Strong tissues hold the shoulder bones together. The tissues are more likely than the bones to be affected by stress, injury, and “wear and tear.” They may stretch or rupture, causing the shoulder to become weak, unstable, or dislocate. Some shoulder conditions require surgery. Arthroscopy allows surgeons to see, diagnose, and treat problems inside the shoulder joint.
Before arthroscopic surgery existed, surgeons made large incisions that affected the surrounding joint structures and tissues. They had to open the shoulder joint to see it and perform surgery. An arthroscopy requires small incisions and is guided by a small viewing instrument. Arthroscopy is less invasive than traditional surgical methods. It has a decreased risk of infection and a shorter recovery period.
Several ligaments connect our shoulder bones together. The ligaments are strong tissues that provide stability. The glenohumeral joint is not a true ball-in-socket joint like the hip. The top of the humerus is round like a ball. It rotates in a shallow fossa (cavity), called the glenoid, on the scapula. A group of ligaments, which form the joint capsule, hold the ball of the humerus in position. In other words, the joint capsule is responsible for holding our arm in place on our body.
Tendons attach our muscles to our bones. Our muscles move our bones by pulling on our tendons. They move our arms to position our hands for a variety of functions. The Biceps tendon is attached at the front of the shoulder. The Biceps works with other muscles to bend or flex our elbow. The shoulder provides stability when our elbow flexes and as we lift objects.
The Rotator Cuff tendons connect strong muscles to the humerus bone. These muscles allow the arm to rotate and move upward to the front, back, and side. A structure called the Subacromial Bursa lubricates the rotator cuff tendons allowing us to perform smooth and painless motions.
We use the rotator cuff muscles to perform overhead motions, such as lifting up our arms to put on a shirt, comb our hair, or reach for an item on a top grocery shelf. These motions are used repeatedly during sports, such as pitching in baseball, serving in tennis, and passing in football.
Shoulder instability can occur when the muscles, ligaments, or tendons are over stretched or become weak. In some cases, one of the shoulder joints may move or be forced out of its position causing the shoulder to dislocate.
The glenohumeral joint is vulnerable to dislocation because it is not a true ball-in-socket joint. In severe cases, the muscle may even detach from the bone. The Biceps muscle, in particular, is prone to pulling away from the Glenoid bone under sharp force, such as from extreme weight lifting.
The rotator cuff is a common source of shoulder pain. The risk of rotator cuff damage increases with age. The aging process can cause the tendons and muscles to degenerate and weaken. This can also result from sudden shoulder movements or overuse, such as pitching in baseball.
Sometimes the aging process can cause bone spurs to grow on the scapula, particularly in the acromion area.
Shoulder impingement syndrome occurs when bone spurs or bursa inflammation narrows the space that is available for the rotator cuff tendons. The tendons can tear as they rub across the bone spur particularly when the arm is elevated. Irritated tendons may develop tendonitis, a painful condition. Often the pain comes from tendon degeneration, similar to the process in tennis elbow. Shoulder impingement syndrome may even cause the tendons to detach from the top of the humerus.
Your surgeon will make several small incisions, about ¼” to ½” in length, near your joint. Your surgeon will fill the joint space with a sterile saline (salt-water) solution. Expansion of the space allows your surgeon to have a better view of your joint structures. Your surgeon will insert the arthroscope and may reposition it to see your joint from different angles.
During the surgical treatment, your doctor may make additional small incisions and use other slender surgical instruments. In some cases, a procedure called Thermal Capsulorrhaphy is used to treat tendons and ligaments with heat. Because the surgical incisions are so small, they will require just a stitch or Steri-Strips, and will then be covered with a bandage.
If you receive arthroscopic surgery, your surgeon will restrict your arm movements for a short period of time following your procedure. You will most likely wear an arm sling for a short length of time, depending on the procedure performed. An occupational or physical therapist will gently help you move your arm at first with passive range of motion exercises. Arm movements are important for circulation and the health of your muscles, and to prevent stiffness. You will progress to performing arm motions by yourself and then will progress to strengthening exercises. Your therapists will help you improve your endurance and coordination as well. Sport specific exercises will be added, when necessary. A home exercise program is continued beyond the period of formal therapy as improvements continue for many months.
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This information is intended for educational and informational purposes only. It should not be used in place of an individual consultation or examination or replace the advice of your health care professional and should not be relied upon to determine diagnosis or course of treatment.
The iHealthSpot patient education library was written collaboratively by the iHealthSpot editorial team which includes Senior Medical Authors Dr. Mary Car-Blanchard, OTD/OTR/L and Valerie K. Clark, and the following editorial advisors: Steve Meadows, MD, Ernie F. Soto, DDS, Ronald J. Glatzer, MD, Jonathan Rosenberg, MD, Christopher M. Nolte, MD, David Applebaum, MD, Jonathan M. Tarrash, MD, and Paula Soto, RN/BSN. This content complies with the HONcode standard for trustworthy health information. The library commenced development on September 1, 2005 with the latest update/addition on April 13th, 2016. For information on iHealthSpot’s other services including medical website design, visit www.iHealthSpot.com.