Shoulder Arthroscopy

Indications & Contraindications - Scope It Out!

• Indications (Diagnostic & Therapeutic):
  • Rotator Cuff Tears (RCT): Full/partial thickness.
  • Shoulder Instability: Recurrent dislocations, Bankart, SLAP lesions.
  • Impingement Syndrome: Subacromial decompression.
  • Biceps Tendon Pathology: Tenotomy/tenodesis.
  • Adhesive Capsulitis (Frozen Shoulder): Capsular release.
  • Loose Body Removal.
  • Synovitis, Septic Arthritis: Lavage, biopsy.
  • AC Joint Arthritis/Osteolysis.
• Contraindications:
  • Absolute: Active skin/joint infection, Unfit for anesthesia.
  • Relative: Severe glenohumeral arthritis (arthroplasty preferred), Significant unaddressed bone loss, Neuromuscular compromise, Poor patient compliance.

⭐ Most common indication for shoulder arthroscopy is rotator cuff repair, especially for full-thickness tears.

Portals & Key Anatomy - Gateway to Glenohumeral

• Standard Portals:
  • Posterior: Main viewing. 2 cm inferior, 1-2 cm medial to posterolateral acromion. Avoids suprascapular nerve.
  • Anterior: Main working. Lateral to coracoid, superior to subscapularis. Risk: cephalic vein, musculocutaneous n.
  • Lateral: RC repair, acromioplasty. Deltoid splitting. Risk: axillary nerve.
• Key Glenohumeral Anatomy:
  • Labrum: Glenoid depth, stability.
  • Rotator Cuff (SITS): Supraspinatus, Infraspinatus, Teres Minor, Subscapularis.
  • Biceps Tendon (LHB): Intra-articular course.
  • Glenohumeral Ligaments (GHL): SGHL, MGHL, IGHC (key anterior stabilizer in ABER - Abduction External Rotation).

⭐ Axillary nerve: ~5-7 cm distal to acromion. At risk with lateral portals & aggressive deltoid retraction.

Common Arthroscopic Procedures - Fix It Inside

• Rotator Cuff Repair:
  • For: Symptomatic full/partial-thickness (>50%) tears.
  • Techniques: Single/double-row, suture bridge; anatomical footprint restoration.
  • Goal: ↑function, ↓pain.
• Bankart Repair:
  • For: Traumatic anterior instability, Bankart lesion (anteroinferior labral tear).
  • Goal: Reattach labrum to glenoid rim.
  • 📌 Mnemonic: "Bankart = Broken Anterior Netty Kartilage At Rim of The glenoid."
• SLAP Lesion Repair:
  • For: Symptomatic SLAP tears (Types II & IV common).
  • Goal: Reattach/debride superior labrum.
• Subacromial Decompression (Acromioplasty):
  • For: Subacromial impingement (refractory).
  • Procedure: Resect ant-inf acromion, C-A lig. release.
• Capsular Release (Arthroscopic):
  • For: Adhesive capsulitis, refractory >3-6 months.
  • Goal: ↑ROM by releasing contracted capsule.
• Biceps Tenodesis/Tenotomy:
  • For: Biceps tendinopathy/SLAP involvement.
  • Tenodesis: Reattach LHB. Tenotomy: Release LHB (Popeye risk).

⭐ In SLAP repairs, avoid over-tensioning biceps anchor; risk of post-op stiffness/pain.

Complications & Post-op Care - Uh Oh & Aftercare

• Complications:
  • Neurovascular Injury: Axillary nerve (most common); risk with portal placement.

    ⭐ Axillary nerve injury is the most common iatrogenic nerve palsy in shoulder arthroscopy.

  • Infection: Rare (<1%); use prophylactic antibiotics.
  • Stiffness/Adhesive Capsulitis: Prevent with early, gentle ROM.
  • Chondrolysis: Cartilage damage; historical link to intra-articular pain pumps.
  • Hardware-related: Suture anchor pull-out or migration.
  • Fluid Extravasation: Swelling; very rarely compartment syndrome.
• Post-op Care:
  • Sling Immobilization: Duration procedure-dependent (e.g., rotator cuff repair 4-6 wks). Protects repair.
  • Pain Management: Cryotherapy, NSAIDs, short-term opioids.
  • Rehabilitation: Phased, protocol-specific.
    • Early: Passive ROM (pendulums, table slides).
    • Later: Active ROM, then strengthening exercises.
  • Wound Care: Keep clean & dry; sutures out 10-14 days.

High‑Yield Points - ⚡ Biggest Takeaways

• Posterior portal: Standard initial viewing portal. Anterior portals: Main working portals.
• Common uses: Rotator cuff repair, Bankart repair (instability), SLAP repair, subacromial decompression.
• Bankart lesion: Anteroinferior labral tear due to dislocation; often with Hill-Sachs lesion.
• SLAP tears: Involve superior labrum (biceps anchor); common in overhead athletes.
• Supraspinatus is the most frequently torn rotator cuff tendon.
• Axillary nerve injury is a key risk, especially with inferior capsular work or portal placement.
• Patient positioning: Beach chair or lateral decubitus, each with specific risks and benefits.