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Arthroscopic Management of the degenerate shoulder

This is a procedure that aims to improve the symptoms of shoulder arthritis in order to postpone a patients’ need for joint replacement surgery.  It may be a good option for you if you have early-to-moderate arthritis of your shoulder, but you are younger than the ideal age for a joint replacement (e.g. less than 60 years old). Some surgeons use the term 'complete articular management' or CAM procedure for this operation.

General anaesthesia +/- regional block keyhole surgery. Performed as day case surgery or overnight stay.

Keyhole procedure, multiple small (<1cm) scars (+/-3cm incision if biceps tenodesis).

This surgery aims to remove all pain generators in your shoulder and may involve several separate procedures: 

Biceps tenotomy/tenodesis

Removal of bone spurs in the ball and socket joint

Trimming of unstable and frayed cartilage 

Micro fracture of exposed bone to promote cartilage healing

Clearance of inflamed joint lining

Subacromial bursa excision and decompression

Acromioclavicular joint excision if painful

What is my recovery after this surgery?

Please take your prescribed painkillers regularly for the first few days. You will be given a sling to wear - you may discard this when comfortable unless told otherwise. PLease begin your rehabilitation programme as soon as you can. Take down any bulky padded dressings on day 2 after surgery, butkeep your wound dry and covered with a dressing for 12 days. You can shower after 4 days if your waterproof dressings are on. 

Patients vary in their symptoms after surgery, but in general you can expect to return to:

Office work after two to four weeks (in a sling if you’ve had a repair)

Light physical work after six to twelve weeks

Heavier labour may take 16-24 weeks after a cuff or biceps repair, but may be sooner if no repair was performed

Driving is allowed once you are competent and confident to control a car both for routine and emergency manoeuvres.  It will probably take four weeks or more for you to be ready. 

By six months, 75% of patients will feel their shoulder is better. 

When will I be followed up?

You will be seen at two weeks after your operation. Follow up thereafter will depend on your progress.

What can go wrong?

Keyhole Shoulder surgery is generally very safe, but specific risks of this surgery include:

Persistent stiffness (5%)

Popeye sign (40% risk with tenotomy, 5% risk with tenodesis) as biceps muscle sits lower in your arm

Lack of symptom relief: approx. 25% will not benefit from this procedure 

Nerve injury  (1%) – trimming of bone spurs can be close to the Axillary nerve.  This nerve could be injured, which might cause weakness of your deltoid muscle (an elevator muscle of your shoulder)