Shoulder Arthroscopy
Shoulder arthroscopy is a closed surgical technique used for both diagnosis and treatment in conditions such as rotator cuff tears, impingement syndrome, recurrent shoulder dislocation and frozen shoulder. The joint and the structures around it are assessed at magnification with a camera.
The Structure of the Shoulder Joint
The shoulder has the widest range of movement of any joint in the body. That freedom comes at a price: the joint surfaces grip one another only to a limited degree, and stability is largely provided by the surrounding rotator cuff muscles, the joint rim (labrum) and the ligaments. Injury to any of these structures can result in pain, loss of strength or a sense of giving way.
In Which Conditions Is It Considered?
- Rotator cuff tear — reattachment of the tendon to the bone (repair)
- Impingement syndrome — widening of the subacromial space
- Recurrent shoulder dislocation and instability — labral and ligament (Bankart) repair
- Frozen shoulder (adhesive capsulitis) — capsular release in resistant cases
- Problems of the long head of the biceps tendon (tenotomy or tenodesis)
- Removal of calcific tendon deposits (calcific tendinitis)
- Removal of loose bodies and inflamed joint lining
- Assessment of acromioclavicular joint problems
Diagnosis and Assessment
Identifying the source of shoulder pain is not always straightforward; pain referred from a neck disc problem can also be felt in the shoulder. Assessment therefore has several steps:
- History: onset of pain, whether there is night pain, which movements aggravate it, any history of injury.
- Physical examination: active and passive range of movement, muscle strength tests, impingement and instability tests.
- Imaging: X-ray helps assess the bone; MRI helps assess tendon, labrum and muscle tissue.
- Overall interpretation: not every finding seen on MRI requires surgery; symptoms, examination and images are assessed together.
For more on this, see My MRI Report Says “Tear”: Do I Definitely Need Surgery?
Conservative Treatment First
In a significant proportion of shoulder problems, surgery is not the first option. Activity modification, pain management, a targeted physiotherapy programme and, in selected cases, injection treatments are considered first. Surgery is considered when there has been an insufficient response to these treatments, or where a tear or instability requiring structural repair is present from the outset.
How Is the Procedure Performed?
Shoulder arthroscopy is generally carried out through a few small portals. Depending on the procedure, the patient is positioned lying on the side or semi-seated. After the structures inside the joint are assessed with the camera, repair, release or debridement is performed for the problem identified. In some situations an open or mini-open addition may be needed after arthroscopic assessment; this possibility is discussed with you beforehand.
Preparing for the Procedure
- Prepare an up-to-date list of every medication you take, including herbal supplements.
- If you take blood thinners, be sure to say so; your physician decides when they are stopped.
- Bring any previous MRI, X-ray and operation reports with you.
- Follow the fasting instructions; this is critical for the safety of anaesthesia.
- Arrange your transport home and someone to accompany you in advance.
For detailed preparation headings, see the Preparing for Orthopaedic Surgery page.
The Postoperative Period
If a repair has been performed, the arm is protected in a sling for a period; the length of that protection is determined by how the repaired tissue heals. The process generally progresses in the order protection → passive movement → active movement → strengthening. Rushing between stages can put the repair at risk.
For detailed headings see the Shoulder Arthroscopy Aftercare Guide.
Risks and What You Should Know
Although arthroscopy is a closed technique, it is still a surgical procedure and every surgical procedure carries risks. The headings below are for general information; your individual risk assessment is made by your physician after examination and investigations.
- Infection — a risk present in every operation, despite the small portals.
- Bleeding or swelling within the joint
- Involvement of nerve and vessel structures (rare)
- Risk of clot formation (deep vein thrombosis), particularly in lower limb procedures
- General risks related to anaesthesia
- Failure to achieve the expected improvement, or persistence of symptoms
- Temporary or lasting restriction of shoulder movement (stiffness)
- Re-tearing of the repaired tendon
The decision to operate is made by weighing together the duration and severity of symptoms, examination findings, imaging results, age, occupation, activity level and any accompanying conditions. Outcomes vary from person to person.
When Should You Seek Assessment?
- If shoulder pain interrupts your sleep at night
- If you have difficulty raising your arm above head height
- If there is loss of strength or a sense of giving way in the shoulder
- If your shoulder has dislocated before and this is recurring
- If pain and loss of movement developed after a fall or a blow
Frequently Asked Questions
Does a rotator cuff tear heal on its own?
Full-thickness tears generally do not heal on their own. However, not every tear requires surgery: the size of the tear, muscle quality, age, activity level and the severity of symptoms are assessed together. In some patients adequate function can be achieved with physiotherapy.
How long will I wear a sling after shoulder arthroscopy?
The duration varies with the procedure performed; the protection period is longer where a repair has been carried out. Your physician determines this according to the repaired tissue and the course of your healing; it would not be appropriate to give a general figure here.
Is surgery essential for frozen shoulder?
Treatment of frozen shoulder is generally based on exercise, pain management and, in selected cases, injection. Arthroscopic capsular release may be considered in cases that persist for a long time, markedly restrict daily life and do not respond to conservative treatment.
My shoulder keeps dislocating — do I need surgery?
In recurrent dislocation there may be structural damage to the joint rim (labrum) and ligaments. The decision is made by assessing the frequency of recurrence, age, sporting and occupational demands, and whether there is bone loss. The same method is not applied to every patient.
Can I return to sport after the operation?
Return to sport depends on the procedure performed, the course of healing and the type of sport. Protection periods are kept longer for contact and overhead sports. The decision to return is made by examination and functional assessment, not by the calendar.
Academic Work
Assoc. Prof. Bertan Cengiz, MD has scientific work published in national and international peer-reviewed journals in the field of shoulder arthroscopy and rotator cuff surgery and related areas of arthroscopic surgery. The publication list and verifiable academic sources are available on the Publications page.
Related Pages
- Arthroscopic Surgery (Keyhole Joint Surgery)
- Shoulder and Upper Extremity
- Rotator Cuff Tear
- Frozen Shoulder (Adhesive Capsulitis)
- Shoulder Arthroscopy Aftercare Guide
The information on this page is for general guidance and does not replace an in-person medical examination. Diagnosis and treatment require a physician’s clinical assessment. Outcomes of any surgical or medical intervention may vary from person to person; no guarantee of a specific result or timeframe is given on this page.