What is shoulder arthroscopy?

Shoulder arthroscopy (sometimes called keyhole surgery) is surgery performed through two or more small skin incisions, each around five to ten millimetres long. A small camera (the arthroscope) is placed inside the shoulder joint, projecting a high-definition image onto a screen. Specialised instruments are passed through the other portals to repair, tighten, or release the structures inside the joint.

What are the advantages of arthroscopic over open shoulder surgery?

Smaller incisions, less soft tissue trauma, less post-operative pain, and a faster early recovery. The camera also allows a more detailed inspection of the joint than is possible through a single open incision, and lets the surgeon address several problems through the same set of portals. For most rotator cuff and labral problems, arthroscopic surgery is the standard of care.

Are there any conditions that should not be done arthroscopically?

Yes. Some procedures are still better performed open. The Latarjet procedure is one example. Dr Piper performs it open, where reliable bone-block fixation is critical and the open exposure is the technique he trained on with Lafosse in Annecy. Shoulder replacements are also performed open. The decision is procedure-specific rather than a blanket preference.

How long does an arthroscopic shoulder procedure take?

A simple subacromial decompression or biceps tenodesis takes about 30 to 60 minutes. An arthroscopic rotator cuff repair takes 60 to 90 minutes depending on the size of the tear. A labral repair takes about 60 minutes. Complex multi-tendon or revision repairs can take longer. Most patients are admitted as day cases or for one overnight stay depending on the procedure.

Will I need a sling after arthroscopic shoulder surgery?

Almost always, but the duration varies. After a labral repair, four weeks. After a rotator cuff repair, six weeks. After a simple subacromial decompression or distal clavicle excision, only a few days for comfort. The sling protects the repaired tissue while it heals back to bone. Compliance with the sling protocol is one of the most important factors in a successful repair.

Subspecialty interest

Arthroscopic shoulder surgery

Advanced keyhole surgery for the shoulder. Dr Piper performs arthroscopic rotator cuff repair, labral repair for shoulder stabilisation, and a wide range of supporting procedures through small portals, with less soft tissue trauma and a faster early recovery than open surgery.

How it works

The principles of arthroscopic shoulder surgery

The shoulder is approached through two or more small incisions called portals, each around five to ten millimetres long. A small camera (the arthroscope) is placed inside the joint and projects a high-definition image onto a screen. Specialised instruments are passed through the other portals to repair, tighten, or release the structures inside the joint.

The technique is performed under general anaesthetic, often combined with a regional nerve block to settle pain in the first 12 to 24 hours after surgery. The shoulder is gently distended with sterile fluid during the procedure to create a working space. The fluid is reabsorbed within hours of finishing.

Compared to traditional open surgery, the smaller incisions cause less soft tissue trauma, less post-operative pain, and a faster early recovery. The arthroscope also allows a more thorough inspection of the joint than is possible through a single open incision, so several problems can be addressed through the same set of portals.

Procedures performed

Conditions Dr Piper treats arthroscopically

Arthroscopy is the standard of care for most rotator cuff and labral problems. The two most technically demanding procedures Dr Piper performs through this approach are rotator cuff repair and labral repair for shoulder stabilisation.

Arthroscopic rotator cuff repair

Re-attachment of torn rotator cuff tendons to the humeral head using suture anchors. Restores the lifting and rotating mechanics of the shoulder. The bread and butter of arthroscopic shoulder surgery.

Read about the procedure

Arthroscopic labral repair

Re-attachment of a torn labrum to the rim of the shoulder socket using suture anchors. The standard operation for first-time and recurrent shoulder instability without major bone loss.

Read about the procedure

Other procedures performed arthroscopically

Subacromial decompression. Removal of bone and bursal tissue from the under-surface of the acromion to create space for the rotator cuff. Used for selected cases of impingement.
Distal clavicle excision. Removal of a small amount of bone from the outer end of the collarbone for AC joint arthritis.
Biceps tenodesis or tenotomy. Treatment for biceps tendon problems. The biceps tendon is either released or re-anchored, depending on the patient.
Capsular release for frozen shoulder. Division of the contracted joint capsule to restore range of motion in resistant cases.
Removal of loose bodies and synovectomy. Clearance of loose cartilage or inflamed synovium from inside the joint.
Calcific tendonitis removal. Direct removal of a persistent calcium deposit that has not responded to non-operative measures.

In theatre

What happens on the day of surgery

You will be admitted on the morning of surgery. The anaesthetist will discuss your anaesthetic and any nerve block. After you are asleep, you will be positioned sitting up (beach chair position).

The shoulder is prepared with antiseptic and draped sterile. The portals are made, the camera is introduced, and the joint is inspected. The repair is then carried out using suture anchors, sutures, and any specialised instruments needed for the procedure. The portals are closed with absorbable sutures and a sling is fitted at the end of the case.

Most arthroscopic procedures are performed as day cases or with a single overnight stay. Patients with a labral repair go home the same day. Patients with rotator cuff repair stay one night.

Recovery

What recovery looks like

Recovery depends on the specific procedure. Smaller procedures (subacromial decompression, distal clavicle excision, biceps tenodesis) involve a sling for comfort for a few days only and an early return to most activities within one to two weeks.

Repairs to tissue that has to heal back to bone (rotator cuff and labral repairs) require a sling for four weeks for a labral repair and six weeks for a rotator cuff repair. Passive range starts within the first week or two, active range progresses through weeks six to twelve, and strengthening starts around three months. Most patients return to driving by six weeks (once out of the sling and with safe two-handed control of the steering wheel) and to office work earlier.

See the dedicated procedure pages for the rehabilitation protocols specific to each repair.

Risks

The risks of arthroscopic shoulder surgery

Arthroscopic shoulder surgery is generally well-tolerated, but no surgery is without risk. The main risks are discussed in detail at consultation and tailored to the specific procedure.

Infection. Uncommon. Antibiotics are given at induction.
Stiffness. Some shoulders take longer than others to regain motion. Most resolve with a structured rehabilitation programme; resistant cases may need a manipulation or arthroscopic capsular release.
Frozen shoulder. A specific condition that causes pain and stiffness in the shoulder. The condition is self-limited (gets better by itself) but recovery from frozen shoulder can take 12 to 18 months or more.
Re-tear or recurrence. A repaired tendon or labrum is never as strong as a healthy one. Re-tear rates depend on the size and chronicity of the original problem.
Nerve injury. Rare. The nerves around the shoulder are mapped before portals are placed. Temporary numbness from the regional block is normal and resolves within hours.
Complex regional pain syndrome (CRPS). A rare condition that causes pain and stiffness in the hand.
Anaesthetic and medical complications. The standard risks of any operation, discussed in detail by the anaesthetist before surgery.

FAQ

Frequently asked questions

What is shoulder arthroscopy?: Shoulder arthroscopy (sometimes called keyhole surgery) is surgery performed through two or more small skin incisions, each around five to ten millimetres long. A small camera (the arthroscope) is placed inside the shoulder joint, projecting a high-definition image onto a screen. Specialised instruments are passed through the other portals to repair, tighten, or release the structures inside the joint.
What are the advantages of arthroscopic over open shoulder surgery?: Smaller incisions, less soft tissue trauma, less post-operative pain, and a faster early recovery. The camera also allows a more detailed inspection of the joint than is possible through a single open incision, and lets the surgeon address several problems through the same set of portals. For most rotator cuff and labral problems, arthroscopic surgery is the standard of care.
Are there any conditions that should not be done arthroscopically?: Yes. Some procedures are still better performed open. The Latarjet procedure is one example. Dr Piper performs it open, where reliable bone-block fixation is critical and the open exposure is the technique he trained on with Lafosse in Annecy. Shoulder replacements are also performed open. The decision is procedure-specific rather than a blanket preference.
How long does an arthroscopic shoulder procedure take?: A simple subacromial decompression or biceps tenodesis takes about 30 to 60 minutes. An arthroscopic rotator cuff repair takes 60 to 90 minutes depending on the size of the tear. A labral repair takes about 60 minutes. Complex multi-tendon or revision repairs can take longer. Most patients are admitted as day cases or for one overnight stay depending on the procedure.
Will I need a sling after arthroscopic shoulder surgery?: Almost always, but the duration varies. After a labral repair, four weeks. After a rotator cuff repair, six weeks. After a simple subacromial decompression or distal clavicle excision, only a few days for comfort. The sling protects the repaired tissue while it heals back to bone. Compliance with the sling protocol is one of the most important factors in a successful repair.

Considering shoulder surgery?

Book an appointment with Dr Piper

Consultations at Lakeview Private Hospital, Norwest. Bring a referral and any imaging you have.

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