Shoulder Repair, Complex - Arthroscopic

Arthroscopy is a surgical technique used to perform procedures on joints using several small incisions instead of a single larger one. A light and camera allow the surgeon to see inside the joint, while specially designed surgical instruments enable the procedure to be performed through the small incisions. Many shoulder procedures can be accomplished arthroscopically. The alternative is an open procedure, which requires a larger incision for direct visualization of the joint.

Debridement is a surgical procedure used to clean the space within a joint. This may involve removing bone spurs, damaged tissue (such as cartilage), or smoothing cartilage and bone surfaces. These actions help relieve pain and improve shoulder function. Debridement may target a specific structure or involve multiple areas within the shoulder.

The shoulder joint is surrounded by a joint capsule made of thick connective tissue that stabilizes the joint. Problems with the joint capsule can lead to conditions like frozen shoulder, where parts of the capsule adhere to each other, restricting movement. Tears in the joint capsule can also cause pain and instability. Arthroscopy is often used to repair damage to the shoulder joint capsule.

The rotator cuff is a group of muscles that cross the shoulder joint and help stabilize it. Rotator cuff injuries are common and often result from repetitive overhead motions. A tendon in the rotator cuff may partially or completely tear away from the humerus (the upper arm bone). Arthroscopic rotator cuff repair can reattach the tendon, relieving pain and restoring normal shoulder function.

A SLAP lesion (superior labrum, anterior to posterior) refers to damage to the labrum, a connective tissue structure surrounding the socket of the shoulder joint. The labrum cushions the joint and contributes to its stability. A SLAP lesion affects the top part of the labrum and can cause symptoms such as pain, swelling, and stiffness. Arthroscopic surgery is often used to repair SLAP lesions.

One of the biceps muscle tendons attaches to the labrum and can contribute to or result from a SLAP lesion. In a procedure called biceps tenodesis, this tendon is detached from the labrum and reattached to the humerus. This can alleviate issues caused by a damaged labrum. Biceps tenodesis may be performed on its own or alongside SLAP lesion repair.

The acromion is the bony structure forming the upper outer part of the shoulder. Beneath the acromion is a bursa (a fluid-filled sac that provides cushioning) and several tendons. Thickening or inflammation of these structures can cause them to press against the acromion, leading to impingement. Impingement results in pain and stiffness, particularly when raising the arms overhead. Acromioplasty is a procedure to decompress this space by reshaping the acromion, reducing pain and improving shoulder function.

Where the acromion meets the clavicle (collarbone) is the acromioclavicular (AC) joint. Damage to this joint often leads to inflammation and bone spur formation, causing pain, stiffness, and potential rotator cuff damage. A distal claviculectomy (also called clavicectomy or the Mumford procedure) involves removing the end of the clavicle where it meets the acromion. Because the AC joint is stabilized by strong ligaments, removing part of the bone usually does not significantly disrupt shoulder function. This procedure is commonly performed arthroscopically.