Fields of treatment / Orthopedy / Arthroscopy of the shoulder joint

For a better overview of the operated joint, the upper limb is suspended on a holder during the operation, and a bandage on the forearm is used to secure the traction. It will be sent to you before the operation begins. The operation is performed under general anesthesia. An arthroscope – an optical device containing a digital camera that transmits an image of the joint to a monitor – is inserted into the joint from one or several incisions of about 1 cm. With the arthroscope, we gradually examine the entire joint space and thereby obtain information about its damage. Special instruments designed for this type of operation can be introduced into the joint through other inputs, with which we perform operations in the joint. According to anatomical conditions, the shoulder joint can be divided into the joint cavity itself (glenohumeral) and the subacromial space (under the upper arm). Both spaces are separated from each other by the joint capsule and the so-called rotator cuff. When it is broken, both spaces communicate with each other. Special circumstances that occur during the operation may lead to an extension of the surgical intervention or a change in the surgical procedure, we ask that you agree to this, rarely occurring option. If we had to proceed only in the original scope of the operation, it could also mean the burden of another operation for you.

1. Instability or recurrent dislocation of the shoulder (glenohumeral joint) - we usually find a detached cartilaginous edge of the joint socket, which is sewn back to the joint socket with the help of special absorbable or titanium anchors. This operation takes about 30-60 minutes. The surgery is followed by fixation of the limb for 4-6 weeks.
2. SLAP climbs - it is similar to the one described above, but here the upper cartilaginous edge of the fossa with the attachment of the long head of the biceps tendon is torn off. Both operations belong to the so-called stabilization procedures.
3. Subacromial impingement - this is a chronic problem and pain in the shoulder when raising the arm. The solution is to increase the space under the upper arm by performing so-called acromioplasty (subacromial decompression), or grinding the lower and outer sides of the upper arm with a special cutter. ASK subacromial decompression itself takes about 30 minutes. This procedure can also be performed in an open manner, which we perform only rarely, usually in combination with another finding and procedure.
4. Rupture of the rotator cuff (RM) - a relatively common injury over the age of 50. During the operation, we sew up the defect of the RM or sew the RM back to the place of the original attachment of the tendon. This procedure is quite difficult in arthroscopic execution and can take more than 60 minutes. The operation can also be performed in an open manner, but recently, arthroscopic surgeries are predominant. The surgery is followed by fixation of the limb for 4-6 weeks. It is not always possible to reconstruct the rotator cuff. It depends on the size of the defect, the quality of the cuff and the time aspect. In such a case, the subacromial space is cleaned with an acromioplasty.
5. Tendinitis of the long head of the biceps and calcifying tendinitis of the supraspinatus muscle tendon - the first case is a chronic damage to the biceps tendon. During the operation, we either release the biceps tendon or sew it into the groove on the head of the humerus. In the second case, we remove calcifications from the tendon. These procedures are usually combined with acromioplasty or RM suture.
6. Other procedures - diagnostic surgery, removal of joint mice, treatment of damaged cartilage, removal of calcium masses (calcification), disruption of adhesions in a stiff ("frozen") shoulder, shoulder redress

After the procedure, maximum rest and rest are recommended. Depending on the type of procedure, it is necessary to keep the shoulder fixed in a sling or orthosis or, on the contrary, to start exercising as soon as possible. To reduce the risk of infection, it is not recommended to remove the bandage and the surgical wound should not come into contact with water. If the bandage gets soaked, it can be changed cleanly. A slightly elevated temperature is part of the normal postoperative course. At a temperature above 38 °C, it is better to take a temperature-reducing medicine (e.g. Paralen - if you are not allergic to it). It is advisable to reduce the pain with analgesics and ice (Dexoket 25mg 3x1tbl, Paralen 500mg – 3x2tbl, Dolmina 50mg 2x1tbl). In case of difficulties (significant pain, persistent temperature above 38 °C, massive leakage of the bandage or other complications), it is better to visit your referring or general practitioner immediately. Inspection, dressing and removal of stitches follows approximately 10 days after the operation by the surgeon or by the referring physician.

The return to normal daily activities is purely individual and depends on the type of joint damage, the patient's health and possible complications. Very generally, it can be said that for hard workers it is better to expect about 10 weeks of incapacity for work, for patients with a sedentary job, 2 weeks. Restoring full shoulder function and returning to normal activities is a long-term process, often lasting up to 6 months.

The introduction of arthroscopy brought a significant improvement in the results of treatment and shortened the healing time of damaged joints. Joint damage of this type can also be treated with open surgery - arthrotomy without the use of an arthroscope. However, the overview in the joint is not so good, the intervention in the joint is significantly more aggressive, and therefore the postoperative course tends to be more complicated in this type of operation. Joint problems can also be treated conservatively without surgical treatment - the use of drugs (pain reliever, anti-inflammatory, muscle tension reliever), injections of the affected joint, rehabilitation therapy including various procedures (laser, magnetotherapy, ultrasound). According to experience, further damage and changes in the joint take place here much faster than in the case of surgical treatment. The result of this process can be damage to the joint to such a degree that the only possible solution is a joint replacement or its surgical immobilization, which will eliminate the pain in the joint.