera, known as an arthroscope, to look at the inside of your shoulder joint. Your surgeon makes very small incisions (1 – 2 cm) to insert the arthroscope and thin surgical instruments.
The procedure is technically demanding, so you’ll need a surgeon who’s skilled in this procedure. This surgery may be right for you if your surgeon believes you have:
- a torn rotator cuff
- a bone rubbing against (impinging on) a tendon.
- a torn labrum causing shoulder instability and/or dislocation. (The labrum is fibrous cartilage that coats the rim of your shoulder socket, keeping the joint in place.)
- damaged ligaments
- bone spurs, fragments or loose cartilage
- a frozen shoulder.
Your doctor will normally send you to have imaging such as X-ray, ultrasound or an MRI scan to confirm the diagnosis.
Repair of a torn rotator cuff tendon
When a rotator cuff tendon tears, it’s no longer attaching properly to the head of your arm bone. Most rotator cuff tears involve the supraspinatus tendon, but other parts of your rotator cuff may also be involved.
Often the tendon frays first, and eventually the damage progresses and the tendon tears away completely. This can happen suddenly when you lift something heavy. Some torn rotator cuffs may not need surgery and can be fixed with more conservative measures. If you’re older, or if you can avoid strenuous sport or heavy manual work, you may not need surgery for your torn rotator cuff.
During surgery, your surgeon brings the edges of your torn rotator cuff tendon together. They’re then re-attached to the bone using sutures. Small rivets, called suture anchors, may be used to help attach the tendon to the bone. The (metal or plastic) anchors are left in place.
There are open or arthroscopic approaches to rotator cuff repair. An open repair may be better if you have a large or complex tear or if you need additional shoulder reconstruction.
Relief of impingement syndrome (bone squashing a tendon)
A bony growth or spur on the underside of your shoulder blade can cause a painful condition called impingement syndrome. Your surgeon can decompress the area by shaving the underside of your shoulder joint and cleaning out the damaged or inflamed tissue. Your coracoacromial ligament may be cut to further release the joint.
Repair of a torn labrum and/or damaged ligaments
The labrum is the cartilage (gristle) that lines the rim of your shoulder joint. It may be injured by acute trauma or by repetitive overuse of your shoulder. In older people, degeneration of the joint can cause a torn labrum.
There are several different types of labrum tears and many don’t need surgery. If your surgeon thinks surgery is needed they may remove the torn part of the labrum, or reattach the torn part using stitches.
Some labrum repairs involve cutting the biceps tendon which may or may not be reattached to your biceps muscle. Your surgeon may also need to repair ligaments that attach to this area.
Removal of bone spurs or loose cartilage
Arthritis can cause the surface of your shoulder joint to become rough. Calcium can be deposited and bone spurs can grow around the joint. Fragments of bone and cartilage can then become loose. If this happens, your surgeon will smooth the rough joint surfaces, removing bony spurs and loose fragments.
Release of frozen shoulder
Your surgeon may recommend surgery for frozen shoulder or other conditions where structures in your shoulder have become tight and painful. Your surgeon will cut through the tight portions of the joint capsule. To be effective, you’ll need to follow this with intensive exercises supervised by a physiotherapist.
Repair for repeated dislocation of your shoulder
The ligaments in your shoulder can get stretched out or detached by injury or overuse. This can cause the ball of your joint to move out of its socket. Your surgeon can tighten or reattach the ligaments.
Sometimes, your surgeon may need to change to an open procedure if they have difficulties during your surgery.
Print this page and take it with you when you discuss your procedure with your surgeon.