skip to main content

Shoulder Arthroscopy

Arthroscopy simply means 'telescopic' or 'keyhole'  surgery in a joint.  Shoulder arthroscopy is now the standard approach used to examine your shoulder joint, your acromioclavicular joint and your subacromial space.  Many surgical procedures can now be achieved arthroscopically, including decompression, rotator cuff repair and shoulder stabilisation.

 Advantages of arthroscopy over open surgery include: less scarring; less muscle damage; a better view of the structures inside the joint and access to areas of the joint that are traditionally hard to reach via open approaches.  Also, the risk of infection after keyhole surgery is much lower than after open surgery and nerve damage and bleeding are also very rare with keyhole techniques. Modern instruments and implants allow us to achieve reliable reconstructions arthroscopically with outcomes as good, or better than via open techniques. 

Shoulder arthroscopy can be performed either with you lying on your side, or with you sitting up as if in a deck chair.   Tiny incisions are made around your shoulder to allow the telescope and instruments to be manoeuvred inside your joint.  During arthroscopic surgery sterile saline is run through your shoulder to widen the joint space and keep the view clear.  Some of the fluid is absorbed and this causes your shoulder region to swell during the operation.  This swelling subsides in the first few hours after your operation and fluid will also leak out from your wounds.  A padded dressing is therefore applied at the end of your operation to absorb this leakage.  Arthroscopic scars heal very well and over time become barely visible. 

Below are some photographs and short videos of shoulder arthroscopy.  I hope they help you to understand where your particular problem fits in.

Initial view of the glenohumeral joint of a right shoulder on insertion of the arthroscope from the posterior portal.  

Labrum = this cartilage rim is attached all around the glenoid edge. In dislocations it is most commonly ripped off from the anrtero-inferior region, but can be damaged anywhere.

MGHL = middle glenohumeral ligament.  This is a fold of shoulder capsule that becomes tight as the shoulder is moved outwards.  Its appearance varies between individuals.

Subscap = tendon of the Subscapularis muscle.  This tendon inserts onto the front of your humeral head (the lesser tuberosity).  The muscle internally rotates the shoulder.

The long head of biceps tendon arises from the top of your glenoid (socket) and runs inside the shoulder joint before entering its groove at the front of your humerus (arm bone) 

The front of the shoulder joint shows the subscapularis tendon's insertion onto the humeral head.  This muscle is the most powerful of the rotator cuff: it internally rotates your shoulder.

The biceps pulley acts as a sling for your biceps tendon as it leaves the joint in its groove.  

The capsule of the rotator interval is normally thin and supple.  In front of it (therefore not seen) lies the coracoid process of the scapula

Moving the scope over the top of the humeral head one can see the undersurface of the supraspinatus and infraspinatus tendons of the rotator cuff.  These are the most commonly affected tendons in rotator cuff disease.